bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are meal kits health promoting? Nutritional analysis of meals from an Australian meal kit service
Authors: Moores Carly J , Bell Lucinda K , Buckingham Michael J , Dickinson Kacie M 
Published: August 2020

Summary
Meal kits are popular for consumers seeking greater convenience in preparing meals at home. The market share for meal kit subscription services (MKSSs) is growing in developed nations including Australia, however, literature about their health promoting qualities, e.g. nutritional composition, is scarce. This study aimed to assess the characteristics and nutritional composition of meals offered from an MKSS over 12 months. Nutritional data were extracted from recipes available to order from HelloFresh in Australia from 1 July 2017 to 30 June 2018. In total, 346 (251 unique) recipes were retrieved. Per serve (median size 580 g), meals contained a median of 2840 kJ (678 kcal) of energy, 58 g carbohydrate (14 g sugar), 44 g protein, 28 g total fat (8 g saturated fat) and 839 mg sodium. Median energy from macronutrients was total fat (38%), carbohydrates (34%), protein (25%) and saturated fat (11%). This paper is the first to describe characteristics of recipes available from an MKSS over a 12-month period of time. With their growing popularity, meal kit delivery services have the capacity to influence consumer food behaviours, diets and subsequently population health. MKSSs may function to promote health though education, training, and enabling home cooking behaviours, and may be a powerful commitment device for home cooking behaviour change. However, it is important for health professionals, including dietitians and nutritionists, to understand the nutritional risks, benefits and suitability of this contemporary mealtime option before recommending them to clients and members of the public as part of health promotion.

Lay summary
Meal kit delivery services are growing in popularity in developed countries, complementing busy lifestyles with pre-measured ingredients and recipe instructions delivered to the home. These meal kits have the ability to influence consumer diets and population health, and may support health promoting diet behaviours, e.g. eating vegetables, and enable home cooking. In this study, we reviewed a years’ worth of recipes from a popular meal kit service. We report that a typical recipe contained approximately nine different ingredients, comprising three vegetables and required three ingredients from the home pantry. Meals took ∼35 min to prepare and were found to be relatively high in energy from fat and protein, and relatively low in energy from carbohydrates. The level of sodium varied widely and some meals exceeded the Australian Suggested Dietary Target for sodium (&lt;2000 mg). Meal kit recipes were found to have health promoting qualities, frequently including vegetable ingredients, however, improvements to recipes would make these meal kits more health promoting. Current diet intakes and the nutritional composition of meal kits recipes should be reviewed before being recommended by health professionals.
The implementation process of the Confident Birth method in Swedish antenatal education: opportunities, obstacles and recommendations
Authors: Jansson Sofia , Farahshoor Sepideh , Linden Karolina , Bogren Malin 
Published: August 2020

Summary
Antenatal clinics in western Sweden have recently invested in a birth method called Confident Birth. In this study, we investigate midwives’ and first line managers’ perceptions regarding the method, and identify opportunities and obstacles in its implementation. Semi-structured individual interviews were conducted with ten midwives and five first line managers working in 19 antenatal clinics in western Sweden. The Consolidated Framework for Implementation Research was used in a directed content analysis approach. Intervention Characteristics—such as perceptions about the Confident Birth method—were found to have equipped the midwives with coping strategies that were useful for expecting parents during birth. Outer Setting—the method was implemented to harmonize the antenatal education, and provided a mean for a birth companionship of choice. Inner setting—included time-consuming preparations and insufficient information at all levels, which affected the implementation. Characteristics of individuals—, such as knowledge and believes in the method, where trust in the method was seen as an opportunity, while long experience of teaching other birth preparatory methods, affected how the Confident Birth method was perceived. Process—such as no strategy for ensuring that the core of the method remained intact or plans for guiding its implementation were major obstacles to successful implementation. The findings speak to the importance of adequate planning, time, information and communication throughout the process to have a successful implementation. Based on lessons learned from this study, we have developed recommendations for successful implementation of interventions, such as the Confident Birth, in antenatal care settings.
Results of a mixed methods evaluation of the Make Healthy Normal campaign
Authors: Kite James , Thomas Margaret , Grunseit Anne , Li Vincy , Bellew William , Bauman Adrian 
Published: August 2020

