bluuebunny/crossref_metadata_2025 huggingface dataset:
Burnout and moral resilience in interdisciplinary healthcare professionals
Authors: Antonsdottir Inga , Rushton Cynda Hylton , Nelson Katie Elizabeth , Heinze Katherine E. , Swoboda Sandra M. , Hanson Ginger C.
Published: June 2021

Aims and objectives

To examine demographic and work characteristics of interdisciplinary healthcare professionals associated with higher burnout and to examine whether the four domains of moral resilience contribute to burnout over and above work and demographic variables.

Background

Healthcare professionals experience complex ethical challenges on a daily basis leading to burnout and moral distress. Measurement of moral resilience is a new and vital step in creating tailored interventions that will foster moral resilience at the bedside.

Design

Cross‐sectional descriptive design.

Methods

Healthcare professionals in the eastern USA were recruited weekly via email for 3 weeks in this cross‐sectional study. Online questionnaires were used to conduct the study. The STROBE checklist was used to report the results.

Results

Work and demographic factors, such as religious preference, years worked in a healthcare profession, practice location, race, patient age, profession and education level, have unique relationships with burnout subscales and turnover intention, with the four subscales of moral resilience demonstrating a protective relationship with outcomes above and beyond the variance explained by work and demographic characteristics.

Conclusions

Higher moral resilience is related to lower burnout and turnover intentions, with multiple work demographic correlates allowing for potential areas of intervention to deal with an increase in morally distressing situations occurring at the bedside. Additionally, patterns of significant and non‐significant relationships between the moral resilience subscales and burnout subscales indicate that these subscales represent unique constructs.

Relevance to clinical practice

Understanding the everyday, pre‐pandemic correlations of moral resilience and burnout among interdisciplinary clinicians allows us to see changes that may exist. Measuring and understanding moral resilience in healthcare professionals is vital for creating ways to build healthier, more sustainable clinical work environments and enhanced patient care delivery.
The roles of free iron, heme, haemoglobin, and the scavenger proteins haemopexin and alpha‐1‐microglobulin in preeclampsia and fetal growth restriction
Authors: Erlandsson Lena , Masoumi Zahra , Hansson Lucas R. , Hansson Stefan R.
Published: June 2021

Background

Preeclampsia (PE) is a complex pregnancy syndrome characterised by maternal hypertension and organ damage after 20 weeks of gestation and is associated with an increased risk of cardiovascular disease later in life. Extracellular haemoglobin (Hb) and its metabolites heme and iron are highly toxic molecules and several defence mechanisms have evolved to protect the tissue.

Objectives

We will discuss the roles of free iron, heme, Hb, and the scavenger proteins haemopexin and alpha‐1‐microglobulin in pregnancies complicated by PE and fetal growth restriction (FGR).

Conclusion

In PE, oxidative stress causes syncytiotrophoblast (STB) stress and increased shedding of placental STB‐derived extracellular vesicles (STBEV). The level in maternal circulation correlates with the severity of hypertension and supports the involvement of STBEVs in causing maternal symptoms in PE. In PE and FGR, iron homeostasis is changed, and iron levels significantly correlate with the severity of the disease. The normal increase in plasma volume taking place during pregnancy is less for PE and FGR and therefore have a different impact on, for example, iron concentration, compared to normal pregnancy. Excess iron promotes ferroptosis is suggested to play a role in trophoblast stress and lipotoxicity. Non‐erythroid α‐globin regulates vasodilation through the endothelial nitric oxide synthase pathway, and hypoxia‐induced α‐globin expression in STBs in PE placentas is suggested to contribute to hypertension in PE. Underlying placental pathology in PE with and without FGR might be amplified by iron and heme overload causing oxidative stress and ferroptosis. As the placenta becomes stressed, the release of STBEVs increases and affects the maternal vasculature.
Rural‐urban differences in hospitalizations for opioid use‐associated infective endocarditis in Kentucky, 2016‐2019
Authors: Siddiqi Kamran , Freeman Patricia R. , Fanucchi Laura C. , Slavova Svetla
Published: June 2021

Purpose

In 2016, the US rate of opioid use‐associated infective endocarditis (OUA IE) hospitalizations was 3.86/100,000 for rural and 3.49/100,000 for urban residents. This study estimates the Kentucky OUA IE hospitalization rates, 2016‐2019, describing differences in rural‐urban residency trends, demographics, relevant comorbidities, and discharge disposition. OUA IE hospitalization rates between counties with and without syringe services programs (SSPs) are also compared.

Methods

We used Kentucky statewide inpatient discharge records from 2016 to 2019. An OUA IE hospitalization was identified by an infective endocarditis discharge diagnosis in any diagnosis field and a concurrent diagnosis indicating opioid use. Rurality was determined based on the 2013 Rural‐Urban Continuum Codes (RUCC).

Findings

Kentucky's rate of OUA IE hospitalizations in 2016 was 8.9/100,000, with no significant variation between rural and urban residents. By 2019, the average rate for urban residents doubled to 17.9/100,000, significantly higher than the rural resident rate, 13.2/100,000. There were no significant rural‐urban differences in percentages of those with concurrent diagnoses of HIV (<1%) or HCV (>60%). Counties that established SSPs in 2017‐2018 had a 39.4% increase in OUA IE rates from 2016 to 2019, while counties without SSPs had a 79.5% increase.

