bluuebunny/crossref_metadata_2025 huggingface dataset:
Blinded study: prospectively defined high-frequency oscillations predict seizure outcome in individual patients
Authors: Dimakopoulos Vasileios , Mégevand Pierre , Boran Ece , Momjian Shahan , Seeck Margitta , Vulliémoz Serge , Sarnthein Johannes
Published: September 2021

Interictal high-frequency oscillations are discussed as biomarkers for epileptogenic brain tissue that should be resected in epilepsy surgery to achieve seizure freedom. The prospective classification of tissue sampled by individual electrode contacts remains a challenge. We have developed an automated, prospective definition of clinically relevant high-frequency oscillations in intracranial EEG from Montreal and tested it in recordings from Zurich. We here validated the algorithm on intracranial EEG that was recorded in an independent epilepsy centre so that the analysis was blinded to seizure outcome. We selected consecutive patients who underwent resective epilepsy surgery in Geneva with post-surgical follow-up > 12 months. We analysed long-term recordings during sleep that we segmented into intervals of 5 min. High-frequency oscillations were defined in the ripple (80–250 Hz) and the fast ripple (250–500 Hz) frequency bands. Contacts with the highest rate of ripples co-occurring with fast ripples designated the relevant area. As a validity criterion, we calculated the test–retest reliability of the high-frequency oscillations area between the 5 min intervals (dwell time ≥50%). If the area was not fully resected and the patient suffered from recurrent seizures, this was classified as a true positive prediction. We included recordings from 16 patients (median age 32 years, range 18–53 years) with stereotactic depth electrodes and/or with subdural electrode grids (median follow-up 27 months, range 12–55 months). For each patient, we included several 5 min intervals (median 17 intervals). The relevant area had high test–retest reliability across intervals (median dwell time 95%). In two patients, the test–retest reliability was too low (dwell time < 50%) so that outcome prediction was not possible. The area was fully included in the resected volume in 2/4 patients who achieved post-operative seizure freedom (specificity 50%) and was not fully included in 9/10 patients with recurrent seizures (sensitivity 90%), leading to an accuracy of 79%. An additional exploratory analysis suggested that high-frequency oscillations were associated with interictal epileptic discharges only in channels within the relevant area and not associated in channels outside the area. We thereby validated the automated procedure to delineate the clinically relevant area in each individual patient of an independently recorded dataset and achieved the same good accuracy as in our previous studies. The reproducibility of our results across datasets is promising for a multicentre study to test the clinical application of high-frequency oscillations to guide epilepsy surgery.
Identification of sample mix-ups and mixtures in microbiome data in Diversity Outbred mice
Authors: Lobo Alexandra K , Traeger Lindsay L , Keller Mark P , Attie Alan D , Rey Federico E , Broman Karl W
Published: September 2021

In a Diversity Outbred mouse project with genotype data on 500 mice, including 297 with microbiome data, we identified three sets of sample mix-ups (two pairs and one trio) as well as at least 15 microbiome samples that appear to be mixtures of pairs of mice. The microbiome data consisted of shotgun sequencing reads from fecal DNA, used to characterize the gut microbial communities present in these mice. These sequence reads included sufficient reads derived from the host mouse to identify the individual. A number of microbiome samples appeared to contain a mixture of DNA from two mice. We describe a method for identifying sample mix-ups in such microbiome data, as well as a method for evaluating sample mixtures in this context.
Sex differences in deleterious mutational effects inDrosophila melanogaster: combining quantitative and population genetic insights
Authors: Ruzicka Filip , Connallon Tim , Reuter Max
Published: September 2021

Fitness effects of deleterious mutations can differ between females and males due to: (i) sex differences in the strength of purifying selection; and (ii) sex differences in ploidy. Although sex differences in fitness effects have important broader implications (e.g., for the evolution of sex and lifespan), few studies have quantified their scope. Those that have belong to one of two distinct empirical traditions: (i) quantitative genetics, which focusses on multi-locus genetic variances in each sex, but is largely agnostic about their genetic basis; and (ii) molecular population genetics, which focusses on comparing autosomal and X-linked polymorphism, but is poorly suited for inferring contemporary sex differences. Here, we combine both traditions to present a comprehensive analysis of female and male adult reproductive fitness among 202 outbred, laboratory-adapted, hemiclonal genomes of Drosophila melanogaster. While we find no clear evidence for sex differences in the strength of purifying selection, sex differences in ploidy generate multiple signals of enhanced purifying selection for X-linked loci. These signals are present in quantitative genetic metrics—i.e., a disproportionate contribution of the X to male (but not female) fitness variation—and population genetic metrics—i.e., steeper regressions of an allele’s average fitness effect on its frequency, and proportionally less nonsynonymous polymorphism on the X than autosomes. Fitting our data to models for both sets of metrics, we infer that deleterious alleles are partially recessive. Given the often-large gap between quantitative and population genetic estimates of evolutionary parameters, our study showcases the benefits of combining genomic and fitness data when estimating such parameters.
Family Matters: Cross-Cultural Differences in Familism and Caregiving Outcomes
Authors: Falzarano Francesca , Moxley Jerad , Pillemer Karl , Czaja Sara J
Published: September 2021

Objectives

The increasing number of minority older adults, and the subsequent increase in family members providing care to these individuals, highlights the need to understand how cultural values contribute to differential caregiving outcomes. Using the sociocultural stress and coping model as a guiding framework, the current study examined cross-cultural relationships among familism, social support, self-efficacy, and caregiving outcomes and examines how these relationships vary as a function of caregiver background characteristics.

