bluuebunny/crossref_metadata_2025 huggingface dataset:
Adverse event following live attenuated chikungunya vaccine in a cynomolgus macaque with pre‐existing chronic hydrocephalus
Authors: Peterson Tiffany A. , MacLean Andrew G. , Russell‐Lodrigue Kasi E. , Didier Peter J. , Weaver Scott C. , Roy Chad J.
Published: April 2019

A cynomolgus macaque (Macaca fascicularis) with a pre‐existing, undiagnosed, subclinical but severe cerebral hydrocephalus was enrolled in a study of long‐term immunogenicity of the IRES/CHIK vaccine. The animal began showing signs of neurological dysfunction post‐vaccination, which progressed and ultimately resulted in euthanasia. The underlying brain abnormality was revealed at necropsy and was subsequently investigated with gross and microscopic examination. This becomes the first reported case of an adverse event following administration of a live attenuated vaccine and suggests the possibility of an increased susceptibility risk of unwanted adverse outcome associated with vaccination in populations with pre‐existing conditions such as hydrocephalus.
Cell‐specific effects of nitric oxide on the efficiency and frequency of long distance contractions in murine colon
Authors: Beck Katharina , Voussen Barbara , Reigl Amelie , Vincent Alexander D. , Parsons Sean P. , Huizinga Jan D. , Friebe Andreas
Published: April 2019

Background

Nitric oxide (NO) mediates inhibitory neurotransmission and is a critical component of neuronal programs that generate propulsive contractions. NO acts via its receptor NO‐sensitive guanylyl cyclase (NO‐GC) which is expressed in smooth muscle cells (SMC) and interstitial cells of Cajal (ICC). Organ bath studies with colonic rings from NO‐GC knockout mice (GCKO) have indicated NO‐GC to modulate spontaneous contractions. The cell‐specific effects of NO‐GC on the dominant pan‐colonic propulsive contraction, the long distance contractions (LDCs), of whole colon preparations have not yet been described.

Methods

Contractions of whole colon preparations from wild type (WT), global, and cell‐specific GCKO were recorded. After transformation into spatiotemporal maps, motility patterns were analyzed. Simultaneous perfusion of the colon enabled the correlation of outflow with LDCs to analyze contraction efficiency.

Key Results

Deletion of NO‐GC in both ICC and SMC (ie, in GCKO and SMC/ICC‐GCKO) caused loss of typical LDC activity and instead generated high‐frequency LDC‐like contractions with inefficient propulsive activity. Frequency was also increased in WT, SMC‐GCKO, and ICC‐GCKO colon in the presence of L‐NAME to block neuronal NO synthase. LDC efficiency was dependent on NO‐GC in SMC as it was reduced in GCKO, SMC‐GCKO, and ICC/SMC‐GCKO colon; LDC efficiency was decreased in all genotypes in the presence of L‐NAME.

Conclusions and Inferences

NO/cGMP signaling is critical for normal peristaltic movements; as NO‐GC in both SMC and ICC is essential, both cell types appear to work in synchrony. The efficiency of contractions to expel fluid is particularly influenced by NO‐GC in SMC.
VT arising from sub‐aortic muscular outflow tract structures: In two patients with ventricular septal defects
Authors: Chang Shu , Marzec Lucas , Kay Joseph , Khanna Amber , Sauer William H. , Nguyen Duy T.
Published: April 2019

Background

Outflow tract ventricular tachycardias (OTVT) most commonly occur in the absence of structural abnormalities. We present two cases in which a structural variant in the outflow tract was critical to the OTVT.

Cases

Subaortic muscular bands were identified using intracardiac echocardiography (ICE) in each of our cases with history of VSD and VT. Mapping demonstrating their critical involvement to the tachycardia and ablation along the muscular bands rendered the ventricular tachycardias non‐inducible.