Abstract
The Make Healthy Normal obesity prevention mass media campaign was implemented in New South Wales, Australia from 2015 to 2018. This study evaluated Phase 2 (2017–18) of that campaign, using three cross-sectional online surveys with men aged 18–54 years (n = 4352) and six focus groups with men aged 35–54 years and parents with children aged 5–12 years (n = 38), reflecting the campaign’s target audiences. We used linear and logistic regressions to examine changes over time in key outcomes, consistent with the campaign’s theorized hierarchy of effects. Focus group data were analysed thematically and integrated with survey results at the interpretation stage. Survey results showed reasonable prompted recognition, although unprompted recall remained low, and there were no consistent, positive shifts in other outcomes, including behaviour. Focus group results suggested that this was because the campaign’s messages, while considered clear and relevant, did not address the constraints participants experienced that made change difficult. Hence, the campaign by itself was unlikely to lead to behaviour change. We need to reconsider the role of campaigns in addressing multi-determined and complex problems. Evaluations should reconsider metrics of success, as they may not immediately result in behaviour change, especially in the absence of complementary policy and environmental strategies.
‘I will welcome this one 101%, I will so embrace it’: a qualitative exploration of the feasibility and acceptability of HIV self-testing among men who have sex with men (MSM) in Lagos, Nigeria
Authors: Dirisu Osasuyi , Sekoni Adekemi , Vu Lung , Adebajo Sylvia , Njab Jean , Shoyemi Elizabeth , Ogunsola Sade , Tun Waimar 
Published: August 2020

Abstract
Men who have sex with men (MSM) are disproportionately affected by HIV in Nigeria. A key strategy in reducing transmission is to increase HIV testing uptake and linkage to treatment for those who test positive. HIV self-testing (HIVST) is an innovative strategy with the potential to increase uptake of HIV testing among key populations at higher risk for HIV. We conducted 23 in-depth-interviews with MSM and two focus group discussions with key opinion leaders to explore perceptions about the feasibility and acceptability of oral HIVST among MSM in Lagos, Nigeria. HIVST was highly acceptable because it was considered convenient to use, painless, private and addressed concerns about stigma. Concerns cited by participants included comprehensibility of instructions to perform and interpret results correctly, as well as lack of support mechanisms to facilitate post-test follow-up and linkage to care. Provision of adequate pre-test information was considered vital as part of the kit distribution process to ensure seamless use of HIVST kits. One-on-one peer-to-peer distribution strategies and retail outlets that facilitate anonymous pick-up are potential distribution channels identified in this study. Overall, our findings suggest that an HIVST program that incorporates these considerations would improve access to HIV testing among MSM in Nigeria.
Peri-implantation intercourse does not lower fecundability
Authors: Stanford Joseph B , Hansen Jared L , Willis Sydney K , Hu Nan , Thomas Alun 
Published: August 2020

Abstract

STUDY QUESTION
Does sexual intercourse in the implantation time window (5–9 days after ovulation) reduce fecundability?

SUMMARY ANSWER
After adjustment for intercourse in the fecund window and clustering by couple, there was no association between intercourse in the implantation time window and fecundity.

WHAT IS KNOWN ALREADY
Previous research has suggested an association between intercourse in the peri-implantation time window (5–9 days after estimated ovulation) and reduced fecundability.

STUDY DESIGN, SIZE, DURATION
We used data from the FERTILI study, a prospective observational study conducted in five European countries, with data collected from 1992 to 1996.

PARTICIPANTS/MATERIALS, SETTING, METHODS
Women who were experienced in fertility awareness tracking kept a daily diary of cervical mucus observations, basal body temperature measurements, coitus and clinically identified pregnancy. We estimated the day of ovulation as cycle length minus 13 days. From 661 women, 2606 cycles had intercourse during the fecund window (from 5 days before to 3 days after the estimated day of ovulation), resulting in 418 pregnancies (conception cycles). An established Bayesian fecundability model was used to estimate the fecundability ratio (FR) of peri-implantation intercourse on fecundability, while adjusting for each partner’s age, prior pregnancy, the couple’s probability of conception and intercourse pattern(s). We conducted sensitivity analyses estimating ovulation as cycle length minus 12 days, or alternatively, as the peak day of estrogenic cervical mucus.

MAIN RESULTS AND THE ROLE OF CHANCE
There was no effect of peri-implantation intercourse on fecundability: adjusted FR for three or more acts of peri-implantation intercourse versus none: 1.00, 95% credible interval: 0.76–1.13. Results were essentially the same with sensitivity analyses. There was an inverse relationship between frequency of intercourse in the fecund window and intercourse in the peri-implantation window.

