bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimates of road traffic deaths in Tanzania
Authors: Mbugua Leah Watetu , Mitra Sudeshna , Neki Kazuyuki , Gutierrez Hialy , Balasubramaniyan Ramshankar , Winer Mercer , Roberts Jaeda , Vos Theo , Hamilton Erin , Naghavi Mohsen , Harrison James E , Job Soames , Bhalla Kavi
Published: May 2022

Introduction

There is considerable uncertainty in estimates of traffic deaths in many sub-Saharan African countries, with the Global Burden of Disease (GBD) and the Global Status Report on Road Safety (GSRRS) reporting widely differing estimates. As a case study, we reviewed and compared estimates for Tanzania.

Methods

We estimated the incidence of traffic deaths and vehicle ownership in Tanzania from nationally representative surveys. We compared findings with GBD and GSRRS estimates.

Results

Traffic death estimates based on the 2012 census (9382 deaths; 95% CI: 7565 to 11 199) and the 2011–2014 Sample Vital Registration with Verbal Autopsy (8778; 95% CI: 7631 to 9925) were consistent with each other and were about halfway between GBD (5 608; 95% UI: 4506 to 7014) and WHO (16 252; 95% CI: 13 130 to 19 374) estimates and more than twice official statistics (3885 deaths in 2013). Surveys and vehicle registrations data show that motorcycles have increased rapidly since 2007 and now comprise 66% of vehicles. However, these trends are not reflected in GBD estimates of motorcycles in the country, likely resulting in an underestimation of motorcyclist deaths.

Conclusion

Reducing discrepancies between GBD and GSRRS estimates and demonstrating consistency with local epidemiological data will increase the legitimacy of such estimates among national stakeholders. GBD, which is the only project that models the road-user distribution of traffic deaths in all countries, likely severely underestimates motorcycle deaths in countries where there has been a recent increase in motorcycles. Addressing police under-reporting and strengthening surveillance capacity in Tanzania will allow a better understanding of the road safety problem and better targeting of interventions.
Adrenal insufficiency
Authors: Kumar Rajeev , Wassif W S
Published: May 2022

Adrenal insufficiency (AI), first described by Thomas Addison in 1855, is characterised by inadequate hormonal production by the adrenal gland, which could either be primary, due to destruction of the adrenal cortex, or secondary/tertiary, due to lack of adrenocorticotropic hormone or its stimulation by corticotropin-releasing hormone. This was an invariably fatal condition in Addison’s days with most patients dying within a few years of diagnosis. However, discovery of cortisone in the 1940s not only improved the life expectancy of these patients but also had a dramatic effect on their overall quality of life. The diagnosis, easily confirmed by demonstrating inappropriately low cortisol secretion, is often delayed by months, and many patients present with acute adrenal crisis. Sudden withdrawal from chronic glucocorticoid therapy is the most common cause of AI. Currently, there remains a wide variation in the management of this condition across Europe. As primary AI is a relatively rare condition, most medical specialists will only manage a handful of these patients in their career. Despite many advances in recent years, there is currently no curative option, and modern cortisol replacement regimens fail to adequately mimic physiological cortisol rhythm. A number of new approaches including allograft of adrenocortical tissue and stem cell therapy are being tried but remain largely experimental.
Postmortem survey of haemoglobin A1c, non-alcoholic steatohepatitis and liver fibrosis within a general population
Authors: Klaric Kristina-Ana , Parai Jacqueline Louise , Kepron Charis Anthea , Walker Alfredo Eugene , Milroy Christopher Mark
Published: May 2022

Aims

Non-alcoholic steatohepatitis (NASH), fatty liver disease and fibrosis are associated with diabetes mellitus and obesity. Previous autopsy series have reported prevalence of fatty liver disease to be 11%–24%. Recent studies, using imaging and serology, suggest a prevalence of 20%–35%, NASH of 5% and advanced fibrosis of 2%–3%. We examined the prevalence of NASH and liver fibrosis in a general autopsy population.

Methods

A cross-sectional study of consecutive, adult, medicolegal autopsies over a 1-year period was conducted. Liver sections were scored for fibrosis, inflammation and steatosis using a modified NASH scoring system. Stepwise logistic regression was used to identify associations between NASH or moderate/severe fibrosis and several clinicopathological parameters, including postmortem haemoglobin A1c (HbA1c).

Results

Of 376 cases, 86 (22.9%) were classified as NASH. Prevalence of diabetes mellitus, body mass index (BMI) and postmortem HbA1c were significantly higher in NASH cases (39.5%, 32.3 kg/m2and 6.88%) than non-NASH cases (12.1%, 27.0 kg/m2and 5.73%). Decedents with moderate/severe fibrosis (6.9%) had higher prevalence of diabetes, BMI and HbA1c (50%, 31.4 kg/m2and 6.7%) compared with those with no/mild fibrosis (16%, 28 kg/m2and 5.9%). HbA1c ≥7% was found to be an independent predictor of NASH (OR 5.11, 95% CI 2.61 to 9.98) and advanced fibrosis (OR 3.94, 95% CI 1.63 to 9.53).