Methods

Baseline data were collected from 243 participants in the Caring for the Caregiver Network randomized controlled intervention trial. Participants completed measures assessing familism, social support, self-efficacy, positive aspects of caregiving, depression, and burden.

Results

African American and Hispanic participants exhibited higher levels of familism compared to Whites. Compared to White participants, African Americans’ endorsement of familism predicted more positive caregiving appraisals. African Americans also reported greater levels of social support, which in turn predicted lower burden and depressive symptoms when compared with Whites. Exploratory analyses demonstrated significant associations between familism and self-efficacy. In the Hispanic subgroup, familism varied as a function of acculturation.

Discussion

Results indicate that greater levels of familism and social support may exert a protective influence against adverse psychosocial caregiving outcomes. These findings can be used to inform intervention efforts targeting culturally congruent, family-centered approaches.
Inclusiveness Plus Mixed Methods: An Innovative Research Design on Transnational Practices of Older Adults
Authors: Tomás Livia , Ravazzini Laura
Published: September 2021

This paper assesses the challenges and the benefits of 2 methodological approaches for improving the study of transnational mobilities of older adults: mixed methods and inclusiveness. The first approach refers to a mixed-methods research design based on surveys and qualitative interviews. We share our experience of conducting a “fully mixed-concurrent-equal-status-design” research project, for which we collected data through quantitative surveys on transnational practices of people aged 55+. Furthermore, we conducted semistructured interviews with adults aged 64+ living or who have lived in Switzerland and spend part of the year in Spain. The second approach relates to the use of an inclusive sample diversified in terms of nationality and migration backgrounds. The inclusive design affects the formulation of questions asked to all participants (and the response options provided in the survey), as well as decisions related to language choices and translations. These elements have to be considered to ensure that older adults from different backgrounds feel included. In a research project on transnational mobility of older adults, conducting an inclusive plus mixed-methods research project pushes researchers to find strategies to balance research objectives with available resources. Maximizing the research team’s methodological background appears to be a suitable approach to address different population groups while working within a budget.
Delayed Again? The Benelux Alternative to the UPC
Authors: Jaeger Thomas
Published: September 2021

What news have we heard from the Unified Patent Court (UPC) lately? None, other than there is yet another holdup from yet another constitutional complaint in Germany? Or, none, other than the Court of Justice of the European Union (CJEU) has by now repeatedly indicated that the model is incompatible with EU law? True: ten years into the UPC Agreement, all is still on hold and functional, and legal challenges are as unresolved as ever. But no news in this case is good news, it allows time to ponder alternatives. One alternative is actually quite obvious: the Benelux Court of Justice, which just gained significant new powers in mid-2018. This article looks at the lessons to be learned from the Benelux Court and outlines a Benelux-plus Patent Court as a legally safe alternative to the UPC.
Company Law
Authors: Hannigan Brenda
Published: September 2021

Company Law brings clarity and analysis to the ever-changing landscape of this field. The text aims to capture the dynamism of the subject, places the material in context, highlights its relevance and topicality, and guides readers through all the major issues. From incorporation through to liquidation and dissolution, the work explores the workings of the corporate entity. The book is divided into five distinct sections covering corporate structure (including legal personality and constitutional issues), corporate governance (including directors’ duties and liabilities), shareholders’ rights and remedies (including powers of decision-making and shareholder petitions), corporate finance (including share and loan capital), and corporate insolvency.
22. The doctrine of capital maintenance
Authors: Hannigan Brenda
Published: September 2021

This chapter discusses the doctrine of capital maintenance which precludes the return of capital, directly or indirectly, to the shareholders ahead of a winding up of the company. The discussion covers the purchase and redemption of a company’s own shares, reduction of capital, distributions to the members, and financial assistance by a company for the acquisition of its own shares. Purchase and redemption schemes (buy-backs) are common transactions and are discussed in detail as is the procedure for a reduction of capital. The key issue for creditors, however, is the risk posed by distributions to members and much of the chapter is devoted to discussing the distribution rules laid down in CA 2006, Part 23 and the common law. The chapter discusses the rules as to distributable profits and the liability of directors in the case of improper distributions and, in particular, their liability for dividends improperly declared.
24. Liquidation and dissolution—winding up the insolvent company
Authors: Hannigan Brenda
Published: September 2021

