bluuebunny/crossref_metadata_2025 huggingface dataset:
Morphological variants of meibomian glands: correlation of meibography features with histopathology findings
Authors: Singh Swati , Naidu Gorrepati C , Vemuganti Geeta , Basu Sayan
Published: August 2021

Purpose

This study describes the histopathological features of different morphological variants of human meibomian glands (MGs) seen on infrared imaging.

Methods

Tarsal plates dissected from seven cadaveric upper eyelids were imaged using infrared meibography, and then studied histopathologically using H&E, peroxisome proliferator-activated receptor gamma (PPARγ, meibocyte differentiation marker) and Ki-67 (cellular proliferation marker) antibody staining. The different morphological characteristics (varying size and shape) of MGs on meibography were correlated with histopathology findings using image analysis software.

Results

Of the total 127 glands, the morphological variants observed on meibography based on size were: normal (n=62), short (n=18), severely short (n=6) and dropout (n=12) glands, and on shape were: hooked (n=2), tortuous (n=5), overlapping (n=1), thick (n=15) and fluffy (n=6) glands. Short, hooked, tortuous and overlapping glands had similar acinar and ductal histology as seen in normal glands whereas thick, and fluffy glands had increased acinar diameter. All glands except the severely short type demonstrated normal signs of holocrine secretory activity and normal nuclear and cytoplasmic PPARγ expression. Severely short glands had nil while short glands had reduced Ki-67 proliferation index (3%±1%) as compared with normal and other variants (8%±5.2%). Gland dropout areas showed no evidence of any glandular tissue on histology.

Conclusion

Hooked, tortuous and overlapping glands had completely normal glandular histology, whereas severely short glands showed atrophic changes with loss of meibocyte differentiation and cellular proliferation. Dropout areas showed total loss of glandular elements. Further studies are needed to validate and to explore the clinical implications of these findings.
Changing trends in ocular trauma during the COVID-19 pandemic in the USA
Authors: Halawa Omar A , Friedman David S , Roldan Ana M , Zebardast Nazlee
Published: August 2021

Background/aims

The COVID-19 pandemic has been associated with a decline in emergency department (ED) presentations for trauma. The purpose of this study is to compare the estimated number and characteristics of eye injuries in 2020, the year of the COVID-19 pandemic, to those in 2011–2019.

Methods

A stratified probability sample of US ED-treated eye injuries was used to calculate the estimated annual number and incidence of these injuries in 2020, the year of the pandemic, and 2011–2019 (prepandemic years). Two-sample t-tests and Pearson χ2were used to assess differences in demographics and injury characteristics. For multiple comparisons, Bonferroni correction was applied.

Results

The estimated number of ED-treated eye injuries per year was 152 957 (95% CI 132 637 to 176 153) in 2020 and 194 142 (95% CI 191 566 to 196 401) in 2011–2019. The annual incidence of ED-treated eye injuries was lower in 2020, at 46 per 100 000 population than in 2011–2019, at 62 per 100 000 per year (p<0.001). In 2020 vs 2011–2019, there was a higher incidence of ruptured globes (0.5 per 100 000 vs 0.3 per 100 000 per year, p<0.001), hyphemas (0.6 per 100 000 vs 0.4 per 100 000 per year, p<0.001), lacerations (1.0 per 100 000 in 2020 vs 0.8 per 100 000 per year, p<0.001) and orbital fractures (0.3 per 100 000 vs 0.03).

Conclusion

The estimated incidence of eye injuries presenting to the ED was significantly lower in 2020 than in 2011–2019, but there was a higher estimated incidence of severe eye injuries. Changes in living and work environments due to the COVID-19 pandemic were likely associated with the differences in ocular trauma presentations observed in this study.
Effectiveness of the CoronaVac vaccine in older adults during a gamma variant associated epidemic of covid-19 in Brazil: test negative case-control study
Authors: Ranzani Otavio T , Hitchings Matt D T , Dorion Murilo , D’Agostini Tatiana Lang , de Paula Regiane Cardoso , de Paula Olivia Ferreira Pereira , Villela Edlaine Faria de Moura , Torres Mario Sergio Scaramuzzini , de Oliveira Silvano Barbosa , Schulz Wade , Almiron Maria , Said Rodrigo , de Oliveira Roberto Dias , Vieira da Silva Patricia , de Araújo Wildo Navegantes , Gorinchteyn Jean Carlo , Andrews Jason R , Cummings Derek A T , Ko Albert I , Croda Julio
Published: August 2021

Objective

To estimate the effectiveness of the inactivated whole virus vaccine, CoronaVac (Sinovac Biotech), against symptomatic covid-19 in the elderly population of São Paulo state, Brazil during widespread circulation of the gamma variant.

Design

Test negative case-control study.

Setting

Community testing for covid-19 in São Paulo state, Brazil.

Participants

43 774 adults aged ≥70 years who were residents of São Paulo state and underwent reverse transcription polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 from 17 January to 29 April 2021. 26 433 cases with symptomatic covid-19 and 17 622 test negative controls with covid-19 symptoms were formed into 13 283 matched sets, one case with to up to five controls, according to age, sex, self-reported race, municipality of residence, previous covid-19 status, and date of RT-PCR test (±3 days).

Intervention

Vaccination with a two dose regimen of CoronaVac.

Main outcome measures

RT-PCR confirmed symptomatic covid-19 and associated hospital admissions and deaths.