Conclusions

NASH and advanced fibrosis were higher in our general adult autopsy population compared with previously published estimates. This is a large series with histological evaluation showing that HbA1c >7.0% is independently associated with NASH and advanced fibrosis.
Indirect impact of the COVID-19 pandemic and its containment measures on social inequalities in hospital utilisation in Italy
Authors: Di Girolamo Chiara , Gnavi Roberto , Landriscina Tania , Forni Silvia , Falcone Manuele , Calandrini Enrico , Cesaroni Giulia , Russo Antonio , Leoni Olivia , Fanizza Caterina , Allotta Alessandra , Costa Giuseppe , Spadea Teresa
Published: May 2022

Background

The pandemic may undermine the equity of access to and utilisation of health services for conditions other than COVID-19. The objective of the study is to evaluate the indirect impact of COVID-19 and lockdown measures on sociodemographic inequalities in healthcare utilisation in seven Italian areas.

Methods

In this multicentre retrospective study, we evaluated whether COVID-19 modified the association between educational level or deprivation and indicators of hospital utilisation and quality of care. We also assessed variations in gradients by sex and age class. We estimated age-standardised rates and prevalence and their relative per cent changes comparing pandemic (2020) and pre-pandemic (2018–2019) periods, and the Relative Index of Inequalities (RIIs) fitting multivariable Poisson models with an interaction between socioeconomic position and period.

Results

Compared with 2018–2019, hospital utilisation and, to a lesser extent, timeliness of procedures indicators fell during the first months of 2020. Larger declines were registered among women, the elderly and the low educated resulting in a shrinkage (or widening if RII <1) of the educational gradients for most of the indicators. Timeliness of procedures indicators did not show any educational gradient neither before nor during the pandemic. Inequalities by deprivation were nuanced and did not substantially change in 2020.

Conclusions

The socially patterned reduction of hospital utilisation may lead to a potential exacerbation of health inequalities among groups who were already vulnerable before the pandemic. The healthcare service can contribute to contrast health disparities worsened by COVID-19 through more efficient communication and locally appropriate interventions.
Clinical activity of PD-1 inhibition in the treatment of locally advanced or metastatic basal cell carcinoma
Authors: In Gino Kim , Nallagangula Aparna , Choi Jacob Seung , Tachiki Lisa , Blackburn Matthew J , Capone Stephen , Bollin Kathryn B , Reuben Daniel Y. , Shirai Keisuke , Zhang-Nunes Sandy , Ragab Omar , Terando Alicia , Hu Jenny C. , Lee Han , Bhatia Shailender , Chandra Sunandana , Lutzky Jose , Gibney Geoffrey Thomas
Published: May 2022

Background

Basal cell carcinoma (BCC) is the most common malignancy worldwide, yet the management of patients with advanced or metastatic disease is challenging, with limited treatment options. Recently, programmed death receptor 1 (PD-1) inhibition has demonstrated activity in BCC after prior Hedgehog inhibitor treatment.

Methods

We conducted a multicenter, retrospective analysis of BCC patients treated with PD-1 inhibitor therapy. We examined the efficacy and safety of PD-1 therapy, as well as clinical and pathological variables in association with outcomes. Progression-free survival (PFS), overall survival (OS) and duration of response (DOR) were calculated using Kaplan-Meier methodology. Toxicity was graded per Common Terminology Criteria for Adverse Events V.5.0.

Results

A total of 29 patients with BCC who were treated with PD-1 inhibition were included for analysis, including 20 (69.0%) with locally advanced and 9 (31.0%) with metastatic disease. The objective response rate was 31.0%, with five partial responses (17.2%), and four complete responses (13.8%). Nine patients had stable disease (31.0%), with a disease control rate of 62.1%. The median DOR was not reached. Median PFS was 12.2 months (95% CI 0.0 to 27.4). Median OS was 32.4 months (95% CI 18.1 to 46.7). Two patients (6.9%) developed grade 3 or higher toxicity, while four patients (13.8%) discontinued PD-1 inhibition because of toxicity. Higher platelets (p=0.022) and any grade toxicity (p=0.024) were significantly associated with disease control rate.

Conclusions

The clinical efficacy of PD-1 inhibition among patients with advanced or metastatic BCC in this real-world cohort were comparable to published trial data. Further investigation of PD-1 inhibition is needed to define its optimal role for patients with this disease.
Genetic architecture in neonatal intensive care unit patients with congenital heart defects: a retrospective study from the China Neonatal Genomes Project
Authors: Wang Huijun , Xiao Feifan , Qian Yanyan , Wu Bingbing , Dong Xinran , Lu Yulan , Cheng Guoqiang , Wang Laishuan , Yan Kai , Yang Lin , Chen Liping , Kang Wenqing , Li Long , Pan Xinnian , Wei Qiufen , Zhuang Deyi , Chen Dongmei , Yin Zhaoqing , Yang Ling , Ni Qi , Liu Renchao , Li Gang , Zhang Ping , Li Xu , Peng Xiaomin , Wang Yao , Chen Huiyao , Ma Xiaojing , Liu Fang , Cao Yun , Huang Guoying , Zhou Wenhao
Published: May 2022

Background

Congenital heart defects (CHDs) are the most common type of birth defects. The genetic aetiology of CHD is complex and incompletely understood. The overall distribution of genetic causes in patients with CHD from neonatal intensive care units (NICUs) needs to be studied.

Methods

CHD cases were extracted from the China Neonatal Genomes Project (2016–2021). Next-generation sequencing results and medical records were retrospectively evaluated to note the frequency of genetic diagnosis and the respective patient outcomes.

Results

In total, 1795 patients were included. The human phenotype ontology term of atrial septal defect, patent ductus arteriosus and ventricular septal defect account for a large portion of the CHD subtype. Co-occurring extracardiac anomalies were observed in 35.1% of patients. 269 of the cases received genetic diagnoses that could explain the phenotype of CHDs, including 172 copy number variations and 97 pathogenic variants. The detection rate of trio-whole-exome sequencing was higher than clinical exome sequencing (21.8% vs 14.5%, p<0.05). Further follow-up analysis showed the genetic diagnostic rate was higher in the deceased group than in the surviving group (29.0% vs 11.9%, p<0.05).

