bluuebunny/crossref_metadata_2025 huggingface dataset:
Heat transfer from glass melt to cold cap: Computational fluid dynamics study of cavities beneath cold cap
Authors: Abboud Alexander W. , Guillen Donna P. , Hrma Pavel , Kruger Albert A. , Klouzek Jaroslav , Pokorny Richard
Published: December 2020

Efficient glass production depends on the continuous supply of heat from the glass melt to the floating layer of batch, or cold cap. Computational fluid dynamics (CFD) are employed to investigate the formation and behavior of gas cavities that form beneath the batch by gases released from the collapsing primary foam bubbles, ascending secondary bubbles, and in the case of forced bubbling, from the rising bubbling gas. The gas phase fraction, temperature, and velocity distributions below the cold cap are used to calculate local and average heat transfer rates as a function of the bubbling rate. It is shown that the thickness of the cavities is nearly independent of the cold cap shape and the amount of foam evolved during batch conversion. It is ~7 mm and up to ~15 mm for the cases without and with forced bubbling used to promote circulation within the melt, respectively. Using computed velocity and temperature profiles, the melting rate of the simulated high‐level nuclear waste glass batch was estimated to increase with the bubbling rate to the power of ~0.3 to 0.9, depending on the flow pattern. The simulation results are in good agreement with experimental data from laboratory‐ and pilot‐scale melter tests.
Are sham‐operated mice a valid comparator in studies using a bladder outlet obstruction model? A pitfall reveals a meaningful insight
Authors: Kitta Takeya , Hattori Tsuyoshi , Chiba Hiroki , Higuchi Madoka , Kanno‐Kakibuchi Yukiko , Ouchi Mifuka , Togo Mio , Abe‐Takahashi Yui , Michishita Mai , Kitano Tatsuya , Kusakabe Naohisa , Shinohara Nobuo
Published: December 2020

Objective

To evaluate voiding behavior characteristics in intact and sham mice, and to examine whether intact mice show changes in “normal” micturition with aging.

Methods

A total of 72 8‐week‐old mice were divided into two groups – intact and sham – and the latter group was subjected to a sham of partial bladder outlet obstruction surgery. Urination frequency was evaluated (through metabolic cages) at 1, 2, 3, 6 and 12 months after the surgery (or at the equivalent time points for the intact mice). To address possible mechanisms for aging and surgical effects on urinary behavior, quantitative real‐time polymerase chain reaction assays were carried out. Primary data were evaluated using scatter plots and descriptive statistics.

Results

In sham mice, urination frequency showed strong variation at the earlier post‐surgical time points (especially at 1 month), with variation decreasing with time. Quantitative real‐time polymerase chain reaction showed that the serotonin 2C receptor‐encoding mRNA accumulated to >28‐fold higher levels at 24 months compared with 3 months in intact mice. A major limitation of the quantitative real‐time polymerase chain reaction experiments was that we did not separate whole bladder into muscle and mucosa.

Conclusions

Although a sham operation is typically used in partial bladder outlet obstruction experiments to provide control animals, the sham group might itself show increased variation in micturition frequency at early times after surgery, compared with intact animals.
Serum potassium abnormalities in chronic kidney disease: prevalence, patient characteristics and clinical outcomes
Authors: Brookes Elizabeth M. , Snider Jonathan , Hart Graeme K. , Robbins Raymond , Power David A.
Published: December 2020

Background

Abnormalities in serum potassium are a well known complication of chronic kidney disease (CKD), but little is known about their impact on inpatient outcomes.

Aims

To better understand the role of dyskalaemia in hospital in‐patients, we assessed the epidemiology of potassium disorders among CKD patients, and the association between admission potassium and inpatient mortality or intensive care unit (ICU) requirement.

Methods

This retrospective hospital‐based cohort study (n = 11 156) included patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 admitted to Austin Health between 2014 and 2018 and who had an admission potassium value. Dialysis patients or those with a renal transplant were excluded. Multivariate logistic analysis was conducted to identify factors associated with hyperkalaemia (≥5.5 mmol/L) and hypokalaemia (<3.5 mmol/L). Odds ratios for inpatient mortality and ICU admission between potassium categories were obtained by multivariate regression with adjustments for demographics, renal function and comorbidities.

Results

Hyperkalaemia and hypokalaemia were present in 6.86% and 2.94% of hospital admissions respectively. In multivariate regression male sex, lower eGFR, diabetes and cardiac failure were associated with higher odds of hyperkalaemia. Thiazide diuretics, loop diuretics, infectious disease and endocrine pathology were associated with higher odds of hypokalaemia. A U‐shaped association was noted between potassium and inpatient mortality. Potassium <4.0 mmol/L and ≥5.0 mmol/L was associated with increased mortality. Only patients with potassium ≥5.5 mmol/L had increased ICU admission risk.

Conclusion

Derangements in potassium frequently occur in CKD inpatients and are independently associated with higher mortality and ICU requirement. Further studies are required to determine whether interventions to maintain normokalaemia improve outcomes in this population.
Dental visit experience and dental care barriers among Hong Kong preschool children with special education needs
Authors: Zhou Ni , Wong Hai Ming , McGrath Colman
Published: December 2020

Background

Children with special education needs (SEN) require additional supports in education settings, as well as extra supports in healthcare services.