Conclusion

The estimated 2016 Kentucky rates of OUA IE hospitalizations are 2 times higher than reported national rates, highlighting Kentucky as one of the areas most affected by this particular opioid use disorder complication. Despite challenges and barriers to the effectiveness of SSPs as a harm reduction measure, our study suggests a positive effect that should be further investigated.
Increased prevalence of gastrointestinal symptoms and disorders of gut‐brain interaction during the COVID‐19 pandemic: An internet‐based survey
Authors: Nakov Radislav , Dimitrova‐Yurukova Desislava , Snegarova Violeta , Nakov Ventsislav , Fox Mark , Heinrich Henriette
Published: June 2021

Background

Quarantine with social distancing has reduced transmission of COVID‐19; however, fear of the disease and these remedial measures cause anxiety and stress. It is not known whether these events have impacted the prevalence of gastrointestinal (GI) symptoms and disorders of brain‐gut interaction (DGBI).

Methods

An online platform evaluated the prevalence of GI symptoms during the COVID‐19 pandemic. Data collection utilized validated questionnaires and was fully anonymized. Findings were compared with identical data acquired in 2019. The association of results with stress and anxiety was analyzed.

Results

Data were collected from 1896 subjects May ‐ August 2019 to 980 non‐identical subjects May ‐ June 2020. GI symptoms were reported by 68.9% during the COVID‐19 lockdown compared with 56.0% the previous year (p < 0.001). The prevalence of irritable bowel syndrome (26.3% vs. 20.0%; p < 0.001), functional dyspepsia (18.3% vs. 12.7%; p < 0.001), heartburn (31.7% vs. 26.2%, p = 0.002), and self‐reported milk intolerance (43.5% vs. 37.8% p = 0.004) was higher during the pandemic. Many individuals reported multiple symptoms. Anxiety was associated with presence of all GI symptoms. High levels of stress impacted functional dyspepsia (p = 0.045) and abdominal pain (p = 0.013). The presence of DGBI (p < 0.001; OR 22.99), self‐reported milk intolerance (p < 0.001; OR 2.50), and anxiety (p < 0.001; OR 2.18) was independently associated with increased GI symptoms during COVID‐19 pandemic.

Conclusions

The prevalence of GI symptoms was significantly higher during the COVID‐19 lockdown than under normal circumstances the previous year. This increase was attributable to increased numbers of patients with DGBI, an effect that was associated with anxiety.
Reconstruction of Large Area of Deep Wound in the Foot and Ankle with Chimeric Anterolateral Thigh Perforator Flap
Authors: Li Run‐guang , Zeng Can‐jun , Yuan Song , Hu Ji‐jie , Zhang Ping , Chen Yun‐biao , Zhao Shan‐wen , Ren Gao‐hong
Published: June 2021

Objective

To evaluate the clinical application and surgical efficacy of the chimeric perforator flap pedicled with the descending branch of the lateral circumflex femoral artery and the lateral thigh muscle flap for the reconstruction of the large area of deep wound in foot and ankle.

Methods

Clinical data of 32 cases who underwent chimeric anterolateral thigh perforator flap to repair the large area of deep wound of the foot and ankle from January 2015 to December 2018 were retrospectively analyzed. The sizes of the defects ranged from 18 cm × 10 cm to 35 cm × 20 cm, with exposed tendon and bone and/or partial defects and necrosis, contaminations, accompanied by different degrees of infection. Following the radical debridement and VSD, chimeric anterolateral thigh perforator flap was employed to repair the deep wounds according to the position, site and deep‐tissue injury of the soft‐tissue defects. The skin flap and muscle flap were fanned out on the wound, and single‐ or two‐staged split‐thickness skin grafting was performed on the muscle flap. The operation time and blood loss were recorded. The survival and healing conditions of the operational site with chimeric anterolateral thigh perforator flap were evaluated post‐operationally. Complications at both recipient site and donor site were carefully recorded.

Results

The mean time of the operation was 325.5 min and average blood loss was 424.8 mL. Among the 32 cases, two cases developed vascular crisis, which were alleviated with intensive investigation and treatment; Four cases suffered from partial necrosis of the flap or skin graft on the muscle flap or on the residual local wound, which were improved after treatment of further dressing change and skin grafting. Another four cases experienced post‐traumatic osteomyelitis accompanied by bone defect were treated with simple bone grafting or Mesquelet bone grafting at 6–8 months after wound healing. Postoperatively, the wounds were properly healed, and the infection was effectively controlled without sinus tract forming. Overall, all 32 cases received satisfactory efficacy, without influencing subsequent functional reconstruction, and observed infection during the 12–36 months post‐operational follow‐up.

Conclusion

The chimeric perforator flap pedicled with the descending branch of the lateral circumflex femoral artery and the lateral thigh muscle flap provides an effective and relative safe procedure for the repair of a large area of deep wound in the foot and ankle, particularly with irregular defect or deep dead space.
Political opportunism and transaction costs in contractual choice of public–private partnerships
Authors: Xiong Wei , Zhong Ninghua , Wang Feng , Zhang Muyang , Chen Bin
Published: June 2021

The New Public Management (NPM) has achieved many successes in public service delivery, but practitioners frequently observed failures in developing and transitional economies. For instance, China's public–private partnerships (PPP) since 2014 have failed to transfer risks to the private sector, to involve private skills and expertise, and to reduce local government's debt. This article claims that PPP failures in China are associated with the contractual type of nonconcessions and the contractual choice is influenced by both political opportunism and transaction costs. Utilizing data of PPP projects in China during 2014–2016, we find that more opportunistic bureaucrats seek to increase projects of nonconcessions, but transaction costs caused by product complexities hinder governments' reliance on nonconcessions. This research extends the core analysis of PPPs in the literature from transaction costs to political opportunism, which widely exists in developing and transitional economies. Thus, our findings partially explain the failure of their NPM practices.