Conclusion

This is the largest cohort study to explore the genetic spectrum of patients with CHD in the NICU in China. Our findings may benefit future work on improving genetic screening and counselling for NICU patients with CHD.
Combining biomarkers for prognostic modelling of Parkinson’s disease
Authors: Vijiaratnam Nirosen , Lawton Michael , Heslegrave Amanda J , Guo Tong , Tan Manuela , Jabbari Edwin , Real Raquel , Woodside John , Grosset Katherine , Chelban Viorica , Athauda Dilan , Girges Christine , Barker Roger A , Hardy John , Wood Nicholas , Houlden Henry , Williams Nigel , Ben-Shlomo Yoav , Zetterberg Henrik , Grosset Donald G , Foltynie Thomas , Morris Huw R
Published: May 2022

Background

Patients with Parkinson’s disease (PD) have variable rates of progression. More accurate prediction of progression could improve selection for clinical trials. Although some variance in clinical progression can be predicted by age at onset and phenotype, we hypothesise that this can be further improved by blood biomarkers.

Objective

To determine if blood biomarkers (serum neurofilament light (NfL) and genetic status (glucocerebrosidase,GBAand apolipoprotein E (APOE))) are useful in addition to clinical measures for prognostic modelling in PD.

Methods

We evaluated the relationship between serum NfL and baseline and longitudinal clinical measures as well as patients’ genetic (GBAandAPOE) status. We classified patients as having a favourable or an unfavourable outcome based on a previously validated model, and explored how blood biomarkers compared with clinical variables in distinguishing prognostic phenotypes .

Results

291 patients were assessed in this study. Baseline serum NfL was associated with baseline cognitive status. Nfl predicted a shorter time to dementia, postural instability and death (dementia—HR 2.64; postural instability—HR 1.32; mortality—HR 1.89) whereas APOEe4 status was associated with progression to dementia (dementia—HR 3.12, 95% CI 1.63 to 6.00). NfL levels and genetic variables predicted unfavourable progression to a similar extent as clinical predictors. The combination of clinical, NfL and genetic data produced a stronger prediction of unfavourable outcomes compared with age and gender (area under the curve: 0.74-age/gender vs 0.84-ALL p=0.0103).

Conclusions

Clinical trials of disease-modifying therapies might usefully stratify patients using clinical, genetic and NfL status at the time of recruitment.
Cerebral cavernous malformations do not fall in the spectrum of PIK3CA-related overgrowth
Authors: Zhang Jun , Abou-Fadel Johnathan , Renteria Mellisa , Belkin Ofek , Chen Bixia , Zhu Yuan , Dammann Philipp , Rigamonti Daniele
Published: May 2022

Somatic gain-of-function (GOF) mutations in phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), the catalytic subunit of phosphoinositide 3-kinase (PI3K), have been recently discovered in cerebral cavernous malformations (CCMs), raising the possibility that the activation of PI3K pathways is a possible universal regulator of vascular morphogenesis. However, there have been contradicting data presented among various groups and studies. To enhance the current understanding of vascular anomalies, it is essential to explore this possible relationship between altered PI3K signalling pathways and its influence on the pathogenesis of CCMs. GOFPIK3CA-mutants have been linked to overgrowth syndromes, allowing this group of disorders, resulting from somatic activating mutations inPIK3CA,to be collectively named asPIK3CA-related overgrowth spectrum disorders. This paper reviews and attempts to conceptualise the relationships and differences among clinical presentations, genotypic and phenotypic correlations and possible coexistence ofPIK3CAandCCMmutations/phenotypes in CCM lesions. Finally, we present a model reflecting our hypothetical understanding of CCM pathogenesis based on a systematic review and conceptualisation of data obtained from other studies.
Delirium and the risk of developing dementia: a cohort study of 12 949 patients
Authors: Leighton Samuel P , Herron James W , Jackson Eric , Sheridan Matthew , Deligianni Fani , Cavanagh Jonathan
Published: May 2022

Background

Delirium is an important risk factor for subsequent dementia. However, the field lacks large studies with long-term follow-up of delirium in subjects initially free of dementia to clearly establish clinical trajectories.

Methods

We undertook a retrospective cohort study of all patients over the age of 65 diagnosed with an episode of delirium who were initially dementia free at onset of delirium within National Health Service Greater Glasgow & Clyde between 1996 and 2020 using the Safe Haven database. We estimated the cumulative incidence of dementia accounting for the competing risk of death without a dementia diagnosis. We modelled the effects of age at delirium diagnosis, sex and socioeconomic deprivation on the cause-specific hazard of dementia via cox regression.

Results

12 949 patients with an incident episode of delirium were included and followed up for an average of 741 days. The estimated cumulative incidence of dementia was 31% by 5 years. The estimated cumulative incidence of the competing risk of death without dementia was 49.2% by 5 years. The cause-specific hazard of dementia was increased with higher levels of deprivation and also with advancing age from 65, plateauing and decreasing from age 90. There did not appear to be a relationship with sex.

