bluuebunny/crossref_metadata_2025 huggingface dataset:
Rationale for azithromycin in COVID-19: an overview of existing evidence
Authors: Gyselinck Iwein , Janssens Wim , Verhamme Peter , Vos Robin
Published: January 2021

Azithromycin has rapidly been adopted as a repurposed drug for the treatment of COVID-19, despite the lack of high-quality evidence. In this review, we critically appraise the current pharmacological, preclinical and clinical data of azithromycin for treating COVID-19. Interest in azithromycin has been fuelled by favourable treatment outcomes in other viral pneumonias, a documented antiviral effect on SARS-CoV-2 in vitro and uncontrolled case series early in the pandemic. Its antiviral effects presumably result from interfering with receptor mediated binding, viral lysosomal escape, intracellular cell-signalling pathways and enhancing type I and III interferon expression. Its immunomodulatory effects may mitigate excessive inflammation and benefit tissue repair. Currently, in vivo reports on azithromycin in COVID-19 are conflicting and do not endorse its widespread use outside of clinical trials. They are, however, mostly retrospective and therefore inherently biased. The effect size of azithromycin may depend on when it is started. Also, extended follow-up is needed to assess benefits in the recovery phase. Safety data warrant monitoring of drug–drug interactions and subsequent cardiac adverse events, especially with hydroxychloroquine. More prospective data of large randomised controlled studies are expected and much-needed. Uniform reporting of results should be strongly encouraged to facilitate data pooling with the many ongoing initiatives.
One-stop shop for variceal surveillance: integration of unsedated ultrathin endoscopy into the routine clinic visit
Authors: Eqbal Ali , Wickremeratne Tehara , Turner Stephanie , Higgins Sarah Elizabeth , Sloss Andrew , Mitchell Jonathan , O'Beirne James
Published: January 2021

Background

The endoscopic appearance of oesophageal varices determines the need for prophylaxis. However, as the point prevalence of varices is low (25%), the majority of surveillance endoscopies are unnecessary and costly. Narrow diameter,ultrathin (UT) endoscopes are more tolerable than conventional upper gastrointestinal (UGI) endoscopes and can be used without sedation. We hypothesised that unsedated UT endoscopy for variceal surveillance could be implemented during the routine outpatient clinic visit allowing accurate diagnosis of varices and the timely provision of prophylaxis.

Methods

Patients with cirrhosis awaiting surveillance endoscopy were identified. UT endoscopy was scheduled during routine clinic review at the same time as ultrasound surveillance for hepatocellular carcinoma. UGI endoscopy was performed unsedated using the E.G Scan II disposable endoscope. Varices were graded using the modified Paquet classification. Video recordings of procedures were reviewed by blinded assessors and agreement was assessed using the kappa statistic.

Results

40 patients (80% male) underwent unsedated UT endoscopy. All procedures were successful and tolerated well in 98% of cases. Median procedure time was 2 min (IQR 1–3). Varices were found in 37.5% (17.5% grade 1 and 20% grade 2). Patients with grade 2 varices were prescribed non-selective beta blockers at the clinic appointment. Kappa statistic for the finding of any varices was 0.636 (p=0.001) and 0.8–1.0 for diagnosis of grade 2 varices (p<0.0001).

Conclusions

Outpatient unsedated ultrathin endoscopy in patients with cirrhosis is accurate, safe and feasible. This integrative care model is convenient, particularly for regional communities, and is likely to result in significant cost savings associated with variceal surveillance.
Association of sleep duration with all-cause and disease-specific mortality in US adults
Authors: Yang Lili , Xi Bo , Zhao Min , Magnussen Costan G
Published: January 2021

Background

Previous studies revealed inconsistent findings regarding the association between sleep duration and all-cause and disease-specific mortality. This study aimed to clarify the association of sleep duration with mortality using a large population-based prospective cohort study from the USA.

Methods

We used data from the National Health Interview Survey (2004–2014) linked to National Death Index records to 31 December 2015. A total of 284 754 participants aged ≥18 years were included. Self-reported sleep duration (average time slept in a 24-hour period) was categorised into seven groups: ≤4 hours, 5 hours, 6 hours, 7 hours (reference), 8 hours, 9 hours and ≥10 hours. Study outcomes included all-cause, cardiovascular disease-specific and cancer-specific mortality. Cox proportional hazards models were used to examine the association between sleep duration and mortality.

Results

During a median follow-up of 5.25 years, we identified 20 872 deaths, of which 4 129 were cardiovascular disease-related and 5 217 were cancer-related. Compared with 7 hours/day of sleep, both short and long sleep durations were associated with an increased risk of all-cause mortality (≤4 hours: HR=1.46, 95% CI=1.33–1.61; 5 hours: HR=1.22, 95% CI=1.13–1.32; 6 hours: HR=1.10, 95% CI=1.05–1.17; 8 hours: HR=1.22, 95% CI=1.17–1.28; 9 hours: HR=1.41, 95% CI=1.31–1.51; ≥10 hours: HR=2.00, 95% CI=1.88–2.13). Similar results were observed for cardiovascular disease-specific and cancer-specific mortality.