LIMITATIONS, REASONS FOR CAUTION
Women with known subfertility were excluded from this study. Many couples in the study were avoiding pregnancy during much of the study, so 61% of otherwise eligible cycles in the database were not at meaningful risk of pregnancy and did not contribute to the analysis. Some couples may not have recorded all intercourse.

WIDER IMPLICATIONS OF THE FINDINGS
We believe the current balance of evidence does not support a recommendation for avoiding intercourse in the peri-implantation period among couples trying to conceive.

STUDY FUNDING/COMPETING INTEREST(S)
No external funding. The authors have no potential competing interests.

TRIAL REGISTRATION NUMBER
N/A.
The effect of Day 3 cell number on pregnancy outcomes in vitrified-thawed single blastocyst transfer cycles
Authors: Wu Jiayi , Zhang Jie , Kuang Yanping , Chen Qiuju , Wang Yun 
Published: August 2020

Abstract

STUDY QUESTION
Does cell number on Day 3 have an impact on pregnancy outcomes in vitrified-thawed single blastocyst transfer cycles?

SUMMARY ANSWER
A low Day 3 cell number (≤5 cells) was independently associated with decreased live birth rate (LBR) during single blastocyst transfer cycles in young women.

WHAT IS KNOWN ALREADY
Day 3 cell number is an effective predictor of IVF success rates when transferring cleavage stage embryos. However, the association between Day 3 blastomere number and pregnancy outcomes after blastocyst transfer is still unknown.

STUDY DESIGN, SIZE, DURATION
A retrospective cohort study of 3543 patients who underwent frozen-thawed single blastocyst transfers from January 2013 to June 2018 at a tertiary-care academic medical center.

PARTICIPANTS/MATERIALS, SETTING, METHODS
Patients were grouped into six groups according to the Day 3 cell number: ≤4 cells, 5 cells, 6 cells, 7 cells, 8 cells and &gt;8 cells. The primary outcome measure was LBR. A logistic regression analysis was performed to explore the independent association between Day 3 blastomere number and LBR after adjustment for some potential confounders.

MAIN RESULTS AND THE ROLE OF CHANCE
In women &lt;35 years old, the LBR varied significantly according to Day 3 cell number, with the rate of 31.2%, 34.4%, 41.9%, 45.1%, 48.1% and 48.2% for the ≤4-cell, 5-cell, 6-cell, 7-cell, 8-cell and &gt;8-cell groups, respectively (P &lt; 0.001). This significant difference was also observed in the high- and low-quality blastocyst subgroups of young women. However, for women ≥35 years old, the rate of live birth was similar between groups. Furthermore, after accounting for confounding factors, the LBR was significantly decreased in the ≤4-cell (adjusted odds ratio (aOR): 0.62, 95% CI: 0.48–0.80, P &lt; 0.001) and 5-cell (aOR: 0.73, 95% CI: 0.57–0.92, P = 0.009) groups as compared to the 8-cell group. Likewise, the blastocysts arising from ≤4-cell (aOR: 0.73, 95% CI: 0.57–0.93, P = 0.010) or 5-cell (aOR: 0.77, 95% CI: 0.61–0.97, P = 0.024) embryos were associated with lower clinical pregnancy rate than those from 8-cell embryos. No significant differences were observed in biochemical pregnancy rate and miscarriage rate.

LIMITATIONS, REASONS FOR CAUTION
A limitation of the current study was its retrospective design. Future prospective studies are needed to confirm our findings.

WIDER IMPLICATIONS OF THE FINDINGS
Our observations suggested that a low Day 3 cell number was related to decreased LBR after blastocyst transfer in young women, which provided vital information for clinicians in selecting blastocyst during IVF treatment.