Winding up or liquidation is the process by which the assets of the company are collected in and realised. This chapter concentrates on the winding up of insolvent companies. The discussion covers: voluntary winding up; compulsory winding up; consequences of the winding-up order; the role and powers of a liquidator; the anti-deprivation rule, proof of debts, and set-off; the order of distribution; and dissolution of the company. The chapter considers the differing types of winding up and, in particular, the ability to have a company wound up where it is unable to pay its debts. It examines the role of the liquidation in realising assets and making distributions to creditors. It considers in detail the order of distribution and the priority accorded to creditors including HMRC (following the expansion of preferential debts), floating chargeholders and unsecured creditors.
STING-mediated Syk Signaling Attenuates Tumorigenesis of Colitis‑associated Colorectal Cancer Through Enhancing Intestinal Epithelium Pyroptosis
Authors: Gong Wenbin , Liu Peizhao , Zhao Fan , Liu Juanhan , Hong Zhiwu , Ren Huajian , Gu Guosheng , Wang Gefei , Wu Xiuwen , Zheng Tao , Zhao Yun , Ren Jianan
Published: September 2021

Background

Stimulator of interferon genes (STING) has essential functions in the immune responses and can induce cancer cell apoptosis. However, it is not completely clear how STING plays a role in colitis-associated colorectal cancer (CAC) and whether it can trigger pyroptosis during the tumorigenesis of CAC.

Methods

To investigate the role of STING-modulated pyroptosis in the development of CAC, STING knockout and Wild type mice were challenged with azoxymethane (AOM) and dextran sodium sulfate (DSS) to establish a murine CAC model. STING pharmacological agonist was used to further study the functions of STING signaling in the tumorigenesis. Moreover, STING endogenous ligand was employed to verify the effects of STING in human colon cancer cells.

Results

STING deficiency mice were more susceptible to CAC by reducing pyroptosis of tumor cells, whereas overactivation of STING with the agonist suppressed tumorigenesis of CAC. STING also managed CAC development by modulating tumor cells proliferation, adhesion, and invasion, as well as inflammatory response. The ex vivo studies indicated that STING could induce pyroptosis via spleen tyrosine kinase (Syk), and Syk knockdown weakened such pyroptotic tumor cells death. In addition, the visible physical interaction between STING and Syk was observed in colorectal tumor samples of CAC patients.

Conclusions

STING-mediated Syk signaling may regulate the tumorigenesis of CAC by modulating pyroptosis of tumor cells, and modulation of STING/Syk serves as a novel therapeutic strategy for CAC therapy.
Rescaling Biology: Increasing Integration Across Biological Scales and Subdisciplines to Enhance Understanding and Prediction
Authors: St. Mary Colette , Powell Thomas H Q , Kominoski John S , Weinert Emily
Published: September 2021

Synopsis

The organization of the living world covers a vast range of spatiotemporal scales, from molecules to the biosphere, seconds to centuries. Biologists working within specialized subdisciplines tend to focus on different ranges of scales. Therefore, developing frameworks that enable testing questions and predictions of scaling requires sufficient understanding of complex processes across biological subdisciplines and spatiotemporal scales. Frameworks that enable scaling across subdisciplines would ideally allow us to test hypotheses about the degree to which explicit integration across spatiotemporal scales is needed for predicting the outcome of biological processes. For instance, how does genomic variation within populations allow us to explain community structure? How do the dynamics of cellular metabolism translate to our understanding of whole-ecosystem metabolism? Do patterns and processes operate seamlessly across biological scales, or are there fundamental laws of biological scaling that limit our ability to make predictions from one scale to another? Similarly, can sub-organismal structures and processes be sufficiently understood in isolation of potential feedbacks from the population, community, or ecosystem levels? And can we infer the sub-organismal processes from data on the population, community, or ecosystem scale? Concerted efforts to develop more cross-disciplinary frameworks will open doors to a more fully integrated field of biology. In this paper, we discuss how we might integrate across scales, specifically by (1) identifying scales and boundaries, (2) determining analogous units and processes across scales, (3) developing frameworks to unite multiple scales, and (4) extending frameworks to new empirical systems.
7Demographics of postural orthostatic tachycardia syndrome in adult population
Authors: Abdeen Mostafa , Hasbay Eda , Hasbay Eliz , Peralta Cesar , Fatima Hafsa , Yang Lan , Shaheen Somia , Suleman Amer
Published: September 2021

Background

Postural Orthostatic Tachycardia Syndrome (POTS) is a dysautonomia of unclear etiology. POTS is defined as a form of orthostatic intolerance characterized by an increase in heart rate ≥ 30 bpm or to a heart rate ≥120 bpm upon standing. The clinical manifestations include dizziness, palpitations fatigue, anxiety, nausea and fainting. There is a paucity of data available on adult population.

This study aims to identify and evaluate demographic features of adult patients with POTS in a large tertiary specialty clinic.

Methods

447 patients diagnosed with POTS between 8/21/2018 and 8/20/2019 were randomly selected from our electronic records, and clinical data obtained during initial outpatient evaluation was reviewed retrospectively for race, gender and age.