新公共管理运动在公共服务供给领域取得了瞩目的成就，但在发展中国家与转型经济体中也经历过挫折。例如，自2014年以来，中国推行的政府与社会资本合作(PPP)模式就未能实现将风险转移到私营部门、引入私营部门的技术和经验及减轻地方政府的债务负担的初衷。正鉴于此，在2017年时，中国财政部对PPP项目进行了大范围的整改。针对这一现象，本文理论分析认为，其主要原因在于地方政府采用了大量非特许经营合同，而该类合同具有低风险、弱运营及政府付费的特征。政府之所以选择此类合同，则基于政治机会主义与交易成本两个方面的考量。进一步，本文基于中国2014–2016年PPP项目的数据，通过实证研究发现:地方主政官员晋升压力越大，其短期拉动GDP增长的动机越强，从而通过非特许经营合同上马的基建项目就越多；但是，项目自身的复杂性会导致非特许经营合同在长期产生高昂的交易成本，从而抑制地方政府上马此类项目。本研究将PPP的研究视角从交易成本拓展到政治机会主义，从而更为全面地阐述了新公共管理运动在转型国家更易遭遇挫折的原因。
The Greek Neuropathic Pain Registry: The structure and objectives of the sole NPR in Greece
Authors: Vadalouca Athina , Alexopoulou‐Vrachnou Evnomia , Rekatsina Martina , Kouroukli Irene , Anisoglou Sousana , Kremastinou Fani , Gabopoulou Zoi , Chloropoulou Panagiota , Micha Georgia , Tsaroucha Athanasia , Siafaka Ioanna
Published: June 2021

Objectives

Neuropathic pain (NP) is a complex condition that impairs the patients’ quality of life. Registries are useful tools, increasingly used as they provide high‐quality data. This article aims to describe the Greek Neuropathic Pain Registry (Gr.NP.R.) design, the patients’ baseline data, and real‐world treatment outcomes.

Methods

The Gr.NP.R. collects electronically, stores, and shares real‐world clinical data from Pain and Palliative Care centers in Greece. It is a web‐based application, which ensures security, simplicity, and transparency. VAS, DN4, and Pain Detect were used for pain and NP assessment.

Results

From 2016 to 2020, 5980 patients with chronic pain, of cancer or non‐cancer origin, were examined and 2334 fulfilled the NP inclusion criteria (VAS > 5, DN4 > 4, and Pain Detect ≥ 19). At the first visit, the mean age was 64.8 years, 65.5% were female patients, and 97.9% were Greek. The mean (SD) time from pain initiation to visiting the pain clinics was 1.5 (3.8) years. Most patients were undertreated. Following the patients’ registration, the national guidelines were implemented. The majority of the prescribed medications were gabapentinoids (70.2%), especially pregabalin (62.6%), and opioids (tramadol, 55.3%). At visits 1 and 6, mean VAS was 7.1 and 5, and mean DN4 score was 5.6 and 3.5, respectively.

Conclusions

The Gr.NP.R. provides information on the demographics, clinical progress, treatment history, treatment responses, and the drugs of choice for patients with cancer and non‐cancer NP. The collected data may help physicians plan the management of their patients.
Perceptions of romantic partners' responses to disclosures of suicidality
Authors: Love Heather A. , LeFebvre Leah E. , Pederson Joshua R.
Published: June 2021

This mixed‐methods study examines how adults in the United States perceive their romantic partner's response to disclosures of suicidality and how romantic relationship characteristics relate to perceptions of disclosure responses. Participants (N = 30) recruited from Reddit completed a survey using open‐ and closed‐ended questions about disclosing suicidality to a romantic partner. Qualitative findings highlight validating and invalidating disclosure responses. Validating responses include two subthemes: (a) emotional, nondirective support, and (b) instrumental, directive support. Invalidating responses are coded when partners are dismissive or display lack of concern. Meta‐inferences from qualitative and quantitative findings reveal associations between participants who perceive their partners' responses as (in)validating and multiple romantic relationship characteristics. Our findings have implications about supporting individuals struggling with suicidality and their romantic partners.
The effects of site preparation equal those of seeding at a dryland restoration site: 6 years of plant community development
Authors: Farrell Hannah L. , Fehmi Jeffrey S. , Gornish Elise S.
Published: June 2021

Dryland ecosystems generally require active restoration to recover from severe land degradation caused by resource and energy extraction operations. While seeding remains one of the most used forms of active restoration, land managers in dryland systems have generally had difficulty re‐establishing desirable plant communities, due in part to alterations in supporting ecosystem processes and the episodic nature of resource availability. In this study, we examined the impacts of site preparation, seeding, and livestock grazing on developing plant communities after the construction of a buried natural gas pipeline corridor in the southwestern United States. We monitored plant species cover and composition beginning with the second season of growth through the sixth. Analysis of each individual year show that conclusions from the initial year of data collection did not well represent the findings in the following years. The site preparation and topsoil treatment had an ongoing positive effect on richness and cover compared to the nearby baseline conditions, while seeding only further increased cover and richness in the first year of monitoring (second season of growth). However, without seeding, the plant communities were driven by ruderal, annual species, whereas the seeded plant communities were driven by desirable seeded perennial grasses and forbs. Grazing and trampling effects were not significant overall, and the effects of livestock may have been confounded with effects of small mammals due to the exclosure configuration. We suggest that the site preparation, topsoil treatment, and configuration linearity of the disturbance corridor allowed for high levels of natural recruitment.
Inequality and growth in the twenty‐first century
Authors: Luo Weijie
Published: June 2021

