bluuebunny/crossref_metadata_2025_split huggingface dataset:
Framing a Needed Discourse on Health Disparities and Social Inequities: Drawing Lessons from a Pandemic
Authors: Martin‐Howard Simone , Farmbry Kyle 
Published: June 2020

AbstractCOVID‐19 provides numerous opportunities for policy makers to consider matters of social equity in relation to the field of public health. Specifically, by reflecting on health disparities in relation to the disproportionate impact of COVID‐19 on minority and historically underserved populations, we can leverage a needed discourse on health outcomes for many communities. Grounded in the social determinants of health conceptual framework, this essay explores the application of the disproportionate impact of COVID‐19 to vulnerable populations and communities of color for a discussion of strategies for minimizing health disparities.
Effective enzymatic debridement of burn wounds depends on the denaturation status of collagen
Authors: Kwa Kelly A. A. , van Haasterecht Ludo , Elgersma Anouk , Breederveld Roelf S. , Groot Marie Louise , van Zuijlen Paul P. M. , Boekema Bouke K. H. L. 
Published: June 2020

AbstractThe treatment of burn wounds by enzymatic debridement using bromelain has shown promising results in our burn center. However, inadequate debridement occurred in a few cases in which the etiology of the burn was attributed to relatively low temperature burns. We hypothesized that bromelain is ineffective in burns in which collagen denaturation, which occurs approximately at 65°C, has not taken place. Our objective was to assess whether there is a relationship between the denaturation of collagen and the ability of bromelain to debride acute scald burn wounds of different temperatures. Ex vivo human skin from four different donors was cut into 1x1 cm samples, and scald burns were produced by immersion in water at temperatures of 40°C, 50°C, 60°C, 70°C, and 100°C for 20 minutes. Denaturation of collagen was assessed with histology, using hematoxylin and eosin (H&E) staining and a fluorescently labeled collagen hybridizing peptide (CHP), and with second harmonic generation (SHG) microscopy. Burned samples and one control sample (room temperature) were weighed before and after application of enzymatic debridement to assess the efficacy of enzymatic debridement. After enzymatic debridement, a weight reduction of 80% was seen in the samples heated to 70°C and 100°C, whereas the other samples showed a reduction of 20%. Unfolding of collagen, loss of basket‐weave arrangement, and necrosis was seen in samples heated to 60°C or higher. Evident CHP fluorescence, indicative of collagen denaturation, was seen in samples of 60°C, 70°C and 100°C. SHG intensity, signifying intact collagen, was significantly lower in the 70°C and 100°C group (P <.05) compared to the lower temperatures. In conclusion, denaturation of collagen in skin samples occurred between 60°C and 70°C and strongly correlated with the efficacy of enzymatic debridement. Therefore, enzymatic debridement with the use of bromelain is ineffective in scald burns lower than 60°C.
A Sensitivity-Based Approach for Reliability Analysis of Randomly Excited Structures With Interval Axial Stiffness
Authors: Sofi Alba , Muscolino Giuseppe , Giunta Filippo 
Published: June 2020

Abstract
Reliability assessment of linear discretized structures with interval parameters subjected to stationary Gaussian multicorrelated random excitation is addressed. The interval reliability function for the extreme value stress process is evaluated under the Poisson assumption of independent up-crossing of a critical threshold. Within the interval framework, the range of stress-related quantities may be significantly overestimated as a consequence of the so-called dependency phenomenon, which arises due to the inability of the classical interval analysis to treat multiple occurrences of the same interval variables as dependent ones. To limit undesirable conservatism in the context of interval reliability analysis, a novel sensitivity-based procedure relying on a combination of the interval rational series expansion and the improved interval analysis via extra unitary interval is proposed. This procedure allows us to detect suitable combinations of the endpoints of the uncertain parameters which yield accurate estimates of the lower bound and upper bound of the interval reliability function for the extreme value stress process. Furthermore, sensitivity analysis enables to identify the most influential parameters on structural reliability. A numerical application is presented to demonstrate the accuracy and efficiency of the proposed method as well as its usefulness in view of decision-making in engineering practice.
Development and Application of a Thin Flat Heat Pipe Design Optimization Tool for Small Satellite Systems
Authors: Isaacs Steven A. , Lapointe Caelan , Hamlington Peter E. 
Published: June 2020