Conclusion

In rare instances, a structural variant may be involved in OTVTs. The use of ICE along with electroanatomic mapping can assist in successful ablation of these ventricular tachycardias.
Societal value of newborn screening for severe combined immune deficiency in Arkansas: An economic analysis
Authors: Hays Laura H.
Published: April 2019

Newborn screening (NBS) is a public health program that detects genetic conditions in neonates enabling treatment before clinical symptoms manifest. Severe combined immune deficiency (SCID) is a primary immune deficiency found in the absence of functioning T and B lymphocytes. Hematopoietic cell transplantation is a potentially curative treatment if received within the first 42 months of life; without treatment, this condition is fatal in the first 2 years of life due to severe opportunistic infections. SCID was added to the recommended uniform panel of conditions for inclusion in state NBS programs in 2010. This manuscript examines the societal costs and benefits of NBS for SCID in Arkansas and implications to health services and social welfare. Total cost per year of all NBS for SCID and resulting early treatment for one patient with SCID in Arkansas is estimated at $1,078,714. Cost of late treatment of one patient with SCID is estimated at $1.43 million. Based on an expected diagnosis of one patient per year in Arkansas, this results in an estimated net cost savings for NBS for SCID in Arkansas of $351,286 per year. Based on cost‐effectiveness analysis, NBS for SCID in Arkansas is cost‐effective, with higher societal benefit than cost.
Does size really matter? A comparative study on floral traits in orchids with two different pollination strategies
Authors: Lussu M. , De Agostini A. , Cogoni A. , Marignani M. , Cortis P.
Published: April 2019

The lock and key hypothesis assumes that male and female genitalia match in a unique system to prevent interspecific crosses. This hypothesis is largely investigated in animals, while there is a distinct lack of studies on plants. Nevertheless, we expect the lock and key hypothesis could apply to plants with complex floral morphologies, such as orchids.

Here we apply a comparative approach to examine the variation of floral functional traits in food‐ and sex‐deceptive orchids. To understand if a specific deception strategy is related to a specific variation in floral traits evaluated the variation in sterile and fertile traits among species and subsequently examined the correlations between male and female reproductive organs of the same species with the aim of investigating the role of the lock and key hypothesis in deceptive orchids.

Our results show that the functional morphology of fertile traits plays a pivotal role in limiting gene flow in species that grow in sympatry. In particular, it was observed that the Reproductive Standardisation Index (RSI) is significantly different in the two pollination strategies and that the correlation between pollinarium length and stigmatic cavity length is stronger in food‐deceptive species when compared to the sex‐deceptive species.

These results reveal that the lock and key hypothesis contributes to maintain boundaries in plants with very complex floral morphology.
Elevated [CO2] effects on crops: Advances in understanding acclimation, nitrogen dynamics and interactions with drought and other organisms
Authors: Tausz‐Posch S. , Tausz M. , Bourgault M.
Published: April 2019

Future rapid increases in atmospheric CO2 concentration [CO2] are expected, with values likely to reach ~550 ppm by mid‐century. This implies that every terrestrial plant will be exposed to nearly 40% more of one of the key resources determining plant growth. In this review we highlight selected areas of plant interactions with elevated [CO2] (e[CO2]), where recently published experiments challenge long‐held, simplified views. Focusing on crops, especially in more extreme and variable growing conditions, we highlight uncertainties associated with four specific areas. (1) While it is long known that photosynthesis can acclimate to e[CO2], such acclimation is not consistently observed in field experiments. The influence of sink–source relations and nitrogen (N) limitation on acclimation is investigated and current knowledge about whether stomatal function or mesophyll conductance (gm) acclimate independently is summarised. (2) We show how the response of N uptake to e[CO2] is highly variable, even for one cultivar grown within the same field site, and how decreases in N concentrations ([N]) are observed consistently. Potential mechanisms contributing to [N] decreases under e[CO2] are discussed and proposed solutions are addressed. (3) Based on recent results from crop field experiments in highly variable, non‐irrigated, water‐limited environments, we challenge the previous opinion that the relative CO2 effect is larger under drier environmental conditions. (4) Finally, we summarise how changes in growth and nutrient concentrations due to e[CO2] will influence relationships between crops and weeds, herbivores and pathogens in agricultural systems.
Airway distensibility: Bringing physiology to the bedside – Reply
Authors: Chen Ning‐Hung , Lin Shih‐Wei , Chuang Li‐Pang
Published: April 2019