This paper analyzes how economic growth can be caused by changes in the income distribution. Persson and Tabellini (1994, The American Economic Review, 84, 600‐621) argue that productivity‐induced income inequality leads to lower growth since distortionary taxes increase and harm capital accumulation. However, this prediction is often challenged empirically. This paper distinguishes between capital income inequality and inequality induced by differences in labor productivity. Greater capital income inequality leads to lower labor tax rates, leading to higher growth. Using data for OECD countries, subsequent growth is found to be positively related to capital income inequality, and negatively related to labor income inequality, as originally conjectured.
Whole‐body vibration preconditioning reduces the formation and delays the manifestation of high‐altitude‐induced venous gas emboli
Authors: Elia Antonis , Eiken Ola , Ånell Rickard , Grönkvist Mikael , Gennser Mikael
Published: June 2021

New Findings

What is the central question of this study?

Is performing a 30‐min whole‐body vibration (WBV) prior to a continuous 90‐min exposure at 24,000 ft sufficient to prevent venous gas emboli (VGE) formation?

What is the main finding and its importance?

WBV preconditioning significantly reduces the formation and delays the manifestation of high‐altitude‐induced VGE. This study suggests that WBV is an effective strategy in lowering decompression stress.

Rapid decompression may give rise to formation of venous gas emboli (VGE) and resultantly, increase the risk of sustaining decompression sickness. Preconditioning aims at lowering the prevalence of VGE during decompression. The purpose of this study was to investigate the efficacy of whole‐body vibration (WBV) preconditioning on high‐altitude‐induced VGE. Eight male subjects performed, on separate days in a randomised order, three preconditioning strategies: 40‐min seated‐rest (control), 30‐min seated‐rest followed by 150 knee‐squats performed over a 10‐min period (exercise) and 30‐min WBV proceeded by a 10‐min seated‐rest. Thereafter, subjects were exposed to an altitude of 24,000 ft (7315 m) for 90 min whilst laying in a supine position and breathing 100% oxygen. VGE were assessed ultrasonically both during supine rest (5‐min intervals) and after three fast, unloaded knee‐bends (15‐min intervals) and were scored using a 5‐grade scale and evaluated using the Kisman Integrated Severity Score (KISS). There was a significant difference in VGE grade (P < 0.001), time to VGE manifestation (P = 0.014) and KISS score following knee‐bends (P = 0.002) across protocols, with a trend in KISS score during supine rest (P = 0.070). WBV resulted in lower VGE grades (median (range), 1 (0–3)) and KISS score (2.69 ± 4.56 a.u.) compared with control (2 (1–3), P = 0.002; 12.86 ± 8.40 a.u., P = 0.011) and exercise (3 (2–4) , P < 0.001; 22.04 ± 13.45 a.u., P = 0.002). VGE were detected earlier during control (15 ± 14 min, P = 0.024) and exercise (17 ± 24 min, P = 0.032) than WBV (54 ± 38 min). Performing a 30‐min WBV prior to a 90‐min continuous exposure at 24,000 ft both delays the manifestation and reduces the formation of VGE compared with control and exercise preconditioning.
Study on the Segmental Pigging Process for the Wet Gas Gathering and Transportation Pipelines of the Puguang Gas Field
Authors: Liu Wu , Shang Jianfeng , Wang Hongsong , Zhao Donghui , Zou Yu
Published: June 2021

The gathering and transportation pipeline known as Line 1 of Puguang Gas Field has the characteristics of wet gathering and transportation containing high sulfur content, large drops, and liquid loading in low-lying areas. In the process of one pigging operation on the site, the surge volume provided by the no. 1 separator in the master gas gathering station was not effectively utilized and the time intervals for the neighboring pipeline sections were too long. In this paper, we designed several pigging proposals. OLGA was applied to analyze the operating parameter changes for the gathering and transportation pipeline Line 1, which finally determined a reasonable pigging sequence. We designed and selected the “optimal pigging proposal”, which the time duration for the pigging operation of the seven pipeline sections was decreased to 16.91 h. Guided by the “optimal pigging proposal”, the downstream pipeline sections will be challenged by the risks of ice blockage. The ground eddy device was improved in the article, for the purpose of draining liquid loadings in low-lying areas in the Puguang Gas Field and controlling the slug flow. In addition, the application effects of the device were analyzed.
Upper Quarter Y-Balance Test in Collegiate Softball Players: Bilateral Arm Comparison and Influence of Reach Order
Authors: Christian Katelyn M. , Moran Matthew F.
Published: June 2021

