bluuebunny/crossref_metadata_2025 huggingface dataset:
Proliferation of Chondrodonta as a proxy of environmental instability at the onset of OAE1a: Insights from shallow‐water limestones of the Apulia Carbonate Platform
Authors: Del Viscio Gabriella , Frijia Gianluca , Posenato Renato , Singh Pulkit , Lehrmann Daniel J. , Payne Jonathan L. , Al‐Ramadan Khalid , Struck Ulrich , Jochum Klaus P. , Morsilli Michele
Published: May 2021

Chondrodonta is an opportunistic, oyster‐like bivalve, common in shallow‐water carbonates of the Cretaceous Tethyan Realm. Despite its high abundance and widespread geographic distribution, the precise relationship between the early Aptian proliferation and environmental perturbations resulting from the Oceanic Anoxic Event 1a (OAE1a), has not been investigated. Stratigraphic and geochemical analyses of the lower Aptian Chondrodonta bedsets within the inner platform limestones of the Apulia Carbonate Platform (Gargano Promontory, southern Italy) are conducted to assess the environmental controls on the Chondrodonta proliferation and its timing and causal relationship to OAE1a. Chondrodonta occurs with sparse to common individuals within requieniid rudist floatstone–rudstones, forms monospecific biostromes during the early phase of stressed environmental conditions and then rapidly disappears at the peak of OAE1a. It proliferates in dysoxic seawater with relatively increased trophic sources, which correlate to increasing nutrient levels in the nearby pelagic realm. Chondrodonta‐rich beds are associated worldwide with the onset of OAE1a and occur in a transitional context between a stable and a strongly stressed environment, where the opportunistic behaviour of Chondrodonta is rather efficient. Increasing nutrient load and unstable environmental conditions right below the peak of OAE1a created an environmental ‘window’ favourable for Chondrodonta to proliferate, outplaying the less tolerant benthos (for example, rudists). The occurrence, duration and position of the environmental window were controlled by local palaeogeographic and hydrodynamic settings (i.e. low energy, decreased seawater oxygenation and circulation). Further increase in inhospitable conditions, leading to OAE1a, constituted an upper threshold for Chondrodonta and allowed mesotrophic taxa like Bacinella–Lithocodium and orbitolinids to dominate the benthic communities. The present study suggests that the proliferation of Chondrodonta in shallow‐water platform carbonates can be used as proxy for the initial phase of ecological stress related to OAE1a.
Changing the healthcare financing paradigm: Domestic actors and international organizations in the agenda setting for diffusion of social health insurance in post‐communist Central and Eastern Europe
Authors: Kaminska Monika Ewa , Druga Ertila , Stupele Liva , Malinar Ante
Published: May 2021

This study elucidates the role of international organizations and domestic actors in post‐communist healthcare reforms aiming at a paradigmatic shift in healthcare financing and the introduction of social health insurance in Albania, Latvia and Poland. It inductively derives a causal mechanism behind the reform processes from these case studies. We demonstrate that the agenda setting for changing the healthcare financing paradigm was domestically driven and underpinned by the “nothing like the old regime” causal mechanism. In the context of post‐communist transition in Central and Eastern Europe this mechanism translated into an “anti‐communist backlash”. The backlash defined the domestic actors' perception of social health insurance as the only acceptable policy option because of its dissimilarity to the previous healthcare financing paradigm, and led to the rejection of World Bank suggestions to retain tax‐based healthcare financing in Poland and Albania. Doctors as policy entrepreneurs played the key role in agenda setting. Pre‐communist experience with social health insurance schemes and transnational cooperation with German and French experts and doctors served as sources of internal and external validation for the new paradigm.
Linking Extraversion to Collective and Individual Forms of Political Participation: The Mediating Role of Political Discussion
Authors: Huber Brigitte , Goyanes Manuel , Gil de Zúñiga Homero
Published: May 2021

Objectives

Scholars are increasingly investigating the role of citizens’ personality in activating political behavior. We test whether extraversion is associated to collective political activities (i.e., activities that include social interaction) and individual ones (i.e., activities that do not include social interactions).

Methods

We use originally collected survey data from five countries (Brazil, Korea, Russia, United States, United Kingdom).

Results

We found that extraversion is positively and directly related to collective political activities in Brazil, Korea and Russia. Results show no direct relationship between individual forms of political activities and extraversion. However, political discussion fully mediates the relationship between extraversion and individual forms of political activities in all five countries.

Conclusion

This study contributes to growing discussions on the role of personality traits in explaining political participation across countries, arguing that the relationship between extraversion and diverse forms of political participation are also context‐driven and nourished by political discussion.
Integration of eddy current sensors into repair patches for fatigue reinforcement at rivet holes
Authors: Schmid Sebastian , Martens Ulrike , Schomburg Werner Karl , Schröder Kai‐Uwe
Published: May 2021

Fatigue cracks at rivet holes occur at advanced service life of aircrafts due to cyclic loading. As a repair method, adhesively bonded stiffener patches enhance the fatigue life of the structure by delaying crack initiation and reducing crack growth. Combining a crack sensor with a repair patch to a sensor‐based stiffener patch allows crack growth reduction and monitoring at the same time. This paper presents a feasibility study on the integration of eddy current sensors into carbon fibre reinforced plastic (CFRP) repair patches. To this end, a specific patch design is developed, and samples are manufactured by ultrasonic fabrication. The performance of the patches is investigated in fatigue tests in terms of ‘crack reinforcement’ and ‘crack detection.’ Both requirements are met. The undertaking of future efforts to tailor the sensor‐based repair patch concept to an individual application in aircraft maintenance seems reasonable.
Do cross‐border mergers and acquisitions reflect participations into global value chains?
Authors: Cipollina Maria , Pietrovito Filomena , Pozzolo Alberto Franco
Published: May 2021

