Pertussis is frequently reported to be more common in females than in males. However, the variability of the sources of these observations makes it difficult to estimate the magnitude and consistency ...of the sex differences by age. To address this question, we used meta-analytic methods to analyze pertussis national incidence rates by sex and age group from nine countries between the years 1990 and 2017.
For each age group, we used meta-analytic methods to combine the female to male incidence rate ratios (RRs) by country and year. Meta-regression was performed to assess the relative contributions of age, country and time-period to the variation in the incidence RRs.
The pooled female to male incidence RRs (with 95% CI) for ages 0-1, 1-4, 5-9 and 10-14, were 1.03 (1.01-1.06), 1.16 (1.14-1.17), 1.18 (1.15-1.22), 1.15 (1.11-1.18) respectively. For the ages 15-44, 45-64 and 65+ they were 1.65 (1.58-1.72), 1.59 (1.53-1.66), 1.20 (1.16-1.24), respectively. While there were some differences between the countries, the directions were consistent. When including age, country and time in meta-regression analyses, almost all the variation could be attributed to the differences between the age groups.
The consistency of the excess pertussis incidence rates in females, particularly in infants and very young children, is unlikely to be due to differences in exposure. Other factors that impact on the immune system, including chromosomal differences and hormones, should be further investigated to explain these sex differences. Future studies should consider sex for better understanding the mechanisms affecting disease incidence, with possible implications for management and vaccine development.
Care bundles are small sets of evidence-based recommendations, designed to support the implementation of evidence-based best clinical practice. However, there is variation in the design and ...implementation of care bundles, which may impact on the fidelity of delivery and subsequently their clinical effectiveness.
A scoping review was carried out using the Arksey and O'Malley framework to identify the literature reporting on the design, implementation and evaluation of care bundles. The Embase, CINAHL, Cochrane and Ovid MEDLINE databases were searched for manuscripts published between 2001 and November 2017; hand-searching of references and citations was also undertaken. Data were initially assessed using a quality assessment tool, the Downs and Black checklist, prior to further analysis and narrative synthesis. Implementation strategies were classified using the Expert Recommendations for Implementing Change (ERIC) criteria.
Twenty-eight thousand six hundred ninety-two publications were screened and 348 articles retrieved in full text. Ninety-nine peer-reviewed quantitative publications were included for data extraction. These consisted of one randomised crossover trial, one randomised cluster trial, one case-control study, 20 prospective cohort studies and 76 non-parallel cohort studies. Twenty-three percent of studies were classified as poor based on Downs and Black checklist, and reporting of implementation strategies lacked structure. Negative associations were found between the number of elements in a bundle and compliance (Spearman's rho = - 0.47, non-parallel cohort and - 0.65, prospective cohort studies), and between the complexity of elements and compliance (p < 0.001, chi-squared = 23.05). Implementation strategies associated with improved compliance included evaluative and iterative approaches, development of stakeholder relationships and education and training strategies.
Care bundles with a small number of simple elements have better compliance rates. Standardised reporting of implementation strategies may help to implement care bundles into clinical practice with high fidelity.
This review was registered on the PROSPERO database: CRD 42015029963 in December 2015.
In the paper published recently in this journal, Kumar et al. explained why the key to improved COVID-19 vaccine uptake is to understand societal reactions leading to vaccine hesitancy. They conclude ...that communications strategies should be tailored to the different phases of vaccine hesitancy. However, within the theoretical framework provided in their paper, vaccine hesitancy should be recognized as having both rational and irrational components. Rational vaccine hesitancy is a natural result of the inherent uncertainties in the potential impact of vaccines in controlling the pandemic. In general, irrational hesitancy is based on baseless information obtained from hearsay and deliberately false information. Risk communication should address both with transparent, evidence-based information. Rational concerns can be allayed by sharing the process in which dilemmas and uncertainties are dealt with by the health authorities. Messages on irrational concerns need to address head on the sources spreading unscientific and unsound information. In both cases, there is a need to develop risk communication that restores trust in the health authorities.
The refractory-to-ice mass ratio in comets Fulle, Marco; Blum, J; Green, S F ...