The upper quarter Y-balance test is an upper extremity, closed kinetic chain assessment that requires individuals to reach in three directions while in a three-point plank position. The upper quarter Y-balance test was performed in 22 collegiate softball players (19.95 ± 1.52 years) to determine the (a) differences between throwing and nonthrowing (NT) sides and (b) influence of reach sequence. While stabilizing on the NT side, participants reached significantly further in the inferolateral direction than the throwing side (NT: 83.7 ± 12.2% arm length; throwing: 80.1 ± 10.5% arm length; p = .03; effect size = −0.57). Altering reach sequence significantly influenced medial reach (p < .01, effect size = 0.66) and composite score (p = .017, effect size = 1.03) when stabilizing on the NT side. Asymmetries in upper quarter Y-balance test in collegiate softball players should be interpreted cautiously, and an ordered test sequence should be consistently followed.
Participant education, spousal education and dementia risk in a diverse cohort of members of an integrated health care delivery system in Northern California
Authors: Gilsanz Paola , Mayeda Elizabeth Rose , Eng Chloe W , Meyer Oanh L , Glymour M Maria , Quesenberry Charles P , Whitmer Rachel A
Published: June 2021

Objective

The role of spousal education on dementia risk and how it may differ by gender or race/ethnicity is unknown. This study examines the association between one’s own education separate from and in conjunction with spousal education and risk of dementia.

Design

Cohort.

Setting

Kaiser Permanente Northern California (KPNC), an integrated health care delivery system.

Participants

8835 members of KPNC who were aged 40–55, married and reported own and spousal education in 1964–1973.

Primary outcome measure

Dementia cases were identified through medical records from 1 January 1996 to 30 September 2017.

Methods

Own and spousal education was self-reported in 1964–1973 and each was classified as four indicator variables (≤high school, trade school/some college, college degree and postgraduate) and as ≥college degree versus <college degree. Age as timescale weighted Cox proportional hazard models adjusted for demographics and health indicators evaluated associations between participant education, spousal education and dementia risk overall and by gender and race/ethnicity.

Results

The cohort was 37% non-white, 46% men and 30% were diagnosed with dementia during follow-up from 1996 to 2017 (mean follow-up=12.7 years). Greater participant education was associated with lower dementia risk independent of spousal education, demographics and health indicators. Greater spousal education was associated with lower dementia adjusting for demographics but became non-significant after further adjustment for participant education. The same pattern was seen for spousal education ≥college degree (not adjusting for participant education HRspousal education≥college degree=0.83 (95% CI: 0.76 to 0.90); adjusting for participant education HRspousal education≥college degree=0.92 (95% CI: 0.83 to 1.01)). These associations did not vary by gender or race/ethnicity.

Conclusion

In a large diverse cohort, we found that higher levels of participant’s own education were associated with lower dementia risk regardless of spousal education. An inverse association between spousal education and dementia risk was also present, however, the effects became non-significant after adjusting for participant education.
Prevalence and fluid management of dehydration in children without diarrhoea admitted to Kenyan hospitals: a multisite observational study
Authors: Omoke Sylvia , English Mike , Aluvaala Jalemba , Gathara David , Agweyu Ambrose , Akech Samuel
Published: June 2021

Objectives

To examine the prevalence of dehydration without diarrhoea among admitted children aged 1–59 months and to describe fluid management practices in such cases.

Design

A multisite observational study that used routine in-patient data collected prospectively between October 2013 and December 2018.

Settings

Study conducted in 13 county referral hospitals in Kenya.

Participants

Children aged 1–59 months with admission or discharge diagnosis of dehydration but had no diarrhoea as a symptom or diagnosis. Children aged <28 days and those with severe acute malnutrition were excluded.

Results

The prevalence of dehydration in children without diarrhoea was 3.0% (2019/68 204) and comprised 15.9% (2019/12 702) of all dehydration cases. Only 55.8% (1127/2019) of affected children received either oral or intravenous fluid therapy. Where fluid treatment was given, the volumes, type of fluid, duration of fluid therapy and route of administration were similar to those used in the treatment of dehydration secondary to diarrhoea. Pneumonia (1021/2019, 50.6%) and malaria (715/2019, 35.4%) were the two most common comorbid diagnoses. Overall case fatality in the study population was 12.9% (260/2019).

Conclusion

Sixteen per cent of children hospitalised with dehydration do not have diarrhoea but other common illnesses. Two-fifths do not receive fluid therapy; a regimen similar to that used in diarrhoeal cases is used in cases where fluid is administered. Efforts to promote compliance with guidance in routine clinical settings should recognise special circumstances where guidelines do not apply, and further studies on appropriate management for dehydration in the absence of diarrhoea are required.
Effect of Human Development Index and other socioeconomic factors on mortality-to-incidence ratio of lips and oral cavity cancer in Mexican states: an ecological study
Authors: Lara-Carrillo Edith , Herrera-Serna Brenda Yuliana , Conzuelo-Rodríguez Gabriel , do Amaral Regiane Cristina , Aguilera-Eguía Raúl Alberto , Toral-Rizo Victor Hugo
Published: June 2021

Objectives

To assess the association between the Human Development Index (HDI) and covariates on the mortality-to-incidence ratio (MIR) of lips and oral cavity cancer (LOCC) in Mexico.

Design

Ecological study.

Setting

Data from 32 Mexican states for year 2019.

Participants

Data set of male and female populations from Mexico.

Exposures

Socioeconomic conditions based on HDI and covariates related to healthcare system capacity (total health spending per capita, school dropout and ratio of medical personnel in direct contact with patients).

Primary and secondary outcome measures

MIR of LOCC by state and sex was calculated from the Global Burden of Disease Study website for year 2019. Data for calculating HDI 2019 by state and covariates were obtained from the National Institute of Statistics and Geography. A multiple regression model was constructed to measure the effects of HDI and covariates on LOCC-MIR.