Results

Out of 447 patients, 407 (91%) are female and 40 (9%) are male. Amongst them, 417 (93%) patients are White Caucasian of which 381 (91%) are female and 36 (9%) are male; 12 (3%) are Black/African-American of which 11 (92%) are female and 1 (8%) is male; 10 (2%) are Hispanic of which 100% are females; 4 (1%) are Asian of which 2 (50%) are females and 2 (50%) are males and 4 from other races of which 3 (75%) were female and 1 (25%) was male. Patients had a mean age of 32.9 with a standard deviation of 11.96.

Conclusions

POTS predominates in females, middle age population, and may be heavily prevalent in White Caucasians.

Key messages

Further clinical studies on more geographically spread populations are encouraged to support our findings on racial prevalen
1477The landscape of COVID-19 trials in Australia
Authors: Aberoumand Mason , Seidler Anna Lene , Williams Jonathan , Webster Angela , Tan Aidan
Published: September 2021

Background

The coronavirus disease 2019 (COVID-19) pandemic has seen a large number of clinical trials launched at unprecedented speed. We aimed to explore the landscape of COVID-19 trials in Australia, and to what extent Australian researchers have responded to global need for coordination and collaboration.

Methods

We systematically searched the Australian New Zealand Clinical Trials Registry (ANZCTR) and ClinicalTrials.gov from 1st January to 16th November 2020. We included all interventional studies addressing prevention, diagnosis or treatment of COVID-19, recruiting in Australia. We analysed the number and size of trials, additional recruitment countries, funding, trial purpose, study design, data sharing plans, and collection of COVID-19 core outcomes.

Results

We identified 56 COVID-19 trials, targeting 33,757 participants. They evaluated drugs (n = 34, 61%), vaccines (n = 10, 18%) or other interventions (n = 12, 21%), e.g. ventilators, digital health. Median target sample size was 150 (Q1-Q3=33-395). Only two trials utilised adaptive methods (Bayesian designs), and of the 34 COVID-19 treatment trials, only one included all core outcomes. Most (80%) indicated they were not planning to share data.

Conclusions

There has been impressive research scale-up and innovation in drug development and digital health, but fast-track procedures may have impacted scientific rigor and research prioritisation. Trials often lacked innovative study designs, were underpowered for clinical outcomes, collected limited core outcomes and did not intend to share data, precluding future evidence synthesis.

Key messages

The research response in Australia has been rapid, but better coordination is required. Infrastructure for innovation would support coordination of research efforts, and reduce research waste.
1461Neighbourhood disadvantage and early childhood mental health inequities across a population of children at school-entry
Authors: Alderton Amanda , O'Connor Meredith , Villanueva Karen , Gunn Lucy , Turrell Gavin , Boulange Claire , Badland Hannah
Published: September 2021

Background

Mental health inequities are shaped by the environments where children develop, including neighbourhoods. Children living in disadvantaged neighbourhoods tend to have poorer development outcomes, yet little evidence has examined positive mental health outcomes, like competence, in young children.

Methods

We examined associations between neighbourhood disadvantage and young children’s competence, as well as mental health difficulties (internalising and externalising), holding constant demographic characteristics and maternal education using multilevel logistic regression (Markov Chain Monte Carlo estimation). Data were from the 2018 Australian Early Development Census, including over 250,000 children entering their first year of school (age approximately 5 years).

Results

Children living in Australia’s most disadvantaged neighbourhoods had higher odds of externalising difficulties (AOR: 1.34; 95% credible interval 1.29 to 1.38), internalising difficulties (AOR: 1.29; 95% credible interval 1.24 to 1.33), and lower odds of competence (AOR: 0.72; 95% credible interval 0.69 to 0.74) than children in the least disadvantaged neighbourhoods.

Conclusions

Across both mental health difficulties and competence, neighbourhood-level inequities were evident. Future research should identify specific neighbourhood features that could address these inequities. Availability of population linked geospatial and child development data in Australia offers opportunities to address these gaps and is prioritised as the next step in this research program.

Key messages

Children in disadvantaged neighbourhoods face lower likelihood of positive mental health (competence) and higher likelihood of mental health difficulties. Identifying specific neighbourhood features that could address these inequities is a priority.
1513Foodborne Outbreak in the Central Prison, Amanat Al-Asimah, Yemen-October, 2020
Authors: Al-eryani Salwa , qeran Mohammed , Saeed labibah , Ghaleb Yasser
Published: September 2021

Background

Foodborne diseases continuous to be one of important health problem in Yemen. On October 9, 2020, the surveillance officer in Amanat Al-Asimah reported increased number of diarrhea cases in the prison. On October 10, 2020, team from Y-FETP was sent to determine the magnitude of the outbreak, identify risk factors and recommend control measures.

Methods

Descriptive and case control study with a ratio of (1: 1) was conducted. Case defined as any person in prison developed of diarrhea or vomiting/nausea or abdominal cramps from 1st-15th October. Control defined as: any person in prison not developed of diarrhea or vomiting or any symptoms. Data was collected by using prepared line list and multivariable logistic analysis used for identifying risk factors.