STUDY FUNDING/COMPETING INTEREST(S)
This study was supported by the National Natural Science Foundation of China (NSFC) (31770989 to Y.W.; 81671520 to Q.C.) and the Shanghai Ninth People’s Hospital Foundation of China (JYLJ030 to Y.W.). The authors have no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER
N/A.
Functional Morphology of Gliding Flight I: Modeling Reveals Distinct Performance Landscapes Based on Soaring Strategies
Authors: Waldrop Lindsay D , He Yanyan , Hedrick Tyson L , Rader Jonathan A 
Published: August 2020

SynopsisThe physics of flight influences the morphology of bird wings through natural selection on flight performance. The connection between wing morphology and performance is unclear due to the complex relationships between various parameters of flight. In order to better understand this connection, we present a holistic analysis of gliding flight that preserves complex relationships between parameters. We use a computational model of gliding flight, along with analysis by uncertainty quantification, to (1) create performance landscapes of gliding based on output metrics (maximum lift-to-drag ratio, minimum gliding angle, minimum sinking speed, and lift coefficient at minimum sinking speed) and (2) predict what parameters of flight (chordwise camber, wing aspect ratio [AR], and Reynolds number) would differ between gliding and nongliding species of birds. We also examine performance based on the soaring strategy for possible differences in morphology within gliding birds. Gliding birds likely have greater ARs than non-gliding birds, due to the high sensitivity of AR on most metrics of gliding performance. Furthermore, gliding birds can use two distinct soaring strategies based on performance landscapes. First, maximizing distance traveled (maximizing lift-to-drag ratio and minimizing gliding angle) should result in wings with high ARs and middling-to-low wing chordwise camber. Second, maximizing lift extracted from updrafts should result in wings with middling ARs and high wing chordwise camber. Following studies can test these hypotheses using morphological measurements.
Rare indications for a lung transplant. A European Society of Thoracic Surgeons survey
Authors: Nosotti Mario , D’Ovidio Frank , Leiva-Juarez Miguel , Keshavjee Shaf , Rackauskas Mindaugas , Van Raemdonck Dirk , Ceulemans Laurens J , Krueger Thorsten , Koutsokera Angela , Schiavon Marco , Rea Federico , Iskender Ilker , Moreno Paula , Alvarez Antonio , Luzzi Luca , Paladini Piero , Rosso Lorenzo , Bertani Alessandro , Venuta Federico , Pecoraro Ylenia , Al-Kattan Khaled , Kubisa Bartosz , Inci Ilhan 
Published: August 2020

Abstract

OBJECTIVES
The European Society of Thoracic Surgeons Lung Transplantation Working Group promoted a survey to evaluate overall survival in a large cohort of patients receiving lung transplants for rare pulmonary diseases.

METHODS
We conducted a retrospective multicentre study. The primary end point was overall survival; secondary end points were survival of patients with the most common diagnoses in the context of rare pulmonary diseases and chronic lung allograft dysfunction (CLAD)-free survival. Finally, we analysed risk factors for overall survival and CLAD-free survival.

RESULTS
Clinical records of 674 patients were extracted and collected from 13 lung transplant centres; diagnoses included 46 rare pulmonary diseases. Patients were followed for a median of 3.1 years. The median survival after a lung transplant was 8.5 years. The median CLAD-free survival was 8 years. The multivariable analysis for mortality identified CLAD as a strong negative predictor [hazard ratio (HR) 6.73)], whereas induction therapy was a protective factor (HR 0.68). The multivariable analysis for CLAD occurrence identified induction therapy as a protective factor (HR 0.51). When we stratified patients by CLAD occurrence in a Kaplan–Meier plot, the survival curves diverged significantly (log-rank test: P &lt; 0.001). Patients with rare diseases who received transplants had chronic rejection rates similar to those of the general population who received transplants.

CONCLUSIONS
We observed that overall survival and CLAD-free survival were excellent. We support the practice of allocating lungs to patients with rare pulmonary diseases because a lung transplant is both effective and ethically acceptable.
Human corpse model for video-assisted thoracoscopic lobectomy simulation and training
Authors: Dell’Amore Andrea , Boscolo-Berto Rafael , Schiavon Marco , Pangoni Alessandro , Porzionato Andrea , Macchi Veronica , De Caro Raffaele , Rea Federico 
Published: August 2020

Abstract

OBJECTIVES
Minimally invasive surgery simulation is an integral part of surgical education and skills acquisition. Our goal was to present a new video-assisted thoracic surgery simulation model based on the human corpse as an alternative to animal models.

METHODS
Selective cannulation of the cadaver heart was used to fill the pulmonary vessels with a gel to improve the visibility and tactile feedback of the vessels and to simulate any bleeding complications. During surgical simulation, the tutor fills out a questionnaire designed to evaluate the duration of the procedure, the correct completion of the surgical steps and the occurrence of complications. At the end of the simulation session, in order to compare the simulation to clinical practice, all the participants were asked to answer 5 questions using a scale from 1 to 10.