Results

Among the states with the highest HDI (>0.780), Colima had the highest aged-standardised rates per 100.000 in men for incidence (5.026) and mortality (3.118). The greatest burden of the disease was found on men, with the highest Men:Women MIR in Colima (3.10) and Baja California Sur (2.73). The highest MIR (>0.65) was found among the states with the lowest HDI (Oaxaca and Chiapas). For each unit of increase of the HDI there was a decrease in the LOCC- MIR of −0.778, controlling for the covariates. The most suitable regression model explained the 57% (F (p): 0.000) of the variance.

Conclusions

Men were most affected by LOCC in Mexican states. The highest MIRs of LOCC were found in the states with the highest HDI. But a worse prognosis of the disease, expressed as a higher MIR, is expected in contexts with lower HDI in the country, even with lower MIRs.
Patient-centred infertility care among Arab women experiencing infertility: a qualitative study
Authors: Webair Hana Hasan , Ismail Tengku Alina Tengku , Ismail Shaiful Bahari , Khaffaji Azza Jameel
Published: June 2021

Objective

The current study aims to define patient-centred infertility care (PCIC) from the perspective of Arab women with infertility.

Design

Semistructured in-depth telephone interviews.

Setting

Hospitals providing infertility care, Jeddah, Saudi Arabia.

Participants

Arab women who received infertility treatment during the 6 months preceding the interview at any hospital in Jeddah, Saudi Arabia. Interviews were conducted with Arab women experiencing infertility from January 2017 to December 2018. A purposive sample of 14 women were included in the final analysis with maximum variation.

Results

Participants highlighted nine important PCIC dimensions. Of these, four were agreed on by all participants: accessibility, minimising cost, information and education, and staff attitudes and communication. The remaining five dimensions were staff competence, physical comfort, privacy, psychological and emotional support, and continuity and coordination of care. The concept of PCIC was related to three major contributors: participants’ demographics, patient experience with infertility care and health-seeking behaviour.

Conclusions

The current study provided nine PCIC dimensions and items, which can guide efforts to improve the quality of infertility care in Arab countries in two ways: first, by raising infertility care providers’ awareness of their patients’ needs, and second, by developing a validated tool based on the dimensions for measuring PCIC from Arab patients’ perspective. Clear differences between the Arab and the European PCIC model were found. Our findings concluded that women continued to exhibit basic unmet needs.
Developing an individualised cross-sectoral programme based on activities of daily living to support rehabilitation of older adults with hip fracture: a qualitative study
Authors: Ropke Alice , Lund Karina , Thrane Camilla , Juhl Carsten , Morville Anne-Le
Published: June 2021

Objectives

To develop an individualised rehabilitation programme for personal and instrumental activities of daily living (ADL) tasks, enabling older adults with hip fractures to perform ADL safely and independently.

Design

Qualitative study inspired by the complex intervention development (Medical Research Council framework phase I) using literature search and research circles.

Settings

University Hospital of Copenhagen, Herlev and Gentofte, and Herlev and Gentofte municipalities.

Participants

One research circle with seven older adults with hip fractures, and one with seven healthcare professionals (occupational therapists and physiotherapists).

Results

Three generic categories were identified: (1) ‘Challenge older adults with goal-oriented ADL tasks’, (2) ‘Implement strategies to enhance independent and safe performance of ADL tasks’, and (3) ‘Communicate the important information to the target group and across sectors’. A programme was developed and an intervention to enhance usual rehabilitation was designed comprising: an individualised intervention component consisting of five additional therapy sessions; one during hospitalisation, four in the municipality and a follow-up phone call.

Conclusions

Engaging and integrating activities into rehabilitation treatment may support rehabilitation. Our study highlighted the need for setting individual goals and challenging older adults with hip fracture by providing guidance in strategies to enhance safe and independent performance of ADL tasks. Furthermore, the need for providing older adults with hip fracture and healthcare professionals with written and oral information about goal setting during the transitional rehabilitation phase was emphasised. Including the perspectives of older adults with hip fracture and healthcare professionals added value to the rehabilitation, and thus ensured an adequate, tangible and implementable rehabilitation programme.

Trial registration number

This article is the first of three articles inspired by Medicial Research Council guidelines. The next study is a feasibility study with the trial registration: ClinicalTrials.gov ID:NCT03828240. The results are right now being written in article. The third study is a randomised controlled trial with the trial registration: ClinicalTrials.gov ID:NCT04207788; Pre-results.
Platform Randomised trial of INterventions against COVID-19 In older peoPLE (PRINCIPLE): protocol for a randomised, controlled, open-label, adaptive platform, trial of community treatment of COVID-19 syndromic illness in people at higher risk
Authors: Hayward Gail , Butler Christopher C , Yu Ly-Mee , Saville Benjamin R , Berry Nicholas , Dorward Jienchi , Gbinigie Oghenekome , van Hecke Oliver , Ogburn Emma , Swayze Hannah , Bongard Emily , Allen Julie , Tonner Sharon , Rutter Heather , Tonkin-Crine Sarah , Borek Aleksandra , Judge David , Grabey Jenna , de Lusignan Simon , Thomas Nicholas P B , Evans Philip H , Andersson Monique I , Llewelyn Martin , Patel Mahendra , Hopkins Susan , Hobbs F D Richard
Published: June 2021

Introduction

There is an urgent need to idenfy treatments for COVID-19 that reduce illness duration and hospital admission in those at higher risk of a longer illness course and complications.