Aim

To investigate dental visit experience and dental care barriers among Hong Kong preschoolers with SEN.

Design

This was designed as a cross‐sectional study. A structured questionnaire was employed to investigate dental attendance and dental care barriers among Hong Kong preschoolers with SEN. Binary logistic regression and multi‐factor ANOVA were performed to identify factors associated with children's dental visit experience.

Results

A total of 383 children were included in the final analysis. The average age of the recruited children was 3.87 ± 0.95 years. 72.5% parents reported that dental visits were a challenging task for their children. Among children with caries, 70.7% had never visited a dentist. Regression models indicated that (a) children over 3 years or children whose parents received tertiary education were more likely to visit a dentist; (b) the existence of dental care barriers was associated with children's primary diagnosis, practical skills, conceptual skills, and parents’ education attainment; and (c) children with low conceptual skills (95%CI:0.71 to 2.40, P < .001), or children from low‐income families (95%CI:1.21 to −0.06, P = .031) had more dental care barriers than their counterparts.

Conclusion

Unmet dental treatment needs and dental care barriers existed among pre‐schoolers with SEN. Dental care barriers were associated with children's developmental profile, parents’ education attainment, and household income.
Making on the Move: Mobility, Makerspaces, and Art Education
Authors: Jordan Alvaro , Knochel Aaron D. , Meisel Nicholas , Reiger Kelsey , Sinha Swapnil
Published: December 2020

Combining the excitement from the maker movement and the novel creation of deployable makerspaces, we review the development of the Mobile Atelier for Kinaesthetic Education (MAKE) 3D. MAKE 3D is a mobile makerspace platform that can be deployed anywhere there is electricity to create a curricular spectacle of digital fabrication in particular additive manufacturing or what is more commonly referred to as 3D printing. Our project combines this notion of curricular spectacle and a mobile makerspace platform, to develop strategies in how to meet the novice user almost anywhere and to entice them into a series of hands‐on activities that would give them a range of knowledge and aptitude for additive techniques in digital fabrication. We review the component parts of our Material to Form curriculum and explore thematic connections between the maker movement and art education including STEAM and interdisciplinarity; design thinking and kinaesthetic learning; and place‐based education and the mobile platform. Informal practices in art education and the mobile makerspace advances forms of place and kinaesthetic learning. Similar curricular setups are therefore encouraged to reinforce and expand prior knowledge, broaden participation and provide an adaptable learning space for STEAM initiatives.
Expression levels of the metalloproteinase ADAM8 critically regulate proliferation, migration and malignant signalling events in hepatoma cells
Authors: Awan Tanzeela , Babendreyer Aaron , Mahmood Alvi Abid , Düsterhöft Stefan , Lambertz Daniela , Bartsch Jörg W. , Liedtke Christian , Ludwig Andreas
Published: December 2020

Hepatocellular carcinoma (HCC) is one of the most common metastatic tumours. Tumour growth and metastasis depend on the induction of cell proliferation and migration by various mediators. Here, we report that the A Disintegrin and Metalloproteinase (ADAM) 8 is highly expressed in murine HCC tissues as well as in murine and human hepatoma cell lines Hepa1‐6 and HepG2, respectively. To establish a dose‐dependent role of different ADAM8 expression levels for HCC progression, ADAM8 expression was either reduced via shRNA‐ or siRNA‐mediated knockdown or increased by using a retroviral overexpression vector. These two complementary approaches revealed that ADAM8 expression levels correlated positively with proliferation, clonogenicity, migration and matrix invasion and negatively with apoptosis of hepatoma cells. Furthermore, the analysis of pro‐migratory and proliferative signalling pathways revealed that ADAM8 expression level was positively associated with expression of β1 integrin as well as with the activation of focal adhesion kinase (FAK), mitogen‐activated protein kinase (MAPK), Src kinase and Rho A GTPase. Finally, up‐regulation of promigatory signalling and cell migration was also seen with a proteolytically inactive ADAM8 mutant. These findings reveal that ADAM8 is critically up‐regulated in hepatoma cells contributes to cell proliferation and survival and furthermore induces pro‐migratory signalling pathways independently of its proteolytic activity. By this, ADAM8 can promote cell functions most relevant for HCC growth and metastasis.
The cost of travel: How dispersal ability limits local adaptation in host–parasite interactions
Authors: Johnson Pieter , Calhoun Dana M. , Moss Wynne E. , McDevitt‐Galles Travis , Riepe Tawni B. , Hallas Joshua M. , Parchman Thomas L. , Feldman Chris R. , Achatz Tyler J. , Tkach Vasyl V. , Cropanzano Josh , Bowerman Jay , Koprivnikar Janet
Published: December 2020