Global value chains (GVCs) are a major feature of globalisation, with a strong impact on the patterns of international trade. In this paper, we study the link between GVCs and cross‐border mergers and acquisitions (M&As), testing the two symmetric hypotheses that a higher degree of participation in GVCs increases the probability that a firm acquires: (i) the producers of their imported inputs or (ii) the users of their exported products. Our analysis is based on a unique data set covering 12 supplier and user sectors, for over 22 investor countries and 47 target countries between 1995 and 2010. Estimating an augmented gravity equation model of cross‐border M&As, inflated with a large number of bilateral sector and country‐fixed effects, we find strong evidence of a positive and statistically significant impact of GVC participation on the total value of cross‐border M&As, although the economic impact is substantial only in the case of few sectors.
Investigation of the Vibration Features and Dynamic Load Sharing Characteristics of Concentric Face Gear Torque Split Transmission
Authors: Dong Jianxiong , Hu Zehua , Tang Jinyuan , Wang Zhiwei , Chen Siyu
Published: May 2021

A concentric face gear torque split system used in the helicopter main transmission to transfer more power and reduce the structure weight is introduced. A mathematical model is proposed to analyze the vibration characteristics as well as load sharing performances of the torque split system. The excitations including mesh stiffness, backlash, static transmission error, and system work torque are considered in the model. The vibration property, dynamic displacement responses, and the system factors which affect the load sharing capacity of the system are studied based on the numerical analysis results. The results show that vibration forms of the system can be classified into three categories: pinion vibration mode, face gear vibration mode, and pinion coupled face gear mode. Resonance peaks and jump phenomena are detected around rotation speed 5772 rpm and 10,250 rpm, mainly related to the coupled translational–rotational–axial of face gears vibration modes. In addition, appropriate gear pair backlash and pinion distribution angle parameters are significant to improve the dynamic load sharing capacity. The increase of the pinion bearings' supporting stiffness will generate worse load sharing characteristics and a relative flexible bearing is recommended to the pinions' supporting.
On the Impact of Aspect Ratio and Other Geometric Effects on the Stability of Rectangular Thermosiphons
Authors: Nguyen Tri , Merzari Elia
Published: May 2021

Single-phase natural circulation thermosiphon loops have been attracting increased interest as they represent the prototype of passive safety systems. However, the stability properties of thermosiphon loops, which can affect and compromise their functionality, are still actively investigated. Traditionally, the stability analysis of thermosiphon loops has been simplified to one-dimensional (1D) calculations, on the argument that the flow would be monodimensional when the diameter of the pipe D is orders of magnitude smaller than the length of the loop Lt. However, at lower Lt/D ratios, rectangular thermosiphon loops show that the flow presents three-dimensional (3D) effect, which also has been confirmed by stability analyses in toroidal loops. In this paper, we performed a series of high-fidelity simulations using the spectral-element code nek5000 to investigate the stability behavior of the flow in rectangular thermosiphon loops. A wide range of Lt/D ratio from 10 to 200 has been considered, and the results show many different outcomes compared to previous 1D analytical calculations or stability theory. Moreover, we analyzed the flow in rectangular thermosiphon loops using proper orthogonal decomposition (POD), and we observed that the cases without flow reversal are characterized by swirl modes typical of bent pipes and high-frequency oscillation of the related time coefficients obtained by Galerkin projection. However, the swirl mode was not observed in cases with flow reversals, and these cases are characterized by symmetric flow field at second POD mode and the similarity of low-frequency oscillation in the projection of POD modes.
Mechatronic Design and Active Disturbance Rejection Control of a Bag Valve-Based Mechanical Ventilator
Authors: Arcos-Legarda Jaime , Tovar Andres
Published: May 2021

This paper presents the mechatronic (mechanical and control system) design of a functional prototype of a portable mechanical ventilator to treat patients with a compromised respiratory function. The portable ventilator ensures adequate oxygenation and carbon dioxide clearance while avoiding ventilator-induced lung injury (VILI). Oxygen is delivered through the compression of a bag valve (Ambu bag) using a moving strap. Carbon dioxide is cleared through the control of a pinch valve actuated by a low-torque servomotor. The positive end-expiratory pressure (PEEP) is controlled by an adjustable mechanical valve of the system. An Arduino Mega microcontroller board is used in this prototype to control the respiratory variables. All mechanical components as well as sensors, actuators, and control hardware are of common use in robotics and are very inexpensive. The total cost of the prototype built in this work is about $425 U.S. dollars. The design is meant to be replicated and utilized in emergency conditions that involve an overwhelming number of cases, such as COVID-19 treatment, in places with no access to commercial mechanical ventilation (MV) technologies. In order to account for variations in the prototype as built, the software developed for this portable MV applies an active disturbance rejection control (ADRC) strategy. This control strategy is presented as a universal control structure for any mechanical ventilator able to supply air flow with controlled pressure and volume.
Detecting, classifying, and counting blue whale calls with Siamese neural networks
Authors: Zhong Ming , Torterotot Maelle , Branch Trevor A. , Stafford Kathleen M. , Royer Jean-Yves , Dodhia Rahul , Lavista Ferres Juan
Published: May 2021