Methods and analysis

The Platform Randomised trial of INterventions against COVID-19 In older peoPLE trial is an open-label, multiarm, prospective, adaptive platform, randomised clinical trial to evaluate potential treatments for COVID-19 in the community. A master protocol governs the addition of new interventions as they become available, as well as the inclusion and cessation of existing intervention arms via frequent interim analyses. The first three interventions are hydroxychloroquine, azithromycin and doxycycline. Eligible participants must be symptomatic in the community with possible or confirmed COVID-19 that started in the preceding 14 days and either (1) aged 65 years and over or (2) aged 50–64 years with comorbidities. Recruitment is through general practice, health service helplines, COVID-19 ‘hot hubs’ and directly through the trial website. Participants are randomised to receive either usual care or a study drug plus usual care, and outcomes are collected via daily online symptom diary for 28 days from randomisation. The research team contacts participants and/or their study partner following days 7, 14 and 28 if the online diary is not completed. The trial has two coprimary endpoints: time to first self-report of feeling recovered from possible COVID-19 and hospital admission or death from possible COVID-19 infection, both within 28 days from randomisation. Prespecified interim analyses assess efficacy or futility of interventions and to modify randomisation probabilities that allocate more participants to interventions with better outcomes.

Ethics and dissemination

Ethical approval Ref: 20/SC/0158 South Central - Berkshire Research Ethics Committee; IRAS Project ID: 281958; EudraCT Number: 2020-001209-22. Results will be presented to policymakers and at conferences and published in peer-reviewed journals.

Trial registration number

ISRCTN86534580.
Comorbidities do not limit improvement in pain and physical function after total knee arthroplasty in patients with knee osteoarthritis: the BEST-Knee prospective cohort study
Authors: King Lauren K , Waugh Esther J , Jones C Allyson , Bohm Eric , Dunbar Michael , Woodhouse Linda , Noseworthy Thomas , Marshall Deborah A , Hawker Gillian A
Published: June 2021

Objective

To assess the relationship between comorbidities and amount of improvement in pain and physical function in recipients of total knee arthroplasty (TKA) for knee osteoarthritis (OA).

Design

Prospective cohort study.

Setting

Two provincial central intake hip and knee centres in Alberta, Canada.

Participants

1051 participants (278 in 6-minute walk test (6MWT) subset), ≥30 years of age with primary knee OA referred for consultation regarding elective primary TKA; assessed 1 month prior and 12 months after TKA.

Primary and secondary outcome measures

Pre-post TKA change in knee OA pain (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)), physical function (Knee injury and Osteoarthritis Outcome Score (KOOS) Physical Function Short-Form) and 6MWT walking distance; and the reporting of an acceptable symptom state (Patient Acceptable Symptom State (PASS)) at 12 months after TKA.

Results

Mean participant age was 67 years (SD 8.8), 59% were female and 85% reported at least one comorbidity. Individuals with a higher number of comorbidities had worse pre-TKA and post-TKA scores for pain, physical function and 6MWT distance. At 12-month follow-up, mean changes in pain, function and 6MWT distance, and proportion reporting a PASS, were similar for those with and without comorbidities. In multivariable regression analysis, adjusted for potential confounders and clustering by surgeon, no specific comorbidities nor total number of comorbidities were associated with less improvement in pain, physical function or 6MWT distance at 12 months after TKA. Patients with diabetes (OR 0.64, 95% CI 0.44 to 0.94) and a higher number of lower extremity troublesome joints (OR 0.85, 95% CI 0.76 to 0.96) had lower odds of reporting a PASS.

Conclusion

For individuals with knee OA, comorbid conditions do not limit improvement in pain, physical function or walking ability after TKA, and most conditions do not impact achieving an acceptable symptom state.
Psychological resilience during COVID-19: a meta-review protocol
Authors: Seaborn Katie , Chignell Mark , Gwizdka Jacek
Published: June 2021

Introduction

The global COVID-19 pandemic continues to have wide-ranging implications for health, including psychological well-being. A growing corpus of research reviews has emerged on the topic of psychological resilience in the context of the pandemic. However, this body of work has not been systematically reviewed for its quality, nor with respect to findings on the effectiveness of tools and strategies for psychological resilience. To this end, a meta-review protocol is proposed with the following objectives: (1) identify review work on the topic of psychological resilience during COVID-19; (2) assess the quality of this review work using A MeaSurement Tool to Assess systematic Reviews; (3) assess the risk of bias in this work; (4) generate a narrative summary of the key points, strengths and weaknesses; (5) identify the psychological resilience strategies that have been reviewed; (6) identify how these strategies have been evaluated for their effectiveness; (7) identify what outcomes were measured and (8) summarise the findings on strategies for psychological resilience so far, providing recommendations, if possible.

Methods and analysis

A systematic meta-review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews for Protocols and Joanna Briggs Institute umbrella review guidelines. Electronic searches of general databases, especially Web of Science, Scopus and PubMed, will be conducted. Only results from January 2020 onwards will be considered, coinciding with the COVID-19 pandemic. Only results in English will be included. Descriptive statistics, thematic analysis and narrative summaries describing the nature of the reviewed work and evaluation of psychological resilience strategies will be carried out.