Conclusions

Our study indicates that both short (≤6 hours/day) and long (≥8 hours/day) sleep durations increase the risk of mortality compared with sleep of 7 hours/day. A normal sleep duration (about 7 hours) every day is recommended for health benefits.
Reach Out and Read and Developmental Screening: Using Federal Dollars through a Health Services Initiative
Authors: Dunlap Marny , Lake Lori , Patterson Shelly , Perdue Bryon , Caldwell Alexandria
Published: January 2021

Oklahoma established the first health services initiative (HSI) to expand Reach Out and Read (ROR), increase developmental screening and improve the quality of well-child visits (Early and Periodic Screening, Diagnostic and Treatment (EPSDT)). ROR uses a book in the exam room to assess development and parent-child interaction, however, little is known about the relationship between this training and using a formal developmental screening tool. The purpose of this study is to see if using federal funding would facilitate ROR expansion and if this expansion would improve developmental screening and EPSDT visits in Oklahoma. Medicaid billing data for state fiscal year (SFY) 2018 and 2019 were analyzed. Standard statistical methods were used to analyze the data descriptively to determine the proportion of developmental screenings performed and EPSDT visits. Comparisons were made between ROR and non-ROR sites. Nine new ROR sites were added with 26 new providers/staff and 130 providers/staff at existing sites trained in ROR from Novenber 2018 to June 2019. In SFY 2018, the developmental screening percentage at non-ROR sites was 33% vs 47% at ROR sites (p<0.0001), in SFY 2019 non-ROR sites were 36% vs 48% at ROR sites (p<0.0001). The EPSDT visit percentage in SFY 2018 was 50% at non-ROR sites vs 69% at ROR sites and in SFY 2019 was 51% at non-ROR sites vs 72% at ROR sites. HSIs are an effective way to fund ROR. Additional funding allowed for increased ROR sites and training. ROR sites are more likely to perform developmental screenings and EPSDT visits.
Ethical examination of deep brain stimulation’s ‘last resort’ status
Authors: Stevens Ian , Gilbert Frederic
Published: January 2021

Deep brain stimulation (DBS) interventions are novel devices being investigated for the management of severe treatment-resistant psychiatric illnesses. These interventions require the invasive implantation of high-frequency neurostimulatory probes intracranially aiming to provide symptom relief in treatment-resistant disorders including obsessive-compulsive disorder and anorexia nervosa. In the scientific literature, these neurostimulatory interventions are commonly described as reversible and to be used as a last resort option for psychiatric patients. However, the ‘last resort’ status of these interventions is rarely expanded upon. Contrastingly, usages of DBS devices for neurological symptoms (eg, Parkinson’s disease, epilepsy or dystonia) have paved the way for established safety and efficacy standards when used earlier in a disease’s timeline. As DBS treatments for these neurological diseases progress to have earlier indications, there is a parallel ethical concern that early implementation may one day become prescribed for psychiatric illnesses. The purpose of this article is to build off contemporary understandings of reversible neurostimulatory interventions to examine and provide clarifications on the ‘last resort’ status of DBS to better address its ethically charged use in psychiatric neurosurgery. To do this, evaluative differences between DBS treatments will be discussed to demonstrate how patient autonomy would be a paramount guiding principle when one day implementing these devices at various points along a psychiatric disease’s timeline. In presenting the clarification of ‘last resort’ status, the ethical tensions of early DBS interventions will be better understood to assist in providing psychiatric patients with more quality of life years in line with their values.
Mitigating ethical conflict and moral distress in the care of patients on ECMO: impact of an automatic ethics consultation protocol
Authors: Wirpsa M Jeanne , Carabini Louanne M , Neely Kathy Johnson , Kroll Camille , Wocial Lucia D
Published: January 2021

Aims

This study evaluates a protocol for early, routine ethics consultation (EC) for patients on extracorporeal membrane oxygenation (ECMO) to support decision-making in the context of clinical uncertainty with the aim of mitigating ethical conflict and moral distress.

Methods

We conducted a single-site qualitative analysis of EC documentation for all patients receiving ECMO support from 15 August 2018 to 15 May 2019 (n=68). Detailed analysis of 20 ethically complex cases with protracted ethics involvement identifies four key ethical domains: limits of prognostication, bridge to nowhere, burden of treatment and system-level concerns. There are three subthemes: relevant contextual factors, the role of EC and observed outcomes. Content analysis of transcripts from interviews with 20 members of the multidisciplinary ECMO team yields supplemental data on providers’ perceptions of the impact of the early intervention protocol.

Results

Limited outcome data for ECMO, unclear indications for withdrawal, adverse effects of treatment and an obligation to attend to programme metrics present significant ethical challenges in the care of this patient population. Upstream EC mitigates ethical conflict by setting clear expectations about ECMO as a time limited trial, promoting consistent messaging among multiple services and supporting surrogate decision-makers. When ECMO becomes a ‘bridge to nowhere’, EC facilitates decision-making that respects patient values yet successfully sets limits on non-beneficial use of this novel therapy.