Results

Adjusted vaccine effectiveness against symptomatic covid-19 was 24.7% (95% confidence interval 14.7% to 33.4%) at 0-13 days and 46.8% (38.7% to 53.8%) at ≥14 days after the second dose. Adjusted vaccine effectiveness against hospital admissions was 55.5% (46.5% to 62.9%) and against deaths was 61.2% (48.9% to 70.5%) at ≥14 days after the second dose. Vaccine effectiveness ≥14 days after the second dose was highest for the youngest age group (70-74 years)—59.0% (43.7% to 70.2%) against symptomatic disease, 77.6% (62.5% to 86.7%) against hospital admissions, and 83.9% (59.2% to 93.7%) against deaths—and declined with increasing age.

Conclusions

Vaccination with CoronaVac was associated with a reduction in symptomatic covid-19, hospital admissions, and deaths in adults aged ≥70 years in a setting with extensive transmission of the gamma variant. Vaccine protection was, however, low until completion of the two dose regimen, and vaccine effectiveness was observe to decline with increasing age among this elderly population.
Effectiveness of intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) in Ghana
Authors: Dosoo David Kwame , Malm Kezia , Oppong Felix Boakye , Gyasi Richard , Oduro Abraham , Williams John , Atibilla Dorcas , Peprah Nana Yaw , Twumasi Mieks , Owusu-Agyei Seth , Greenwood Brian , Chandramohan Daniel , Asante Kwaku Poku
Published: August 2021

Introduction

Ghana adopted the revised WHO recommendation on intermittent preventive treatment in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) in 2012. This study has assessed the effectiveness and safety of this policy in Ghana.

Methods

A total of 1926 pregnant women enrolled at antenatal care (ANC) clinics were assessed for birth outcomes at delivery, and placental histology results for malaria infection were obtained from 1642 participants. Association of reduced placental or peripheral malaria, anaemia and low birth weight (LBW) in women who received ≥4 IPTp-SP doses compared with 3 or ≤2 doses was determined by logistic regression analysis.

Results

Among the 1926 participants, 5.3% (103), 19.2% (369), 33.2% (640) and 42.3% (817) of women had received ≤1, 2, 3 or ≥4 doses, respectively. There was no difference in risk of active placental malaria (PM) infection in women who received 3 doses compared with ≥4 doses (adjusted OR (aOR) 1.00, 95% CI 0.47 to 2.14). The risk of overall PM infection was 1.63 (95% CI 1.07 to 2.48) in 2 dose group and 1.06 (95% CI 0.72 to 1.57) in 3 dose group compared with ≥4 dose group. The risk of LBW was 1.55 (95% CI 0.97 to 2.47) and 1.06 (95% CI 0.68 to 1.65) for 2 and 3 dose groups, respectively, compared with the ≥4 dose group. Jaundice in babies was present in 0.16%, and 0% for women who received ≥4 doses of SP.

Conclusion

There was no difference in the risk of PM, LBW or maternal anaemia among women receiving 3 doses compared with ≥4 doses. Receiving ≥3 IPTp-SP doses during pregnancy was associated with a lower risk of overall PM infection compared with 2 doses. As there are no safety concerns, monthly administration of IPTp-SP offers a more practical opportunity for pregnant women to receive ≥3 doses during pregnancy.
Sexual harassment at work within Belgian Defence: a prevalence study
Authors: Buyse Kaatje , Goorts K , Peeters D , Dhondt E , Portzky G
Published: August 2021

Introduction

Sexual harassment (SH) at work can have an impact on the general health and well-being and on the productivity of the employee. To date, the Belgian Armed Forces do not have any accurate data about SH. Therefore, this study assessed the prevalence of SH within Belgian Defence.

Methods

The prevalence of SH and staff mental well-being was investigated in a sample of 399 female soldiers. Using quantitative analysis, we measured the impact on mental well-being and the relation to demographic characteristics. Using a qualitative analysis in a subsample of eight female soldiers, we investigated barriers to reporting SH and the impact on professional performance and psychosocial well-being.

Results

The prevalence of non-physical SH is 36.1% over the last 12 months and 64.4% over the course of a career. Physical SH has a prevalence of 16.1% and 43.4%, respectively. Rape prevalence was reported to be 1.4% over the past 12 months, 9% over the course of their career.

One in three female soldiers suffer from reduced mental well-being, which was significantly associated with SH. In the interviews, female employees report an impact of SH on professional and personal performance. The willingness to report is low due to misunderstanding, disinformation and psychosocial insecurity.

Conclusion

High prevalence numbers were found suggesting an important impact on the professional performance and mental well-being of female military personnel. Organisational changes may create more willingness among victims to report incidents to the designated services.
Use of an isometric mid-thigh pull test during musculoskeletal rehabilitation: can the criterion values from the updated British Army physical employment standards be used to inform UK Defence Rehabilitation practice?
Authors: Walters Vanessa , Coppack RJ , Cassidy RP , Suffield C , Papadopoulou T , Bilzon J , Ladlow P
Published: August 2021

Introduction

Objective outcome measures that can quantify the force generating capacity of the lower limb are required to allow clinicians to accurately measure functional status and treatment adaptations over time. The aim of this prospective observational cohort study is to: (1) evaluate the acceptability of the isometric mid-thigh pull (IMTP) test as a measure of functional strength with military personnel undergoing residential hip pain rehabilitation; (2) compare the peak force values recorded against the updated Army physical employment standards (PES) assessment criteria and (3) assess if the minimum PES required of military personnel has the potential to inform clinical decision making and return to duty criteria within UK Defence Rehabilitation.