See Letter
Objectively Measured Environmental Correlates of Toddlers’ Physical Activity and Sedentary Behavior
Authors: Hunter Stephen , Rosu Andrei , Hesketh Kylie D. , Rhodes Ryan E. , Rinaldi Christina M. , Rodgers Wendy , Spence John C. , Carson Valerie
Published: April 2019

Purpose: Examine objectively measured environmental correlates of physical activity and sedentary behavior in toddlers (12–35 mo). Methods: Participants were recruited at immunization appointments in Edmonton, Canada. Physical activity and sedentary time were objectively measured via accelerometers (n = 149). The parents reported screen time and demographic characteristics via a questionnaire (n = 249). Postal codes were used to link neighborhood data via geographic information systems. Neighborhood data included 4 environmental domains: functional (ie, walkability), safety (ie, crime), esthetic (ie, tree density), and destination (ie, cul-de-sac density, wooded area percentage, green space percentage, recreation density, park density). Weather data (temperature and precipitation) were obtained via historical weather records. Multilevel multiple linear regression models were used to account for clustering of participants within neighborhoods and adjustment of demographic variables. Results: Each additional 10°C of mean temperature was significantly associated with 5.74 (95% confidence interval, 0.96–10.50) minutes per day of higher light-intensity physical activity, though the effect size was small (f2 = 0.08). No other significant associations were observed. Conclusions: The lack of significant findings for neighborhood environment factors suggests proximal factors (eg, features of the home environment) may be more important in predicting toddlers’ physical activity and sedentary behavior. More indoor physical activity opportunities may be needed on colder days for toddlers.
Delayed catalyst function enables direct enantioselective conversion of nitriles to NH
2
-amines
Authors: Zhang Shaochen , del Pozo Juan , Romiti Filippo , Mu Yucheng , Torker Sebastian , Hoveyda Amir H.
Published: April 2019

Amines emerge, as copper bides its time

Concurrent operation of two or more catalytic cycles requires a delicate balance of relative rates. Zhang
et al.
developed an amine synthesis in which allenes and nitriles are coupled under reductive conditions. A copper catalyst was charged with successively borylating the allene, coupling the intermediate to the nitrile, and then enantioselectively reducing that next intermediate to the amine. However, formation and reaction of the copper-boryl complex were too slow relative to a competing copper hydride. By adding an innovative delay cycle, the authors succeeded in keeping the fast-reacting hydride at bay until needed.

Science
, this issue p.
45
Комбинированная численная модель цунами
Authors: Носов Михаил Александрович , Nosov Mikhail Aleksandrovich , Колесов Сергей Владимирович , Kolesov Sergei Vladimirovich
Published: April 2019

Построена численная модель, описывающая динамику поверхностных гравитационных и акустических волн, возбуждаемых в океане малыми динамическими деформациями дна. В основу модели положена линейная потенциальная теория. Модель представляет собой комбинацию двух динамически сопряженных блоков: глубоководного и мелководного. Глубоководный блок решает трехмерную задачу потенциальной теории волн в сигма-сферических координатах, мелководный блок - двумерную задачу теории длинных волн в сферических координатах. Изложены результаты тестирования модели с применением аналитического решения задачи для плоского горизонтального дна. Проведен сравнительный анализ результатов воспроизведения цунами на Центральных Курилах 15.11.2006 и 13.01.2007 с использованием вновь построенной и традиционной длинноволновой моделей.
Численное моделирование образования гидрата при нагнетании холодного газа в снежный массив
Authors: Шагапов Владислав Шайхулагзамович , Shagapov Vladislav Shaikhulagzamovich , Чиглинцева Ангелина Сергеевна , Chiglintseva Angelina Sergeevna , Шепелькевич Олег Александрович , Shepel'kevich Oleg Aleksandrovich
Published: April 2019