Conclusion

Data from this study support the conclusion that ECMO poses unique ethical challenges that necessitate a standardised protocol for early, routine EC—at least while this medical technology is in its nascent stages.
Taking it to the bank: the ethical management of individual findings arising in secondary research
Authors: Graham Mackenzie , Hallowell Nina , Solberg Berge , Haukkala Ari , Holliday Joanne , Kerasidou Angeliki , Littlejohns Thomas , Ormondroyd Elizabeth , Skolbekken John-Arne , Vornanen Marleena
Published: January 2021

A rapidly growing proportion of health research uses ‘secondary data’: data used for purposes other than those for which it was originally collected. Do researchers using secondary data have an obligation to disclose individual research findings to participants? While the importance of this question has been duly recognised in the context of primary research (ie, where data are collected from participants directly), it remains largely unexamined in the context of research using secondary data. In this paper, we critically examine the arguments for a moral obligation to disclose individual research findings in the context of primary research, to determine if they can be applied to secondary research. We conclude that they cannot. We then propose that the nature of the relationship between researchers and participants is what gives rise to particular moral obligations, including the obligation to disclose individual results. We argue that the relationship between researchers and participants in secondary research does not generate an obligation to disclose. However, we also argue that the biobanks or data archives which collect and provide access to secondary data may have such an obligation, depending on the nature of the relationship they establish with participants.
Red herrings, circuit-breakers and ageism in the COVID-19 debate
Authors: Lawrence David R , Harris John
Published: January 2021

In their recent paper ‘Why lockdown of the elderly is not ageist and why levelling down equality is wrong’ Savulescu and Cameron attempt to argue the case for subjecting the ‘elderly’ to limits not imposed on other generations. We argue that selective lockdown of the elderly is unnecessary and cruel, as well as discriminatory, and that this group may suffer more than others in similar circumstances. Further, it constitutes an unjustifiable deprivation of liberty.
Hearing loss as a predictor for hearing protection attenuation among miners
Authors: Ullman Elon D , Smith Lauren M , McCullagh Marjorie C , Neitzel Richard L
Published: January 2021

Objective

This study investigated risk factors for poor earplug fit, with a focus on the association between hearing loss and personal attenuation ratings (PARs).

Methods

Earplug fit was assessed by obtaining PARs using a real ear at attenuation threshold (REAT) system. Hearing loss was assessed using the unoccluded hearing thresholds measured during the REAT testing and the results of a speech-in-noise test. Potential predictors of PARs were modelled using both simple and multiple linear regression. Hearing loss was the primary predictor of interest.

Results

Data were collected from 200 workers at ten above-ground mining sites in the Midwestern USA. Workers reported wearing their hearing protection on average 73.9% of the time in a high noise environment (mean 8-hour time-weighted average noise exposure 85.5 dBA, range 65–103 dBA). One-quarter (26.7%) of workers were found to have a hearing loss (hearing threshold ≥25 dB across 1–4 kHz), and 42% reported symptoms of tinnitus. Workers with a hearing loss had a significantly lower PAR than those without a hearing loss (β=−5.1, SE=1.7).

Conclusions

The results of the adjusted regression models suggest that workers with hearing loss achieved significantly lower PARs than those without hearing loss. This association between hearing loss and hearing protection devices (HPD) fit brings into focus the potential benefit of fit checks to be included in hearing conservation programmes. Workers found to have hearing loss should be prioritised for fit testing, as their hearing impairment may be associated with poor HPD fit.
Ambient temperatures, heatwaves and out-of-hospital cardiac arrest in Brisbane, Australia
Authors: Doan Tan N , Wilson Daniel , Rashford Stephen , Bosley Emma
Published: January 2021

Background

The health impacts of temperatures are gaining attention in Australia and worldwide. While a number of studies have investigated the association of temperatures with the risk of cardiovascular diseases, few examined out-of-hospital cardiac arrest (OHCA) and none have done so in Australia. This study examined the exposure–response relationship between temperatures, including heatwaves and OHCA in Brisbane, Australia.

Methods

A quasi-Poisson regression model coupled with a distributed lag non-linear model was employed, using OHCA and meteorological data between 1 January 2007 and 31 December 2019. Reference temperature was chosen to be the temperature of minimum risk (21.4°C). Heatwaves were defined as daily average temperatures at or above a heat threshold (90th, 95th, 98th, 99th percentile of the yearly temperature distribution) for at least two consecutive days.

Results

The effect of any temperature above the reference temperature was not statistically significant; whereas low temperatures (below reference temperature) increased OHCA risk. The effect of low temperatures was delayed for 1 day, sustained up to 3 days, peaking at 2 days following exposures. Heatwaves significantly increased OHCA risk across the operational definitions. When a threshold of 95th percentile of yearly temperature distribution was used to define heatwaves, OHCA risk increased 1.25 (95% CI 1.04 to 1.50) times. When the heat threshold for defining heatwaves increased to 99th percentile, the relative risk increased to 1.48 (1.11 to 1.96).

Conclusions

Low temperatures and defined heatwaves increase OHCA risk. The findings of this study have important public health implications for mitigating strategies aimed at minimising temperature-related OHCA.
Characteristics and outcomes of young patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: retrospective analysis in a multiethnic Asian population
Authors: Tung Benjamin WL , Ng Zhe Yan , Kristanto William , Saw Kalyar Win , Chan Siew-Pang , Sia Winnie , Chan Koo Hui , Chan Mark , Kong William , Lee Ronald , Loh Joshua P , Low Adrian F , Poh Kian Keong , Tay Edgar , Tan Huay Cheem , Yeo Tiong-Cheng , Loh Poay Huan
Published: January 2021

Objective

ST segment elevation myocardial infarction (STEMI) is associated with significant mortality leading to loss of productive life years, especially in younger patients. This study aims to compare the characteristics and outcomes of young versus older patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) to help focus public health efforts in STEMI prevention.