Classical theory suggests that parasites will exhibit higher fitness in sympatric relative to allopatric host populations (local adaptation). However, evidence for local adaptation in natural host–parasite systems is often equivocal, emphasizing the need for infection experiments conducted over realistic geographic scales and comparisons among species with varied life history traits. Here, we used infection experiments to test how two trematode (flatworm) species (Paralechriorchis syntomentera and Ribeiroia ondatrae) with differing dispersal abilities varied in the strength of local adaptation to their amphibian hosts. Both parasites have complex life cycles involving sequential transmission among aquatic snails, larval amphibians and vertebrate definitive hosts that control dispersal across the landscape. By experimentally pairing 26 host‐by‐parasite population infection combinations from across the western USA with analyses of host and parasite spatial genetic structure, we found that increasing geographic distance—and corresponding increases in host population genetic distance—reduced infection success for P. syntomentera, which is dispersed by snake definitive hosts. For the avian‐dispersed R. ondatrae, in contrast, the geographic distance between the parasite and host populations had no influence on infection success. Differences in local adaptation corresponded to parasite genetic structure; although populations of P. syntomentera exhibited ~10% mtDNA sequence divergence, those of R. ondatrae were nearly identical (<0.5%), even across a 900 km range. Taken together, these results offer empirical evidence that high levels of dispersal can limit opportunities for parasites to adapt to local host populations.
The health‐related quality of life and psychological profile in patients with oropharyngeal Pemphigus Vulgaris in complete clinical remission: A case‐control study
Authors: Calabria Elena , Adamo Daniela , Leuci Stefania , Pecoraro Giuseppe , Coppola Noemi , Aria Massimo , Mignogna Michele D.
Published: December 2020

Background

Pemphigus Vulgaris (PV) is a severe autoimmune blistering disease which may affect the patient's health‐related quality of life (HR‐QoL) and mood even during quiescent disease activity. We sought to evaluate HR‐QoL, quality of sleep (QoS), anxiety and depression in oropharyngeal PV patients (OPV) in complete clinical remission on or off therapy (CCR‐on, CCR‐off).

Methods

Thirty OPV patients and 30 healthy controls were enrolled. The Short Form 36 Health Survey Questionnaire (SF‐36), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Hamilton Rating Scale for Depression (HAM‐D) and Hamilton Rating Scale for Anxiety (HAM‐A) were administered. Descriptive statistics, including the Mann‐Whitney U test and hierarchical multiple linear regression analysis, were used.

Results

The OPV patients had statistically lower scores in the majority of items of the SF‐36 and higher scores in the PSQI, HAM‐A and HAM‐D than the healthy controls (P < .004; P < .001; and P < .001 respectively). Nine (30%) of the OPV patients were poor sleepers (PSQI > 5) with higher scores in the SF‐36, HAM‐A and HAM‐D compared with the good sleepers (PSQI < 5). No statistically significant difference was detected in the OPV group when comparing patients in CCR‐on and CCR‐off, or in consideration of the cumulative time of the disease duration.

Conclusions

HR‐QoL of OPV patients can be impaired even over periods of relatively well‐being, therefore, clinicians should monitor periodically their HR‐QoL, QoS and psychological profile in order to guide treatments also toward improving their HR‐QoL.
Cognitive flow in health care settings: A systematic review
Authors: McQueen Sydney , Jiang Stephanie , McParland Aidan , Hammond Mobilio Melanie , Moulton Carol‐anne
Published: December 2020

Introduction

The state of cognitive flow, colloquially known as being ‘in the zone’, has been linked with enhanced performance, happiness, career satisfaction and decreased burnout. However, the concept has not been adopted strongly in health care training, continuing professional development, or daily practice. A systematic review with a narrative synthesis was undertaken to map the evidence for flow in health care.

Methods

A search was conducted in MEDLINE, PsycInfo, and EMBASE in July 2019 and updated in October 2020 for manuscripts discussing flow in all health care disciplines. Articles published between 1806 and 13 October 2020 were included. Two authors independently reviewed titles and abstracts (and subsequently full texts where necessary) for inclusion. Disagreements were resolved by consensus. Data were extracted on location, manuscript type, population and context, measures, and key findings.

Results

A total of 4923 unique abstracts were initially retrieved, and 15 articles were included in the final review. We report on the experience, benefits and strategies to support flow in health care. Flow may benefit providers by enhancing career enjoyment, wellness and performance, while mitigating exhaustion, burnout, and stress. Although research from other domains has focused on supporting flow through individualised training, our results highlight the importance of system and environmental factors.

Conclusions

Supporting professional and trainee flow in health care requires a holistic approach, including individual training and system‐level interventions.
Orchestration of virulence factor expression and modulation of biofilm dispersal in Erwinia amylovora through activation of the Hfq‐dependent small RNA RprA
Authors: Peng Jingyu , Schachterle Jeffrey K. , Sundin George W.
Published: December 2020

