bluuebunny/crossref_metadata_2025_split huggingface dataset:
Indirect effects of COVID-19 on maternal, neonatal, child, sexual and reproductive health services in Kampala, Uganda
Authors: Burt Jessica Florence , Ouma Joseph , Lubyayi Lawrence , Amone Alexander , Aol Lorna , Sekikubo Musa , Nakimuli Annettee , Nakabembe Eve , Mboizi Robert , Musoke Philippa , Kyohere Mary , Namara Lugolobi Emily , Khalil Asma , Le Doare Kirsty 
Published: August 2021

BackgroundCOVID-19 impacted global maternal, neonatal and child health outcomes. We hypothesised that the early, strict lockdown that restricted individuals’ movements in Uganda limited access to services.MethodsAn observational study, using routinely collected data from Electronic Medical Records, was carried out, in Kawempe district, Kampala. An interrupted time series analysis assessed the impact on maternal, neonatal, child, sexual and reproductive health services from July 2019 to December 2020. Descriptive statistics summarised the main outcomes before (July 2019–March 2020), during (April 2020–June 2020) and after the national lockdown (July 2020–December 2020).ResultsBetween 1 July 2019 and 31 December 2020, there were 14 401 antenatal clinic, 33 499 deliveries, 111 658 childhood service and 57 174 sexual health attendances. All antenatal and vaccination services ceased in lockdown for 4 weeks.During the 3-month lockdown, the number of antenatal attendances significantly decreased and remain below pre-COVID levels (370 fewer/month). Attendances for prevention of mother-to-child transmission of HIV dropped then stabilised. Increases during lockdown and immediately postlockdown included the number of women treated for high blood pressure, eclampsia and pre-eclampsia (218 more/month), adverse pregnancy outcomes (stillbirths, low-birth-weight and premature infant births), the rate of neonatal unit admissions, neonatal deaths and abortions. Maternal mortality remained stable. Immunisation clinic attendance declined while neonatal death rate rose (from 39 to 49/1000 livebirths). The number of children treated for pneumonia, diarrhoea and malaria decreased during lockdown.ConclusionThe Ugandan response to COVID-19 negatively impacted maternal, child and neonatal health, with an increase seen in pregnancy complications and fetal and infant outcomes, likely due to delayed care-seeking behaviour. Decreased vaccination clinic attendance leaves a cohort of infants unprotected, affecting all vaccine-preventable diseases. Future pandemic responses must consider impacts of movement restrictions and access to preventative services to protect maternal and child health.
Codevelopment of COVID-19 infection prevention and control guidelines in lower-middle-income countries: the ‘SPRINT’ principles
Authors: Haldane Victoria , Ratnapalan Savithiri , Perera Niranjala , Zhang Zhitong , Ge Shiliang , Choi Mia , Lau Lincoln L , Samaraweera Sudath , Dodd Warren , Walley John , Wei Xiaolin 
Published: August 2021

IntroductionThe COVID-19 pandemic has required the rapid development of comprehensive guidelines to direct health service organisation and delivery. However, most guidelines are based on resources found in high-income settings, with fewer examples that can be implemented in resource-constrained settings. This study describes the process of adapting and developing role-specific guidelines for comprehensive COVID-19 infection prevention and control in low-income and middle-income countries (LMICs).MethodsWe used a collaborative autoethnographic approach to explore the process of developing COVID-19 guidelines. In this approach, multiple researchers contributed their reflections, conducted joint analysis through dialogue, reflection and with consideration of experiential knowledge and multidisciplinary perspectives to identify and synthesise enablers, challenges and key lessons learnt.ResultsWe describe the guideline development process in the Philippines and the adaptation process in Sri Lanka. We offer key enablers identified through this work, including flexible leadership that aimed to empower the team to bring their expertise to the process; shared responsibility through equitable ownership; an interdisciplinary team; and collaboration with local experts. We then elaborate on challenges including interpreting other guidelines to the country context; tensions between the ideal compared with the feasible and user-friendly; adapting and updating with evolving information; and coping with pandemic-related challenges. Based on key lessons learnt, we synthesise a novel set of principles for developing guidelines during a public health emergency. The SPRINT principles are grounded in situational awareness, prioritisation and balance, which are responsive to change, created by an interdisciplinary team navigating shared responsibility and transparency.ConclusionsGuideline development during a pandemic requires a robust and time sensitive paradigm. We summarise the learning in the ‘SPRINT principles’ for adapting guidelines in an epidemic context in LMICs. We emphasise that these principles must be grounded in a collaborative or codesign process and add value to existing national responses.
Contraception in Person-Contraception Online (CiP-CO) cohort study
Authors: Rezel-Potts Emma , Palmer Melissa J , Free Caroline J , McCulloch Hannah , Baraitser Paula 
Published: August 2021