Решена задача об образовании гидрата в снежном массиве, в исходном состоянии насыщенном газом, при нагнетании этого же газа. Построенная математическая модель основывается на уравнениях механики сплошной среды. Для осесимметричной задачи с протяженной областью фазовых переходов построены автомодельные решения, описывающие поля температур и давлений, а также насыщенностей снега, гидрата и газа в массиве. Численное решение задачи было реализовано методом стрельбы. Показано, что в зависимости от исходного термобарического состояния системы «газ--лед», а также интенсивности нагнетания газа, определяемой массовым его расходом, в области фильтрации можно выделить три характерные зоны, отличающиеся по своей структуре и протяженности: ближняя, в которой снег полностью перешeл в состав гидрата, и, следовательно, присутствуют только фазы гидрата и газа, промежуточная, в которой происходит образование гидрата из газа и льда, и дальняя, насыщенная фазами газа и льда. Изучено влияние массового расхода нагнетаемого газа, начальной снегонасыщенности и исходной температуры массива на протяженность объемной зоны образования гидрата в условиях отрицательной температуры, а также на величину температуры и гидратонасыщенности на границе, разделяющей ближнюю и промежуточную зоны.
Моделирование двухфазных течений в трещиноватой среде с кавернами
Authors: Блонский Артeм Вадимович , Blonsky Artem Vadimovich , Савенков Евгений Борисович , Savenkov Evgenii Borisovich
Published: April 2019

Работа посвящена математическому моделированию течений в дискретных системах трещин с учетом течений вдоль каверн, отнесенных к пересечениям трещин. Рассматривается физико-математическая модель двухфазного течения, которая учитывает переток между трещинами и кавернами, капиллярные и гравитационные силы. Капиллярные силы описаны моделью Юнга-Лапласа, которая учитывает угол смачиваемости породы, поверхностное натяжение, раскрытие трещин и диаметры сечения каверн. Описаны вычислительные алгоритмы решения задачи. Методами численного моделирования проведено исследование влияния течения в кавернах на процесс вытеснения нефти водой в трещиновато-кавернозной среде при различных типах смачиваемости породы. Показано, что наличие каверн на пересечениях трещин может в определенных условиях оказать существенное влияние на характеристики течения.
Применение метода граничных элементов в задачах аэродинамического проектирования
Authors: Шевелев Юрий Дмитриевич , Shevelev Yurii Dmitrievich , Егоров Н А , Egorov N A
Published: April 2019

Рассматривается метод граничных элементов, предназначенный для численного моделирования линеаризованных течений сплошной среды. Метод обеспечивает один из самых высоких уровней быстродействия среди всех подходов вычислительной аэродинамики. Это достигается благодаря отказу от построения пространственных расчетных сеток, поскольку величины, подлежащие определению в ходе решения задачи обтекания, распределены вдоль поверхности компоновок и, если необходимо, по поверхности вихревого следа. Данная работа подразделялась на следующие этапы: построение математической модели поверхности сложной формы и разбиение еe на панели, построение согласованной сетки на поверхности, расчeт аэродинамических характеристик двух компоновок самолетов. Результаты получены для чисел Маха, соответствующих дозвуковым течениям.
Динамика эпидемического процесса с антибиотикоустойчивым вариантом возбудителя
Authors: Герасимов Андрей Николаевич , Gerasimov Andrei Nikolaevich
Published: April 2019

Рассмотрена система «паразит-хозяин» с двумя вариантами возбудителя инфекционного заболевания, имеющих полный перекрестный иммунитет, причем один из вариантов может с некоторой вероятностью переходить в другой. Данная система соответствует эпидемическому процессу возбудителя инфекционного возбудителя, имеющего антибиотикоустойчивый вариант. Исследован характер поведения решений. Доказано, что для основного случая имеется единственное нетривиальное стационарное решение, являющееся глобальным аттрактором. Получена скорость экспоненциального приближения малых отклонений к стационарному решению.
Некоторые точные решения задачи о течении жидкости в сокращающемся эластичном сосуде
Authors: Мозохина Анастасия Сергеевна , Mozokhina Anastasiya Sergeevna , Мухин Сергей Иванович , Mukhin Sergei Ivanovich
Published: April 2019

Рассматриваются некоторые точные решения уравнений гемодинамики в сокращающемся сосуде в квазиодномерном приближении применительно к задачам, возникающим при описании течения лимфы. Приведены решения для линеаризованной задачи в случае принудительных малых сокращений просвета сосуда. Получено и исследовано аналитическое решение нелинейной системы при зависимости сечения сосуда только от времени. Точные решения воспроизведены в численном расчeте.
Pharmacological management of abnormal tone and movement in cerebral palsy
Authors: Lumsden Daniel E , Crowe Belinda , Basu Anna , Amin Sam , Devlin Anita , DeAlwis Yasmin , Kumar Ram , Lodh Rajib , Lundy Claire T , Mordekar Santosh R , Smith Martin , Cadwgan Jill
Published: April 2019