Methods

Data from the Coronary Care Unit database of the National University Hospital, Singapore from July 2015 to June 2019 were reviewed. Patients were divided into young (<50 years old) or older (≥50 years old) groups.

Results

Of the 1818 consecutive patients with STEMI who underwent PPCI, 465 (25.6%) were <50 years old. Young compared with older patients were more likely to be male, current smokers, of Indian ethnicity, have family history of ischaemic heart disease (IHD) and had lower 1 year mortality (3.4% vs 10.4%, p<0.0001). Although diabetes, hypertension or dyslipidaemia was less common among young patients, the prevalence of having any one of these risk factors was high in the range of 28% to 38%. Age was an independent predictor of mortality in the older but not younger patients with STEMI, and diabetes showed a trend towards mortality in both groups.

Conclusion

Young patients with STEMI are more often smokers, of Indian ethnicity and had family history of IHD, although cardiometabolic risk factors are also prevalent. Mortality is lower, but not negligible, among the young patients with STEMI. Public health efforts are needed to reduce the prevalence of these risk factors among the constitutionally susceptible population.
Tip of the iceberg: a tertiary care centre retrospective study of left ventricular hypertrophy aetiologies
Authors: Beneyto Maxime , Cariou Eve , Brunel Jérémy , Scripcariu Alex , Delasnerie Hubert , Brun Stéphanie , Lavie-Badie Yoan , Dupin Deguine Delphine , Galinier Michel , Carrié Didier , Lairez Olivier
Published: January 2021

Aims

To phenotype patients referred to a tertiary centre for the exploration of a left ventricular hypertrophy (LVH) starting from 12 mm of left ventricular wall thickness (LVWT).

Methods and results

Consecutive patients referred for aetiological workup of LVH, beginning at 12 mm of LVWT were retrospectively included in this tertiary single-centred observational study. Patients presenting with severe aortic stenosis were excluded. Aetiological workup was reviewed for each subject and aetiologies were adjudicated by expert consensus.

Among 591 patients referred for LVH aetiological workup, 41% had a maximal LVWT below 15 mm. LVH aetiologies were led by cardiac amyloidosis (CA, 34.3%), followed by sarcomeric hypertrophic cardiomyopathy (S-HCM, 32.1%), hypertensive cardiomyopathy (21.7%), unknown aetiology (7.6%) and other (4.2%), including Anderson-Fabry’s disease (1.7%). CA and S-HCM affected over 50% of patients with mild LVH (12–14 mm); the prevalence of these aetiologies rose with LVH severity. Among patients with Anderson-Fabry’s disease, 4 (40%) had a maximal LVWT <15 mm.

Conclusions

Mild LVH (ie, 12–14 mm) conceals multiple aetiologies that can lead to specific treatment, cascade family screening and specific follow-up. Overall, CA is nowadays the leading cause of LVH in tertiary centers.
Implementation of a national HIV pre-exposure prophylaxis service is associated with changes in characteristics of people with newly diagnosed HIV: a retrospective cohort study
Authors: Grimshaw Ceilidh , Estcourt Claudia S , Nandwani Rak , Yeung Alan , Henderson David , Saunders John Michael
Published: January 2021

Objectives

To review characteristics of individuals newly diagnosed with HIV following implementation of a national pre-exposure prophylaxis (PrEP) programme (comprehensive PrEP services, delivered in sexual health clinics) to inform future delivery and broader HIV prevention strategies.

Methods

We extracted data from national HIV databases (July 2015–June 2018). We compared sociodemographic characteristics of individuals diagnosed in the period before and after PrEP implementation, and determined the proportion of ‘potentially preventable’ infections with the sexual health clinic–based PrEP delivery model used.

Results

Those diagnosed with HIV before PrEP implementation were more likely to be male (342/418, 81.8% vs 142/197, 72.1%, p=0.005), be white indigenous (327/418, 78.2% vs 126/197, 64.0%, p<0.001), report transmission route as sex between men (219/418, 52.4% vs 81/197, 41.1%, p=0.014), and have acquired HIV in the country of the programme (302/418, 72.2% vs 114/197, 57.9% p<0.001) and less likely to report transmission through heterosexual sex (114/418, 27.3% vs 77/197, 39.1%, p=0.002) than after implementation.

Pre-implementation, 8.6% (36/418) diagnoses were ‘potentially preventable’ with the PrEP model used. Post-implementation, this was 6.6% (13/197), but higher among those with recently acquired HIV (49/170, 28.8%). Overall, individuals with ‘potentially preventable’ infections were more likely to be male (49/49, 100% vs 435/566, 76.9%, p<0.001), aged <40 years (37/49, 75.5% vs 307/566, 54.2%, p=0.004), report transmission route as sex between men (49/49, 100% vs 251/566, 44.3%, p<0.001), have previously received post-exposure prophylaxis (12/49, 24.5% vs 7/566, 1.2%, p<0.001) and less likely to be black African (0/49, 0% vs 67/566, 11.8%, p=0.010) than those not meeting this definition.