Methods

Acceptability was assessed against patient’s adherence to the testing procedures and test burden. Clinician acceptability was assessed against ease of administration and safety of test procedure. Hip pain was recorded before, immediately following and 1 hour after testing. Net peak force was recorded using portable force plates.

Results

Full patient and clinician acceptability to IMTP testing procedures were demonstrated. Minimal changes in visual analogue scale (VAS) pain scores were demonstrated between baseline values at rest and follow-up. Despite being medically downgraded and functionally compromised due to chronic hip pain, 100% of patients met the PES expected on entry to the British Army and 79% met the PES expected at the end of basic training.

Conclusion

The IMTP provides rehabilitation clinicians with an objective quantifiable measure of maximum muscle strength that can be used early in the rehabilitation care pathway. Based on our finding, it is unclear if the current British Army PES can be used as a criterion standard in Defence Rehabilitation. Therefore, further research focused on generating clinically relevant patient-specific IMTP score criteria, with a larger sample of diverse diagnostic sub-groups is required.
‘‘Those who do not vaccinate don’t love themselves, or anyone else’’: a qualitative study of views and attitudes of urban pregnant women towards maternal immunisation in Panama
Authors: Simas Clarissa , Larson Heidi J , Paterson Pauline
Published: August 2021

Objectives

To identify pregnant women’s views and attitudes towards maternal immunisation in Panama based on in-depth interviews and focus groups.

Setting

Two main urban centres in Panama (San Miguelito and Panama City).

Participants

Fifty-six pregnant women from Panama City (n=29) and San Miguelito (n=27).

Methods

In-depth interviews and focus groups were conducted, audio-recorded, transcribed verbatim and analysed using a deductive-inductive approach.

Results

Our findings suggest that this population perceives vaccination as a key component of maternal healthcare, not an elective part of it. The pregnant women interviewed disclosed a heightened perception of vulnerability to infectious diseases. For this reason, safety and effectiveness of maternal vaccines were closely associated for many participants (a vaccine was perceived as safe if it was effective against disease). Refusal of maternal vaccination was strongly associated with parental negligence. Participants reported the participation of husbands and partners in the decision-making around their health. Most participants reported high information-seeking behaviour, particularly online; many interviewees confirmed any information obtained online with their healthcare professionals (HCPs). Vaccine recommendations from HCPs appeared to be one of the main predictors of maternal immunisations among the sample interviewed. While acceptability of maternal vaccines was high in this sample, some pregnant women expressed concerns and doubts (e.g., that maternal vaccines could cause miscarriages) which require attention. Finally, many participants reported difficulties in accessing maternal vaccination, pointing to financial and physical barriers.

Conclusions

The acceptability of maternal immunisation was high among the interviewed women. The pregnant women’s receptiveness to maternal vaccinations, even when information provided was limited, is suggestive of high levels of trust in HCPs. Even so, HCPs and health officials should remain alert to apprehensions expressed by pregnant women. Many participants reported struggles in accessing maternal vaccination, pointing to issues that merit further examination.
Casting versus flexible intramedullary nailing in displaced forearm shaft fractures in children aged 7–12 years: a study protocol for a randomised controlled trial
Authors: Grahn Petra , Sinikumpu Juha-Jaakko , Nietosvaara Yrjänä , Syvänen Johanna , Salonen Anne , Ahonen Matti , Helenius Ilkka
Published: August 2021

Introduction

The forearm is the most common fracture location in children, with an increasing incidence. Displaced forearm shaft fractures have traditionally been treated with closed reduction and cast immobilisation. Diaphyseal fractures in children have poor remodelling capacity. Malunion can cause permanent cosmetic and functional disability. Internal fixation with flexible intramedullary nails has gained increasing popularity, without evidence of a better outcome compared with closed reduction and cast immobilisation.

Method and analysis

This is a multicentre, randomised superiority trial comparing closed reduction and cast immobilisation to flexible intramedullary nails in children aged 7–12 years with >10° of angulation and/or >10 mm of shortening in displaced both bone forearm shaft fractures (AO-paediatric classification: 22D/2.1–5.2). A total of 78 patients with minimum 2 years of expected growth left are randomised in 1:1 ratio to either treatment group. The study has a parallel non-randomised patient preference arm. Both treatments are performed under general anaesthesia. In the cast group a long arm cast is applied for 6 weeks. The flexible intramedullary nail group is immobilised in a collar and cuff sling for 4 weeks. Data are collected at baseline and at each follow-up until 1 year.

Primary outcome is (1) PROMIS paediatric upper extremity and (2) forearm pronation-supination range of motion at 1-year follow-up. Secondary outcomes are Quick DASH, Paediatric Pain Questionnaire, Cosmetic Visual Analogue Scale, wrist and elbow range of motion as well as any complications and costs of treatment.

We hypothesise that flexible intramedullary nailing results in a superior outcome.

Ethics and dissemination

We have received ethical board approval (number: 78/1801/2020) and permissions to conduct the study from all five participating university hospitals. Informed consent is obtained from the parent(s). Results will be disseminated in peer-reviewed publications.