Abstract
With easier access to space and the growing integration of power-dense components, small-scale thermal management solutions are increasingly in demand for small satellite systems. Due to the strict mass and volume requirements commanded by such power-dense small spacecraft, heat pipes with thin and flat architectures provide nearly ideal solutions for the efficient transfer and dissipation of heat. Unlike traditional heat pipes, however, the performance of thin heat pipes is heavily dependent on details of the internal heat pipe structure, including the vapor core geometry and structural mechanical characteristics. In this study, the development and testing of a new computational modeling and optimization tool are presented for the design of thin flat heat pipes. The computational model is described in detail and includes parameters that define properties of the liquid wick, vapor core, and structural case. The model is coupled to a gradient-based optimization procedure that minimizes a multi-objective cost function for a range of operating conditions. The cost function is expressed as the weighted sum of the total temperature drop, the liquid/vapor pressure ratio, the total mass of the heat pipe, and the structural deflection of the heat pipe during operation. The combined computational modeling and optimization tool is then used to design a copper-methanol flat heat pipe for a small satellite mission, where the optimization is performed with respect to both cold and hot orbital conditions. Validation of the optimized heat pipe is performed using computational fluid dynamics (CFD) simulations of the initial and final designs.
Developing the infrastructure to support the optimisation of antibiotic prescribing using the learning healthcare system to improve healthcare services in the provision of primary care in England
Authors: Palin Victoria , Tempest Edward , Mistry Chirag , van Staa Tjeerd P 
Published: June 2020

IntroductionThe learning healthcare system (LHS) underpinned by data analysis and feedback to clinical care providers is thought to improve quality of care. The work aimed to implement an LHS for antibiotic prescribing in primary care in England.MethodDeidentified patient-level data from general practices were processed and analysed at regular intervals (fortnightly increments). A dashboard application was developed and implemented displaying analytical graphics to give periodic feedback to clinicians, tailored to each clinical site. Benchmarking parameters were established by the analysis of two large national primary care datasets allowing peer-to-peer comparisons. To date, the dashboard is available to 70 English practices.ConclusionsSuccessful implementation and uptake of the secure technical LHS infrastructure for the analysis and feedback to clinicians of their antibiotic prescribing demonstrate a great appetite for this type of frequent prescribing review in primary care, combining advanced data analytics with tailored feedback.
Geographic variation in tobacco use in India: a population-based multilevel cross-sectional study
Authors: Singh Ankur , Arora Monika , Bentley Rebecca , Spittal Matthew J , Do Loc G , Grills Nathan , English Dallas R 
Published: June 2020

ObjectiveThis study aims to quantify the extent to which people’s use of tobacco products varies by local areas (city ward and village) across India and the variation in this clustering by tobacco products.DesignCross-sectional study.Setting and participantsData on 73 954 adults across 2547 city wards and villages were available for analysis from 30 states and 2 union territories in India.Primary and secondary outcome measuresWe included as primary outcomes self-reported any tobacco use, current cigarette smoking, current bidi smoking, current smokeless tobacco use and a derived variable for dual use describing respondents who engaged in both smoking and smokeless tobacco use.ResultsThe median risk of an individual using tobacco was 1.64 times greater if a person hypothetically moved from an area of low to high risk of tobacco use (95% CI: 1.60 to 1.69). Area-level partitioning of variation differed by tobacco product used. Median ORs ranged from 1.77 for smokeless tobacco use to 2.53 for dual use.ConclusionsTobacco use is highly clustered geographically in India. To be effective in India, policy interventions should be directed to influence specific local contextual factors on adult tobacco use. Where people live in India influences their use of tobacco, and this association may be greater than has been observed in other settings. Tailoring tobacco control policies for local areas in India may, therefore, provide substantial public health benefits.
Exposure to endocrine-disrupting chemicals and anthropometric measures of obesity: a systematic review and meta-analysis
Authors: Ribeiro Carolina Martins , Beserra Bruna Teles Soares , Silva Nadyellem Graciano , Lima Caroline Lourenço , Rocha Priscilla Roberta Silva , Coelho Michella Soares , Neves Francisco de Assis Rocha , Amato Angélica Amorim 
Published: June 2020