The goal of this project is to use acoustic signatures to detect, classify, and count the calls of four acoustic populations of blue whales so that, ultimately, the conservation status of each population can be better assessed. We used manual annotations from 350 h of audio recordings from the underwater hydrophones in the Indian Ocean to build a deep learning model to detect, classify, and count the calls from four acoustic song types. The method we used was Siamese neural networks (SNN), a class of neural network architectures that are used to find the similarity of the inputs by comparing their feature vectors, finding that they outperformed the more widely used convolutional neural networks (CNN). Specifically, the SNN outperform a CNN with 2% accuracy improvement in population classification and 1.7%–6.4% accuracy improvement in call count estimation for each blue whale population. In addition, even though we treat the call count estimation problem as a classification task and encode the number of calls in each spectrogram as a categorical variable, SNN surprisingly learned the ordinal relationship among them. SNN are robust and are shown here to be an effective way to automatically mine large acoustic datasets for blue whale calls.
Physical Activity, Sedentary Behavior, and Time in Bed Among Finnish Adults Measured 24/7 by Triaxial Accelerometry
Authors: Husu Pauliina , Tokola Kari , Vähä-Ypyä Henri , Sievänen Harri , Suni Jaana , Heinonen Olli J. , Heiskanen Jarmo , Kaikkonen Kaisu M. , Savonen Kai , Kokko Sami , Vasankari Tommi
Published: May 2021

Background: Studies measuring physical activity (PA) and sedentary behavior on a 24/7 basis are scarce. The present study assessed the feasibility of using an accelerometer at the hip while awake and at the wrist while sleeping to describe 24/7 patterns of physical behavior in working-aged adults by age, sex, and fitness. Methods: The study was based on the FinFit 2017 study where the physical behavior of 20- to 69-year-old Finns was assessed 24/7 by triaxial accelerometer (UKKRM42; UKK Terveyspalvelut Oy, Tampere, Finland). During waking hours, the accelerometer was kept at the right hip and, during time in bed, at the nondominant wrist. PA variables were based on 1-min exponential moving average of mean amplitude deviation of the resultant acceleration signal analyzed in 6-s epochs. The angle for the posture estimation algorithm was used to identify sedentary behavior and standing. Evaluation of time in bed was based on the wrist movement. Fitness was estimated by the 6-min walk test. Results: A total of 2,256 eligible participants (mean age 49.5 years, SD = 13.5, 59% women) wore the accelerometer at the hip 15.7 hr/day (SD = 1.4) and at the wrist 8.3 hr/day (SD = 1.4). Sedentary behavior covered 9 hr 18 min/day (SD = 1.8 hr/day), standing nearly 2 hr/day (SD = 0.9), light PA 3.7 hr/day (SD = 1.3), and moderate to vigorous PA 46 min/day (SD = 26). Participants took 7,451 steps per day (SD = 2,962) on average. Men were most active around noon, while women had activity peaks at noon and at early evening. The low-fit tertile took 1,186 and 1,747 fewer steps per day than the mid- and high-fit tertiles (both p < .001). Conclusions: One triaxial accelerometer with a two wear-site approach provides a feasible method to characterize hour-by-hour patterns of physical behavior among working-aged adults.
The Effect of Information Placebo on Physical Activity in Overweight and Obese Children
Authors: Fanti-Oren Shira , Birenbaum-Carmeli Daphna , Eliakim Alon , Pantanowitz Michal , Schujovitzky Dana , Nemet Dan
Published: May 2021

Purpose: To assess the effect of 1 week of consuming a placebo “energy drink” compared with a week of drinking regular water on daily physical activity in obese children participating in a weight reduction multidisciplinary program. Methods: Seventeen prepubertal (age = 128.7 [26.6] m) overweight and obese children (7 females and 10 males) participated in the study. Participants received 7 bottles of mineral water per week for 2 weeks. Different types of information were randomly provided regarding the drink consumed in each week: standard (water) versus deliberate positive information (presumed energy drink and placebo). Daily step count was measured using pedometers and compared using paired t test. Results: After consuming the placebo drink, children demonstrated a significantly higher average daily step number (10,452 [4107]) compared with the days they drank water (8168 [2928], P < .005). This difference was attributed mainly to male participants. Conclusion: The use of placebo in the form of deliberate positive information was associated with a significant increase in real-life physical activity in overweight and obese children, especially in boys. Positive information may be used to encourage children with obesity to enhance daily physical activity and energy expenditure.
Correlation Between Heart Rate at Maximal Fat Oxidation and Aerobic Threshold in Healthy Adolescent Boys and Girls
Authors: Meucci Marco , Nandagiri Vibhav , Kavirayuni Venkata S. , Whang Alexander , Collier Scott R.
Published: May 2021