Background

The evidence base to guide the pharmacological management of tone and abnormal movements in cerebral palsy (CP) is limited, as is an understanding of routine clinical practice in the UK. We aimed to establish details of motor phenotype and current pharmacological management of a representative cohort across a network of UK tertiary centres.

Methods

Prospective multicentre review of specialist motor disorder clinics at nine UK centres, collecting data on clinical features and pharmacological management of children and young people (CYP) with CP over a single calendar month.

Results

Data were collected from 275 CYP with CP reviewed over the calendar month of October 2017. Isolated dystonia or spasticity was infrequently seen, with a mixed picture of dystonia and spasticity ± choreoathetosis identified in 194/275 (70.5%) of CYP. A comorbid diagnosis of epilepsy was present in 103/275 (37.4%). The most commonly used medications for abnormal tone/movement were baclofen, trihexyphenidyl, gabapentin, diazepam and clonidine. Medication use appeared to be influenced separately by the presence of dystonia or spasticity. Botulinum toxin use was common (62.2%). A smaller proportion of children (12.4%) had undergone a previous neurosurgical procedure for tone/movement management.

Conclusions

CYP with CP frequently present with a complex movement phenotype and comorbid epilepsy. They have multiple therapy, medical and surgical management regimens. Future trials of therapeutic, pharmacological or surgical interventions in this population must adequately encompass this complexity in order to be translatable to clinical practice.
Longitudinal analysis of health disparities in childhood
Authors: Oosterhoff Marije , Joore Manuela A , Bartelink Nina H M , Winkens Bjorn , Schayck Onno C P , Bosma Hans
Published: April 2019

Objective

Combatting disparities in health outcomes among children is a major public health concern. This study focuses on two questions: (1) To what extent does socioeconomic status (SES) contribute to disparities in health outcomes? and (2) To what extent can social inequalities in health outcomes be explained by differences in children’s health behaviours?

Design

This study included 2-year follow-up data of 1259 children (4–12 years of age) who participated in the ‘Healthy Primary School of the Future’ project (ClinicalTrials.govNCT02800616). SES was measured by maternal and paternal education and household income (adjusted for family size). Health outcomes were body mass index (BMI) z-score, health resource use, school absenteeism, health-related quality of life and psychosocial health, measured over 2 years of follow-up (2015–2017). Health behaviours included physical activity, and consumption of fruits, vegetables and sweetened beverages. Associations between SES and baseline health behaviours were examined, and mixed models for repeated measures were used to assess associations between SES and health outcomes over 2 years of follow-up.

Results

A high socioeconomic background was significantly associated with better health outcomes (all outcomes). For example, children with a low SES had higher BMI z-scores (beta coefficient: 0.42, 95% CI 0.22 to 0.62) and higher consumption healthcare costs (ratio of mean costs: 2.21, 95% CI 1.57 to 3.10). Effects of SES changed very little after controlling for health behaviours.

Discussion

Our findings strongly suggest that socioeconomic background has a pervasive impact on disparities in child health, but gives little support to the idea that social inequalities in child health can be tackled by means of lifestyle interventions.
Semirigid cervical spine collar and risk of missing significant soft tissue injuries
Authors: Hussain Mohammed Hassan , Corsar Kenneth
Published: April 2019

We report the case of an initial misdiagnosis of significant scalp soft tissue hidden beneath a semirigid cervical collar. A 16-year-old unrestrained rear seat passenger was involved in an RTA sustaining a subdural haematoma, cervical spine fractures and what was initially diagnosed as a significant degloving scalp injury. The patient was admitted to the intensive care unit intubated sedated, and with a cervical collar. The scalp injury was dressed with a view that potential reconstructive surgery would be needed subsequently.