Erwinia amylovora is the causative agent of the devastating disease fire blight of pome fruit trees. After infection of host plant leaves at apple shoot tips, E. amylovora cells form biofilms in xylem vessels, restrict water flow, and cause wilting symptoms. Although E. amylovora is well known to be able to cause systemic infection, how biofilm cells of E. amylovora transit from the sessile mode of growth in xylem to the planktonic mode of growth in cortical parenchyma remains unknown. Increasing evidence has suggested the important modulatory roles of Hfq‐dependent small RNAs (sRNAs) in the pathogenesis of E. amylovora. Here, we demonstrate that the sRNA RprA acts as a positive regulator of amylovoran exopolysaccharide production, the type III secretion system (T3SS), and flagellar‐dependent motility, and as a negative regulator of levansucrase activity and cellulose production. We also show that RprA affects the promoter activity of multiple virulence factor genes and regulates hrpS, a critical T3SS regulator, at the posttranscriptional level. We determined that rprA expression can be activated by the Rcs phosphorelay, and that expression is active during T3SS‐mediated host infection in an immature pear fruit infection model. We further showed that overexpression of rprA activated the in vitro dispersal of E. amylovora cells from biofilms. Thus, our investigation of the varied role of RprA in affecting E. amylovora virulence provides important insights into the functions of this sRNA in biofilm control and systemic infection.
A nonproteinaceousFusariumcell wall extract triggers receptor‐like protein‐dependent immune responses in Arabidopsis and cotton
Authors: Babilonia Kevin , Wang Ping , Liu Zunyong , Jamieson Pierce , Mormile Brendan , Rodrigues Olivier , Zhang Lin , Lin Wenwei , Danmaigona Clement Catherine , Menezes de Moura Stéfanie , Alves‐Ferreira Marcio , Finlayson Scott A. , Loring Nichols Robert , Wheeler Terry A. , Dever Jane K. , Shan Libo , He Ping
Published: December 2020

Fusariumwilt caused by the ascomycete fungusFusarium oxysporumis a devastating disease of many economically important crops. The mechanisms underlying plant responses toF. oxysporuminfections remain largely unknown.

We demonstrate here that a water‐soluble, heat‐resistant and nonproteinaceousF. oxysporumcell wall extract (FoCWE) component from multipleF. oxysporumisolates functions as a race‐nonspecific elicitor, also termed pathogen‐associated molecular pattern (PAMP). FoCWE triggers several demonstrated immune responses, including mitogen‐activated protein (MAP) kinase phosphorylation, reactive oxygen species (ROS) burst, ethylene production, and stomatal closure, in cotton and Arabidopsis.

Pretreated FoCWE protects cotton seeds against infections by virulentF. oxysporumf. sp.vasinfectum(Fov), and Arabidopsis plants against the virulent bacterium,Pseudomonas syringae, suggesting the potential application of FoCWEs in crop protection. Host‐mediated responses to FoCWE do not appear to require LYKs/CERK1, BAK1 or SOBIR1, which are commonly involved in PAMP perception and/or signalling. However, FoCWE responses andFusariumresistance in cotton partially require two receptor‐like proteins, GhRLP20 and GhRLP31.

Transcriptome analysis suggests that FoCWE preferentially activates cell wall‐mediated defence, andFovhas evolved virulence mechanisms to suppress FoCWE‐induced defence. These findings suggest that FoCWE is a classical PAMP that is potentially recognised by a novel pattern‐recognition receptor to regulate cotton resistance toFusariuminfections.
The labour of fun: masculinities and the organisation of labour games in a modern workplace
Authors: Wu Tongyu
Published: December 2020

The U.S. tech industry has been going through a re‐shuffling of labour forces, which destabilises the previous masculine structure. Drawing on 11 months of ethnographic work and 46 interviews, this study finds that labour games have become a contested terrain where different groups of engineers promote their masculine selves. Brogrammers highlight their brogramming masculine habitus through initiating ‘pranking‐games’. Tech hobbyists embodied with video‐gaming habitus invest in the ‘number games’ through which they display their technological masculinity. Despite the divergent motives, two minority groups—coding peasants and female workers—choose to distance themselves from these labour games, which reinforce their marginalised status. These findings contribute to masculinity scholarship and the study of labour games by demonstrating how labour games organised on the engineering floor have become a crucial milieu for the construction of masculinities.
Combined antibiotic, steroid, and moisturizer for atopic dermatitis: A two‐year case series of patient‐reported outcomes
Authors: Rajkumar Jeffrey , Jetter Nathan , Samuels Katy , Schwartz Alan
Published: December 2020

Background

Eczema treatments that target Staphylococcus aureus include topical mixtures of antimicrobial agent and corticosteroid diluted in a moisturizer base, previously described in the literature as compounded antibacterial, steroid, and moisturizer (CASM). There have been no placebo‐controlled blinded studies of CASM. Thus, patient‐reported outcome data may prove valuable.

Objective

To determine the patient‐reported clinical course of eczema treatment with CASM.

Methods

Longitudinal case series between May 2016 and August 2018 of CASM patients/parents. Patients completed surveys including the POEM measure at start of treatment, 1 week, 2 weeks, 1 month, 3 months, 6 months, 9 months, and 12 months thereafter. Response curves were fitted to severity measures over time and compared by patient age group; survival analysis was used to estimate time‐to‐clear status as a function of patient age and initial severity.

Results

A total of 2153 reports were received from 728 unique respondents with a median patient age of 7 and range of 0‐85. Response curves showed significant improvement over time leading to plateaus between 30 and 60 days of treatment. Overall mean improvement between start and day 90 for POEM was 14.3 (from 20.0 [95% CI 11.4‐28.8] to 5.7 [95% CI −3.2 to 14.8]). Improvement was seen in each age group.