Purpose: To investigate the association between the heart rate (HR) at maximal fat oxidation (MFO) and the HR at the aerobic threshold (AerT) in adolescent boys and girls, and to identify sex differences in the intensity that elicits MFO (Fatmax) as a percentage of HR peak (HRpeak). Methods: Fifty-eight healthy adolescents participated in this study (29 boys and 29 girls). Participants performed a cardiopulmonary exercise test on a cycle ergometer. MFO was calculated using a stoichiometric equation, and the AerT was identified using gas exchange parameters. Results: A strong correlation between HR at Fatmax and HR at AerT was found in both boys and girls (r = .96 and .94, respectively). Fatmax as a percentage of HRpeak occurred at 61.0% (4.9%) of HRpeak and 66.8% (6.9%) of HRpeak in adolescent boys and girls (P = .001, F = 13.6), respectively. MFO was higher in boys compared with girls (324 [150] and 240 [95] mg/min, respectively), and no sex differences were observed in the relative contribution of fat to energy expenditure at Fatmax. Conclusions: HR at Fatmax and HR at AerT were highly correlated in adolescent boys and girls. Girls obtained Fatmax at a higher percentage of HRpeak than boys.
Earth's climate destiny finally seen more clearly
Authors: Voosen Paul
Published: May 2021

Landmark study narrows bounds for "climate sensitivity," ruling out benign warming.
Chaperone-mediated autophagy regulates the pluripotency of embryonic stem cells
Authors: Xu Yi , Zhang Yang , García-Cañaveras Juan C. , Guo Lili , Kan Mengyuan , Yu Sixiang , Blair Ian A. , Rabinowitz Joshua D. , Yang Xiaolu
Published: May 2021

Autophagy regulates stemness

Embryonic stem cells can propagate indefinitely and differentiate when called to do so. Xu
et al.
now analyze how cellular metabolism affects the balance between pluripotency and differentiation (see the Perspective by Borsa and Simon). For cells in the pluripotent state, the transcription factors Oct4 and Sox2 suppress chaperone-mediated autophagy (CMA). When CMA is released with differentiation, the isocitrate dehydrogenases IDH1 and IDH2 are degraded, resulting in less α-ketoglutarate, which is needed by the histone and DNA demethylases that sustain pluripotency. CMA thus links cellular metabolism to epigenetic regulation, tipping the balance between pluripotent renewal and differentiation.

Science
, this issue p.
397
; see also p.
373
COVID-19 affects HIV and tuberculosis care
Authors: Abdool Karim Quarraisha , Abdool Karim Salim S.
Published: May 2021

The COVID-19 response should be balanced with the need to manage other diseases
Mathematical models to guide pandemic response
Authors: Metcalf C. Jessica E. , Morris Dylan H. , Park Sang Woo
Published: May 2021

Models can be used to learn from the past and prepare for the future
The pull of the red planet
The Sirens of Mars
Sarah Stewart Johnson
Crown, 2020. 288 pp.
Once Upon a Time I Lived on Mars
Kate Greene
St. Martin's Press, 2020. 240 pp.
Authors: Shindell Matthew
Published: May 2021

Two candid accounts consider the history and future of life on Mars
Macroscale entanglement and measurement
Authors: Lau Hoi-Kwan , Clerk Aashish A.
Published: May 2021

The entangled motion of macroscopic vibrating membranes can be measured precisely
The frontier is not endless for all
Authors: Thorp H. Holden
Published: May 2021

Recent weeks have seen numerous calls for more investment in research and development (R&D) in the United States. This is understandable with a new administration that is friendlier to science and with The Endless Frontier Act—a measure that could double the budget of the National Science Foundation in 5 years—under consideration in Congress. Proponents of the bill are heralding its potential to enhance America's competitiveness: A large part of the new money would go for “use-inspired” basic research aimed at economic growth. Although the new money for science would be long overdue, and there are provisions in the bill to try to extend its geographical benefit, care must be taken to ensure that funds are distributed more equitably than in the past. If science in the United States is truly to be an endless frontier, the benefits must extend equitably to all.
Detection of CTX-M-27 β-Lactamase Genes on Two Distinct Plasmid Types in ST38 Escherichia coli from Three U.S. States
Authors: Cameron Andrew , Mangat Rupinder , Mostafa Heba H. , Taffner Samantha , Wang Jun , Dumyati Ghinwa , Stanton Richard A. , Daniels Jonathan B. , Campbell Davina , Lutgring Joseph D. , Pecora Nicole D.
Published: May 2021

Infections caused by extended-spectrum β-lactamase (ESBL)-producing
Escherichia coli
are a significant cause of morbidity and health care costs. Globally, the prevailing clonal type is ST131 in association with the
bla
CTX-M-15
β-lactamase gene.
Simultaneous acute myocardial infarction, stroke and critical limb ischaemia: an unusual presentation requiring multidisciplinary approach
Authors: Simpson Danielle Lee
Published: May 2021

We report the case of a 57-year-old man who presented overnight to a district general hospital as a primary percutaneous coronary intervention alert for an inferior ST elevation myocardial infarction. On presentation to cardiac catheterisation lab, he had ongoing chest pain but began to complain of left-sided limb weakness and pain in his right leg. He was found to have dense hemiparesis on examination with an National Institute of Health Stroke Scale of 8 and an absent right femoral pulse. During the procedure, his common iliac arteries were imaged showing a complete occlusion of his right common iliac. After stenting the culprit lesion in his right coronary artery, he was transferred to a different hospital within the trust where he could receive thrombolysis for his stroke. Unfortunately, after thrombolysis, he went on to develop haemorrhagic transformation of his stroke and an upper gastrointestinal bleed with prolonged recovery of his neurological symptoms after a 27-day hospital stay; but CT arterial imaging showed resolution of right common iliac occlusion predischarge. Here, we discuss the best possible approach to management with simultaneous thrombotic events.
Oral myofibroma presenting as an aggressive gingival lesion
Authors: Savithri Vindhya , Suresh Rakesh , Janardhanan Mahija , Aravind Thara
Published: May 2021

