bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

AimsThis 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.MethodsWe 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.ResultsLimited 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.ConclusionData 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.
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

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

BackgroundThe 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.MethodsA 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.ResultsThe 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).ConclusionsLow 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

ObjectiveST 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.MethodsData 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.ResultsOf 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.ConclusionYoung 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

AimsTo 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 resultsConsecutive 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.ConclusionsMild 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

ObjectivesTo 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.MethodsWe 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.ResultsThose 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.ConclusionsThe 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

ObjectivesPatient-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.MethodsSemi-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.ResultsWe 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.ConclusionsThough 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

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

ObjectiveHigh 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.MethodsThis 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 participantsInterviews 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.ResultsWhānau 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.ConclusionIn 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.
Structure scalars and their evolution for massive objects in f(R) gravity
Authors: Bhatti M. Z. , Yousaf Z. , Tariq Z. 
Published: January 2021

AbstractIn 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

AbstractWe 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.
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.