Results

A total of fifty-one cases met the case definition. All cases were males with the mean of age (31.3±3.06). Al-Qala’ah ward was the most affected area (AR 5.7/100) and none of the cases died. The implicated food items were: tomato sauce (OR 4.92: CI 2.11-11.49) and potato sauce (OR 5.68: CI 2.29-14.07). Tanks were open and in bad condition and handling of food were poor. Laboratory results of examined food and water samples revealed Shigella flxneri sero type II and coliform growth and Staph. aurous were isolated from nasal of 3 cookers.

Conclusions

The foodborne outbreak in prison was associated with eating contaminated food in main restaurants. Monitoring of food consumed, rigorous implementation of food handling instructions and health education of handlers, and periodic inspection of water tanks in prisons are recommended.

Key messages

Highlight the importance of foodborne illness which leads to a negative impact on affected people loss of work, medical costs, long-term disability, and even death.in addition to bad impact on the economy especially in a poor country such as Yemen which has lacked awareness of the foodborne illness and doesn't have any surveillance system and regulation
1497Implementing the TRAPD model for the Saudi adaptation of the Composite International Diagnostic Interview 3.0
Authors: Altwaijri Yasmin
Published: September 2021

Background

The World Mental Health-Composite International Diagnostic Interview (CIDI) 3.0, originally in English, is a fully-structured interview designed for the assessment of mental disorders. Although Arabic translations of CIDI from countries like Lebanon and Iraq exist, a Modern Standard Arabic translation was developed to suit the Saudi population. While the translation model used in the present paper has been used to translate instruments in Asian and European languages, there is no study to the best of our knowledge which has used this specific model to translate a validated instrument from English to Arabic.

Case presentation

This paper describes the Saudi adaptation of CIDI 3.0. The TRAPD team translation model—comprising of translation, review, adjudication, pretesting and documentation—was implemented to carry out the Saudi adaptation of CIDI 3.0. Pretests involving cognitive interviewing and pilot study led to translation revisions which consequently confirmed that Saudi respondents had a good understanding of various items of the instrument. The adaptation procedures for the Saudi CIDI 3.0 were well documented and the instrument was linguistically validated with the Saudi population.

Conclusions

The TRAPD model was successfully implemented to adapt the CIDI 3.0 to be used as the main survey instrument for the Saudi National Mental Health Survey, findings of which will provide health policy makers mental health indicators for health decision making and planning.

Key messages

The CIDI 3.0 is a resourceful tool for examining mental health issues in the GCC.
591The “Big 6”: A purpose-based framework for motivating and teaching epidemiologic methods
Authors: Avelino-silva Vivian , Zablotska Lydia , Martin Jeffrey
Published: September 2021

Focus of Presentation

Many beginning students in health-related fields do not understand the types of questions that epidemiology can address. This results in underappreciation of the relevance of epidemiology. Even students dedicated to learning epidemiology and/or medicine have difficulty identifying the common features of disparate research questions and hence are limited in their ability to critique research. The reasons for these limitations are multifold, but we believe that traditional approaches of teaching epidemiology □ by study design □ is a substantial contributor. To better promote and deepen understanding of epidemiology, we have developed a purpose-based teaching approach called the “Big 6”.

Findings

In courses aimed towards graduate students in epidemiology and medical students, we now introduce what epidemiologic research can do and how to perform it according to the general purpose/goal/objective of research. We focus on six of the most common purposes/goals/objectives - the “Big 6”.

Conclusions

Introducing epidemiology according to general purposes of research (the “Big 6”) gives students a framework to understand the relevance of epidemiology and rapidly critique the validity of epidemiologic research.

Key messages

A purpose-based approach to teaching epidemiology may be more engaging and promote better understanding and application of epidemiologic methods.
403Mental Health Needs in International Students of African Descent: Findings from the Healthy Minds Network
Authors: Baba Zeinab , Edelblute Heather
Published: September 2021

Background

Mental health issues are becoming of increasing concern for college students while universities are also becoming more internationalized with students from diverse countries. Students of sub-Sahara African (SSA) descent represent a group understudied in the mental health literature who may have unique mental health needs.

Methods

Data on students of SSA descent (n = 916) was obtained for academic years 2016-2019 of the Healthy Minds Network (HMN), a yearly web-based survey conducted on US university campuses. Logistic regression analysis was conducted to identify factors associated with ever receiving counseling or therapy for mental health concerns.

Results

Over half (57%) were female with a mean age of 25.7. On the Patient Health Questionnaire (PHQ-9), 23% scored in the moderate, moderately severe, or severe depression range. Two-thirds expressed not receiving counseling or therapy for mental health concerns. In multivariate models, males (OR 0.5 (0.3-0.8), p = 0.01)) were less likely to receive counseling or therapy compared to females; students with more days of emotional or mental difficulties were increasingly more likely to ever receive counseling or therapy compared to students with no days of emotional or mental difficulties. Ever receiving counseling or therapy was associated with a rarely stressful financial situation (OR 2.6 (1.2-5.9), p = 0.02)).

Conclusions

Males may require incentives to get assistance with mental health issues. Making counseling more affordable could improve usage rates by students with more stressful financial situations.