Conclusions

The sexual health clinic–based national PrEP delivery model appeared to best suit men who have sex with men and white indigenous individuals but had limited reach into other key vulnerable groups. Enhanced models of delivery and HIV combination prevention are required to widen access to individuals not benefiting from PrEP at present.
‘It’s literally giving them a solution in their hands’: the views of young Australians towards patient-delivered partner therapy for treating chlamydia
Authors: Layton Elly , Goller Jane L , Coombe Jacqueline , Temple-Smith Meredith , Tomnay Jane , Vaisey Alaina , Hocking Jane S
Published: January 2021

Objectives

Patient-delivered partner therapy (PDPT) is a method for providing antibiotic treatment for the sexual partners of an index patient with an STI by means of a prescription or medication that the index patient gives to their sexual partner(s). Qualitative research regarding barriers and enablers to PDPT has largely focused on the views of healthcare providers. In this study, we sought to investigate the views of young people (as potential health consumers) regarding PDPT for chlamydia.

Methods

Semi-structured telephone interviews were conducted with young Australian men and women. Participants were asked to provide their views regarding PDPT from the perspective of both an index patient and partner. Purposive and snowball sampling was used. Data were analysed thematically.

Results

We interviewed 22 people (13 women, 9 men) aged 18–30 years, 15 of whom had previously been tested for chlamydia. Despite none having previous knowledge of or experience using PDPT, all viewed it positively and thought it should be widely available. Participants reported that they would be willing to give PDPT to their sexual partners in situations where trust and comfort had been established, regardless of the relationship type. Protecting their partners’ privacy was essential, with participants expressing reluctance to provide their partners’ contact details to a doctor without consent. Beyond logistical benefits, PDPT was viewed as a facilitator to partner notification conversations by offering partners a potential solution. However, most interviewees indicated a preference to consult with a healthcare provider (GP or pharmacist) before taking PDPT medication. Participants indicated that legitimacy of information when navigating a chlamydia diagnosis was crucial and was preferably offered by healthcare providers.

Conclusions

Though PDPT is unlikely to fully replace partners’ interactions with healthcare providers, it may facilitate partner notification conversations and provide partners greater choice on how, when and where they are treated.
Youth and young adult risk perceptions and behaviours in response to an outbreak of e-cigarette/vaping-associated lung injury (EVALI) in the USA
Authors: Kreslake Jennifer M , Diaz Megan C , Shinaba Muftau , Vallone Donna M , Hair Elizabeth C
Published: January 2021

Objective

To determine whether awareness of emerging vaping-attributable health conditions influences vaping-related risk perceptions and behaviours among young people.

Design

Respondents aged 15–24 years (n=3536) were drawn from a repeated cross-sectional online panel survey (222 participants/week) during an e-cigarette/vaping-associated lung injury (EVALI) outbreak in the USA (September 2019–January 2020). Logistic regression models tested for associations between EVALI awareness and perceived lung injury risk and product harm, stratified by e-cigarette/vape use and controlling for awareness of other e-cigarette/vaping news stories, demographic characteristics and outbreak week. Other models measured the association between perceived risk of lung injury and intentions to use (non-users) or intentions to quit (current users) e-cigarettes/vape products. Changes in national retail e-cigarette sales data were examined during national EVALI outbreak reporting.

Results

EVALI awareness was associated with: perceived risk of lung injury (current users OR 1.59, p=0.004; non-users OR 2.11, p<0.001); belief that e-cigarettes/vapes contain dangerous chemicals (current users OR 1.47, p=0.017; non-users OR 1.88, p<0.001) and belief that e-cigarettes/vapes are harmful (current users OR 1.66, p=0.002; non-users OR 1.67, p<0.001). Perceived risk of lung injury from e-cigarette/vape use was associated with intentions to own e-cigarette/vape products (ever-users OR 0.25, p<0.001; never-users OR 0.61, p=0.004) and intentions to quit among current users (OR 2.02, p=0.002). Declines in e-cigarette sales were observed following news of the EVALI outbreak.

Conclusions

News of vaping-attributable health conditions may prevent e-cigarette/vape use and encourage cessation among young people. Tobacco control campaigns should address uncertain health effects of e-cigarettes or vape products and align with risk communication by public health agencies during outbreaks.
Exploring indigenous perspectives on tobacco tax: how some Māori families are responding in Aotearoa New Zealand
Authors: Gifford Heather , Waa Andrew , Cvitanovic Lynley , Potaka-Osborne Gill , Kerehoma-Cook Anania
Published: January 2021

Objective

High smoking prevalence rates, combined with a steep tax on tobacco and lower household income, mean that 5% of Māori (indigenous) whānau (family unit) expenditure in New Zealand is on tobacco. This paper outlines whānau perceptions of, and behavioural responses to, increasing tobacco tax.

Methods

This qualitative study was informed by the Kaupapa Māori theory and used a simplified interpretive phenomenological analysis thematic hybrid methodology. A semistructured, open-ended interview guide was designed and used in one-off focus group interviews.

Setting and participants

Interviews were separately conducted with each of 15 whānau units. A total of 72 participants, most of whom were smokers, took part in the interviews carried out in two geographical regions: one rural/provincial and one urban.