Myofibromas are benign neoplasms of myofibroblastic origin and rarely encountered in the oral cavity. Myofibroma may frequently grow rapidly leading to suspicion of malignancy. This may lead to a tendency for aggressive management. The histopathology of this tumour has similarity with other spindle cell tumours and often requires immunohistochemical staining for diagnosis. Here, we present a case of myofibroma in a 15-year-old female patient who reported with an aggressive gingival swelling and discuss the various histopathological differential diagnosis.
Arterial events, venous thromboembolism, thrombocytopenia, and bleeding after vaccination with Oxford-AstraZeneca ChAdOx1-S in Denmark and Norway: population based cohort study
Authors: Pottegård Anton , Lund Lars Christian , Karlstad Øystein , Dahl Jesper , Andersen Morten , Hallas Jesper , Lidegaard Øjvind , Tapia German , Gulseth Hanne Løvdal , Ruiz Paz Lopez-Doriga , Watle Sara Viksmoen , Mikkelsen Anders Pretzmann , Pedersen Lars , Sørensen Henrik Toft , Thomsen Reimar Wernich , Hviid Anders
Published: May 2021

Objective

To assess rates of cardiovascular and haemostatic events in the first 28 days after vaccination with the Oxford-AstraZeneca vaccine ChAdOx1-S in Denmark and Norway and to compare them with rates observed in the general populations.

Design

Population based cohort study.

Setting

Nationwide healthcare registers in Denmark and Norway.

Participants

All people aged 18-65 years who received a first vaccination with ChAdOx1-S from 9 February 2021 to 11 March 2021. The general populations of Denmark (2016-18) and Norway (2018-19) served as comparator cohorts.

Main outcome measures

Observed 28 day rates of hospital contacts for incident arterial events, venous thromboembolism, thrombocytopenia/coagulation disorders, and bleeding among vaccinated people compared with expected rates, based on national age and sex specific background rates from the general populations of the two countries.

Results

The vaccinated cohorts comprised 148 792 people in Denmark (median age 45 years, 80% women) and 132 472 in Norway (median age 44 years, 78% women), who received their first dose of ChAdOx1-S. Among 281 264 people who received ChAdOx1-S, the standardised morbidity ratio for arterial events was 0.97 (95% confidence interval 0.77 to 1.20). 59 venous thromboembolic events were observed in the vaccinated cohort compared with 30 expected based on the incidence rates in the general population, corresponding to a standardised morbidity ratio of 1.97 (1.50 to 2.54) and 11 (5.6 to 17.0) excess events per 100 000 vaccinations. A higher than expected rate of cerebral venous thrombosis was observed: standardised morbidity ratio 20.25 (8.14 to 41.73); an excess of 2.5 (0.9 to 5.2) events per 100 000 vaccinations. The standardised morbidity ratio for any thrombocytopenia/coagulation disorders was 1.52 (0.97 to 2.25) and for any bleeding was 1.23 (0.97 to 1.55). 15 deaths were observed in the vaccine cohort compared with 44 expected.

Conclusions

Among recipients of ChAdOx1-S, increased rates of venous thromboembolic events, including cerebral venous thrombosis, were observed. For the remaining safety outcomes, results were largely reassuring, with slightly higher rates of thrombocytopenia/coagulation disorders and bleeding, which could be influenced by increased surveillance of vaccine recipients. The absolute risks of venous thromboembolic events were, however, small, and the findings should be interpreted in the light of the proven beneficial effects of the vaccine, the context of the given country, and the limitations to the generalisability of the study findings.
Health spending and vaccination coverage in low-income countries
Authors: Castillo-Zunino Francisco , Keskinocak Pinar , Nazzal Dima , Freeman Matthew C
Published: May 2021

Introduction

Routine immunisation is a cost-effective way to save lives and protect people from disease. Some low-income countries (LIC) achieved remarkable success in childhood immunisation. Yet, previous studies comparing the relationship between economic growth and health spending with vaccination coverage have been limited. We investigated these relationships among LIC to understand what financial changes lead to childhood immunisation changes.

Methods

We identified which financial indicators were significant predictors of vaccination coverage in LIC by fitting regression models for several vaccines, controlling for population density, land area and female years of education. We then identified LIC with high vaccination coverage (LIC+) and compared their economic and health spending trends with other LIC (LIC−) and lower-middle income countries. We used cross-country multi-year regressions with mixed-effects to test financial indicators’ rate of change. We conducted statistical tests to verify if financial trends of LIC+ were significantly different from LIC−.