Conclusions

Our study reinforces the link between delirium and future dementia in a large cohort of patients. It highlights the importance of early recognition of delirium and prevention where possible.
Improving patient pathways for systemic lupus erythematosus: a multistakeholder pathway optimisation study
Authors: Schlencker Aurelien , Messer Laurent , Ardizzone Marc , Blaison Gilles , Hinschberger Olivier , Dahan Etienne , Sordet Christelle , Walther Julia , Dory Anne , Gonzalez Maria , Kleinlogel Stéphanie , Bramont-Nachman Aurélia , Barrand Lionel , Payen-Revol Isabelle , Sibilia Jean , Martin Thierry , Arnaud Laurent
Published: May 2022

Objective

Among the most significant challenges in SLE are the excessive diagnosis delay and the lack of coordinated care. The aim of the study was to investigate patient pathways in SLE in order to improve clinical and organisational challenges in the management of those with suspected and confirmed SLE.

Methods

We conducted a cross-sectional study of patients with SLE, healthcare providers and other representative stakeholders. Focus groups were conducted, and based on the collected data the most impactful disruption points in SLE patient pathways were identified. A novel framework to improve individual patient pathways in SLE was developed, discussed and validated during a consensus meeting with representative stakeholders.

Results

Six thematic clusters regarding disruption in optimal patient pathways in SLE were identified: appropriate and timely referral strategy for SLE diagnosis; the need for a dedicated consultation during which the diagnosis of SLE would be announced, and following which clarifications and psychological support offered; individualised patient pathways with coordinated care based on organ involvement, disease severity and patient preference; improved therapeutic patient education; prevention of complications such as infections, osteoporosis and cancer; and additional patient support. During the consensus meeting, the broader panel of stakeholders achieved consensus on these attributes and a framework for optimising SLE patient pathways was developed.

Conclusions

We have identified significant disruption points and developed a novel conceptual framework to improve individual patient pathways in SLE. These data may be of valuable interest to patients with SLE, their physicians, health organisations as well as policy makers.
Risk-relativity is still a nonsense
Authors: Pickering Neil John , Newton-Howes Giles , Walker Simon
Published: May 2022

In this short response to Gray’s article Capacity and Decision Making we double down on our argument that risk-relativity is a nonsense. Risk relativity is the claim that we should set a higher standard of competence for a person to make a risky choice than to make a safe choice. Gray’s response largely involves calling attention to the complexities, ramifications and multiple value implications of decision-making, but we do not deny any of this. Using the notion of quality of care mentioned by Gray, we construct an argument that might be used to support risk relativity. But it is no more persuasive than the arguments put forward by risk-relativists.
Biopower under a state of exception: stories of dying and grieving alone during COVID-19 emergency measures
Authors: Rangel J.Cristian , Holmes Dave , Perron Amélie , Miller Granville E
Published: May 2022

During the COVID-19 pandemic, restrictions for visitors and caregivers in healthcare settings and long-term care (LTC) facilities were enacted in the larger context of public health policies that included physical distancing and shelter-in-place orders. Older persons residing in LTC facilities constituted over half of the mortality statistics across Canada during the first wave of the COVID-19 pandemic. Using the poststructuralist work of Agamben, Foucault and Mbembe we conducted a thematic analysis on news reports. The extracts of media stories presented in our paper suggest that the scholarship on (bio)power and necropolitics is central for understanding the ways the COVID-19 crisis reveals the pragmatic priorities—and the ‘health’ and political values—that undergird the moral imagination of the public, including the educated classes of advanced Western democracies. Our critical analysis shows that by isolating individuals who were sick, fragile, and biologically and socially vulnerable, undifferentiated population management policies like social distancing, when piled on the structural weakness of health systems, reproduced inequities and risk for those in need of medical care, advocacy, and social companionship in acute moments of illness, death and grief. Considering the unprecedented deployment of governmental power via public health interventions based on social regulation to protect the population during the crisis—how can we understand so much death and suffering among the most vulnerable?
Beyond ‘born not made’: challenging character, emotions and professionalism in undergraduate medical education
Authors: Allitt Marie , Frampton Sally
Published: May 2022

In this article we explore the historical antecedents and ongoing perpetuation of the idea that medical professionals must adhere to a specific ‘character’. In the late nineteenth century, an ideal of the medical student as ‘born not made’ was substantiated through medical school opening addresses and other medical literature. An understanding prevailed that students would have a natural inclination that would suit them to medical work, which was predicated on class structures. As we move into the twentieth-century context, we see that such underpinnings remained, even if the idea of ‘character’ becomes ‘characteristics’. This was articulated through emerging psychological and sociological perspectives on education, as well as medical school admission processes. The significance ascribed to character and characteristics-based suitability continues to exclude and limits who can access medical careers. In the final part of the article, we argue that a framework of uncertainty can and should be mobilised to re-evaluate the role of doctors’ education and critique long-standing notions of professional identity, via the integration of medical humanities and clearer professionalism teaching within medical curricula.
Xenotransplantation and borders: two Indian narratives
Authors: Srihari Meenakshi
Published: May 2022

This paper examines two Indian texts, Anand Gandhi’s filmThe Ship of Theseus(2012) and Manjula Padmanabhan’s playHarvest(1998), which deal with complex biopolitical and geopolitical questions around organ transplantation, for their treatment of corporeal, geopolitical and ethical borders.

By dramatising the lives of carriers who are both receivers and donors, the texts enact boundaries, visible and invisible, from both sides. I focus on the carrier of the diseased organ—already a stranger, as Jean-Luc Nancy describes his own failing heart inL’Intrus(2000)—and the carrier of the alien organ and show how these raise moral and ethical questions around organ transplantation. I first argue that these texts foreground biopolitical quandaries even as they narrate the moral economies of transplantation. I then delineate the ways in which the texts employ a posthuman imaginary. The texts raise questions around organ transplantation that while emanating from the invasion of corporeal borders also reflect the permeability of social borders, and while doing so, posit the human in today’s medicalised terrain as a fragmented, multiple self that is embedded in the environment and co-evolves with it.