Trial registration number

NCT04664517.
Social determinants and changes in energy drink consumption among adolescents in Norway, 2017–2019: a cross-sectional study
Authors: Kaldenbach Siri , Strand Tor A , Solvik Beate Stokke , Holten-Andersen Mads
Published: August 2021

Objectives

To describe the social determinants and development in energy drink consumption among Norwegian adolescents in 2017, 2018 and 2019.

Design

Cross-sectional, online, annual, nationwide surveys (Ungdata).

Setting

Responses collected online from January 2017 to December 2019.

Participants

Lower and upper secondary school students (n=297 102) aged 12–19 years who responded in 2017, 2018 and 2019.

Main outcome measures

Frequency of energy drink consumption.

Results

Over the 3-year period, 66.4% of the men and 41.8% of the women had consumed energy drink once a week or more. The proportion of female high consumers (consuming energy drink more than four times a week) increased from 3.3% to 4.9% between 2017 and 2019; for male, the increase was from 9.8% to 11.5%. In females, the proportion of high consumers increased with 24% (relative risk; CI) (1.24; 1.09 to 1.41) from 2017 to 2018 and 46% (1.46; 1.31 to 1.62) from 2017 to 2019. The corresponding increases in males were 10% (1.10; 1.01 to 1.20) from 2017 to 2018 and 12% (1.12; 1.05 to 1.19) from 2017 to 2019. Any energy drink consumption as well as high energy drink consumption were independently associated with school level, less central residency, low socioeconomic status, physical inactivity and high leisure screen time.

Conclusion

We found an increase in high consumers among both boys and girls between 2017 and 2019. The observed increase in energy drink consumption among adolescents can explain some of the increased sales of energy drink in Norway.
Innovators’ views on involving users and patients in surgical device development: a qualitative interview study
Authors: Woudstra Kas , Tummers Marcia , Rovers Maroeska M , Reuzel Rob
Published: August 2021

Objectives

Involving end-users and patients in the development of surgical devices, even when patients are not end-users, is deemed important in policy and in academia since it could improve strategic choices in research and development (R&D). Nonetheless, research into innovators’ views on end-user and patient involvement is rare. This study explores what end-users and patients are being involved by innovators during development, what methods for involvement are being used and what topics are being discussed with these end-users and patients.

Design

A qualitative study featuring semi-structured interviews with innovators of surgical devices. Interviews were recorded and a thematic analysis was performed on verbatim transcripts.

Participants

15 interviews were conducted with 19 innovators of 14 surgical devices.

Setting

Innovation practices of surgical devices in the Netherlands and Belgium.

Results

End-users were engaged in R&D with formal methods and in unsystematic ways. These users all work in the clinical domain, for example, as surgeons or nurses. The innovators engaged users to analyse problems for which a device could be a solution, define functionalities, make design choices, analyse usability, ensure safety and improve aesthetics. Patients were rarely involved. Innovators stated that patients are not considered to be end-users, that physicians can represent patient interests and that involving patients is unethical as false expectations could be raised.

Conclusion

Innovators involve end-users with methods and unsystematic ways in the development of surgical devices. Despite governmental calls for patient involvement in the development of medical devices and surgical devices, innovators do not generally involve patients.
Education and training as key drivers for improving the quality of fluid balance charts: findings from a quality improvement project
Authors: Madu Alpha , Asogan Harshini , Raoof Ajmal
Published: August 2021

Reviewing fluid balance charts is a simple and effective method of assessing and monitoring the hydration status of patients. Several articles report that these charts are often either inaccurately or incompletely filled thereby limiting their usefulness in clinical practice. We had a similar experience in our practice at Kettering General Hospital and conducted a quality improvement project with a goal to increase the number of charts that were completely and accurately filled by a minimum of 50% in a 1-month period and to reassess the sustainability of this improvement after 6 months. Data from baseline measurements showed that only 25% of the charts in the ward had accurate measurements, 20% had correct daily totals and 14% had complete records of all intakes and losses. We collected feedback from nursing staff in the ward on what challenges they faced in using these charts and how best to support them. Corroborated by evidence from the literature, we discovered that inadequate training was a major factor responsible for the poor quality of documentation in these charts. Using simultaneous plan–do–study–act cycles, we designed and delivered personalised teaching on fluid balance chart documentation to the nursing staff. Subsequent data showed remarkable improvements in all the parameters we assessed. For instance, the proportion of charts with accurate measurements increased by 55% and those with complete entries by 122%. Unfortunately, we were unable to demonstrate sustainability of these improvements as our second set of data collection coincided with the SARS-CoV-2 outbreak. In this project, we were able to demonstrate that simple and cost-efficient measures such as adequate training of nursing staff could remarkably improve the quality of fluid balance charts used in our hospitals. We suggest that this training should be included as part of the regular competency assessments for nurses and other healthcare staff.
Anorexia nervosa and the gastrointestinal tract
Authors: Jafar Wisam , Morgan James
Published: August 2021

Anorexia nervosa (AN) is a complex eating disorder associated with a high morbidity and mortality, however, there is a lack of dedicated training for healthcare professionals outside of mental health specialities. There has been a reported increase in acute admissions of patients with AN, which may have been precipitated by the isolation and loss of support networks created by the COVID-19 pandemic. The purpose of this review is to highlight that AN can present with a wide variety of signs and symptoms relating to both the hollow and solid organs of the gastrointestinal (GI) tract some of which may even be life threatening. The overlap of symptoms with several other functional and organic GI diseases makes diagnosis challenging. Gastroenterologists and allied healthcare professionals need to be aware of the wide array of possible GI manifestations not only to help rationalise investigations but to also facilitate early involvement of the relevant multidisciplinary teams. Many of the GI manifestations of AN can be reversed with careful nutritional therapy under the guidance of nutrition support teams.
Remote ischaemic conditioning in ST elevation myocardial infarction: a registry-based randomised trial
Authors: Bainey Kevin R , Zheng Yinggan , Coulden Richard , Sonnex Emer , Thompson Richard , Mei Junyi , Bastiany Alexandra , Welsh Robert
Published: August 2021

Objectives

Remote ischaemic conditioning (RIC) has been tested as a possible strategy for mitigating reperfusion injury in ST elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PPCI). However, surrogate outcomes have shown inconsistent effects with lack of clinical correlation.