Key messages

University administrators should consider options to address mental health concerns of this student group..
232The Impact of Australasian Voluntary Front of Pack Nutrition Labelling on Packaged Food Reformulation
Authors: Bablani Laxman , Mhurchu Cliona Ni , Neal Bruce , Skeels Christopher , Staub Kevin , Blakely Tony
Published: September 2021

Background

Front-of-pack nutrition labelling (FoPL) of packaged foods can promote healthier diets. Australia & New Zealand (NZ) adopted the voluntary Health Star Rating (HSR) scheme in 2014. We studied the impact of voluntary adoption of HSR on food reformulation overall, and for more- versus less-healthy foods.

Methods

Annual nutrition information panel data was collected for non-seasonal packaged foods sold in major supermarkets in Auckland from 2013-19, and Sydney from 2014-18. We used difference-in-differences to estimate reformulation associated with HSR adoption.

Results

Healthier products adopted HSR more than unhealthy products: 35% of products that achieved four or more stars displayed the label compared to 15% of products that achieved two stars or less. Products that adopted HSR were 6.5% & 10.7% more likely to increase their rating by ≥ 0.5 stars in Australia and NZ, respectively. Labelled products showed a -4.2% [95% CI -6.5% to -1.9%] relative decline in sodium content in NZ, but there was no sodium change in Australia. There was a -2.3% [-3.7% to -1.0 %] change in sugar content in NZ and a -1.1% [-2.2% to 0.0%] difference in Australia. Initially unhealthy products showed larger reformulation when adopting HSR than healthier products.

Conclusions

Overall, introduction of HSR had a small effect on product reformulation. The voluntary nature of the HSR program lowers effectiveness because labels were mostly placed on already healthy products. These already healthy products had limited scope for reformulation.

Key messages

HSR adoption by unhealthy products should be incentivized, or mandated, by governments to maximise reformulation
437Comparison of stillbirth trends in Wales and Western Australia using pooled routinely collected health data
Authors: Bailey Helen , Kotecha Sarah J , Watkins William J , Adane Akilew , Shepherd Carrington CJ , Kotecha Sailesh
Published: September 2021

Background

As there are variations in stillbirth rates and trends, even among high income countries, international comparisons can provide insights into how reductions in stillbirths can be achieved. We compared stillbirth rates and trends over time in Wales and Western Australia (WA).

Methods

We pooled population-based data of all births of at least 24 weeks’ gestation occurring between 1993-2015 in Wales and WA, divided into 6 time-periods. The stillbirth rate per 1,000 births was estimated for each cohort in each time-period. Multivariable Poisson regression analyses, were performed to evaluate the interaction between cohort and time-period. relative risk (RRs) and 95% Confidence Intervals (CIs) for each time-period and cohort were calculated.

Results

The overall stillbirth rate declined by 15.9% in Wales and 40.4% in WA. Using WA and 1993-1996 as the reference group, the adjusted RRs for stillbirths at 39-41 weeks’ gestation in the most recent study period (2013-15) were 0.85 (95% CI 0.64 to 1.13) in Wales and 0.51 (95% CI 0.36 to 0.73) in WA.

Conclusions

The stillbirth rate disparities between Wales and WA have widened in the last two decades (especially among term births). Some of these differences may be partially explained by maternal lifestyle behaviours such as smoking, but we had insufficient population-level data to investigate their contribution.

Key messages

The stillbirth rate was persistently higher in Wales than WA from 1993 to 2015, with widening disparities after adjustment for important risk factors.
637Validation of anaemia, haemorrhage and blood disorder reporting in routinely collected hospital data
Authors: Baldwin Heather , Torvaldsen Siranda , Rickard Kristen , Nippita Tanya , Patterson Jillian
Published: September 2021

Background

Blood and bleeding related conditions are reported in hospital administrative data, however the reliability of these data is unknown. Here we examine the reliability of reporting of conditions including anaemia, obstetric haemorrhage and blood disorders, and procedures, such as transfusion and hysterectomy, in hospital records compared with obstetric databases.

Methods

Women giving birth to singleton infants in two tertiary hospitals in New South Wales, Australia, between 2011 and 2015 were included. Reporting in the hospital data, drawn from the Electronic Medical Records, was compared to that in linked obstetric data, obtained from the ObstetriX system, using obstetric data as the gold standard.

Results

36,051 births were included. Sensitivity for anaemia and blood disorders was low (2.5–24.8%, positive predictive value (PPV) 12.0–82.6%), high for postpartum haemorrhage, transfusion and hysterectomy (82.8–96.0%, PPV 78.0–89.6%), and moderate for other obstetric haemorrhage (sensitivity: 41.9–65.1%, PPV: 50.0–56.8%) and placental complications (sensitivity 68.2–81.3%, PPV: 20.3–72.3%). Specificity and negative predictive values were high.

Conclusions

Anaemia and blood disorders are poorly reported in hospital data. Postpartum haemorrhage, transfusion and hysterectomy are well reported, while other obstetric haemorrhage and placental complications are moderately well reported.