Conclusions

Patient‐reported outcomes suggest efficacy of CASM. There were large reductions in POEM scores, mostly in the first 30 days of treatment for all age groups.
Personal and Political: Post‐Traumatic Stress Through the Lens of Social Identity, Power, and Politics
Authors: Muldoon Orla T. , Lowe Robert D. , Jetten Jolanda , Cruwys Tegan , Haslam S. Alexander
Published: December 2020

Post‐traumatic stress disorder (PTSD) has always been controversial and highly politicized. Here, using a social identity approach, we review evidence that trauma and its aftermath are fundamentally linked to social position, sociopolitical capital, and power. We begin this contribution by demonstrating how a person's group memberships (and the social identities they derive from these memberships) are inherently linked to the experience of adversity. We then go on to consider how it is through group memberships that individuals are defined by their trauma risk and trauma histories—that is, a person's group memberships and their trauma are often inherently linked. Considering the importance of group memberships for understanding trauma, we argue that it is important to see these, and group processes more generally, as more than just “demographic” risk factors. Instead, we argue that when groups are defined by their trauma history or risk, their members will often derive some sense of self from this trauma. For this reason, attributes of group memberships are important in developing an understanding of adjustment and adaptation to trauma. In particular, groups' status, their recourse to justice, and the level of trust and solidarity within the group are all central to the impact of traumatic events on individual‐level psychological resilience. We review evidence that supports this analysis by focusing on the exacerbating effects of stigma and social mistrust on post‐traumatic stress, and the value of solidarity and strong identities for resilience. We conclude that because of these group‐related processes, trauma interweaves the personal with the political and that post‐traumatic stress is fundamentally about power, positionality, and politics.
Fair Play, Reciprocity, and Natural Duties of Justice
Authors: Klosko George
Published: December 2020

In this paper, I respond to what is currently the most significant criticism of the principle fair play as a basis for political obligations. In a series of cases in which obligations appear to be established by fair play, important scholars contend that the moral principle at work is not fair play but a natural duty of justice to provide essential benefits to other people. Such natural duty accounts strikingly ignore requirements of reciprocity, to make appropriate return for benefits received. In addition, careful examination of possible natural duty explanations of such cases indicates severe difficulties explaining exactly to whom the natural duties in question are owed and why they may require significant costs.
Quantitative Risk Assessment on the Transport of Dangerous Goods Vehicles Through Unidirectional Road Tunnels: An Evaluation of the Risk of Transporting Hydrogen
Authors: Caliendo Ciro , Genovese Gianluca
Published: December 2020

A quantitative risk analysis (QRA) concerning dangerous goods vehicles (DGVs), including also vehicles for the transport of liquid hydrogen (LH2TVs), running through unidirectional motorway tunnels was performed. An event tree was built, and a wide parametric analysis based on different geometric and traffic characteristics of tunnels was carried out. The effects of the annual average daily traffic (AADT) per lane, the tunnel length (L), the percentage both of heavy goods vehicles (HGVs) and DGVs (for a given 7% of LH2TVs) were investigated. The results in terms of social risk, as expressed by F/N curves and the expected value (EV), show an increased risk level with the presence of the hydrogen transported, and with certain F/N curves that might also lie above the acceptability limit. This means that additional safety measures should be implemented in order to reduce the risk level or that, alternatively, appropriate strategies of traffic control systems should be taken. A statistical modeling for developing a predictive method of the EV is also performed. The outcomes show that the regression coefficients have the signs expected. In particular, the EV increases with the tunnel length (L), the AADT, and the percentage both of HGVs and DGVs. However, the magnitude of estimated coefficients indicates that the expected value EV increases more with the traffic (AADT per lane, HVGs, or DGVs) than the tunnel length. The application of the approximate method might help the Tunnel Management Agencies (TMAs) in making quick decisions, at a preliminary stage, about temporarily allowing, forbidding or limiting the circulation of DGVs and/or LH2TVs through tunnels; and subsequently investigating in greater depth the potential hazards due to the transport of hydrogen in the worst cases individualized.
The Neo‐populist Surge in Italy between Territorial and Traditional Cleavages*
Authors: Bazzoli Nico , Lello Elisa
Published: December 2020

The rise of neo‐populist parties in Western countries is a current issue in social sciences. Over the past two decades, and with increasing emphasis in recent years, a notable body of research has been preoccupied with explaining the complex relationship between populism and places. This paper fits in this literature and is aimed at verifying the role played by territorial inequalities and the urban‐rural divide on voting preferences in Italy. Through a detailed statistical analysis carried out at the municipal scale, we hereby compare recent trends in national (2013, 2018) and European (2019) Elections with socioeconomic and demographic data to shed light on the drivers of political change. In particular, we focus on the two main Italian parties labeled as populist: the Lega and the Movimento 5 Stelle. Analyses show that support for such parties is only partially related to rural areas, territorial inequalities, and place peripherality, highlighting the need for a more comprehensive explanation of the neo‐populist surge. Accordingly, we argue that besides demand‐side factors, other supply‐side ones should be considered, especially in Italy, where electoral behaviors are embedded in diverse local geopolitical histories that still play an important role in orienting voting.
Motivations for Social Interaction: The Case of Pokémon Go After the Fad Ended
Authors: Evans Jocelyn , Evans Sara Z. , Shank Daniel B. , Fallon Quinton P.
Published: December 2020

Objective

We survey Pokémon Go players regarding motivations/patterns of gameplay and sociability over time to understand human interaction in augmented game settings. We disentangle effects of solo versus social and past versus current gameplay through replication of the Pokémon Go Motive Scale.