RESULTS
We have performed 2 hands-on sessions using 2 human corpses for each session. Each surgeon performed 1 lobectomy using video-assisted thoracoscopic surgery (VATS) first as the operator and at least 1 lobectomy as an assistant. The median operative time was 83 min in favour of surgeons who had previously performed more than 30 video-assisted lobectomies (P = 0.03). All the surgeons were able to complete all the steps of the procedure; surgeons who had performed fewer than 10 lobectomies required more support by the tutors than the other surgeons. The median total score was 40.5 (interquartile range 39–44.8).

CONCLUSIONS
We believe that this model includes most of the features necessary to validate a surgical simulator and allows realistic training for performing a VATS lobectomy. This model could be an effective alternative to anaesthetized animals for VATS lobectomy training and simulation.
Redo sternotomy versus left ventricular assist device explant as risk factors for early mortality following heart transplantation
Authors: Ribeiro Roberto Vanin Pinto , Alvarez Juglans Souto , Fukunaga Naoto , Yu Frank , Adamson Mitchell Brady , Foroutan Farid , Cusimano Robert James , Yau Terrence , Ross Heather , Alba Ana Carolina , Billia Filio , Badiwala Mitesh Vallabh , Rao Vivek 
Published: August 2020

Abstract

OBJECTIVES
There is an increasing proportion of patients with a previous sternotomy (PS) or durable left ventricular assist device (LVAD) undergoing heart transplantation (HT). We hypothesized that patients with LVAD support at the time of HT have a lower risk than patients with PS and may have a comparable risk to patients with a virgin chest (VC).

METHODS
This is a single-centre retrospective cohort study of all adults who underwent primary single-organ HT between 2002 and 2017. Multivariable Cox regression analyses were performed to compare 30-day and 1-year mortality between transplanted patients with a VC (VC-HT), a PS (PS-HT) or an LVAD explant (LVAD-HT).

RESULTS
Three hundred seventy-nine patients were analysed (VC-HT: 196, PS-HT: 94, LVAD-HT: 89). A larger proportion of patients in the LVAD-HT group were males (83%), had blood group O (52%), non-ischaemic aetiology (70%) and sensitization (67%). The PS-HT group had a higher frequency of patients with congenital heart disease (30%) and PSs compared to LVAD-HT patients (P &lt; 0.001). PS-HT and LVAD-HT patients required a longer bypass time (P &lt; 0.001) and showed a greater estimated blood loss (P &lt; 0.001). Postoperatively, LVAD-HT required haemodialysis more frequently than the VC-HT group (P = 0.031). Multivariable analyses found that PS-HT patients had increased 30-day mortality compared to VC-HT [hazard ratio (HR) 2.63, 95% confidence interval (CI) 1.15–6.01; P = 0.022] while LVAD-HT did not (HR 2.17, 95% CI 0.96–4.93; P = 0.064). At 1-year, neither PS-HT nor LVAD-HT groups were significantly associated with increased mortality compared to VC-HT.

CONCLUSIONS
Transplants in recipients with PS-HT demonstrated increased early mortality compared to VC-HT patients. Although LVAD explant is often technically challenging, this population demonstrated similar mortality compared to those VC-HT patients. The chronic and perioperative support provided by the LVAD may play a favourable role in early patient outcomes compared to other redo sternotomy patients.
When Law Forgets: Coherence and Memory in the Determination of Stateless Palestinian Refugee Claims in Canada
Authors: Blum Joshua 
Published: August 2020

Abstract
This article highlights the incoherence in Canada’s treatment of many Palestinian refugee claims, and argues that this state of affairs is best understood as a failure of legal memory. The drafters of the Refugee Convention recognized both Palestinian refugees’ collective entitlement to protection, and the distinct protection needs of stateless persons. Canadian refugee law, however, contains no trace of this history. As a result, refugee determination in Canada does not account for the persecution that caused and maintains Palestinian statelessness, and holds an often-misplaced focus on where a stateless person ‘habitually resided’ at the expense of where they are actually at risk. This article charts the path to the present legal regime for stateless Palestinian refugee claimants in Canada, and identifies three problematic trends in the application of the Convention refugee definition to Palestinian claims. Alternative interpretations of the law are then offered to restore recognition of the collective nature of the persecution of Palestinian refugees, and the distinct human rights problem of statelessness.