BackgroundOnline contraception services increasingly provide information, clinical assessment and home-delivered oral contraceptives (OCs). Evidence is lacking on the effects of online contraceptive service use on short-term contraceptive continuation.MethodsCohort study comparing contraceptive continuation between new users of a free-to-access online OC service in South East London with those from other, face-to-face services in the same area. Online questionnaires collected data on participants’ sociodemographic characteristics, motivations for OC access, service ratings, OC knowledge and contraceptive use. Contraceptive use in the 4-month study period was measured using health service records. Unadjusted and multivariable logistic regression models compared outcomes between the online service group and those using other services.ResultsOnline service-users (n=138) were more likely to experience short-term continuation of OCs compared with participants using other services (n=98) after adjusting for sociodemographic and other characteristics (adjusted OR 2.94, 95% CI 1.52 to 5.70). Online service-users rated their service more highly (mean 25.22, SD 3.77) than the other services group (mean 22.70, SD 4.35; p<0.001), valuing convenience and speed of access. Among progestogen-only pill users, knowledge scores were higher for the online group (mean 4.83, SD 1.90) than the other services group (mean 3.87, SD 1.73; p=0.007). Among combined oral contraceptive users, knowledge scores were similar between groups.ConclusionsFree-to-access, online contraception has the potential to improve short-term continuation of OCs. Further research using a larger study population and analysis of longer-term outcomes are required to understand the impact of online services on unintended pregnancy.
Self-assembly nanovaccine containing TLR7/8 agonist and STAT3 inhibitor enhances tumor immunotherapy by augmenting tumor-specific immune response
Authors: Zhang Lele , Huang Jiacheng , Chen Xiaona , Pan Caixu , He Yong , Su Rong , Guo Danjing , Yin Shengyong , Wang Shuai , Zhou Lin , Chen Jianxiang , Zheng Shusen , Qiao Yiting 
Published: August 2021