Ethics and dissemination

Ethical approval is not needed for systematic review protocols. The results of the meta-review will be published in an international peer-reviewed journal. The raw and summarised data will be shared in the journal or other open venues.

PROSPERO registration number

CRD42021235288.
Revisiting Russell’s troodontid: autecology, physiology, and speculative tool use1
Authors: Varricchio D.J. , Hogan J.D. , Freimuth W.J.
Published: June 2021

Dale Russell described the osteology, morphology, and ecology of the small theropod “Stenonychosaurus inequalis” in two papers, speculating on its life habits, brain power, vision, movement, feeding, and hand capabilities. Russell even pondered a tool-using dinosauroid, the hypothetical troodontid descendant if the lineage had survived the Cretaceous–Paleogene extinction event. We revisit the life habits of the North American troodontids Troodon formosus and Latenivenatrix mcmasterae in part by reviewing various trace fossils of T. formosus discovered in Montana. These fossils include egg clutches, a nest, and recently discovered regurgitalites. We also contemplate the possibility of dinosaur tool use. Troodon likely constructed earthen nests in the same way that ratites and other birds did to create their nesting scrapes through backward hindlimb kicks. The more complex clutch architecture suggests dexterous movement of the eggs, potentially requiring manual manipulation. Functionally, reproductive traces support elevated body temperatures and a metabolic output that approach but do not equal that of modern birds. Brooding would require very high energy investment from the adult. The regurgitalites largely contain multi-individual aggregations of the marsupialiform Alphadon and support Russell’s hypotheses of troodontids as crepuscular to nocturnal, intelligent, small game hunters with elevated metabolism and enhanced vision. Tool use in a few crocodilians and widely among extant birds suggests a reasonable possibility of this behavior in nonavian dinosaurs. Whether an avian-comparable encephalization quotient and freed forelimbs would make North American troodontids good candidates for exhibiting such behavior remains an open and speculative question. However, given the minimal modification made to tools by modern archosaurs, recognition of fossil tools poses a challenging problem.
A Modeling Study of Dislocation Sidewall Gettering in II-VI and III-V Semiconductor Heterostructures
Authors: Kujofsa Tedi , Ayers J. E.
Published: June 2021

Since the invention of dislocation sidewall gettering (DSG) in 2000 the technique has been applied extensively in infrared focal-plane arrays and flat-panel displays. However, development of DSG technology has been guided mostly by empirical trials due to the lack of detailed physical models. Here we demonstrate the application of a dislocation dynamics model to evaluate DSG approaches in both ZnSySe1-y/GaAs (001) and InGaxAs1-x/GaAs (001) heterostructures. We find that the effectiveness of DSG is strongly dependent on composition in both material systems.
Single Chemical Sensor for Multi-Analyte Mixture Detection and Measurement: A Review
Authors: Zhang Bo , Gao Pu-Xian
Published: June 2021

Multi-analyte chemical sensor aims to transform subtle variations in multiple analytes’ physical or chemical properties into distinct output signals. Chemically responsive nanostructure array (nanoarray) promises as a competitive sensor platform due to its robust physical properties, tunable chemical composition, and high surface area for analyte interaction. Specifically, the well-defined size, shape, and tunable surface structure and properties make it feasible to develop either new sensing modes on single device or integrated multi-modular sensors. In conjunction with the well-developed resistor-type sensors and sensor arrays, the complementary utilization of and intercorrelation with the electrochemical, optical, voltammetry modes in the multi-modular sensing strategies could provide multi-dimensional measurements to different analytes in a complex mixture form, where species information could be accurately and robustly separated from spatially collective responses. This review intends to provide a survey of the recent progress on multi-analyte sensing strategies and their unique structure design, as well as the related sensing mechanics in interaction of analytes and sensitizer and the behind mechanism for analytes’ differentiation.
Compact 1-Bit Full Adder and 2-Bit SRAMs Using n-SWS-FETs
Authors: Salama H. , Saman B. , Gudlavalleti R. , Mays R. , Heller E. , Chandy J. , Jain F.
Published: June 2021

This paper presents Spatial Wavefunction Switched (SWS)-FETs have been proposed to implement ternary and quaternary logic, 2-bit DRAM cells, and static random-access memories (SRAMs) in nMOS-SWS and CMOS-SWS configurations. This paper presents simulation of a 1-bit Full Adder using n-SWS-FETs. In addition, simulation of 2-bit SRAMs is presented for a quantum dot channel and a four quantum well nSWS-FET.SRAMs.
Additively Manufactured RF Devices for 5G, IoT, RFID, WSN, and Smart City Applications
Authors: Cui Yepu , Jung Eui Min , Adeyeye Ajibayo , Lynch Charles , He Xuanke , Tentzeris Manos
Published: June 2021

With the development of inkjet-/3D-/4D-printing additive manufacturing technologies, flexible 3D substrate with complex structures can be patterned with dielectric, conductive and semi-conductive materials to realize novel RF designs. This paper provides a review of state-of-the-art additively manufactured passive RF devices including antennas and frequency selective surfaces (FSS), couplers, where origami-inspired structure enables unprecedented capabilities of on-demand continuous frequency tunability and deployability. This paper also discusses additively manufactured active RF modules and systems such as inkjet printed RF energy harvester system with high sensitivity and efficiency for Internet of Things (IoT), smart cities and wireless sensor networks (WSN) applications, inkjet-printed RF front ends, and inkjet-printed mm-wave backscatter modules.