Results

During 2014–2018, gross domestic product per capita (p=0.67–0.95, range given by tests with different vaccines), total/private health spending per capita (p=0.57–0.97, p=0.32–0.57) and aggregated development assistance for health (DAH) per capita (p=0.38–0.86) were not significant predictors of vaccination coverage in LIC. Government health spending per capita (p=0.022–0.073) and total/government spending per birth on routine immunisation vaccines (p=0.0007–0.029, p=0.016–0.052) were significant positive predictors of vaccination coverage. From 2000 to 2016, LIC+ increased government health spending per capita by US$0.30 per year, while LIC− decreased by US$0.16 (significant difference, p<0.0001). From 2006 to 2017, LIC+ increased government spending per birth on routine immunisation vaccines by US$0.22 per year, while LIC− increased by US$0.10 (p<0.0093).

Conclusion

Vaccination coverage success of some LIC was not explained by economic development, total health spending nor aggregated DAH. Vaccination coverage success of LIC+ was associated with increasing government health spending particularly in routine immunisation vaccines.
Clinical course and outcome of patients with COVID-19 in Mumbai City: an observational study
Authors: de Souza Rosemarie , Mhatre Sharayu , Qayyumi Burhanuddin , Chitkara Garvit , Madke Tushar , Joshi Mohan , Bharmal Ramesh , Asgaonkar D S , Lakhani Prem , Gupta Sudeep , Chaturvedi Pankaj , Dikshit Rajesh , Badwe Rajendra
Published: May 2021

Objective

To understand the outcome of hospitalised patients from Mumbai City, which had the highest number of COVID-19 cases in India.

Design

Observational study with follow-up.

Setting

Data extraction from medical records of patients with COVID-19 admitted to Nair Hospital & TN Medical College, Mumbai, India.

Participants

689 patients with COVID-19 were admitted in the hospital from 26 March 2020 to 11 May 2020.

Primary and secondary outcome measures

In-hospital mortality; joint effect of comorbidity and age on the risk of dying.

Results

A total of 689 patients (median age 44 years) admitted with RT-PCR-confirmed COVID-19 were included in the study. Of these, 77.36% of patients were discharged alive while 22.64% died. 11.61% required some kind of oxygen support while 2.8% of patients required intensive care unit admissions. Older age (HR 2.88, 95% CI 2.09 to 3.98), presence of comorbidities (HR 2.56, 95% CI 1.84 to 3.55), history of hypertension (HR 3.19, 95% CI 1.67 to 6.08), and presence of symptoms at the time of admission (HR 3.21, 95% CI 1.41 to 7.26) were associated with increased risk of in-hospital mortality. Treatment with a combination of azithromycin with hydroxychloroquine, antiviral or steroid compared with no treatment did not alter the disease course and in-hospital mortality. The combined effect of old age and presence of comorbid conditions was more pronounced in women than men.

Conclusions

In-hospital patients were younger, less symptomatic with lesser need of ventilators and oxygen support as compared with many western countries.

Trial registration

Not applicable (observational study, not a clinical trial).
Practice of death surveillance and response for maternal, newborn and child health: a framework and application to a South African health district
Authors: Mukinda Fidele Kanyimbu , George Asha , Van Belle Sara , Schneider Helen
Published: May 2021

Objective

To assess the functioning of maternal, perinatal, neonatal and child death surveillance and response (DSR) mechanisms at a health district level.

Design

A framework of elements covering analysis of causes of death, and processes of review and response was developed and applied to the smallest unit of coordination (subdistrict) to evaluate DSR functioning. The evaluation design was a descriptive qualitative case study, based on observations of DSR practices and interviews.

Setting

Rural South African health district (subdistricts and district office).

Participants

A purposive sample of 45 front-line health managers and providers involved with maternal, perinatal, neonatal and child DSR. The DSR mechanisms reviewed included a system of real-time death reporting (24 hours) and review (48 hours), a nationally mandated confidential enquiry into maternal death and regular facility and subdistrict mortality audit and response processes.

Primary outcome measures

Functioning of maternal, perinatal, neonatal and child DSR.

Results

While DSR mechanisms were integrated into the organisational routines of the district, their functioning varied across subdistricts and between forms of DSR. Some forms of DSR, notably those involving maternal deaths, with external reporting and accounting, were more likely to trigger reactive fault-finding and sanctioning than other forms, which were more proactive in supporting evidence-based actions to prevent future deaths. These actions occurred at provider and system level, and to a limited extent, in communities.

Conclusions

This study provides an empirical example of the everyday practice of DSR mechanisms at a district level. It assesses such practice based on a framework of elements and enabling organisational processes that may be of value in similar settings elsewhere.
Timeliness of diagnosis of breast and cervical cancers and associated factors in low-income and middle-income countries: a scoping review protocol
Authors: Nnaji Chukwudi A , Kuodi Paul , Walter Fiona M , Moodley Jennifer
Published: May 2021

Introduction

Breast and cervical cancer are leading causes of morbidity and mortality in women globally, with disproportionately high burdens in low-income and middle-income countries (LMICs). While the incidence of both cancers increases across LMICs, many cases continue to go undiagnosed or diagnosed late. The aim of this review is to comprehensively map the current evidence on the time to breast or cervical cancer diagnosis and its associated factors in LMICs.

Methods and analysis

This scoping review (ScR) will be informed by Arksey and O"Malley’s enhanced ScR methodology framework. It will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We will conduct a comprehensive search of the following electronic databases: MEDLINE (via PubMed), Cochrane Library, Scopus and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). Two reviewers will independently screen all abstracts and full texts using predefined inclusion criteria. All publications describing the time to diagnosis and its associated factors in the contexts of breast or cervical cancer will be considered for inclusion. Evidence will be narratively synthesised and analysed using a predefined conceptual framework.