BackgroundCancer vaccines are a promising strategy for cancer immunotherapy. Cancer vaccines elicits a specific cytotoxic immune response to tumor antigens. However, the efficacy of traditional peptide-based cancer vaccines is limited due to the inefficient delivery of antigens and adjuvants to dendritic cells (DCs). Therefore, it is necessary to develop a novel rationally designed cancer vaccine to maximize its desired effects.MethodsASelf-assemblingVehicle-freeMulti-componentAntitumor nanoVaccine (SVMAV) was constructed by using an unsaturated fatty acid docosahexaenoic acid (DHA)-conjugated antigen and R848 (a Toll-like receptor 7/8 agonist) to encapsulate stattic (a signal transducer and activator of transcription 3 inhibitor). The characteristics of SVMAV were investigated. The ability of SVMAV to promote DC functions was examined by in vitro analysis. The antitumor effects of SVMAV and its combination with antiprogrammed cell death protein 1 antibody (aPD-1) were also investigated in vivo. The potential application of SVMAV for neoantigen-targeted, personalized cancer vaccines was examined in an orthotopic hepatocellular carcinoma model.ResultsThe obtained SVMAV efficiently migrated into lymph nodes and primed CD8+T cells for exert neoantigen-specific killing by promoting the antigen uptake by DCs, stimulating DC maturation, and enhancing antigen cross-presentation, due to the simultaneous delivery of the antigen, R848 and stattic. SVMAV could not only yield a robust antitumor effect for primary melanoma allografts, but also exert a protective effect for lung metastases. Moreover, combination treatment of SVMAV and aPD-1 exerted synergistic antitumor activity and extended the survival duration of melanoma-bearing mice. Notably, a cell line-specific neoantigen-based SVMAV was designed according to predicted neoantigens for Hepa1-6 cells to examine the potential application of SVMAV for personalized cancer vaccine. Encouragingly, neoantigen-specific SVMAV achieved stronger antitumor activity than aPD-1 in an orthotopic hepatocellular cancer model established with Hepa1-6 cells.ConclusionsIn summary, this study offers an efficient codelivery platform for neoantigens and immunoregulatory compounds to enhance immune responses during cancer immune therapy.
Cutaneous lupus concerns from the patient perspective: a qualitative study
Authors: Yan Daisy , Zamalin Danielle , Chakka Srita , Krain Rebecca , Concha Josef , Feng Rui , Ahmed Sarah , Okawa Joyce , Werth Victoria P 
Published: August 2021

ObjectiveThere is a need to identify concerns unique to patients with cutaneous lupus erythematosus (CLE), which may not be captured by current common-practice dermatological quality-of-life tools. This study formally characterises what bothers patients with CLE about their disease by conducting semistructured, qualitative interviews.MethodsSixteen patients with CLE were interviewed about how their cutaneous findings impact their daily life. Each interview was transcribed, coded and categorised for recurrent themes. Current CLE activity and damage were also assessed by the Cutaneous Lupus Activity and Severity Index tool.ResultsResponses were categorised into six themes, including Fear of Disease Progression, Unwanted Attention, Self-Consciousness, Physical Signs/Symptoms, Emotional Symptoms and Functional Decline. The most commonly reported themes were Self-Consciousness, mentioned by 13 of 16 (81.3%) patients, Physical Symptoms, mentioned by 12 of 16 (75%), and then Fear of Disease Progression, by 11 of 16 (68.8%). Frequently mentioned physical signs/symptoms included erythema, itch, dyspigmentation, scar and alopecia. The physical signs/symptoms were categorised as activity signs/symptoms, damage signs and other. For activity signs, erythema was mentioned most frequently (5 of 16), then scale (2 of 16). For activity symptoms, itch was mentioned most frequently (6 of 16), then pain (5 of 16). For damage signs, dyspigmentation was mentioned most frequently (4 of 16), followed by scarring (3 of 16). Patients less than 60 years old were more likely to report emotional symptoms than older patients (p<0.05), but there was no significant variation in frequency of reported themes between race, sex or subtype of CLE.ConclusionsThese patient experiences and resultant themes elucidated by this study are worth noting in future standardised estimations of the quality of life of patients with CLE. Additionally, the concerns shown by these interviews are important topics for providers to discuss when evaluating patient disease progression.
Tobacco industry’s ‘behind the scenes’ tactics in Singapore
Authors: van der Eijk Yvette , Tan Grace Ping Ping 
Published: August 2021