By addressing the altered sense of self of the ‘body-in-transplant’ through a posthumanist lens that accounts for relationality and the acknowledgement of a plural self, the paper hopes to make a contribution to a better understanding of the vulnerable post-transplant patient.
Cervical spine ligamentum flavum gaps: MR characterisation and implications for interlaminar epidural injection therapy
Authors: Joshi Jatin , Roytman Michelle , Aiyer Rohit , Mauer Elizabeth , Chazen J Levi
Published: May 2022

Background

Cervical epidural steroid injections are commonly performed to manage pain from cervical spine disease. Cadaveric studies have demonstrated incomplete ligamentum flavum fusion in the central interlaminar region with resultant midline gaps. We performed an MR-based characterization of cervical ligamentum flavum midline gaps to improve understanding of their prevalence and guide interventionalists in procedural planning.

Methods

Fifty patients were retrospectively reviewed following institutional review board approval. Axial T2-weighted spinecho sequences were used to evaluate ligamentum flavum integrity at the interlaminar spaces of C5–C6, C6–C7 and C7–T1. Interlaminar spaces were further subdivided into superior, middle, and inferior portions, yielding 150 interlaminar regions characterized from C5 to T1. Subsequently, a novel categorization of gap morphology was performed, highlighting gap morphology (anterior, posterior, full, or no gap).

Results

Full gaps of the ligamentum flavum, with direct epidural space exposure, were observed with variable prevalence at all three levels evaluated. The highest incidence of full ligamentum flavum gaps were observed at C7–T1, occurring in 71.4% of patients at both its middle and inferior portions. The inferior aspect of C5–C6 demonstrated the lowest observed rates of full ligamentum flavum gap (2%).

Conclusions

Ligamentum flavum gaps occur in the lower cervical spine at high rates, with the highest prevalence of full thickness ligamentum flavum gaps at C7–T1. Interventionists must be aware of these important normal variants and evaluate preprocedural MRI to plan interventions.
Characterising a syndemic among black women at risk for HIV: the role of sociostructural inequity and adverse childhood experiences
Authors: Tsuyuki Kiyomi , Chan Erica , Lucea Marguerite B , Cimino Andrea , Rudolph Abby E , Tesfai Yordanos , Campbell Jacquelyn C , Catabay Christina J , Stockman Jamila K
Published: May 2022

ObjectivesBlack women disproportionately experience STIs (including HIV/AIDS), gender-based violence, substance misuse and mental health conditions. Addressing a gap in syndemic research, we characterised comorbidity overlap within the context of sociostructural inequities and adverse childhood experiences (ACEs) among black women in Baltimore, Maryland.

MethodsBetween 2015 and 2018, black women (n=305) were recruited from STI clinics in Baltimore, Maryland. Among those with complete survey data (n=230), we conducted a latent class analysis to differentiate women based on their profile of the following syndemic comorbidities: STIs, adult sexual victimisation, substance misuse and mental health disorders. We then examined the association between ACEs and syndemic latent class membership.

ResultsThirty-three percent of women experienced three to nine ACEs before age 18 years, and 44% reported four to six comorbidities. The two-class latent class solution demonstrated the best fit model, and women were categorised in either class 1 (past-year STI; 59%) or class 2 (syndemic comorbidities; 41%). Women in class 2 were more likely to report unstable housing (10% vs 3%) and identify as bisexual/gay (22% vs 10%) than women in class 1. ACEs were significantly associated with an increased likelihood of class 2 membership.

ConclusionsThis study reinforces the importance of screening for ACEs and offering trauma-informed, integrated care for black women with syndemic comorbidities. It also highlights the critical nature of tailoring interventions to improve sociostructural equity, preventing and reducing syndemic development.
Epidemiology and spatial distribution of people diagnosed with HIV between 1997 and 2020 in Kerman, Iran
Authors: Mirzaei Hossein , Mirzazadeh Ali , Barouni Mohsen , Ranjbar Ebrahim , Eybpoosh Sana , Sharifi Hamid
Published: May 2022

Objective

This study described the epidemiology and geographical distribution of people diagnosed with HIV in Kerman, Iran, between 1997 and 2020.

Methods

We used case-based HIV surveillance data of all people diagnosed with HIV in Kerman between 1997 and 2020. We compared the age, gender, modes of transmission and spatial distribution of newly diagnosed HIV-infected people in three time periods (1997–2004, 2005–2012 and 2013–2020). The χ2 test for trend, one-sample t-test and Kruskal-Wallis H test were used to compare the differences between the three time periods. We also used ArcGIS to map both HIV services and people living with HIV (PLWH) in 2020. The nearest neighbour index and kernel density were used to identify the spatial distribution of PLWH.

Results

A total of 459 (27.5% women) people were diagnosed with HIV during 1997–2020. The proportion of women (9.3% in 1997–2004 and 48.3% in 2013–2020, p<0.001), HIV infection through sexual contacts (11.6% in 1997–2004 and 50.3% in 2013–2020, p<0.001), HIV infection under the age of 5 years (0.8% in 1997–2004 and 5.4% in 2013–2020, p=0.01) and mean age at diagnosis among men (34.9 in 1997–2004 and 39.8 years in 2013–2020, p=0.004) significantly increased over time. 36.2% of diagnosed cases had CD4 counts under 200 x 10ˆ6/L between 2013 and 2020, with no significant improvement over time. Most newly diagnosed cases of HIV were from the eastern parts of the city. The clusters of PLWH in 2020 matched with the locations of HIV services.