Ethics and dissemination

As this is a ScR of publicly available data, with no primary data collection, it will not require ethical approval. Findings will be disseminated widely through a peer-reviewed publication and forums such as conferences and community engagement sessions. This review will provide a user-friendly evidence summary for understanding the enormity of diagnostic delays and associated factors for breast and cervical cancers in LMICs, while helping to inform policy actions and implementation of interventions for addressing such delays.
Semiqualitative research protocol to explore cancer care workforce perceptions of the health system response to COVID-19 preparations in Southeast Queensland, Australia
Authors: Gasper Harry , Ahern Elizabeth , Roberts Natasha , Chan Bryan , Hughes Brett , Kennedy Glen , Wyld David , Eastgate Melissa , Lwin Zarnie
Published: May 2021

Introduction

Sars-CoV-2 is a novel coronavirus responsible for COVID-19 officially declared pandemic in March 2020. Health systems worldwide responded with swift changes to increase workflow capacity while protecting the vulnerable, including those with cancer. This led to unprecedented and rapid restructuring of health service provision. Published data from the 2003 SARS pandemic focuses on medical and nursing staff, overlooking other departmental employees such as administration officers or food service workers. Our protocol aims to document directives and adjustments communicated to staff in two cancer care departments and correlate this with measures of distress and perceived preparedness across the spectrum of all staff involved in cancer care.

Methods and analysis

We use a semiqualitative approach comprising weekly diarising of events and simultaneous staff surveys. Principal investigators will document changes at a metropolitan quaternary cancer centre and a regional cancer centre. Communications, directives and changes will be diarised in real time in four executional domains. Simultaneously, prospective voluntary self-administered online surveys will be conducted at regular intervals by staff. The survey assesses the perceived institutional preparedness and personal well-being, with a combination of Likert scaled and open response questions. A semiquantitative self-assessment of distress adapted from National Comprehensive Cancer Network distress thermometer is incorporated. Additionally, open-text personal reflections on themes including difficult decisions will be invited. Survey participants will be drawn from various work areas of the cancer care departments: administrative staff, health professionals, for example, allied health, ancillary workers, nursing and medical.

Ethics and dissemination

The study has been reviewed and approved by the Human Research Ethics Committee (LNR/2020/QRBW/62982). Published literature on domains of distress neglects categories of healthcare worker who form an essential part of the care delivery team. Our study hopes to gather insights about psychosocial impact and adjustment which could direct responses in future emergencies.
Collaboration and knowledge generation in an 18-year quality improvement research programme in Australian Indigenous primary healthcare: a coauthorship network analysis
Authors: Bailie Jodie , Potts Boyd Alexander , Laycock Alison Frances , Abimbola Seye , Bailie Ross Stewart , Cunningham Frances Clare , Matthews Veronica , Bainbridge Roxanne Gwendalyn , Conte Kathleen Parker , Passey Megan Elizabeth , Peiris David
Published: May 2021

Objectives

Though multidisciplinary research networks support the practice and effectiveness of continuous quality improvement (CQI) programmes, their characteristics and development are poorly understood. In this study, we examine publication outputs from a research network in Australian Indigenous primary healthcare (PHC) to assess to what extent the research network changed over time.

Setting

Australian CQI research network in Indigenous PHC from 2002 to 2019.

Participants

Authors from peer-reviewed journal articles and books published by the network.

Design

Coauthor networks across four phases of the network (2002–2004; 2005–2009; 2010–2014; 2015–2019) were constructed based on author affiliations and examined using social network analysis methods. Descriptive characteristics included organisation types, Indigenous representation, gender, student authorship and thematic research trends.

Results

We identified 128 publications written by 308 individual authors from 79 different organisations. Publications increased in number and diversity over each funding phase. During the final phase, publication outputs accelerated for organisations, students, project officers, Indigenous and female authors. Over time there was also a shift in research themes to encompass new clinical areas and social, environmental or behavioural determinants of health. Average degree (8.1), clustering (0.81) and diameter (3) indicated a well-connected network, with a core-periphery structure in each phase (p≤0.03) rather than a single central organisation (degree centralisation=0.55–0.65). Academic organisations dominated the core structure in all funding phases.

Conclusion

Collaboration in publications increased with network consolidation and expansion. Increased productivity was associated with increased authorship diversity and a decentralised network, suggesting these may be important factors in enhancing research impact and advancing the knowledge and practice of CQI in PHC. Publication diversity and growth occurred mainly in the fourth phase, suggesting long-term relationship building among diverse partners is required to facilitate participatory research in CQI. Despite improvements, further work is needed to address inequities in female authorship and Indigenous authorship.
Do people living in rural and urban locations experience differences in harm when admitted to hospital? A cross-sectional New Zealand general practice records review study
Authors: Atmore Carol , Dovey Susan , Gauld Robin , Gray Andrew R , Stokes Tim
Published: May 2021

Objective

Little is known about differences in hospital harm (injury, suffering, disability, disease or death arising from hospital care) when people from rural and urban locations require hospital care. This study aimed to assess whether hospital harm risk differed by patients’ rural or urban location using general practice data.

Design

Secondary analysis of a 3-year retrospective cross-sectional general practice records review study, designed with equal numbers of rural and urban patients and patients from small, medium and large practices. Hospital admissions, interhospital transfer and hospital harm were identified.