BackgroundTobacco companies have maintained a profitable business in Singapore, despite its strong anti-tobacco climate and commitment to protect public health policymaking from tobacco industry interference in line with Framework Convention on Tobacco Control Article 5.3. This study describes how tobacco companies influence policymaking in a highly regulated environment such as Singapore’s, where there is a strong government commitment to Article 5.3.MethodsAnalysis of internal tobacco industry documents detailing the industry’s lobbying activities in Singapore, retrieved via snowball searches in the Truth Tobacco Industry Documents Library. Subsequently, we conducted one-on-one interviews with key informants from sectors mentioned in the documents (academia, arts, government, public health, media, trade, education) to fill gaps in information and provide context to events described in the documents.ResultsIn the 1980s and 1990s, tobacco companies observed that, to influence policy within Singapore’s ‘hostile’ environment, they needed to use ‘behind the scenes’ tactics, targeting influential individuals at social functions or industry-sponsored events. Tobacco companies used arts and education sponsorships primarily for political purposes, to gain visibility with policymakers. Tobacco companies cultivated relationships with academic researchers and the media to avoid smoke-free legislation in the 1990s and, in the 2010s, appear to have used similar tactics to challenge Singapore’s e-cigarette ban.ConclusionsCountries with a strong commitment to Article 5.3 should consider the tobacco industry’s potential interference in policymaking beyond relationships in the government sector, particularly in academia, arts, education and the media, and the more subtle or indirect manners in which these relationships are built.
Revisiting interpretation of relative density from shallow depth CPTs in sand
Authors: Krogh Lone , Quinteros Santiago , Engin Harun Kursat , Lunne Tom 
Published: August 2021

The relative density is an important state parameter in the determination of engineering properties of marine sands. Existing industry-acknowledged cone penetration test (CPT) correlations to relative density have been developed almost exclusively from the results of calibration chamber testing performed at stress levels higher than 50 kPa. A few studies suggest correlations for low stress levels as well, however, mainly for unaged normally consolidated soils. Existing formulations are often found to be challenged in the application for dense to very dense aged overconsolidated marine sands. This paper investigates the conditions and response of overconsolidated medium dense to very dense sand (as typically found in the North Sea) at shallow depths (less than 50 kPa) for a penetrating cone. It provides recommendations for a consistent set of parameters linking CPT parameters to the stress conditions, expressed by the apparent overconsolidation ratio and coefficient of earth pressure at rest, and the relative density. The recommendations are based on a comprehensive field-testing campaign at a sand site in Cuxhaven, Germany, supported by a suite of laboratory testing and numerical analyses.
Demystifying Drought: Strategies to Enhance the Communication of a Complex Hazard
Authors: Ward Rebecca , Lackstrom Kirsten , Davis Corey 
Published: August 2021

Abstract
Drought is a complex phenomenon that is difficult to characterize and monitor. Accurate and timely communication is necessary to ensure that affected sectors and the public can respond and manage associated risks and impacts. To that end, myriad drought indicators, indices, and other tools have been developed and made available, but understanding and using this information can be a challenge for end users who are unfamiliar with the information or presentation or for decision-makers with expertise in areas outside of climate and drought. This article highlights a project that aimed to improve the usability and dissemination of drought information for North Carolina (NC) audiences by addressing specific needs for a better understanding of how drought is monitored, the climatic and environmental conditions that can cause or worsen drought, and the impacts occurring in NC’s different sectors and subregions. Conducted to support NC’s official, statewide drought monitoring process, the project’s methods and results have utility for other geographies and contexts. The project team designed an iterative process to engage users in the development, evaluation, refinement, and distribution of new resources. Featured products include the Weekly Drought Update infographic, which explains the factors used to determine NC’s drought status, and the Short-Range Outlook infographic, a synthesis of National Weather Service forecasts. Effective strategies included using stakeholders’ preferred and existing channels to disseminate products, emphasizing impacts relevant to different user groups (such as agriculture, forestry, and water resources) rather than indices, and employing concise narratives and visualizations to translate technical and scientific information.
Extreme rainfall events in the Northeastern USA become more frequent with rising temperatures, but their intensity distribution remains stable
Authors: Olafsdottir Helga Kristin , Rootzén Holger , Bolin David 
Published: August 2021