Monthly Notices of the Royal Astronomical Society,
01/2019, Volume:
482, Issue:
3
Journal Article
Peer reviewed
Open access
We review the complex relationship between the dust-to-gas mass ratio usually estimated in the material lost by comets, and the refractory-to-ice mass ratio inside the nucleus, which constrains the ...origin of comets. Such a relationship is dominated by the mass transfer from the perihelion erosion to fallout over most of the nucleus surface. This makes the refractory-to-ice mass ratio inside the nucleus up to 10 times larger than the dust-to-gas mass ratio in the lost material, because the lost material is missing most of the refractories which were inside the pristine nucleus before the erosion. We review the refractory-to-ice mass ratios available for the comet nuclei visited by space missions, and for the Kuiper Belt Objects with well-defined bulk density, finding the 1-σ lower limit of 3. Therefore, comets and KBOs may have less water than CI-chondrites, as predicted by models of comet formation by the gravitational collapse of cm-sized pebbles driven by streaming instabilities in the protoplanetary disc.
Playing action video games enhances several different aspects of visual processing; however, the mechanisms underlying this improvement remain unclear. Here we show that playing action video games ...can alter fundamental characteristics of the visual system, such as the spatial resolution of visual processing across the visual field. To determine the spatial resolution of visual processing, we measured the smallest distance a distractor could be from a target without compromising target identification. This approach exploits the fact that visual processing is hindered as distractors are brought close to the target, a phenomenon known as crowding. Compared with nonplayers, action-video-game players could tolerate smaller target-distractor distances. Thus, the spatial resolution of visual processing is enhanced in this population. Critically, similar effects were observed in non-video-game players who were trained on an action video game; this result verifies a causative relationship between video-game play and augmented spatial resolution.
Integrated models combine multiple data types within a unified analysis to estimate species abundance and covariate effects. By sharing biological parameters, integrated models improve the accuracy ...and precision of estimates compared to separate analyses of individual data sets. We developed an integrated point process model to combine presence-only and distance sampling data for estimation of spatially explicit abundance patterns. Simulations across a range of parameter values demonstrate that our model can recover estimates of biological covariates, but parameter accuracy and precision varied with the quantity of each data type. We applied our model to a case study of black-backed jackals in the Masai Mara National Reserve, Kenya, to examine effects of spatially varying covariates on jackal abundance patterns. The model revealed that jackals were positively affected by anthropogenic disturbance on the landscape, with highest abundance estimated along the Reserve border near human activity. We found minimal effects of landscape cover, lion density, and distance to water source, suggesting that human use of the Reserve may be the biggest driver of jackal abundance patterns. Our integrated model expands the scope of ecological inference by taking advantage of widely available presence-only data, while simultaneously leveraging richer, but typically limited, distance sampling data.
Progression from paroxysmal to persistent atrial fibrillation (AF) has important clinical implications and is relevant to the management of patients with AF.
The purpose of this study was to define ...the long-term rate of progression from paroxysmal to persistent AF and the relevant clinical variables.
The Canadian Registry of Atrial Fibrillation enrolled patients after a first electrocardiographic diagnosis of paroxysmal AF. Associations between baseline characteristics and clinical outcomes were evaluated using a multivariable Cox proportional hazard model and a competing risk model accounting for death as a competing risk, where appropriate.
We enrolled 755 patients (61.7% men) aged between 14 and 91 years (mean age 61.2 ± 14.2 years). The median follow-up was 6.35 years (interquartile range 2.93-10.04 years), with a rate of progression to persistent AF at 1, 5, and 10 years was 8.6%, 24.3%, and 36.3%, respectively. All-cause mortality was 30.3% at 10 years. Factors associated with AF progression were increasing age (hazard ratio HR 1.40; 95% confidence interval CI 1.23-1.60, for each 10-year increment), mitral regurgitation (HR 1.87; 95% CI 1.28-2.73), left atrial dilatation (HR 3.01; 95% CI 2.03-4.47), aortic stenosis (HR 2.40; 95% CI 1.05-5.48), and left ventricular hypertrophy (HR .47; 95% CI 1.04-2.08). Factors associated with a lower rate of progression were a faster heart rate during AF (HR 0.94; 95% CI 0.92-0.96 per 5-beat/min increment) and angina (HR 0.54; 95% CI 0.38-0.77). After accounting for death as a competing risk, left ventricular hypertrophy and aortic stenosis were no longer significant.