Conclusion

We observed important changes in HIV epidemiology regarding gender, modes of transmission, number of paediatric cases and density maps over time in Kerman. These changes should be considered for precise targeting of HIV prevention and treatment programmes.
Specific detection of Treponema pallidum in clinical samples: validation of a qPCR assay combining two genomic targets
Authors: Salle Romain , Mayslich Constance , Grange Philippe Alain , Leducq Valentin , Ollagnier Guillaume , Heller Ugo , Saule Julie , Martinet Pervenche , Robert Jean-Luc , Benhaddou Nadjet , Fouere Sebastien , Dupin Nicolas
Published: May 2022

Objectives

We evaluated a real-time quantitative PCR (qPCR) for detection of the Treponema pallidum (TP) genome in clinical samples through simultaneous detection of two genomic targets.

Methods

We performed qPCR with TaqMan technology using two TP genes, polA and tpp47, as targets, with an internal positive control. The qPCR assay was compared with syphilis diagnosis based on a combination of clinical examination, serological results and inhouse nested PCR (nPCR). Samples were analysed at the National Reference Center for STIs at Cochin Hospital in Paris.

Results

In total, from October 2010 to December 2016, 320 documented clinical samples (mucosal and cutaneous swabs) were collected from patients with or without syphilis attending STI centres in France. The qPCR had an overall sensitivity of 89% (95% CI 85.1% to 92.1%), a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 88% (95% CI 84.3% to 91.5%). The agreement between qPCR and nPCR results was 94% (κ=0.88, 95% CI 0.83 to 0.93). Calibration of the qPCR assay, by cloning both the polA and tpp47 genes, defined the detection threshold as 1 copy/µL of DNA elution.

Conclusions

We validated a new qPCR for detecting the TP genome in clinical samples with excellent sensitivity and specificity. The cloning of polA and tpp47 genes for calibration would be interesting in the evaluation of bacterial loads in samples.
Self-sampled specimens demonstrate comparable accuracy and consistency to clinician-sampled specimens for HPV detection among men who have sex with men in China
Authors: Ni Yuxin , Lu Ying , He Xi , Li Yumei , Li Yongqing , Guo Shiyu , Ong Jason J. , Xu Chen , Wang Xiaman , Yan Xumeng , Tao Yusha , Liu Na , Tang Weiming
Published: May 2022

Objectives

Despite a high risk of human papillomavirus (HPV) infection among men who have sex with men (MSM), few have ever tested. This study aimed to evaluate the feasibility and accuracy of HPV self-sampling among Chinese MSM, with the purpose of measuring the feasibility of self-sampling as an alternative in HPV testing scenarios.

Methods

Eligible participants were those who were assigned male at birth, aged 18 or above, had sex with men in the past year and had never gotten HPV vaccine. Participants followed the instructions to self-sample and were also clinician-sampled from the same anatomical sites (oral fluid, penis and rectum) in both approaches. All specimens were processed using multiplex PCR assay. The reference standard of an individual with a true positive for HPV is determined via PCR test, regardless of sampling methods. Sensitivity and specificity were calculated for each approach independently and kappa test was used to assess the consistency between the two approaches.

Results

Overall, 211 MSM were recruited at the local clinic from April to October 2020 in Zhuhai, China. The mean age was 31 years old. Only 3% of the participants sought help from healthcare providers during self-sampling. The prevalence of HPV was 49% (103 of 211). Clinician sampling detected 91 of 103 MSM infected with HPV, with a sensitivity of 88.3% (95% CI 80.2 to 93.6) and a specificity of 100.0% (95% CI 95.7 to 100.0). Self-sampling detected 81 of 103 MSM infected with HPV, with a sensitivity of 78.6% (95% CI 69.2 to 85.9) and a specificity of 100.0% (95% CI 95.7 to 100.0). The level of agreement was moderate between clinician sampling and self-sampling (k=0.67).

Conclusions

Self-sampled HPV testing demonstrated comparable accuracy and consistency to clinician sampling among MSM in China. It holds the potential to complement sexual health services especially among key populations.
Distribution of HIV self-tests by men who have sex with men attending a French sexual health centre: results of the OTO study
Authors: Gosset Daniel , Plathey Marine , Lert France , Lasry Stéphane , Jedrzejewski Thibaut , Gazalet Philippe , L'Yavanc Thomas , Pierre Nadège , Kachal Abdessamad , Frémondière Marc , Ohayon Michel , Palich Romain
Published: May 2022

Objectives

HIV self-tests (HSTs) have been deployed to reduce the burden of undiagnosed HIV infections in subpopulations undertested. We assumed that patients attending sexual health centres could themselves distribute HSTs in their close network. This study aimed to assess the proportion and the characteristics of the participants who distributed HSTs, as well as the characteristics of people who received HSTs.

Methods

Three HSTs were given to patients attending “Le 190” Sexual Health Center, Paris, France, having consented for the study, between July 2018 and August 2020. Participants had to distribute HSTs within 6 months, preferably to individuals in their close circle who have not been tested for a long time. Then they had to complete a self-questionnaire, exploring HIV status, sexual practices, number of distributed HSTs, profile of persons who received HSTs, and if known, result of used HSTs. Univariable logistic regression was used to determine factors associated with HST distribution.