Results

Whānau were concerned about the rising cost of tobacco. However, this concern had not generally translated into quit attempts. Whānau had instead developed innovative tobacco-related practices. Working collectively within their whānau, they were able to continue to smoke, although in a modified fashion, despite the rising costs of tobacco. Whānau thereby resisted the intended outcome of the government’s tobacco tax which is to reduce rates of smoking prevalence.

Conclusion

In the face of significant government disinvestment in New Zealand tobacco control over the last 10 years, hypothecated taxes should be used to scale up Māori-specific cessation and uptake prevention programmes, supporting authentic Māori partnerships for endgame solutions including restricting the availability and appeal of tobacco.
The effect of selected drugs on the mitigation of myocardial injury caused by gamma radiation
Authors: Kura Branislav , Kalocayova Barbora , Szeiffova Bacova Barbara , Fulop Marko , Sagatova Andrea , Sykora Matus , Andelova Katarina , Abuawad Ziad , Slezak Jan
Published: January 2021

Radiation damage of healthy tissues represents one of the complications of radiotherapy effectiveness. This study is focused on the screening of potentially effective drugs routinely used in medical practice and involved in the mechanism of radiation injury, namely for radiation-induced production of free radicals in the body. Experiments in rats revealed significant reduction of oxidative stress (malondialdehyde) and inflammatory marker (tumor necrosis factor α) in 10 Gy irradiated groups after administration of atorvastatin and a slight decrease after tadalafil administration, which indicates that one of the possible mechanisms for mitigation of radiation-induced cardiac damage could be the modulation of nitric oxide (NO) in endothelium and phosphodiesterase 5. In addition, miRNAs were analyzed as potential markers and therapeutically effective molecules. Expression of miRNA-21 and miRNA-15b showed the most significant changes after irradiation. Atorvastatin and tadalafil normalized changes of miRNA (miRNA-1, miRNA-15b, miRNA-21) expression levels in irradiated hearts. This screening study concludes that administration of specific drugs could mitigate the negative impact of radiation on the heart, but more detailed experiments oriented to other aspects of drug effectiveness and their exact mechanisms are still needed.
Structure scalars and their evolution for massive objects in f(R) gravity
Authors: Bhatti M. Z. , Yousaf Z. , Tariq Z.
Published: January 2021

In this manuscript, the Riemann tensor is split orthogonally to get five scalar functions known as structure scalars which have significance to gain insight into the composition and structure of spherically symmetric self-gravitating objects. Certain stellar equations are then evaluated to gather information about physical characteristics of such astrophysical objects. These stellar equations are further written in terms of acquired structure scalars so that the basic properties such as pressure anisotropy and energy density inhomogeneity of the fluid under consideration can be explored. Also, we have explored few static spherically symmetric solutions to show significance of structure scalars in the background of f(R) gravity.
Polarized parton distribution functions: parametrization and transverse momentum dependence
Authors: Nematollahi H. , Abolhadi P. , Atashbar S. , Mirjalili A. , Yazdanpanah M. M.
Published: January 2021

We extract the polarized parton distribution functions (PPDFs) of proton. To this end we do a global analysis on recent and up-to-dated experimental data of polarized nucleon and deuteron structure functions at the NLO accuracy of perturbative QCD. We use the Jacobi polynomials expansion technique to do the required analyses. To achieve a more realistic estimation of the PPDFs and observable uncertainties we employ the Hessian error propagation. Following that we apply a theoretical approach which is based on imposing Lorentz structure in the parton model to investigate the transverse momentum dependence of these PPDFs. In this approach, the transverse momentum dependent (TMD) polarized parton distributions, which are also called the helicity distributions, are related to the integrated ones. This relation is indicating the priority and importance of data analysis for PPDFs. The results show a convenient general treatment expected for TMD densities which are in fact resulted from data analysis and fitting processes of integrated PPDFs in an adequate and a proper way.
ON THE APPROXIMATE SOLUTIONS FOR A SYSTEM OF COUPLED KORTEWEG–DE VRIES EQUATIONS WITH LOCAL FRACTIONAL DERIVATIVE
Authors: JAFARI HOSSEIN , JASSIM HASSAN KAMIL , BALEANU DUMITRU , CHU YU-MING
Published: January 2021

In this paper, we utilize local fractional reduced differential transform (LFRDTM) and local fractional Laplace variational iteration methods (LFLVIM) to obtain approximate solutions for coupled KdV equations. The obtained results by both presented methods (the LFRDTM and the LFLVIM) are compared together. The results clearly show that those suggested algorithms are suitable and effective to handle linear and as well as nonlinear problems in engineering and sciences.
NEW NEWTON’S TYPE ESTIMATES PERTAINING TO LOCAL FRACTIONAL INTEGRAL VIA GENERALIZED p-CONVEXITY WITH APPLICATIONS
Authors: LI YONG-MIN , RASHID SAIMA , HAMMOUCH ZAKIA , BALEANU DUMITRU , CHU YU-MING
Published: January 2021