Setting

New Zealand (NZ) general practice clinical records including hospital discharge data.

Participants

Randomly selected patient records from randomly selected general practices across NZ. Patient enrolment at rural and urban general practices defined patient location.

Outcomes

Admission and harm risk and rate ratios by rural-urban location were investigated using multivariable analyses adjusted for age, sex, ethnicity, deprivation, practice size. Preventable hospital harm, harm severity and harm associated with interhospital transfer were analysed.

Results

Of 9076 patient records, 1561 patients (17%) experienced hospital admissions with no significant association between patient location and hospital admission (rural vs urban adjusted risk ratio (aRR) 0.98 (95% CI 0.83 to 1.17)). Of patients admitted to hospital, 172 (11%) experienced hospital harm. Rural location was not associated with increased hospital harm risk (aRR 1.01 (95% CI 0.97 to 1.05)) or rate of hospital harm per admission (adjusted incidence rate ratio 1.09 (95% CI 0.83 to 1.43)). Nearly half (45%) of hospital harms became apparent only after discharge. No urban patients required interhospital transfer, but 3% of rural patients did. Interhospital transfer was associated with over twice the risk of hospital harm (age-adjusted aRR 2.33 (95% CI 1.37 to 3.98), p=0.003).

Conclusions

Rural patient location was not associated with increased hospital harm. This provides reassurance for rural communities and health planners. The exception was patients needing interhospital transfer, where risk was more than doubled, warranting further research.
Spatial distribution and factors associated with low birth weight in Ethiopia using data from Ethiopian Demographic and Health Survey 2016: spatial and multilevel analysis
Authors: Liyew Alemneh Mekuriaw , Sisay Malede Mequanent , Muche Achenef Asmamaw
Published: May 2021

Objective

This study aimed to assess the spatial distribution, individual and community-level factors associated with low birth weight in Ethiopia.

Method

Secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Survey data. A total of 2110 neonates were included in this study. Spatial autocorrelation analysis was conducted to assess the spatial clustering of LBW. Besides, the spatial scan statistics and ordinary kriging interpolation were done to detect the local level clusters and to assess predicted risk areas, respectively. Furthermore, a multilevel logistic regression model was fitted to determine individual and community-level factors associated with LBW. Finally, most likely clusters with log-likelihood ratio (LLR), relative risk and p value from spatial scan statistics and adjusted OR (AOR) with 95% CI for multilevel logistic regression model were reported.

Results

LBW was spatially clustered in Ethiopia. Primary (LLR=11.57; p=0.002) clusters were detected in the Amhara region. Neonates within this spatial window had a 2.66 times higher risk of being LBW babies as compared with those outside the window. Besides, secondary (LLR=11.4; p=0.003; LLR=10.14, p=0.0075) clusters were identified at southwest Oromia, north Oromia, south Afar and southeast Amhara regions. Neonates who were born from severely anaemic (AOR=1.40, 95% CI (1.03 to 2.15)), and uneducated (AOR=1.90, 95% CI (1.23 to 2.93)) mothers, those who were born before 37 weeks of gestation (AOR=5.97, 95% CI (3.26 to 10.95)) and women (AOR=1.41, 95% CI (1.05 to 1.89)), had significantly higher odds of being LBW babies.

Conclusion

The high-risk areas of LBW were detected in Afar, Amhara and Oromia regions. Therefore, targeting the policy interventions in those hotspot areas and focusing on the improvement of maternal education, strengthening anaemia control programmes and elimination of modifiable causes of prematurity could be vital for reducing the LBW disparity in Ethiopia.
Prevalence and dynamic features of psychological issues among Chinese healthcare workers during the COVID-19 pandemic: a systematic review and cumulative meta-analysis
Authors: Zhang Huijuan , Li Wei , Li Hui , Zhang Caidi , Luo Jinjing , Zhu Yikang , Wu Hui , Zhu Zhuoying , Xu Yifeng , Wang Jijun , Li Chunbo
Published: May 2021

Background

The COVID-19 pandemic has placed tremendous pressure on healthcare workers who are at the frontline in the battle against it, causing various forms of psychological distress.

Aims

To outline the prevalence and dynamic changing features of medical workers’ psychological issues and to review the related national policies during the COVID-19 pandemic in China.

Methods

We systematically searched for studies on the psychological states of Chinese medical staff from 1 January 2020 to 8 May 2020. The aggregate prevalence of each psychological issue was calculated and plotted to observe the changes over time. Policies on psychological support for medical staff during the pandemic were reviewed to explore their link to the prevalence of psychological problems.

Results

In total, 26 studies were included in this study. A total of 22 062 medical workers were surveyed from 31 January to 27 February 2020. Medical staff exhibited a substantial prevalence of anxiety symptoms, depression symptoms, stress-related symptoms and sleep problems during the survey period, with aggregate prevalence rates of 27.0%, 26.2%, 42.1% and 34.5%, respectively. Cumulative meta-analyses revealed that the prevalence of psychological distress peaked at the beginning of the pandemic and subsequently exhibited a slow downward trend.

Conclusion

Chinese medical staff displayed significant psychological disturbance during the outbreak of the COVID-19 pandemic, which was especially severe at the early stage. Implementing supportive policies may help alleviate ongoing psychological problems in healthcare workers.