Results

Overall, 682/1062 (64%) patients accepted to be included in the study, and 283/682 (42%) completed the questionnaire. 97% were men who have sex with men (MSMs), including 86 (30%) HIV-positive individuals and 119 (42%) HIV Pre-Exposure Prophylaxis (PrEP) users. The proportion of participants having distributed 0, 1, 2 or 3 HSTs was 31%, 15%, 27% and 27%, respectively. Participants having distributed at least one HST (n=195, 69%) were more likely to have previously used HSTs themselves (OR=3.90, 95% CI=1.84 to 8.29, p<0.001). On the 901 HSTs in possession of participants who answered the questionnaire, 455 (50%) were distributed. 79% of recipients were MSMs, and 42% of whom had not been tested for more than 1 year. The result was known for 220 HSTs, including 5 positive (2.3%).

Conclusion

MSMs attending sexual health centres could be good disseminators of HSTs, targeting a population with high level of undiagnosed HIV infections, especially if they have already experimented it.
Trends in public interest in shopping and point-of-sales of JUUL and Puff Bar 2019–2021
Authors: Majmundar Anuja , Xue Zheng , Asare Samuel , Nargis Nigar
Published: May 2022

Introduction

We investigated public interest in shopping and point-of-sales (POS) of JUUL and Puff Bar products in the context of five regulatory, company sales policy and other events of interest that may have influenced the trajectory of these products during 2019–2021.

Methods

Outcome variables included relative search volume (RSV) from Google search queries indicative of shopping interest in and aggregate dollar sales from Nielsen POS for JUUL and Puff Bar in the USA from March 2019 to May 2021. Adjusted autoregressive integrated moving average assessed the observed and predicted trends and adjusted linear regression analysis measured the relative rate of change in the outcome variables for each time period of interest.

Results

After the Trump administration announced its plans to ban flavoured e-cigarettes and JUUL Labs, Inc.’s decided to suspend the sales of its sweet and fruity flavoured products, JUUL’s shopping interest RSV and sales declined while Puff Bar’s shopping interest RSV peaked, and its sales increased. From the period following FDA’s announcement of its enforcement guidance policy on unauthorised flavoured cartridge-based e-cigarettes until May 2021, JUUL’s shopping interest RSV and sales continued to decline. Puff Bar’s shopping interest RSV increased, and its sales peaked until the House approved the flavoured e-cigarette ban bill. Puff Bar’s sales steeply declined following suspension of its sales in February 2020. The decline, however, slowed after Puff Bar products were relaunched as ‘synthetic nicotine’ e-cigarettes.

Conclusions

Puff Bar’s unprecedented peak in the shopping interest and sales of Puff Bar warrants continued surveillance.
Analysis of mainstream emissions, secondhand emissions and the environmental impact of IQOS waste: a systematic review on IQOS that accounts for data source
Authors: El-Kaassamani Malak , Yen Miaoshan , Talih Soha , El-Hellani Ahmad
Published: May 2022

Objective

To highlight the general features of IQOS literature focusing on the chemical analysis of IQOS emissions.

Data sources

PubMed, Web of Science and Scopus databases were searched on 8 November 2021 using the terms ‘heated tobacco product’, ‘heat-not-burn’, ‘IQOS’ and ‘tobacco heating system’ with time restriction (2010–2021). The search yielded 5480 records.

Study selection

Relevant publications on topics related to IQOS assessment were retrieved (n=341). Two reviewers worked separately and reached agreement by consensus.

Data extraction

Data on author affiliation and funding, article type and date of publication were extracted. Publications were categorised depending on their focus and outcomes. Data on IQOS emissions from the chemical analysis category were extracted.

Data synthesis

Of the included publications, 25% were published by Philip Morris International (PMI) affiliates or PMI-funded studies. PMI-sponsored publications on emissions, toxicology assessments and health effects were comparable in number to those reported by independent research, in contrast to publications on IQOS use, market trends and regulation. Data on nicotine yield, carbonyl emissions, other mainstream emissions, secondhand emissions and IQOS waste were compared between data sources to highlight agreement or disagreement between PMI-sponsored and independent research.

Conclusions

Our analysis showed agreement between the data sources on nicotine yield from IQOS under the same puffing conditions. Also, both sources agreed that IQOS emits significantly reduced levels of some emissions compared with combustible cigarettes. However, independent studies and examination of PMI’s data showed significant increases in other emissions from and beyond the Food and Drug Administration’s harmful and potentially harmful constituents list.
Building trauma capability: using geospatial analysis to consider military treatment facilities for trauma center development
Authors: Lee Blair C , McEvoy Christian S , Ross-Li Dan , Norris Emily A , Tadlock Matthew D , Shackelford Stacy A , Jensen Shane D
Published: May 2022

Background

The Military Health System must develop and sustain experienced surgical trauma teams while facing decreased surgical volumes both during and between deployments. Military trauma resources may enhance local trauma systems by accepting civilian patients for care at military treatment facilities (MTFs). Some MTFs may be able to augment their regional trauma systems by developing trauma center (TC) capabilities. The aim of this study was to evaluate the geographical proximity of MTFs to the continental US (CONUS) population and relative to existing civilian adult TCs, and then to determine which MTFs might benefit most from TC development.

Methods

Publicly available data were used to develop a list of CONUS adult civilian level 1 and level 2 TCs and also to generate a list of CONUS MTFs. Census data were used to estimate adult population densities across zip codes. Distances were calculated between zip codes and civilian TCs and MTFs. The affected population sizes and reductions in distance were tabulated for every zip code that was found to be closer to an MTF than an existing TC.