Key messages

Hospital data may be a reliable source of information on postpartum haemorrhage, blood transfusion and hysterectomy. Caution is advised in the use of hospital data for studies of anaemia and blood disorders, and other sources should be sought where possible.
492Determinants of mother to child transmission of HIV in West Shewa, Oromiya: Mixed-method study
Authors: Banja Fufa
Published: September 2021

Background

Without intervention, transmission rate of HIV from mother to child ranges from 15% to 45%, that can be reduced to below 5% with effective intervention. In West Shewa zone transmission rate is 10% currently. Aim of the study is to identify determinants of transmission of HIV from mother to child in West Shewa Zone which has 2.1 million populations.

Methods

Mixed methods: unmatched case-control study, N = 96(24 cases, 72 controls) and one-on-one questioner was conducted. Variables of interest were collected using structured and semi-structured questioner and data abstraction forms from mothers of exposed infants, medical records of mothers and children.

Result

Majority among cases(70.8%) were not included in to option B+ program. Home delivery increases 6 times chance of HIV, AOR=6.047, CI(1.549–29.230), none inclusion in to option B+ increase 18 chance of HIV transmission, AOR=18.0;CI(5.0–68.1). Partner noninvolvement to HIV care increases chance of transmission by 7.3 times, AOR=7.3;CI(1.14–37.459). Mother- mother support program decrease chance of transmission by 86.5% with AOR=0.135CI (0.11–0.396). Poor ANC practices among rural residents contributed to unaware MTCT of HIV.

Conclusion

Mother-to-mother support program has protective effect, while None inclusion to option B+, partner noninvolvement to HIV care, Home delivery and poor ANC practice were determinant factors of HIV transmission from mother to child.

Key messages

Health education and awareness creation should be implemented by HEW to improve ANC practice, and increase VCT among rural residents.
923Quantifying multiple causes of death: Observed patterns in Australia, 2006–2017
Authors: Bishop Karen , Balogun Saliu , Eynston-Hinkins James , Moran Lauren , Moreno-Betancur Margarita , Korda Rosemary , Rao Chalapati , Banks Emily , Joshy Grace
Published: September 2021

Background

Four fifths of deaths in Australia involve multiple causes, but statistics typically use a single underlying cause of death (UC). The UC approach alone is insufficient for understanding the impact of non-underlying causes and identifying comorbid disease associations at death. Analysis of multiple causes of death (MC) is needed to measure the impact of all causes. We described MC patterns, considering cause-of-death coding and certification practices in Australia.

Methods

Using deaths registered in Australia from 2006 to 2017 (n = 1773525) coded to the International Classification of Diseases (ICD) and an extended classification (n = 136 causes) based on a World Health Organization short list, we described MCoD data by cause. Age-standardised rates based on UC and MC were compared using the standardised ratio of multiple to underlying causes (SRMU) to estimate the contribution of the cause to mortality compared to using the UC approach. Comorbidity was explored using the cause of death association indicator (CDAI) to compare the observed joint frequency of a contributory-underlying cause combined with expected frequency of the contributory cause (with any UC).

Results

On average 3.4 conditions caused each death and 24.4% of deaths had 5 plus causes. Largest SRMUs were for genitourinary diseases (8.0), blood diseases (7.8) and musculoskeletal conditions (6.7). CDAIs showed high associations between, for example, accidental alcohol and opioid poisoning, septicaemia and skin infections, and traumatic brain injury and falls.

Conclusions

MC indicators enhance measures of mortality and reassess the role of causes of death for descriptive and analytical epidemiology.

Key messages

This research demonstrates the value of MC analysis for Australian mortality data.
856A gestational age specific prognostic model for adverse perinatal events in obese women
Authors: Bone Jeffrey , Lisonkova Sarka
Published: September 2021

Background

Obesity is one of the most preventable pre-pregnancy risk factors for adverse perinatal events. Despite this, there are few body-mass-index (BMI) specific prognostic models for timing of delivery associated with the lowest number of adverse perinatal events. Our aim was to build a predictive model to quantify gestational age-specific rates of adverse birth outcomes in obese women with and without additional risk factors.

Methods

All singleton births at ≥ 34 weeks’ gestation in British Columbia, Canada, 2008-2017 (n = 283,697) were included and data were obtained from the British Columbia Perinatal Database Registry. A multivariable Cox proportional hazards model including demographic and obstetric risk factors was used to estimate gestational age specific risk of composite perinatal mortality and severe morbidity.

Results

Among all women, 13.1% were obese (pre-pregnancy BMI ≥30m/kg2), 60.1% had normal BMI (18.5-24.9 m/kg2). In high-risk obese women (nulliparous with chronic hypertension, and diabetes), adjusted outcome rates (per 1000 ongoing pregnancies) were 7.5 at 34-36 weeks, 20.4 at 37-39 weeks, and 83.5 at ≥ 40 weeks’ gestation. In all obese women, the rates were 1.93, 6.27, and 18.5 per 1000 ongoing pregnancies, respectively. In contrast, on average these rates were 1.14, 4.03 and 11.6 per 1000 ongoing pregnancies, respectively, among women with normal BMI.