Methods

We use OLS regression to determine how motivation affects hours of gameplay, to measure changes in hours spent playing Pokémon Go, and to capture perceptions of engagement with the game over time.

Results

We find seven motivations: exercise, fun, escapism, nostalgia, friendship maintenance, relationship initiation, and achievement. Initiating new relationships leads to increased social playing time and increased perceptions of Pokémon Go as both interesting and challenging.

Conclusion

Intrinsic rewards hold the most staying power as a distinct motivation for gameplay. Implications go beyond Pokemon Go gaming to shed light on the differential impact of human motivation for social interaction in games that utilize augmented reality.
Epidemiology of multimorbidity among people living with HIV in sub-Saharan Africa: a systematic review protocol
Authors: Oladimeji Kelechi Elizabeth , Dzomba Armstrong , Adetokunboh Olatunji , Zungu Lindiwe , Yaya Sanni , Goon Daniel Ter
Published: December 2020

Introduction

Sub-Saharan Africa remains the epicentre of the HIV pandemic, yet enormous knowledge gaps still exist to elicit a comprehensive portrait of multimorbidity and HIV linkage. This study aims to conduct a systematic meta-analysis of peer-reviewed literature to investigate the current status of multimorbidity epidemiology among people living with HIV (PLHIV) in sub-Saharan Africa.

Methods and analysis

Our review will assess observational studies (ie, cohort, case–control and cross-sectional) on multimorbidity associated with HIV/AIDS between 1 January 2005 and 31 October 2020 from sub-Saharan Africa. Databases to be searched include PubMed/MEDLINE, Scopus, Web of Science, Cochrane library, African Index Medicus and African Journals Online. We will also search the WHO clinical trial registry and databases for systematic reviews. The search strategy will involve the use of medical subject headings and key terms to obtain studies on the phenomena of HIV and multimorbidity at high precision. Quality assessment of eligible studies will be ascertained using a validated quality assessment tool for observational studies and risk of bias through sensitivity analysis to identify publication bias. Further, data on characteristics of the study population, multimorbid conditions, epidemiological rates and spatial distribution of multimorbid conditions in PLHIV will be extracted. Heterogeneity of individual studies will be evaluated using the I2 statistic from combined effect size estimates. The statistical analysis will be performed using STATA statistical software V.15 and results will be graphically represented on a forest plot.

Ethics and dissemination

Ethical approval is not applicable in this study as it is a systematic review of published literature. The review findings may also be presented at conferences or before other relevant stakeholders.

PROSPERO registration number

CRD42020148668.
Barriers and facilitators to patient uptake and utilisation of digital interventions for the self-management of low back pain: a systematic review of qualitative studies
Authors: Svendsen Malene Jagd , Wood Karen Wood , Kyle John , Cooper Kay , Rasmussen Charlotte Diana Nørregaard , Sandal Louise Fleng , Stochkendahl Mette Jensen , Mair Frances S , Nicholl Barbara I
Published: December 2020

Objectives

Low back pain (LBP) is a leading contributor to disability globally. Self-management is a core component of LBP management. We aimed to synthesise published qualitative literature concerning digital health interventions (DHIs) to support LBP self-management to: (1) determine engagement strategies, (2) identify barriers and facilitators affecting patient uptake/utilisation and (3) develop a preliminary conceptual model of barriers and facilitators to uptake/utilisation.

Design

Systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

Data sources

MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, DoPHER, TRoPHI, Web of Science and OT Seeker, from January 2000 to December 2018, using the concepts: LBP, DHI and self-management.

Eligibility criteria

Peer-reviewed qualitative study (or component) examining engagement with, or barriers and/or facilitators to the uptake/utilisation of an interactive DHI for self-management of LBP in adults (community, primary or secondary care settings).

Data extraction and synthesis

Standardised data extraction form was completed. COREQ (Consolidated criteria for Reporting Qualitative research) checklist was used to assess methodology. Data was synthesised narratively for engagement strategies, thematically for barriers/facilitators to uptake/utilisation and normalisation process theory was applied to produce a conceptual model.

Results

We identified 14 191 citations, of which 105 full-text articles were screened, and five full-text articles from four studies included. These were from community and primary care contexts in Europe and the USA, and involved 56 adults with LBP and 19 healthcare professionals. There was a lack of consideration on how to sustain engagement with DHIs. Examination of barriers and facilitators for uptake/utilisation identified four major themes: IT (information technology) usability–accessibility; quality–quantity of content; tailoring–personalisation; and motivation–support. These themes informed the development of a preliminary conceptual model for uptake/utilisation of a DHI for LBP self-management.

