Background: There is much concern regarding undisclosed corporate authorship (“ghostwriting”) in the peer-reviewed medical literature. However, there are no studies of how disclosure of ghostwriting alone impacts the perceived credibility of research results.

Findings: We conducted a randomized vignette study with experienced nurses (n = 67), using a fictional study of antidepressant medication. The vignette described a randomized controlled trial and gave efficacy and adverse effect rates. Participants were randomly assigned to one of two authorship conditions, either (a) traditional authorship (n = 35) or (b) ghostwritten paper (n = 32), and then completed a perceived credibility scale. Our primary hypothesis was that the median perceived credibility score total would be lower in the group assigned to the ghostwritten paper. Our secondary hypotheses were that participants randomized to the ghostwritten condition would be less likely to (a) recommend the medication, and (b) want the psychiatrist in the vignette as their own clinician. We also asked respondents to estimate efficacy and adverse effect rates for the medication.

There was a statistically significant difference in perceived credibility among those assigned to the ghostwriting condition. This amounted to a difference of 9.0 points on the 35-point perceived credibility scale as tested through the Mann–Whitney U test. There was no statistically significant difference between groups in terms of recommending the medication, wanting the featured clinician as their own, or in estimates of efficacy or adverse effects (p > .05 for all such comparisons).

Conclusion: In this study, disclosure of ghostwriting resulted in lower perceived credibility ratings.

Background: Despite improvements in maternity healthcare services over the last few decades, more than 2.7 million babies worldwide are stillborn each year. The global health agenda is silent about stillbirth, perhaps, in part, because its wider impact has not been systematically analysed or understood before now across the world. Our study aimed to systematically review, evaluate and summarise the current evidence regarding the psychosocial impact of stillbirth to parents and their families, with the aim of improving guidance in bereavement care worldwide.

Methods: Systematic review and meta-summary (quantitative aggregation of qualitative findings) of quantitative, qualitative, and mixed-methods studies. All languages and countries were included.

Results: Two thousand, six hundred and nineteen abstracts were identified; 144 studies were included. Frequency effect sizes (FES %) were calculated for each theme, as a measure of their prevalence in the literature. Themes ranged from negative psychological symptoms post bereavement (77 · 1) and in subsequent pregnancies (27 · 1), to disenfranchised grief (31 · 2), and incongruent grief (28 · 5), There was also impact on siblings (23 · 6) and on the wider family (2 · 8). They included mixed-feelings about decisions made when the baby died (12 · 5), avoidance of memories (13 · 2), anxiety over other children (7 · 6), chronic pain and fatigue (6 · 9), and a different approach to the use of healthcare services (6 · 9). Some themes were particularly prominent in studies of fathers; grief suppression (avoidance)(18 · 1), employment difficulties, financial debt (5 · 6), and increased substance use (4 · 2). Others found in studies specific to mothers included altered body image (3 · 5) and impact on quality of life (2 · 1). Counter-intuitively, Some themes had mixed connotations. These included parental pride in the baby (5 · 6), motivation for engagement in healthcare improvement (4 · 2) and changed approaches to life and death, self-esteem, and own identity (25 · 7). In studies from low/middle income countries, stigmatisation (13 · 2) and pressure to prioritise or delay conception (9) were especially prevalent.

Conclusion: Experiencing the birth of a stillborn child is a life-changing event. The focus of the consequences may vary with parent gender and country. Stillbirth can have devastating psychological, physical and social costs, with ongoing effects on interpersonal relationships and subsequently born children. However, parents who experience the tragedy of stillbirth can develop resilience and new life-skills and capacities. Future research should focus on developing interventions that may reduce the psychosocial cost of stillbirth.

Cellular heterogeneity plays a pivotal role in a variety of functional processes in vivo including carcinogenesis. However, our knowledge about cell-to-cell diversity and how differences in individual cells manifest in alterations at the population level remains very limited mainly due to the lack of appropriate tools enabling studies at the single-cell level. We present a study on changes in cellular heterogeneity in the context of pre-malignant progression in response to hypoxic stress. Utilizing pre-malignant progression of Barrett’s esophagus (BE) as a disease model system we studied molecular mechanisms underlying the progression from metaplastic to dysplastic (pre-cancerous) stage. We used newly developed methods enabling measurements of cell-to-cell differences in copy numbers of mitochondrial DNA, expression levels of a set of mitochondrial and nuclear genes involved in hypoxia response pathways, and mitochondrial membrane potential. In contrast to bulk cell studies reported earlier, our study shows significant differences between metaplastic and dysplastic BE cells in both average values and single-cell parameter distributions of mtDNA copy numbers, mitochondrial function, and mRNA expression levels of studied genes. Based on single-cell data analysis, we propose that mitochondria may be one of the key factors in pre-malignant progression in BE.