Conclusions

Obese women are at increased risk of poor perinatal outcomes at all gestational ages. These risks are compounded by other conditions known to effect perinatal outcomes.

Key messages

Obese women require specific guidelines for timing of optimal delivery.
205Zoonotic disease transmission risk in displaced populations
Authors: Braam Gates Scholar Dorien , Jephcott Freya , Wood James
Published: September 2021

Background

Repeated spillover events of zoonotic diseases from animals to humans, in combination with unprecedented levels of forced migration, present a major challenge to the global health security agenda. Infectious disease risk is affected by a range of ecological, political and socio-economic drivers.

Methods

This study uses a qualitative case study methodology to determine how displacement affects the risks of zoonotic disease transmission. Based on key informant interviews and observational studies in Jordan and Pakistan, the study analyses social-structural factors impacting zoonotic disease transmission.

Results

The study shows that displacement may influence zoonotic disease transmission through its impact on environmental, socio-economic and behavioural factors, influenced by historical, political and socio-economic processes. Sporadic outbreaks of zoonoses including cutaneous leishmaniasis, rabies and Tuberculosis are reported among displaced populations. Risk factors include a decline in health services, increased population density, changes in environment, and reduced quality and availability of shelter, water and nutrition, in turn determining vulnerability to vectors and pathogens.

Conclusions

Risk factors affecting zoonoses in displacement are complex and interlinked. While the presence of animals may increase the risk in densely populated areas lacking hygiene, livestock may be beneficial to the health status of displaced by improving nutrition. Responses need to be interdisciplinary, multilevel and contextualized.

Key messages

To mitigate the risk of zoonotic disease transmission during displacement, responses need to include pathogen and vector control, as well as reducing vulnerability to disease, including through access to health and veterinary services and humanitarian assistance.
1322A pilot study of faecal sample collection from prospective cohort study participants
Authors: Bruinsma Fiona , Giles Graham , Lynch Brigid , Whalen Theresa , Tsimiklis Helen , Southey Melissa , Milne Roger
Published: September 2021

Background

Faecal specimens offer a relatively accessible means of assessing the gut microbial community. We conducted a pilot study to compare the feasibility of different protocols for self-collection of faecal specimens from Australian Breakthrough Cancer (ABC) Study participants.

Methods

Pilot study participants were randomly selected from ABC Study participants who had not yet been invited to participate in follow-up. All pilot study participants were asked to provide a faecal sample using FOBT cards and complete a ‘day of sample’ questionnaire. Participants were randomised to 1 of 4 groups defined by combination of (i) a request (or not) to also provide a faecal sample using a tube containing 2.5ml of 95% ethanol and (ii) a request (or not) to complete a food frequency questionnaire.

Results

1,136 ABC Study participants were invited to participate in the pilot study. Of the 56% that opted in, 88% returned the requested sample. Very few participants (5%) actively opted out. Overall, 49% of invited participants returned a sample. There was no statistically significant difference between the groups in the percentage of participants who completed the pilot study.

Conclusions

The pilot study demonstrated the feasibility of self-collection of faecal samples. Increasing the time commitment and complexity (through provision of an additional sample suspended in ethanol and a FFQ) did not reduce the likelihood of successful completion.

Key messages

The findings demonstrate the feasibility of collecting faecal samples both on an FOBT card and in a tube containing ethanol, and a lengthy FFQ, within a prospective cohort study.
206Clinical Epidemiology Knowledge Retention in Accelerated Teaching and Learning
Authors: Carfagnini Quinten , Law Madelyn , Zahradnik Michelle
Published: September 2021

Background

Accelerated courses continue to be part of the changing landscape in medical education despite limited evidence to support their efficacy in relation to knowledge retention. The purpose of this study was to determine if a difference in knowledge retention exists over time between students enrolled in a traditional versus an accelerated clinical epidemiology course.

Methods

The current study incorporated an epidemiologic prospective cohort design. The course in clinical epidemiology focused on evidence-based decision making for diagnostic and therapeutic research methods and problem-based learning. Knowledge retention was assessed at four-times points (baseline, three, six and 12 months) for students enrolled in either traditional (13 weeks) or accelerated (1 week) courses. Linear mixed-effect regression modeling was incorporated to examine the change in trajectory of knowledge retention over four points in time between students enrolled in traditional and accelerated teaching formats.

Results

A significant main effect of traditional versus accelerated course format on retention of knowledge over time was not found (β=-0.341, p = 0.410), suggesting that knowledge retention is not compromised regardless of teaching format. Furthermore, the greatest diminished knowledge retention was observed between baseline and 12 months (β = 10.595, p < 0.0001), followed by three months (β = 3.864, p < 0.0001) and six months (β = 1.180, p < 0.0001).

Conclusion

This study determined that accelerated course format does not compromise short- and long-term clinical epidemiology knowledge retention in students.

Key message

University administrators and faculty should not be suspicious of knowledge retention issues in accelerated courses and should endorse accelerated learning opportunities.