ObjectiveEndocrine-disrupting chemicals (EDCs) are viewed as a major potential link between the environment and obesity development. We did a systematic review and meta-analysis to examine the association between exposure to EDCs and obesity.Data sources, design and eligibility criteriaPubMed, Scopus and Web of Science were searched from inception to 6 June 2018 for studies primarily addressing the association between exposure to EDCs after the age of 2 years and anthropometric measures of obesity or body fat. The Newcastle-Ottawa scale was used to assess the risk of bias.Data extraction and synthesisTwo independent reviewers screened and conducted data extraction and synthesis. A third reviewer resolved disagreements.ResultsA total of 73 studies investigating bisphenol A (32 286 individuals), organochlorine compounds (34 567 individuals), phthalates (21 401 individuals), polybrominated biphenyls (2937 individuals), polycyclic aromatic hydrocarbons (5174 individuals), parabens (4097 individuals), benzoic acid (3671 individuals) and polyfluoroalkyl substances (349 individuals) met our inclusion criteria. Most had a cross-sectional design and low or medium risk of bias. In qualitative analysis, bisphenol A and phthalates were consistently associated with general and abdominal obesity, in children and adults, and some studies suggested this association was age-dependent and gender-dependent. Meta-analysis indicated a significant association between exposure to bisphenol A and overweight (OR 1.254, 95% CI 1.005 to 1.564), obesity (OR 1.503, 95% CI 1.273 to 1.774) and increased waist circumference (OR 1.503, 95% CI 1.267 to 1.783) in adults, and between exposure to 2,5-dichlorophenol and obesity in children (OR 1.8, 95% CI 1.1018 to 3.184).ConclusionMost observational studies supported a positive association between obesity and exposure to EDCs. Although causality cannot be determined from these data, they underscore the need to limit human exposure to EDCs in light of the evidence from animal and cell-based studies indicating the effects of these chemicals on adiposity.PROSPERO registration numberCRD42018074548.
Cross-cultural adaptation and psychometric validation of the Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P)
Authors: Ghanbari-Firoozabadi Mahdieh , Mirzaei Masoud , Vafaii Nasab Mohammadreza , Grace Sherry L , Okati-Aliabad Hassan , Madadizadeh Farzan , Dadras Hakimeh , Amrolahi Najmeh , Entezari Mohamadmehdi , Sadrbafghi Seyed Mahmood 
Published: June 2020

ObjectivesThis study aimed to translate, cross-culturally adapt and psychometrically validate a Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P) and to identify the main barriers in an Iranian setting.SettingAfshar cardiac rehabilitation (CR) centre, affiliated with the Yazd University of Medical Sciences, in the centre of Iran.DesignThis was a multimethod study, culminating in a cross-sectional survey.ParticipantsInpatient CR graduates who did not attend their initial outpatient CR appointment.MethodThe 21-item CRBS was translated and cross-culturally adapted in accordance with best practices; an expert panel considered the items and previous non-attending patients were interviewed via phone to refine the scale. Next, structural validity was assessed; participants were invited to complete the CRBS on the phone between March 2017 and February 2018. Using exploratory factor analysis (EFA) with principal component analysis extraction and oblique rotation. Second, confirmatory factor analysis (CFA) was used to verify the results; several goodness-of-fit indices were considered. The internal consistency and 3-week test–retest reliability of the scale (5% subsample) were evaluated using Cronbach’s α and intraclass correlation (ICC), respectively.ResultsFace, content and cross-cultural validity were established by the experts and patients (n=50). One thousand and one hundred (40.7%) of the 2700 patients completed the CRBS-P. Structural validity was established by EFA (Bartlett’s test p<0.001; =0.759) and confirmed by the CFA; a four-factor solution with 18 items accounting for 61.256% of variance had the best fit (χ2/df=3.206, root mean square error of approximation=0.061 and Comparative Fit Index=0.959). The internal consistency and test–retest reliability (n=42) of the scale were acceptable (ICC=0.743 95% CI (0.502 to 0.868); overall α=0.797). The top barriers were not knowing about CR, cost and lack of encouragement from physicians.ConclusionThe four-factor, 18-item CRBS-P had good psychometric properties, and hence can be reliably and validly used to measure CR barriers in Iran and other Persian-speaking populations.
Knowledge acquisition and retention after a high flow training programme in Peru: a quasi-experimental single group pre–post design
Authors: Ellington Laura E , Becerra Rosario , Mallma Gabriela , Tantaleán da Fieno José , Nair Deepthi , Onchiri Frankline , Nielsen Katie R 
Published: June 2020