AbstractBoth intensities of individual extreme rainfall events and the frequency of such events are important for infrastructure planning. We develop a new statistical extreme value model, the PGEV model, which makes it possible to use high quality annual maximum series data instead of lesswell checked daily data to estimate trends in intensity and frequency separately. The method is applied to annual maxima data from the NOAA Atlas 14, Volume 10, dating from approximately 1900 to 2014, showing that in the majority of 333 rain gauge stations in the Northeastern USA the frequency of extreme rainfall events increases as mean temperature increases, but that there is little evidence of trends in the distribution of the intensities of individual extreme rainfall events. The median of the frequency trends corresponds to extreme rainfalls becoming 83% more frequent for each centigrade degree of temperature increase. Naturally, increasing trends in frequency also increase the yearly or 10-yearly risks of very extreme rainfall events. Three other large areas in the contiguous USA, the Midwest, the Southeast, and Texas, are also studied, and show similar but weaker trends than those in the Northeast.
Removing the Effects of Tropical Dynamics from North Pacific Climate Variability
Authors: Zhao Yingying , Newman Matthew , Capotondi Antonietta , Di Lorenzo Emanuele , Sun Daoxun 
Published: August 2021

AbstractTeleconnections from the Tropics energize variations of the North Pacific climate, but detailed diagnosis of this relationship has proven difficult. Simple univariate methods, such as regression on El Niño-Southern Oscillation (ENSO) indices, may be inadequate since the key dynamical processes involved -- including ENSO diversity in the Tropics, re-emergence of mixed layer thermal anomalies, and oceanic Rossby wave propagation in the North Pacific -- have a variety of overlapping spatial and temporal scales. Here we use a multivariate Linear Inverse Model to quantify tropical and extra-tropical multi-scale dynamical contributions to North Pacific variability, in both observations and CMIP6 models. In observations, we find that the Tropics are responsible for almost half of the seasonal variance, and almost three quarters of the decadal variance, along the North American coast and within the subtropical front region northwest of Hawaii. SST anomalies that are generated by local dynamics within the Northeast Pacific have much shorter time scales, consistent with transient weather forcing by Aleutian low anomalies. Variability within the Kuroshio-Oyashio Extension (KOE) region is considerably less impacted by the Tropics, on all time scales. Consequently, without tropical forcing the dominant pattern of North Pacific variability would be a KOE pattern, rather than the Pacific Decadal Oscillation (PDO). In contrast to observations, most CMIP6 historical simulations produce North Pacific variability that maximizes in the KOE region, with amplitude significantly higher than observed. Correspondingly, the simulated North Pacific in all CMIP6 models is shown to be relatively insensitive to the Tropics, with a dominant spatial pattern generally resembling the KOE pattern, not the PDO.
Ototoxicity and Teprotumumab
Authors: Highland Julie , Gordon Steven , Reddy Deepika , Patel Neil 
Published: August 2021

Objectives: Teprotumumab, a novel monoclonal antibody, targets the insulin-like growth factor 1 (IGF-1) receptor. IGF-1 receptors, found in muscle and fat adjacent to the eye and implicated in Graves Ophthalmopathy, are also in the cochlea. In clinical trials, 5 participants reported self-limited audiologic symptoms but there are no objective data in the literature. The aim of this report is to describe one of the first known cases of teprotumumab-induced irreversible sensorineural hearing loss. Methods: Case report at a tertiary referral center Results: A 61 year old female with Graves ophthalmopathy presented with bilateral hearing loss, sound distortion, and tinnitus following treatment with teprotumumab. Audiogram showed mild sloping to moderately-severe sensorineural hearing loss. Repeat audiometry obtained 4 months after cessation of teprotumumab and treatment with oral corticosteroids was unchanged. Conclusions: This is one of the first descriptive cases of ototoxicity resulting in irreversible sensorineural hearing loss in the setting of treatment with teprotumumab. Periodic audiologic evaluations should be recommended to patients on teprotumumab.