Results

562 civilian adult level 1 and level 2 TCs and 33 military medical centers and hospitals were identified. Compared with their closest civilian TCs, MTFs showed mean reductions in distance ranging from 0 to 30 miles, affecting populations ranging from 12 000 to over 900 000 adults. Seven MTFs were identified that would offer clinically significant reductions in distance to relatively large population centers.

Discussion

Some MTFs may offer decreased transit times and improved care to large adult populations within their regional trauma systems by developing level 1 or level 2 TC capabilities. The results of this study provide recommendations to focus further study on seven MTFs to identify those that merit further development and integration with their local trauma systems.

Level of evidence

IV.
Interdependence of the new “MUON G-2” result and the W-boson mass
Authors: Bagnaschi Emanuele , Chakraborti Manimala , Heinemeyer Sven , Saha Ipsita , Weiglein Georg
Published: May 2022

The electroweak (EW) sector of the Minimal Supersymmetric extension of the Standard Model (MSSM), assuming the lightest neutralino as Dark Matter (DM) candidate, can account for a variety of experimental results. This includes the DM direct detection limits, the searches for EW superpartners at the LHC, and in particular the discrepancy between the experimental result for the anomalous magnetic moment of the muon, $$(g-2)_\mu $$

(
g
-
2
)

μ

, and its Standard Model (SM) prediction. The new “MUON G-2” result, combined with the older BNL result on $$(g-2)_\mu $$

(
g
-
2
)

μ

, yields a deviation from the SM prediction of $$\Delta a_\mu = ({25.1}\pm {5.9}) \times 10^{-10}$$

Δ

a
μ

=

(

25.1

±

5.9

)

×

10

-
10

, corresponding to $${4.2}\,\sigma $$

4.2

σ

. Using this updated bound, together with the other constraints, we calculate the MSSM prediction for the mass of the W boson, $$M_W$$

M
W

. We assume contributions only from the EW sector, i.e. the colored sector of the MSSM, in agreement with the search limits, is taken to be heavy. We investigate five scenarios, distinguished by the mechanisms which yield a relic DM density in agreement with the latest Planck bounds. We find that with the new $$(g-2)_\mu $$

(
g
-
2
)

μ

result taken into account and depending on the scenario, values up to "Equation missing" are reached. The largest values are obtained for wino DM and in the case of slepton co-annihilation, where points well within the $$1\,\sigma $$

1

σ

range of the experimental world average of $$M_W^{\mathrm {exp}}= 80.379 \pm 0.012 \,\, \mathrm {GeV}$$

M
W
exp

=
80.379
±
0.012

GeV

are reached, whereas the SM predicts a too small value of $$M_W^{\mathrm {SM}}= 80.353 \,\, \mathrm {GeV}$$

M
W
SM

=
80.353

GeV

. We analyze the dependence of $$M_W^{\mathrm {MSSM}}$$

M
W
MSSM

on the relevant masses of the EW superpartners and demonstrate that future $$M_W$$

M
W

measurements, e.g. at the ILC, could distinguish between various MSSM realizations. Sizable contributions to $$M_W^{\mathrm {MSSM}}$$

M
W
MSSM

are associated with a relatively light $$\tilde{\chi }_{1}^0$$

χ
~

1

0

, accompanied by either a light chargino or a light smuon, setting interesting targets for future collider searches.
Gravitational lensing by a black-bounce-Reissner–Nordström spacetime
Authors: Zhang Jing , Xie Yi
Published: May 2022

We investigate the weak and strong deflection gravitational lensing by a black-bounce-Reissner–Nordström spacetime and obtain their lensing observables. Assuming the supermassive black holes in the Galactic Center and at the center of M87, Sgr A* and M87* respectively, as the lenses, we evaluate these observables and assess their detectability. We also intensively compare these lensing signatures with those of various tidal or charged spacetimes. We find that it might be possible to distinguish these spacetimes by measuring the fluxes difference of the lensed images by Sgr A* in its quiet stage.
Dynamical complexity and the gravitational collapse of compact stellar objects
Authors: Bogadi Robert S. , Govender Megandhren
Published: May 2022

We investigate the dynamics of the gravitational collapse of a compact object via a complexity factor scalar which arises from the orthogonal splitting of the Riemann tensor. This scalar has the property of vanishing for systems which are isotropic in pressure and homogeneous in the energy density. In this way, the complexity factor can give further details of the progression of inhomogeneity as the collapse proceeds. Furthermore, we show that complexity may be used in comparing models and justifying their physical viability. Thus, it could become an integral part of the physical analysis of relativistic collapse in addition to energy conditions analysis, (in)stability, and recently investigated force dynamics.
Double Differential Blocks Based Frequency Compensation: A Four-Stage CMOS Amplifier
Authors: Sanaei Ali Mohammad , Biabanifard Ali , Khadem Mohammad Saeed , Aghaee Toktam
Published: May 2022

In this paper, an efficient frequency compensation method is investigated for a four-stage CMOS amplifier. The frequency compensation network includes two sets of capacitors at the differential block output. The proposed compensated amplifier is described symbolically to obtain the transfer function. Meanwhile, the proposed configuration is designed at the circuit level and is simulated via 0.18[Formula: see text][Formula: see text]m CMOS technology. Compared to the other existing methods, the proposed amplifier satisfies the figure of merits considerably. This stems from the fact that lower capacitor values are used to perform compensation, leading to lower die occupation, and reach boosted gain bandwidth products. Leveraging both the configuration and design procedure, a high-performance four-stage is presented in this paper.