Atmospheric radiocarbon (¹⁴C) represents an important observational constraint on emissions of fossil-fuel derived carbon into the atmosphere due to the absence of ¹⁴C in fossil fuel reservoirs. The high sensitivity and precision that accelerator mass spectrometry (AMS) affords in atmospheric ¹⁴C analysis has greatly increased the potential for using such measurements to evaluate bottom-up emissions inventories of fossil fuel CO₂(CO₂ff), as well as those for other co-emitted species. Here we use observations of ¹⁴CO₂ and a series of primary hydrocarbons and combustion tracers from discrete air samples collected between June 2009 and September 2010 at the National Oceanic and Atmospheric Administration Boulder Atmospheric Observatory (BAO; Lat: 40.050° N, Lon: 105.004° W) to derive emission ratios of each species with respect to CO₂ff. The BAO tower is situated at the boundary of the Denver metropolitan area to the south and a large industrial and agricultural region to the north and east, making it an ideal location to study the contrasting mix of emissions from the activities in each region. The species considered in this analysis are carbon monoxide (CO), methane (CH₄), acetylene (C₂H₂), benzene (C₆H₆), and C₃–C₅ alkanes. We estimate emissions for a subset of these species by using the Vulcan high resolution CO2ff emission data product as a reference. We find that CO is overestimated in the 2008 National Emissions Inventory (NEI08) by a factor of ~2. A close evaluation of the inventory suggests that the ratio of CO emitted per unit fuel burned from on-road gasoline vehicles is likely over-estimated by a factor of 2.5. Using a wind-directional analysis of the data, we find enhanced concentrations of CH₄, relative to CO₂ff, in air influenced by emissions to the north and east of the BAO tower when compared to air influenced by emissions in the Denver metro region to the south. Along with enhanced CH₄, the strongest enhancements of the C₃–C₅ alkanes are also found in the north and east wind sector, suggesting that both the alkane and CH₄ enhancements are sourced from oil and gas fields located to the northeast, though it was not possible to rule out the contribution of non oil and gas CH₄ sources.

The Arctic, even more so than other parts of the world, has warmed substantially over the past few decades. Temperature and humidity influence the rate of development, survival and reproduction of pathogens and thus the incidence and prevalence of many infectious diseases. Higher temperatures may also allow infected host species to survive winters in larger numbers, increase the population size and expand their habitat range. The impact of these changes on human disease in the Arctic has not been fully evaluated. There is concern that climate change may shift the geographic and temporal distribution of a range of infectious diseases. Many infectious diseases are climate sensitive, where their emergence in a region is dependent on climate-related ecological changes. Most are zoonotic diseases, and can be spread between humans and animals by arthropod vectors, water, soil, wild or domestic animals. Potentially climate-sensitive zoonotic pathogens of circumpolar concern include Brucella spp., Toxoplasma gondii, Trichinella spp., Clostridium botulinum, Francisella tularensis, Borrelia burgdorferi, Bacillus anthracis, Echinococcus spp., Leptospira spp., Giardia spp., Cryptosporida spp., Coxiella burnetti, rabies virus, West Nile virus, Hantaviruses, and tick-borne encephalitis viruses.

Urban environments are the primary contributors to global anthropogenic carbon emissions. Because much of the growth in CO₂ emissions will originate from cities, there is a need to develop, assess, and improve measurement and modeling strategies for quantifying and monitoring greenhouse gas emissions from large urban centers. In this study the uncertainties in an aircraft-based mass balance approach for quantifying carbon dioxide and methane emissions from an urban environment, focusing on Indianapolis, IN, USA, are described. The relatively level terrain of Indianapolis facilitated the application of mean wind fields in the mass balance approach. We investigate the uncertainties in our aircraft-based mass balance approach by (1) assessing the sensitivity of the measured flux to important measurement and analysis parameters including wind speed, background CO₂ and CH₄, boundary layer depth, and interpolation technique, and (2) determining the flux at two or more downwind distances from a point or area source (with relatively large source strengths such as solid waste facilities and a power generating station) in rapid succession, assuming that the emission flux is constant. When we quantify the precision in the approach by comparing the estimated emissions derived from measurements at two or more downwind distances from an area or point source, we find that the minimum and maximum repeatability were 12 and 52%, with an average of 31%. We suggest that improvements in the experimental design can be achieved by careful determination of the background concentration, monitoring the evolution of the boundary layer through the measurement period, and increasing the number of downwind horizontal transect measurements at multiple altitudes within the boundary layer.