Methods

We performed a registry-based randomised study of patients with STEMI allocated to RIC (4 cycles of blood pressure cuff inflation to 200 mm Hg for 5 min of ischaemia followed by 5 min of reperfusion) or standard of care (SOC) during PPCI. We examined the associations of RIC on core laboratory measurements of myocardial perfusion, infarct size (IS), left ventricular (LV) performance and clinical outcomes.

Results

A total of 252 patients were enrolled. The median age was 61 (IQR: 55–70) years and 72.8% were male. Sum ST segment deviation resolution ≥50% was similar between RIC and SOC (65.2% vs 55.7%, p=0.269). In those with 3-day cardiovascular MRI (n=88), no difference in median (25th, 75th percentiles) IS (14.9% (4.5%, 23.1%) vs 16.1% (3.3%, 22.0%), p=0.980), LV dimensions (LV end-diastolic volume index: 78.7 (71.1, 91.2) mL/m2 vs 79.9 (71.2, 88.8) mL/m2, p=0.630; LV end-systolic volume index: 48.8 (35.7, 51.4) mL/m2 vs 37.9 (31.8, 47.5) mL/m2, p=0.551) or ejection fraction (50.0% (41.0%–55.0%) vs 50.0% (43.0%–56.0%), p=0.554) was demonstrated. Similar results were observed with 90-day cardiovascular MRI. At 1 year, the clinical composite of death, congestive heart failure, cardiogenic shock and recurrent myocardial infarction was similar in RIC and SOC (21.7% vs 13.3%, p=0.110).

Conclusions

In a contemporary registry-based randomised study of patients with STEMI undergoing PPCI, adjunctive therapy with RIC did not improve myocardial perfusion, reduce IS or alter LV performance. Consequently, there was no difference in clinical outcomes within 1 year.

Trial registration number

NCT03930589.
The making of a professional digital caregiver: personalisation and friendliness as practices of humanisation
Authors: Hallqvist Johan
Published: August 2021

The aim of this paper is to explore how a digital caregiver, developed within a Swedish interdisciplinary research project, is humanised through health-enhancing practices of personalisation and friendliness. The digital caregiver is developed for being used in older patients’ homes to enhance their health. The paper explores how the participants (researchers and user study participants) of the research project navigate through the humanisation of technology in relation to practices of personalisation and friendliness. The participants were involved in a balancing act between making the digital caregiver person-like and friend-like enough to ensure the health of the patient. Simultaneously, trying to make the patients feel like as if they were interacting with someone rather than something—while at the same time not making the digital caregiver seem like a real person or a real friend. This illustrates the participants’ discursive negotiations of the degree of humanisation the digital caregiver needs in order to promote the health of the patient. A discursive conflict was identified between a patient discourse of self-determination versus a healthcare professional discourse of authority and medical responsibility: whether the digital caregiver should follow the patient’s health-related preferences or follow the healthcare professionals’ health rules. Hence, a possible conflict between the patient and the digital caregiver might arise due to different understandings of friendliness and health; between friendliness (humanisation) as a health-enhancing practice governed by the patient or by the healthcare professionals (healthcare professionalism).
Lung and extrathoracic cancer incidence among underground uranium miners exposed to radon progeny in the Příbram region of the Czech Republic: a case–cohort study
Authors: Kelly-Reif Kaitlin , Sandler Dale P , Shore David , Schubauer-Berigan Mary , Troester Melissa , Nylander-French Leena , Richardson David B
Published: August 2021

Objectives

Radon is carcinogenic, but more studies are needed to understand relationships with lung cancer and extrathoracic cancers at low exposures. There are few studies evaluating associations with cancer incidence or assessing the modifying effects of smoking.

Methods

We conducted a case–cohort study with 16 434 underground uranium miners in the Czech Republic with cancer incidence follow-up 1977–1996. Associations between radon exposure and lung cancer, and extrathoracic cancer, were estimated with linear excess relative rate (ERR) models. We examined potential modifying effects of smoking, time since exposure and exposure rate.

Results

Under a simple ERR model, assuming a 5-year exposure lag, the estimated ERR of lung cancer per 100 working level months (WLM) was 0.54 (95% CI 0.33 to 0.83) and the estimated ERR of extrathoracic cancer per 100 WLM was 0.07 (95% CI −0.17 to 0.72). Most lung cancer cases were observed among smokers (82%), and the estimated ERR of lung cancer per 100 WLM was larger among smokers (ERR/100 WLM=1.35; 95% CI 0.84 to 2.15) than among never smokers (ERR/100 WLM=0.12; 95% CI −0.05 to 0.49). Among smokers, the estimated ERR of lung cancer per 100 WLM decreased with time since exposure from 3.07 (95% CI −0.04 to 10.32) in the period 5–14 years after exposure to 1.05 (95% CI 0.49 to 1.87) in the period 25+ years after exposure.