This paper aims to investigate the notion of [Formula: see text]-convex functions on fractal sets [Formula: see text] Based on these novel ideas, we derived an auxiliary result depend on a three-step quadratic kernel by employing generalized [Formula: see text]-convexity. Take into account the local fractal identity, we established novel Newton’s type variants for the local differentiable functions. Several special cases are apprehended in the light of generalized convex functions and generalized harmonically convex functions. This novel strategy captures several existing results in the relative literature. Application is obtained in cumulative distribution function and generalized special weighted means to confirm the relevance and computational effectiveness of the considered method. Finally, we supposed that the consequences of this paper can stimulate those who are interested in fractal analysis.
ACHIEVING MORE PRECISE BOUNDS BASED ON DOUBLE AND TRIPLE INTEGRAL AS PROPOSED BY GENERALIZED PROPORTIONAL FRACTIONAL OPERATORS IN THE HILFER SENSE
Authors: AL-QURASHI MAYSAA , RASHID SAIMA , KARACA YELIZ , HAMMOUCH ZAKIA , BALEANU DUMITRU , CHU YU-MING
Published: January 2021

A user-friendly approach depending on nonlocal kernel has been constituted in this study to model nonlocal behaviors of fractional differential and difference equations, which is known as a generalized proportional fractional operator in the Hilfer sense. It is deemed, for differentiable functions, by a fractional integral operator applied to the derivative of a function having an exponential function in the kernel. This operator generalizes a novel version of Čebyšev-type inequality in two and three variables sense and furthers the result of existing literature as a particular case of the Čebyšev inequality is discussed. Some novel special cases are also apprehended and compared with existing results. The outcome obtained by this study is very broad in nature and fits in terms of yielding an enormous number of relating results simply by practicing the proportionality indices included therein. Furthermore, the outcome of our study demonstrates that the proposed plans are of significant importance and computationally appealing to deal with comparable sorts of differential equations. Taken together, the results can serve as efficient and robust means for the purpose of investigating specific classes of integrodifferential equations.
The Chinese (Mandarin) instructions of the 6-minute walk test: A validation study
Authors: Tan Vivian Z. , Lee Meredith Q. , Wong Daryl L. , Huang Katherin S. , Chan Melissa Y. , Yan Clement C. , Yeung Meredith T.
Published: January 2021

Background/Objective: To date, a validated Chinese (Mandarin) six-minute walk test (6MWT) translated instruction is not available. Translation of the Chinese 6MWT instruction is done in an ad hoc manner within the Chinese-speaking populations. This study aimed to develop a set of valid and reliable Chinese (Mandarin) instructions of the 6MWT.

Methods: Translation was performed from the original English instruction via the recommended “Process of translation and adaptation of instruments” by the World Health Organization to generate the Chinese instructions. The Chinese instructions were tested with 52 healthy adult participants for its validity. Each participant underwent three 6MWTs and a cardiopulmonary exercise test. Randomization allowed participants to undergo the walk test in both the original English and the new Chinese instructions. Face and content validity, intra-rater and inter-rater reliability of the Chinese instructions of the 6MWT were established through the translation process. Criterion validity was established by analyzing the results of the 6MWT and cardiopulmonary exercise test.

Results: Intraclass correlation coefficient for inter-rater reliability was excellent ([Formula: see text], 95% confidence [Formula: see text]–1.000). Similarly, the intra-rater reliability across the three raters was high (R1: [Formula: see text], 95% confidence interval [Formula: see text]–1.000; R2: [Formula: see text], 95% [Formula: see text]–1.000; R3: [Formula: see text], 95% [Formula: see text]–1.000). The 6-min walk distances collected from the Chinese and English instructed trials correlated positively with the maximal oxygen consumption ([Formula: see text], [Formula: see text]; [Formula: see text], [Formula: see text]).

Conclusion: This is the first study to develop and validate the Chinese (Mandarin) instructions of the 6MWT, and the translation is as reliable and valid as the original English instructions.
Constraint-based Scheduling for Paint Shops in the Automotive Supply Industry
Authors: Winter Felix , Musliu Nysret
Published: January 2021

Factories in the automotive supply industry paint a large number of items requested by car manufacturing companies on a daily basis. As these factories face numerous constraints and optimization objectives, finding a good schedule becomes a challenging task in practice, and full-time employees are expected to manually create feasible production plans.

In this study, we propose novel constraint programming models for a real-life paint shop scheduling problem. We evaluate and compare our models experimentally by performing a series of benchmark experiments using real-life instances in the industry. We also show that the decision variant of the paint shop scheduling problem is NP-complete.
Lectures and collaborative working improves the performance of medical students
Authors: Montrezor Luís Henrique
Published: January 2021

Snapshot: The use of short lecture classes associated with collaborative group work, which involved the elaboration of a portfolio, with well-defined modalities and objectives, improved the students’ grades and decreased the percentage of incorrect answers on tests. Most of the students believed that the collaborative work contributed to their learning about digestive physiology, and most of them reported being comfortable working in their groups, without feeling dominated by other group members.
Larvicidal Evaluation against Aedes aegypti and Antioxidant and Cytotoxic Potential of the Essential Oil of Tridax procumbens L. Leaves
Authors: Brandão Lethicia B. , Santos Lizandra L. , Martins Rosany L. , Rodrigues Alex B. L. , Rabelo Erica de M. , Galardo Allan K. R. , Almeida Sheylla S. M. da S. de
Published: January 2021