ObjectiveRespiratory infections remain the leading infectious cause of death in children under 5 and disproportionately affect children in resource-limited settings. Implementing non-invasive respiratory support can reduce respiratory-related mortality. However, maintaining competency after deployment can be difficult. Our objective was to evaluate the effectiveness of a comprehensive multidisciplinary high-flow training programme in a Peruvian paediatric intensive care unit (PICU).DesignQuasi-experimental single group pre–post intervention study design.SettingQuaternary care PICU in a resource-constrained setting in Lima, Peru.ParticipantsAttending physicians, fellows, paediatric residents, registered nurses, respiratory therapists and medical technicians working in the PICU were invited to participate.InterventionsConcurrent with initial high-flow deployment, we implemented a training programme consisting of lectures, case-based discussion and demonstrations with baseline, 3-month and 12-month training sessions. Pre-training and post-training assessment surveys were distributed surrounding all training sessions.Primary and secondary outcome measuresThe primary outcome was achieving minimum competency (median score of 80%) on the high flow training assessment tool. Secondary outcomes included knowledge acquisition (differences in pre-baseline and post-baseline training assessments), short-term retention (differences in post-baseline and pre-3-month refresher training assessments) and long-term retention (differences in post-3-month refresher and pre-12-month refresher training assessments).ResultsEighty participants (50% nurses, 15% ICU physicians and 34% other providers) completed the baseline assessment. Participants showed improvement in overall score and all subtopics except the clinical application of knowledge after baseline training (p<0.001). Participants failed to retain minimum competency at 3-month and 12-month follow-up assessments (70% (IQR: 57–74) and 70% (IQR: 65–74), respectively). After repeat training sessions, overall knowledge continued to improve, exceeding baseline performance (78% (IQR: 70–87), 83% (IQR: 74–87) and 87% (IQR: 83–91) at baseline, 3 and 12 months, respectively).ConclusionThis study suggests the need for repeat training sessions to achieve and maintain competency after the implementation of new technology.
Nurture Early for Optimal Nutrition (NEON) programme: qualitative study of drivers of infant feeding and care practices in a British-Bangladeshi population
Authors: Lakhanpaul Monica , Benton Lorna , Lloyd-Houldey Oliver , Manikam Logan , Rosenthal Diana Margot , Allaham Shereen , Heys Michelle 
Published: June 2020