Within 10 years of presenting with paroxysmal AF, >50% of patients will progress to persistent AF or be dead. Increasing age, mitral regurgitation, aortic stenosis, left ventricular hypertrophy, and left atrial dilatation were associated with progression to persistent AF.
Vitamin A is essential for life in all vertebrate animals. Vitamin A requirement can be met from dietary preformed vitamin A or provitamin A carotenoids, the most important of which is β-carotene. ...The metabolism of β-carotene, including its intestinal absorption, accumulation in tissues, and conversion to vitamin A, varies widely across animal species and determines the role that β-carotene plays in meeting vitamin A requirement. This review begins with a brief discussion of vitamin A, with an emphasis on species differences in metabolism. A more detailed discussion of β-carotene follows, with a focus on factors impacting bioavailability and its conversion to vitamin A. Finally, the literature on how animals utilize β-carotene is reviewed individually for several species and classes of animals. We conclude that β-carotene conversion to vitamin A is variable and dependent on a number of factors, which are important to consider in the formulation and assessment of diets. Omnivores and herbivores are more efficient at converting β-carotene to vitamin A than carnivores. Absorption and accumulation of β-carotene in tissues vary with species and are poorly understood. More comparative and mechanistic studies are required in this area to improve the understanding of β-carotene metabolism.
The adverse events reported from the COVID-19 mRNA vaccines have varied from very mild, such as pain near the vaccination site, to more severe, with occasional anaphylaxis. Details of age-specific ...gender differences for the adverse effects are not well documented.
Age and gender disaggregated data on reports of adverse events following two or three doses of the Pfizer-BioNTech COVID-19 vaccine were obtained from four cross-sectional studies. The first was from reports submitted to the Israel Ministry of Health national adverse events database (for ages 16 and above). The second was from a national cross-sectional survey based on an internet panel (for ages 30 and above), and the third and fourth were from cross-sectional surveys among employees of a large company (for ages 20-65) using links to a self-completed questionnaire.
In all studies, the risks of adverse events were higher following the second dose and consistently higher in females at all ages. The increased risk among females at all ages included local events such as pain at the injection site, systemic events such as fever, and sensory events such as paresthesia in the hands and face. For the combined adverse reactions, for the panel survey the female-to-male risk ratios (RRs) were 1.89 for the first vaccine dose and 1.82 for the second dose. In the cross-sectional workplace studies, the female-to-male RRs for the first, second and third doses exceeded 3.0 for adverse events, such as shivering, muscle pain, fatigue and headaches.
The consistent excess in adverse events among females for the mRNA COVID-19 vaccine indicates the need to assess and report vaccine adverse events by gender. Gender differences in adverse events should be taken into account when determining dosing schedules.
Summary
The multidisciplinary International Committee for the Advancement of Procedural Sedation presents the first fasting and aspiration prevention recommendations specific to procedural sedation, ...based on an extensive review of the literature. These were developed using Delphi methodology and assessment of the robustness of the available evidence. The literature evidence is clear that fasting, as currently practiced, often substantially exceeds recommended time thresholds and has known adverse consequences, for example, irritability, dehydration and hypoglycaemia. Fasting does not guarantee an empty stomach, and there is no observed association between aspiration and compliance with common fasting guidelines. The probability of clinically important aspiration during procedural sedation is negligible. In the post‐1984 literature there are no published reports of aspiration‐associated mortality in children, no reports of death in healthy adults (ASA physical status 1 or 2) and just nine reported deaths in adults of ASA physical status 3 or above. Current concerns about aspiration are out of proportion to the actual risk. Given the lower observed frequency of aspiration and mortality than during general anaesthesia, and the theoretical basis for assuming a lesser risk, fasting strategies in procedural sedation can reasonably be less restrictive. We present a consensus‐derived algorithm in which each patient is first risk‐stratified during their pre‐sedation assessment, using evidence‐based factors relating to patient characteristics, comorbidities, the nature of the procedure and the nature of the anticipated sedation technique. Graded fasting precautions for liquids and solids are then recommended for elective procedures based upon this categorisation of negligible, mild or moderate aspiration risk. This consensus statement can serve as a resource to practitioners and policymakers who perform and oversee procedural sedation in patients of all ages, worldwide.
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