Conclusions

We highlight key barriers and facilitators that should be considered when designing DHIs for LBP self-management. Our findings are in keeping with reviews of DHIs for other long-term conditions, implying these findings may not be condition specific.

Systematic review registration

A protocol for this systematic review was registered with https://www.crd.york.ac.uk/PROSPERO/ (CRD42016051182) on 10 November 2016. https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42016051182
Engaging practices and communities in the development of interventions to promote HPV vaccine uptake: a protocol for implementing Boot Camp Translation in the private practice setting
Authors: Brewer Sarah E , Simpson Matthew J , Rice John D , Skendaore Amanda , O'Leary Sean T
Published: December 2020

Introduction

TheHealthy People 2020report states a goal of 80% uptake of recommended vaccines among adolescents, including the human papillomavirus (HPV) vaccine. However, the rate of uptake of the HPV vaccine is estimated at 51% in 2018, which leaves young people vulnerable to morbidity and mortality from preventable, HPV-related cancers. Reasons for this are multifactorial and include factors at the level of the provider, primary care practice, patient and family, and community. The development of interventions that are responsive to these multifactorial barriers in real-world settings is a priority. Boot Camp Translation (BCT) is a community-engaged approach to message development for translating evidence-based practices into clinics and communities. This project aims to (1) Engage practices and communities in the development of interventions to promote HPV vaccine uptake and (2) Evaluate the impact of the BCT-designed intervention on practice-level HPV vaccine initiation rates. We hypothesise that the BCT-designed intervention will increase the rate of HPV vaccine initiation in the practices.

Methods and analysis

This study will implement HPV-focused BCT in three counties in Colorado with a below average county-level vaccination rate. Each BCT group will design a multipronged intervention targeted at patients, parents, providers and the general community to then be disseminated in the participating practices and communities over the subsequent 6-month period. The long-term goal is to develop a replicable approach and low-cost method of increasing HPV vaccine uptake that is easily adaptable to different settings and sociodemographic contexts.

Ethics and dissemination

This study is approved by the Colorado Multiple Institutional Review Board. Results will be disseminated through peer-reviewed manuscripts and conference presentations, as well as within Colorado practice-based research networks.

Trial registration number

NCT04279964
Maximum blood glucose levels during hospitalisation to predict mortality in patients with acute coronary syndrome: a retrospective cohort study
Authors: Qian Jun , Kuang Lijun , Che Lin , Chen Fei , Liu Xuebo
Published: December 2020

Objective

The aim in this study was to stratify maximum blood glucose levels to identify the the best cut-off value of glucose levels to predict mortality in acute coronary syndrome (ACS) patients, regardless of whether they had diabetes.

Design

A retrospective cohort study.

Setting

All clinical data were obtained from the ‘Medical Information Mart for Intensive Care III’ database.

Participants

A total of 3078 patients with ACS were included in the study. We divided the patients into four levels based on their maximum blood glucose levels (glucosemax), then analysed the relationship between each group with mortality.

Results

Among enrolled patients, 2780 and 298 were survivors and non-survivors, respectively. Blood glucose levels and mortality showed a ‘tick’ type relationship, with levels 3 and 4 found to be closely associated with increased hospital mortality (p<0.05), relative to level 1 (<6.1 mmol/L), used as the reference group. No significant association was observed in mortality between level 2 and level 1 (p=0.095). In addition, we found a gradual increase in OR for level 2 (OR: 2.42, 95% CI 0.86 to 6.80, p=0.095), level 3 (OR: 4.33, 95% CI 1.55 to 12.13, p=0.005) and level 4 (OR: 7.27, 95% CI 2.56 to 20.62, p<0.001), relative to level 1. Based on receiver operating characteristic curves, the optimal cut-off value for predicting mortality were 11.5 (area under curve (AUC)=0.724), 11.2 (AUC=0.729), 13.4 (AUC=0.638), 15.8 (AUC=0.717) and 11.3 mmol/L (AUC=0.764) in all ACS, acute myocardial infarction, unstable angina, diabetes and non-diabetes patients, respectively. The results of subgroup analysis suggested that in patients with significantly elevated blood glucose, the mortality of non-diabetes was higher than patients with diabetes (OR: 0.42, 95% CI 0.31 to 0.57, p<0.001).

Conclusion

Overall, glucosemax ≥11.5 mmol/L had a significant association with increased mortality in patients with ACS. Non-diabetes ACS patients need a more robust blood glucose management strategy compared with diabetes counterparts.
Use of infectious disease surveillance reports to monitor the Zika virus epidemic in Latin America and the Caribbean from 2015 to 2017: strengths and deficiencies
Authors: Morris Joan K , Dolk Helen , Durán Pablo , Orioli Ieda Maria
Published: December 2020

Objectives

To summarise the occurrence of congenital Zika syndrome (CZS) in Latin America and the Caribbean from 2015 to 2017 using two outcome measures derived from infectious disease surveillance reports and to assess the completeness of these reports.

Design

Surveillance study.

Setting

Pan American Health Organization (PAHO)/WHO epidemiology reports on confirmed and suspected Zika virus infection and cases of CZS.

Participants

Populations of 47 countries in the South and Central Americas, Mexico and the Caribbean.