ObjectivesTo explore optimal infant feeding and care practices and their drivers within the British-Bangladeshi population of East London, UK, as an exemplar to inform development of a tailored, coadapted participatory community intervention.DesignQualitative community-based participatory research.SettingCommunity and children’s centres and National Health Service settings within Tower Hamlets, London, UK.Participants141 participants completed the community study including: British-Bangladeshi mothers, fathers, grandmothers and grandfathers of infants and young children aged 6–23 months, key informants and lay community members from the British-Bangladeshi population of Tower Hamlets, and health professionals working in Tower Hamlets.Results141 participants from all settings and generations identified several infant feeding and care practices and wider socioecological factors that could be targeted to optimise nutritional outcomes. Our modifiable infant feeding and care practices were highlighted: untimely introduction of semi and solid foods, overfeeding, prolonged parent-led feeding and feeding to ‘fill the belly’. Wider socioecological determinants were highlighted, categorised here as: (1) society and culture (e.g. equating ‘chubby baby’ to healthy baby), (2) physical and local environment (e.g. fast food outlets, advertising) and (3) information and awareness (e.g. communication with healthcare professionals around cultural norms).ConclusionsParenting interventions should be codeveloped with communities and tailored to recognise and take account of social and cultural norms and influence from different generations that inform infant feeding and care practices and may be of particular importance for infants from ethnically diverse communities. In addition, UK infant feeding environment requires better regulation of marketing of foods for infants and young children if it is to optimise nutrition in the early years.
Barriers towards organ donor registration and consent among people of Indian origin living globally: a systematic review and integrative synthesis—protocol
Authors: Vincent Britzer Paul , Randhawa Gurch , Cook Erica 
Published: June 2020

IntroductionThe need for organs is comparatively higher among people of Indian origin due to the higher prevalence of end-stage organ failure. In spite of the higher need, they have a lower number of organ donors. Studies have been carried out among people of Indian origin living globally to understand the reasons for the low donation rate, but there has been no systematic review that has integrated all of these studies to synthesise the current literature. Therefore, the purpose of this review is to examine the barriers towards organ donor registration and consent among Indians living globally.Methods and analysisA systematic search will be conducted using the following relevant databases namely CINHAL, MEDLINE, PsycINFO, Scopus, Web of Science, PubMed Central, Global Health and Grey literature. Studies from 1994 that satisfy our inclusion criteria will be included. Two reviewers will conduct the screening, data extraction and quality assessment of the studies; in event of any disagreement between the two reviewers at any stage, the third reviewer will reconcile any disagreements and consensus will be made.Ethics and disseminationAs this study includes only secondary data, ethical approval for secondary data usage has been sought. This study will use Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to report and the study outcomes will be disseminated through a relevant peer-review publication, related conferences and also to various non-governmental organisations globally which are working with this particular community; following which further research can be developed based on this evidence and also helps in building a culturally competent strategy.PROSPERO registration numberCRD42019155274.
Implementation of e-mental health interventions for informal caregivers of adults with chronic diseases: a protocol for a mixed-methods systematic review with a qualitative comparative analysis
Authors: Coumoundouros Chelsea , von Essen Louise , Sanderman Robbert , Woodford Joanne 
Published: June 2020

IntroductionInformal caregivers provide the majority of care to individuals with chronic health conditions, benefiting the care recipient and reducing use of formal care services. However, providing informal care negatively impacts the mental health of many caregivers. E-mental health interventions have emerged as a way to provide accessible mental healthcare to caregivers. Much attention has been given to reviewing the effectiveness and efficacy of such interventions, however, factors related to implementation have received less consideration. Therefore, this mixed-methods systematic review will aim to examine factors associated with the effectiveness and implementation of e-mental health interventions for caregivers.Methods and analysisEligible studies published since 1 January 2007 will be searched for in several electronic databases (CINAHL Plus with Full Text, the Cochrane Library, EMBASE, PsycINFO, PubMed and Web of Science), clinical trial registries and OpenGrey, with all screening steps conducted by two independent reviewers. Studies will be included if they focus on the implementation or effectiveness of e-mental health interventions designed for informal adult caregivers of adults with cancer, heart disease, stroke, diabetes, dementia or chronic obstructive pulmonary disease. Pragmatic randomised controlled trials quantitatively reporting on caregiver anxiety, depression, psychological distress or stress will be used for a qualitative comparative analysis to identify combinations of conditions that result in effective interventions. Qualitative and quantitative data on implementation of e-mental health interventions for caregivers will be integrated in a thematic synthesis to identify barriers and facilitators to implementation. These results will inform future development and implementation planning of e-mental health interventions for caregivers.Ethics and disseminationEthical approval is not required for this study as no primary data will be collected. Results will be disseminated in the form of a scientific publication and presentations at academic conferences and plain language summaries for various stakeholders.PROSPERO registration numberCRD42020155727.