Conclusions

We observed positive associations between cumulative radon exposure and lung cancer, consistent with prior studies. We observed a positive association between cumulative radon exposure and extrathoracic cancers, although the estimates were small. There was evidence that the association between radon and lung cancer was modified by smoking in a multiplicative or super-multiplicative fashion.
Airflow obstruction, impaired lung function and risk of sudden cardiac death: a prospective cohort study
Authors: Cheng Yun-Jiu , Chen Zhen-Guang , Yao Feng-Juan , Liu Li-Juan , Zhang Ming , Wu Su-Hua
Published: August 2021

Background

Growing evidence suggests that compromised lung health may be linked to cardiovascular disease. However, little is known about its association with sudden cardiac death (SCD).

Objectives

We aimed to assess the link between impaired lung function, airflow obstruction and risk of SCD by race and gender in four US communities.

Methods

A total of 14 708 Atherosclerosis Risk in Communities (ARIC) study participants who underwent spirometry and were asked about lung health (1987–1989) were followed. The main outcome was physician-adjudicated SCD. Fine-Gray proportional subdistribution hazard models with Firth’s penalised partial likelihood correction were used to estimate the HRs.

Results

Over a median follow-up of 25.4 years, 706 (4.8%) subjects experienced SCD. The incidence of SCD was inversely associated with FEV1in each of the four race and gender groups and across all smoking status categories. After adjusting for multiple measured confounders, HRs of SCD comparing the lowest with the highest quintile of FEV1were 2.62 (95% CI 1.62 to 4.26) for white males, 1.80 (95% CI 1.03 to 3.15) for white females, 2.07 (95% CI 1.05 to 4.11) for black males and 2.62 (95% CI 1.21 to 5.65) for black females. The above associations were consistently observed among the never smokers. Moderate to very severe airflow obstruction was associated with increased risk of SCD. Addition of FEV1significantly improved the predictive power for SCD.

Conclusions

Impaired lung function and airflow obstruction were associated with increased risk of SCD in general population. Additional research to elucidate the underlying mechanisms is warranted.
Strategic and contested use of food laws to ban smokeless tobacco products in India: a qualitative analysis of litigation
Authors: Dsouza Riddhi , Bhojani Upendra
Published: August 2021

Objective

To understand how food laws are used, contested and interpreted to ban certain forms of chewing tobacco in India.

Methods

A qualitative study analysing all the tobacco-related litigation under the food laws in India. We used an inductive thematic analysis of the litigation contents.

Results

The tobacco industry systematically deployed litigation to (1) challenge the categorisation of smokeless tobacco products as food, and hence, questioned the use of food laws for regulating these products; (2) challenge the regulatory power of the state government in banning tobacco products via the food laws; and (3) challenge the applicability of the general food laws that enabled stricter regulations beyond what is prescribed under the tobacco-specific law.

Conclusion

Despite facing several legal challenges from the tobacco industry, Indian states optimised food laws to enable stricter regulations on smokeless tobacco products than were feasible through use of a tobacco-specific law.
Mode-based characterisation of swell deformations in a high-plasticity Paleogene clay
Authors: Kinslev Emil Mejlhede , Hededal Ole , Rocchi Irene , Zania Varvara
Published: August 2021

Accurate prediction of soil deformations is important in unloading as well as loading. Historically, however, the loading scenario has been the most common and thus the most extensively studied phenomenon, leaving unloading less well described. Overconsolidated high-plasticity clays are particularly challenging in this regard due to their complex deformation behaviour that has previously shown two conceptually different unloading behaviours. Based on a series of incremental loading and constant rate of strain compression and swelling tests on folded Røsnæs Clay, these unloading behaviours are unified in a framework as different swell modes, and an additional swell mode is identified. These different modes represent a variation in swell-inhibiting structure, seemingly unrelated to the structure in compression. The use of constant rate of strain tests greatly enhanced the detailed description of stiffness development in each mode, which may be characterised by up to three swell phases. The parameters governing the occurrence of the swell modes are identified along with the variables that define the transition between the swell phases and their detailed development.
Growth and morphological responses of gerbera seedlings to narrow-band lights with different light spectral combinations as sole-source lighting in a controlled environment
Authors: Kamath Devdutt , Kong Yun , Dayboll Chevonne , Blom Theo , Zheng Youbin
Published: August 2021

To optimize light-emitting diode (LED) spectral recipes for gerbera (Gerbera jamesonii) seedling propagation, seed germination and seedling morphology, biomass, flowering, and storage quality were observed in four cultivars, ‘Midi Dark Purple’, ‘Majorette Red Dark Eye’, ‘Maxi Pink’, and ‘Maxi White’, under six spectrum treatments: (1) FL, cool white fluorescent light; (2) RB, a photon flux ratio of 85% red and 15% blue (RB-LED); (3) RB + UVB, RB-LED combined with 0.5 μmol·m−2·s−1 of ultraviolet-B; (4) RB + UVA, RB-LED combined with 9.6 μmol·m−2·s−1 of ultraviolet-A; (5) RB + G, a photon flux ratio of 60% red, 15% blue, and 25% green; (6) RB + FR, RB-LED combined with 17.3 μmol·m−2·s−1 of far-red. For all treatments, the photosynthetic photon flux density was 165 μmol·m−2·s−1 under a 16-h photoperiod. Seedling growth and morphology were similar under FL and RB for all cultivars, except for a wider canopy of ‘Majorette Red Dark Eye’ under RB. Each of the tri-chromatic light treatments (i.e., RB + UVB, RB + UVA, RB + G or RB + FR) showed similar effects as RB, except for thicker ‘Maxi Pink’ stems under RB + FR. Furthermore, the quality index, an integrated evaluation of seedling quality, was similar under all the treatments for each cultivar. Given the similar seedling quality and the advantages of LEDs, RB-LED can potentially replace FL for controlled-environment gerbera seedling production, but the tri-chromatic lights tested in this study appear to be unnecessary.
AAC Profit field pea
Authors: Bing Deng-Jin , Beauchesne Don , Cuthbert Richard , Naeem Hamid
Published: August 2021