Primary and secondary outcome measures

The number of CZS cases per 1000 births (using 2016–2017 births as a denominator) and the number of CZS cases per 1000 births in women with Zika virus infection during pregnancy.

Results

By 4 January 2018, 548623 suspected and 239063 confirmed Zika virus infections had been reported to PAHO/WHO from 47 countries. In 25 countries, over 80% of infections were reported as suspected. There were 3617 confirmed CZS cases in 25 countries; 2952 (82%) had occurred in Brazil. The number of CZS cases per 1000 births varied considerably with Brazil and several Caribbean island communities (Puerto Rico, St Martin, Martinique, Guadeloupe and Grenada) having the highest CZS prevalence above 0.5 per 1000 births. Analysing the number of CZS cases per 1000 births in women infected with Zika virus during their pregnancy highlighted the inaccuracies of the data, with Venezuela likely to have had severe under-reporting of CZS.

Conclusions

Expressing data on CZS in relation to total births, rather than as absolute numbers, better illustrates the burden of disease, providing that under-reporting of CZS is not too severe. Data on infections in pregnant women enable potential under-reporting of CZS to be identified. Both measures are recommended for future PAHO/WHO publications. Evidence of severe under-reporting of Zika virus infections and CZS makes interpretation of the data and comparisons between countries challenging.
Perceptions and experiences of the public regarding the COVID-19 pandemic in Nepal: a qualitative study using phenomenological analysis
Authors: Bhatt Navin , Bhatt Bandana , Gurung Soniya , Dahal Suresh , Jaishi Amrit Raj , Neupane Bandana , Budhathoki Shyam Sundar
Published: December 2020

Objectives

Perceptions of people regarding COVID-19 influences their health behaviour in terms of seeking public health services. This helps the government in planning appropriate public health strategies. Therefore, this study intends to explore the perceptions of people towards COVID-19 and their experiences during the pandemic in Nepal.

Design, setting and participants

This qualitative study was conducted among the public in Kathmandu, Kanchanpur, Bajura and Jhapa districts of Nepal. Eight focus group discussions and 40 in-depth interviews were conducted by using a maximum variation sampling method.

Results

The findings were organised into the following themes: General understanding of COVID-19, Disease prevention, Source of information and misconceptions, Expectation and challenges; and Personal and societal consequences of COVID-19, social distancing and lockdown. There was a good general understanding among respondents about COVID-19, personal preventive measures and population-level strategies. They responded that the use of masks, sanitisers, handwashing and proper lockdown would help to prevent the disease. The respondents acknowledged the vital role of media in increasing awareness. Participants also expressed concerns over the misleading news spread by some media. The lack of social interaction, isolation and loss of income were raised as pertinent issues by the participants as potentially leading to psychological consequences. Health workers and public both raised concerns over inadequate Personal Protective Equipment, under-prepared health system, unorganised public quarantine centres, and public violation of lockdown

Conclusions

This study reports participants’ views on disease prevention measures such as maintaining personal hygiene, adhering to physical distancing, and using personal protective equipments. Additionally, it illuminates the confusion among public due to conflicting public health messages from different sources of information which was deemed as misleading by the participants. This research sheds light on people’s perspectives and experiences that can inform population-targeted policies in the future.
Processing of positive newborn screening results: a qualitative exploration of current practice in England
Authors: Chudleigh Jane , Chinnery Holly , Holder Pru , Carling Rachel S , Southern Kevin , Olander Ellinor , Moody Louise , Morris Stephen , Ulph Fiona , Bryon Mandy , Simpson Alan
Published: December 2020

Objective

To explore current communication practices for positive newborn screening results from the newborn bloodspot screening (NBS) laboratory to clinicians to highlight differences, understand how the pathways are implemented in practice, identify barriers and facilitators and make recommendations for future practice and research.

Design

A qualitative exploratory design was employed using semi-structured interviews.

Setting

Thirteen NBS laboratories in England.

Participants

Seventy-one clinicians; 22 NBS laboratory staff across 13 laboratories and 49 members of relevant clinical teams were interviewed.

Results

Assurance of quality and consistency was a priority for all NBS laboratories. Findings indicated variation in approaches to communicating positive NBS results from laboratories to clinical teams. This was particularly evident for congenital hypothyroidism and was largely influenced by local arrangements, resources and the fact individual laboratories had detailed standard operating procedures for how they work. Obtaining feedback from clinical teams to the laboratory after the child had been seen could be challenging and time-consuming for those involved. Pathways for communicating carrier results for cystic fibrosis and sickle cell disease could be ambiguous and inconsistent which in turn could hamper the laboratories efforts to obtain timely feedback regarding whether or not the result had been communicated to the family. Communication pathways for positive NBS results between laboratories and clinical teams could therefore be time-consuming and resource-intensive.

Conclusion

The importance placed on ensuring positive NBS results were communicated effectively and in a timely fashion from the laboratory to the clinical team was evident from all participants. However, variation existed in terms of the processes used to report positive NBS results to clinical teams and the people involved. Variant practice identified may reflect local needs, but more often reflected local resources and a more consistent ‘best practice’ approach is required, not just in the UK but perhaps globally.

Trial registration number

ISRCTN15330120.