The present study evaluated the antioxidant, cytotoxic, and larvicidal potential of the essential oil of Tridax procumbens leaves, as well as identified the compounds present in the essential oil. The antioxidant activity was evaluated by the sequestration method of 2,2-diphenyl-1-picrylhydrazyl radical, the cytotoxic activity was evaluated using Artemia salina, the larvicidal bioassay was performed with larvae in the third stage of development of the Aedes aegypti mosquito, and the identification of the metabolites was performed by gas chromatography coupled to the mass spectrometer (GC-MS). The phytochemical oil analysis showed the presence of 20 compounds, with thymol and γ-terpinene being the main ones. It presented antioxidant activity with an IC50 of 194.51 μg mL−1, demonstrating antioxidant activity in the highest concentrations tested. It presented low cytotoxic activity against A. salina, with an LC50 of 1238.67 μg mL−1, demonstrating atoxicity in the concentrations tested. The essential oil presented good larvicidal activity when compared to the literature, with an LC50 = 79.0 μg mL−1 in 24 hours and LC50 of 69.15 μg mL−1 in 48 hours. In this way, it was possible to identify that the essential oil of the leaves of T. procumbens presented potential for the development of a natural larvicide, as well as antioxidant activity satisfactory to the radical DPPH and low toxicity to A. salina.
Prognostic Significance of Preoperative Fibrinogen‐to‐Prealbumin Ratio in Patients with Stage I–III Colorectal Cancer Undergoing Surgical Resection: A Retrospective Cohort Study
Authors: Hailun Xie  , Huang Shizhen , Yuan Guanghui , Tang Shuangyi , Gan Jialiang
Published: January 2021

Background. The objective of this study was to explore the role of preoperative fibrinogen‐to‐prealbumin ratio (FPR) in evaluating the prognosis of patients with stage I–III colorectal cancer (CRC). Methods. This retrospective study enrolled 584 stage I–III CRC patients undergoing surgical resection. Logistic regression analysis was used to explore the correlation between FPR and postoperative complications. The Kaplan‐Meier curve and Cox proportional hazards model were used to identify the prognostic factors. The nomograms were constructed based on the prognostic factors. The concordance index and calibration curve were used to determine the accuracy of the nomograms. Time‐dependent receiver operating characteristic was used to compare the predictive prognostic efficacy of nomograms and TNM stage. Results. FPR was determined to be an independent factor affecting postoperative complications. Patients with a low‐FPR had a significantly better prognosis than those with a high‐FPR (disease‐free survival, p = 0.028; overall survival, p = 0.027), especially patients with stage I CRC (disease‐free survival, p = 0.015; overall survival, p = 0.017). The Cox proportional hazards model identified FPR as an independent poor prognostic factor of disease‐free survival (hazard ratio (HR) = 1.459, 95% confidence interval (CI) = 1.074–1.954, p = 0.011) and overall survival (HR = 1.405, 95% CI = 1.034–1.909, p = 0.030). The prognostic nomograms had good accuracy and were superior to the traditional TNM stage. Conclusions. FPR is a potential indicator for predicting short‐ and long‐term prognosis of stage I–III CRC patients undergoing surgical resection.
A Kind of FM-BEM Penalty Function Method for a 3D Elastic Frictional Contact Nonlinear System
Authors: Yu Chunxiao , Jing Dinghui , Fu Chang , Yang Yanfang
Published: January 2021

In this paper, a kind of node_face frictional contact FM-BEM penalty function method is presented for 3D elastic frictional contact nonlinear problems. According to the principle of minimum potential energy, nonpenetrating constraints are introduced into the elastic frictional contact system as a penalty term. By using the least square method and penalty function method, an optimization mathematical model and a mathematical programming model with a penalty factor are established for the node_face frictional contact nonlinear system. For the two models, a penalty optimization IGMRES (m) algorithm is proposed, and the influences of different penalty factors on the solution of the whole system are analyzed. Finally, a numerical simulation is carried out for two elastic frictional contact objects, and some important results including displacements, pressures, friction forces, and friction slips in the contact area are presented. Theoretical analysis and numerical experiment show that the newly presented FM-BEM penalty function method not only is efficient and practical but also has much superiority. It is easy to implement, and it is fast convergent with good stability.
Path Planning of Unmanned Autonomous Helicopter Based on Human-Computer Hybrid Augmented Intelligence
Authors: Han Zengliang , Chen Mou , Zhou Tongle , Nie Zhiqiang , Wu Qingxian
Published: January 2021

Unmanned autonomous helicopter (UAH) path planning problem is an important component of the UAH mission planning system. The performance of the automatic path planner determines the quality of the UAH flight path. Aiming to produce a high-quality flight path, a path planning system is designed based on human-computer hybrid augmented intelligence framework for the UAH in this paper. Firstly, an improved artificial bee colony (I-ABC) algorithm is proposed based on the dynamic evaluation selection strategy and the complex optimization method. In the I-ABC algorithm, the following way of on-looker bees and the update strategy of nectar source are optimized to accelerate the convergence rate and retain the exploration ability of the population. In addition, a space clipping operation is proposed based on the attention mechanism for constructing a new spatial search area. The search time can be further reduced by the space clipping operation under the path planning result within acceptable changes. Moreover, the entire optimization process and results can be feeded back to the knowledge database by the human-computer hybrid augmented intelligence framework to guide subsequent path planning issues. Finally, the simulation results confirm that a feasible and effective flight path can be quickly generated by the UAH path planning system based on human-computer hybrid augmented intelligence.