AAC Profit is a semi-leafless, yellow cotyledonary field pea (Pisum sativum L.) cultivar developed at Agriculture and Agri-Food Canada Lacombe Research and Development Centre, Lacombe, Alberta, Canada. It has a maturity of 101 d, thousand-seed weight of 218 g, and a lodging score of 4.1 on the scale of 1–9 (1 = upright, 9 = prostrate). The seed crude protein content of AAC Profit is 24.5%. AAC Profit is resistant to powdery mildew (caused by Erysiphe pisi), and moderately susceptible to mycosphaerella blight (caused by Mycosphaerella pinodes) and fusarium wilt (caused by Fusarium oxysporum).
The peculiar Jeans length
Authors: Tsagas Christos G.
Published: August 2021

Typical observers in the universe do not follow the smooth Hubble expansion, but move relative to it. Such bulk peculiar motions introduce a characteristic scale that is closely analogous to the familiar Jeans length. This “peculiar Jeans length” marks the threshold below which relative-motion effects dominate the linear kinematics. There, cosmological measurements can vary considerably between the bulk-flow frame and that of the Hubble expansion, entirely due to the observers’ relative motion. When dealing with the deceleration parameter, we find that the peculiar Jeans length varies between few and several hundred Mpc. On these scales, the deceleration parameter measured by the bulk-flow observers can be considerably larger (or smaller) than its Hubble-frame counterpart. This depends on whether the peculiar motion is locally expanding (or contracting), relative to the background expansion. Then, provided expanding and contracting bulk flows are randomly distributed, nearly half of the observers in the universe could be misled to think that their cosmos is over-decelerated. The rest of them, on the other hand, may come to believe that their universe is under-decelerated, or even accelerated in some cases. We make two phenomenological predictions that could in principle support this scenario.
Two-sided constraints on Lorentz invariance violation from Tibet-AS$$\gamma $$ and LHAASO very-high-energy photon observations
Authors: Satunin Petr
Published: August 2021

We present new two-sided constraints on the Lorentz Invariance violation energy scale for photons with quartic dispersion relation from recent gamma ray observations by the Tibet-AS$$\gamma $$
γ
and LHAASO experiments. The constraints are based on the consideration of the processes of photon triple splitting (superluminal scenario) and the suppression of shower formation (subluminal). The constraints in the subluminal scenario are better than the pair production constraints and are the strongest in the literature.
Role of central depression in the estimation of Coulomb excitation cross-section and absorption effects
Authors: Goyal Monika , Kumar Rajiv , Singh Pardeep , Seth Raj Kumar , Kharab Rajesh
Published: August 2021

We have investigated the role of central depression parameter on the estimation of survival probability, the Coulomb excitation cross-sections and absorption effects of [Formula: see text] system. The variation in central depression is found to be affecting all the above-mentioned quantities significantly. The survival probability and the Coulomb excitation cross-section are found to be decreasing with increase in [Formula: see text] while the absorption effects are found to be increasing.
Hand Gesture Recognition Based on sEMG Signal and Convolutional Neural Network
Authors: Su Ziyi , Liu Handong , Qian Jinwu , Zhang Zhen , Zhang Lunwei
Published: August 2021

Recently, deep learning has become a promising technique for constructing gesture recognition classifiers from surface electromyography (sEMG) signals in human–computer interaction. In this paper, we propose a gesture recognition method with sEMG signals based on a deep multi-parallel convolutional neural network (CNN), which solves the problem that traditional machine learning methods may lose too much useful information during feature extraction. CNNs provide an efficient way to constrain the complexity of feedforward neural networks by weight sharing and restriction to local connections. Sophisticated feature extraction is to be avoided and hand gestures are to be classified directly. A multi-parallel and multi-convolution layer convolution structure is proposed to classify hand gestures. Experiment results show that in comparison with five traditional machine learning methods, the proposed method could achieve higher accuracy.
Design of Low Leakage 9T SRAM Cell with Improved Performance for Ultra-Low Power Devices
Authors: Kumar Harekrishna , Tomar V. K.
Published: August 2021