Large urban emissions of greenhouse gases result in large atmospheric enhancements relative to background that are easily measured. Using CO₂ mole fractions and Δ¹⁴C and δ¹³C values of CO₂ in the Los Angeles megacity observed in inland Pasadena (2006–2013) and coastal Palos Verdes peninsula (autumn 2009–2013), we have determined time series for CO₂ contributions from fossil fuel combustion (C_ff) for both sites and broken those down into contributions from petroleum and/or gasoline and natural gas burning for Pasadena. We find a 10 % reduction in Pasadena C_ff during the Great Recession of 2008–2010, which is consistent with the bottom-up inventory determined by the California Air Resources Board. The isotopic variations and total atmospheric CO₂ from our observations are used to infer seasonality of natural gas and petroleum combustion. The trend of CO₂ contributions to the atmosphere from natural gas combustion is out of phase with the seasonal cycle of total natural gas combustion seasonal patterns in bottom-up inventories but is consistent with the seasonality of natural gas usage by the area's electricity generating power plants. For petroleum, the inferred seasonality of CO₂ contributions from burning petroleum is delayed by several months relative to usage indicated by statewide gasoline taxes. Using the high-resolution Hestia-LA data product to compare C_ff from parts of the basin sampled by winds at different times of year, we find that variations in observed fossil fuel CO₂ reflect seasonal variations in wind direction. The seasonality of the local CO₂ excess from fossil fuel combustion along the coast, on Palos Verdes peninsula, is higher in autumn and winter than spring and summer, almost completely out of phase with that from Pasadena, also because of the annual variations of winds in the region. Variations in fossil fuel CO₂ signals are consistent with sampling the bottom-up Hestia-LA fossil CO₂ emissions product for sub-city source regions in the LA megacity domain when wind directions are considered.

Recent advances in fossil fuel CO₂ (FFCO₂) emission inventories enable sensitivity tests of simulated atmospheric CO₂ concentrations to sub-annual variations in FFCO₂ emissions and what this implies for the interpretation of observed CO₂. Six experiments are conducted to investigate the potential impact of three cycles of FFCO₂ emission variability (diurnal, weekly and monthly) using a global tracer transport model. Results show an annual FFCO₂ rectification varying from −1.35 to +0.13 ppm from the combination of all three cycles. This rectification is driven by a large negative diurnal FFCO₂ rectification due to the covariation of diurnal FFCO₂ emissions and diurnal vertical mixing, as well as a smaller positive seasonal FFCO₂ rectification driven by the covariation of monthly FFCO₂ emissions and monthly atmospheric transport. The diurnal FFCO₂ emissions are responsible for a diurnal FFCO₂ concentration amplitude of up to 9.12 ppm at the grid cell scale. Similarly, the monthly FFCO₂ emissions are responsible for a simulated seasonal CO₂ amplitude of up to 6.11 ppm at the grid cell scale. The impact of the diurnal FFCO₂ emissions, when only sampled in the local afternoon, is also important, causing an increase of +1.13 ppmv at the grid cell scale. The simulated CO₂ concentration impacts from the diurnally and seasonally varying FFCO₂ emissions are centered over large source regions in the Northern Hemisphere, extending to downwind regions. This study demonstrates the influence of sub-annual variations in FFCO₂ emissions on simulated CO₂ concentration and suggests that inversion studies must take account of these variations in the affected regions.

Background: Studies show that ex-prisoners often experience more health problems than the general population; unfortunately, these issues follow them upon their release from prison. As such, it is possible re-entry rates signal the need for neighborhood-based health care organizations (HCOs). We ask: are incarceration and re-entry rates associated with the availability of HCOs?

Methods: Using 2008 Central Business Pattern data, 2008 prison admissions and release data, and 2000 and 2010 census data, we test whether prison admission and release rates impact the availability of HCOs net of neighborhood characteristics in Arkansas using Logit-Poisson hurdle models with county fixed effects.

Results: We find that the incarceration and re-entry rates – together known as coercive mobility -- are related to whether a neighborhood has one or more HCOs, but not to the number of HCOs in a neighborhood.

Conclusion: Future public policies should aim to locate health care organizations in areas where there is significant churning of individuals in and out of prison.

Objective: To estimate the effects on homicide rates of the gang truce that was brokered in El Salvador in 2012.

Methods: Mathematical models based on municipal-level census, crime and gang-intelligence data were used to estimate the effect of the truce on homicide rates. One model estimated the overall effect after accounting for the linear trend and seasonality in the homicide rate. In a moderated-effect model, we investigated the relationship between the truce effect and the numbers of MS13 (Mara Salvatrucha 13) and Eighteenth-Street gang members imprisoned per 100 000 population. We then ran each of these two models with additional control variables. We compared values before the truce – 1 January 2010 to 29 February 2012 – with those after the truce – 1 March 2012 to 31 December 2013.

Findings: The overall-effect models with and without additional control variables indicated a homicide rate after the truce that was significantly lower than the value before the truce, giving rate ratios of 0.55 (95% confidence interval, CI: 0.49–0.63) and 0.61 (95% CI: 0.54–0.69), respectively. For any given municipality, the effectiveness of the truce appeared to increase as the number of MS13 gang members imprisoned per 100 000 population increased. We did not observe the same significant relationship for imprisoned Eighteenth-Street gang members.

Conclusion: In the 22 months following the establishment of a national gang truce, the homicide rate was about 40% lower than in the preceding 26 months. The truce’s impact appeared particularly strong in municipalities with relatively high numbers of imprisoned MS13 gang members per 100 000 population.