In this paper, a 9T SRAM cell with low power (LP9T) and improved performance has been proposed. This cell is free from half-select issue and works with single-ended read and differential write operation in the sub-threshold region. To evaluate the relative performance, the obtained characteristics of LP9T SRAM cell are compared with other state-of-the-art designs at 45-nm technology node. The read and write power dissipation of LP9T SRAM cell is reduced by [Formula: see text] and [Formula: see text] as compared to Conv.6T SRAM cell. In proposed cell, leakage power is reduced by [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text] as compared to conventional 6T (Conv.6T), low power (LP8T), transmission gate 8T(TG8T), transmission gate 9T (TG9T), Schmitt trigger 9T (ST9T), and positive feedback control 10T (PFC10T) SRAM cells. This reduction in leakage power is attributed to stacking effect. LP9T SRAM cell also exhibits significant improvement in read/write access time as compared to all considered cells. Also, the read and write energy of proposed cell is lowest among all considered cells. The LP9T SRAM cell has [Formula: see text] and [Formula: see text] higher read and write stability as compared to Conv.6T SRAM cell. Proposed SRAM cell has the highest value of ON to OFF current ratio ([Formula: see text]) which signifies the highest bit-cell density among all considered cells. The LP9T SRAM cell occupies [Formula: see text] large area as compared to Conv.6T SRAM cell. The overall quality of SRAM cell is calculated through the electrical quality metric (EQM). It is observed that LP9T SRAM cell has the highest value of EQM in comparison to considered cells at 0.3[Formula: see text]V supply voltage.
Towers and elementary embeddings in toral relatively hyperbolic groups
Authors: Perez Christopher
Published: August 2021

In a remarkable series of papers, Zlil Sela classified the first-order theories of free groups and torsion-free hyperbolic groups using geometric structures he called towers. It was later proved by Chloé Perin that if [Formula: see text] is an elementarily embedded subgroup (or elementary submodel) of a torsion-free hyperbolic group [Formula: see text], then [Formula: see text] is a tower over [Formula: see text]. We prove a generalization of Perin’s result to toral relatively hyperbolic groups using JSJ and shortening techniques.
Current status of different detector technologies in the searches of 0νββ decay
Authors: Karmakar S. , Singh M. K.
Published: August 2021

In this paper, we focused on the different detector technologies used in the search of [Formula: see text] decay, from beginning till date. We have also explained the advance technology which is planned for near future by various worldwide experimental collaboration in the search of [Formula: see text] decay.
RESEARCH STATUS OF SURFACE MODIFICATION OF TITANIUM-BASED ALLOYS BY PACK CEMENTATION
Authors: HAN FENG , YUAN SHUO , LIN NAIMING , ZENG QUNFENG , JIA HONGBING , LI MAOLIN , WU YUCHENG
Published: August 2021

With the continuously rapid development of materials science, better properties are equably required in the area of material surface engineering, especially the surface friction and high-temperature oxidation resistance of titanium alloy. It is a great approach to select a scientific way for surface treatment to improve the surface performance so as to obtain surface films/coatings/layers. It can provide a vital latent remedy to the insufficient high-temperature oxidation resistance and wear resistance of titanium alloys. Pack cementation is a reliable means at present by virtue of its distinct composition, covering pollution-free and the firm metallurgical bonding between the alloying coating and the matrix. In the last few years, with the growing demands for the surface performance of materials in multifarious harsh environments, the coating obtained by pack cementation is developing toward controlling coating composition accurately and applying it to complex parts. This review opens with an abbreviated introduction of pack cementation technology. The recent developments of pack cementation technology for enhancing diverse surface properties are scientifically reviewed in the aspects of background, previous research results and the future development directions.
INVESTIGATION OF MICROSTRUCTURE PROPERTIES OF NbC–B COATED HARDOX 400 STEEL BY TRD METHOD AND EVALUATION OF WEAR BEHAVIOR BY TAGUCHI METHOD
Authors: ÇELİK YAHYA HIŞMAN , ERTEM MEHMET , GÜR ALI KAYA , KURT BÜLENT , CALIGULU UĞUR , ÖZAY ÇETIN , YILDIZ TÜLAY
Published: August 2021

In this study, Hardox 400 steel used as substrate material was coated through solid media Thermoreactive Diffusion (TRD) method using Ferro Niobium and Ferro Boron powders from carbide forming element powders. Coating was carried out in three different temperatures ([Formula: see text]C, [Formula: see text]C and [Formula: see text]C) and three different time intervals (1, 2 and 3[Formula: see text]h). Microstructures of the coated specimens were examined by optical microscope, Scanning Electron Microscope (SEM), Energy Dispersive X-Ray Spectroscopy (EDX) and X-ray Diffraction (XRD); and hardness values were measured. The effects of coating parameters on coating thickness and hardness were analyzed by ANOVA. In addition, specimens were subjected to wear tests to determine the effect of hardness and coating parameters on wear. In the wear tests, Taguchi test design setup was used. The obtained results were compared with the Hardox 400 steel used under current conditions. It was seen from optical microscope and SEM images that Hardox 400 steel surface could be coated with TRD method depending on coating parameters. The average thickness of NbC–B coating ranged from 1.797[Formula: see text][Formula: see text]m to 5.596[Formula: see text][Formula: see text]m under different process temperature and time. Rising the coating time and temperature increased the coating thickness by 311.40%. EDX analysis showed that the coating layer was composed of B, C, Fe and Nb elements, and XRD analysis also showed that the phase in the coating layer is NbC–B. The NbC–B phase was determined to be an important factor in increasing the hardness. The coating hardness is enhanced by 320.80% depending on the coating parameters. Optimum coating thickness, hardness and wear results were obtained from high coating temperature and time. Uncoated Hardox 400 steels were worn out more compared to the coated Hardox 400 steels. The contribution of coating temperature and time to wear resistance was 1.46% and 8.02%, respectively. It was observed that the important parameter for wear volume was the applied load.