This case demonstrates that while cervical collars remain a fundamental aspect of initial prehospital care in trauma, they have potential drawbacks to their use, which need to be carefully noted. Some of these drawbacks have been reported extensively in the literature. This case outlines the necessity of a thorough secondary survey in the trauma patient as the cervical collar can obscure the assessment of significant head and neck soft tissue injuries.
Assessing assumptions for statistical analyses in randomised clinical trials
Authors: Nielsen Emil Eik , Nørskov Anders Kehlet , Lange Theis , Thabane Lehana , Wetterslev Jørn , Beyersmann Jan , de Uña-Álvarez Jacobo , Torri Valter , Billot Laurent , Putter Hein , Winkel Per , Gluud Christian , Jakobsen Janus Christian
Published: April 2019

In order to ensure the validity of results of randomised clinical trials and under some circumstances to optimise statistical power, most statistical methods require validation of underlying statistical assumptions. The present paper describes how trialists in major medical journals report tests of underlying statistical assumptions when analysing results of randomised clinical trials. We also consider possible solutions how to improve current practice by adequate reporting of tests of underlying statistical assumptions. We conclude that there is a need to reach consensus on which underlying assumptions should be assessed, how these underlying assumptions should be assessed and what should be done if the underlying assumptions are violated.
Primary care physicians’ decision-making processes in the context of multimorbidity: protocol of a systematic review and thematic synthesis of qualitative research
Authors: Silvério Rodrigues David , Sousa Paulo Faria , Basílio Nuno , Antunes Ana , Antunes Maria da Luz , Santos Maria Isabel , Heleno Bruno
Published: April 2019

Introduction

Good patient outcomes correlate with the physicians’ capacity for good clinical judgement. Multimorbidity is common and it increases uncertainty and complexity in the clinical encounter. However, healthcare systems and medical education are centred on individual diseases. In consequence, recognition of the patient as the centre of the decision-making process becomes even more difficult. Research in clinical reasoning and medical decision in a real-world context is needed. The aim of the present review is to identify and synthesise available qualitative evidence on primary care physicians’ perspectives, views or experiences on decision-making with patients with multimorbidity.

Methods and analysis

This will be a systematic review of qualitative research where PubMed, CINAHL, PsycINFO, Embase and Web of Science will be searched, supplemented with manual searches of reference lists of included studies. Qualitative studies published in Portuguese, Spanish and English language will be included, with no date limit. Studies will be eligible when they evaluate family physicians’ perspectives, opinions or perceptions on decision-making for patients with multimorbidity in primary care. The methodological quality of studies selected for retrieval will be assessed by two independent reviewers before inclusion in the review using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis will be used to identify key categories and themes from the qualitative data. The Confidence in the Evidence from Reviews of Qualitative research approach will be used to assess how much confidence to place in findings from the qualitative evidence synthesis.

Ethics and dissemination

This review will use published data. No ethical issues are foreseen. The findings will be disseminated to the medical community via journal publication and conference presentation(s).

PROSPERO registration number

ID 91978.
Reliability and validity of the Turkish version of the Individual-Level Abortion Stigma Scale: a methodological study
Authors: Cetinkaya Aynur , Özmen Dilek , Uyar Fatma , Tayhan Ali
Published: April 2019

Objectives

The aim of this study was to assess the reliability and validity of the Turkish version of the Individual-Level Abortion Stigma Scale.

Setting

Three hospitals affiliated to Public Hospitals Union General Secretariat in Manisa, a city located in Western Turkey.

Design

This was a methodological study.

Participants

A total of 230 women aged 22–49 years who previously underwent abortion and volunteered to participate in the study.

Primary and secondary outcome measures

Data analysis was performed using the SPSS and LISREL software. The Content Validity Index was calculated based on the values obtained from expert opinions. In the reliability analysis, Cronbach’s alpha values were calculated for the overall scale and its subscales. To test the stability of the scale over time, the scale was readministered to 30 women in the study 15 days later and the test–retest values (Pearson’s correlation coefficients) were determined. In the validity analysis, the exploratory and confirmatory factor analyses were performed. In the exploratory factor analysis, the principal component analysis was performed using the varimax rotation and the factor loading of the scale was examined. Confirmatory factor analysis was performed to investigate the item-factor construct of the scale.

Results

The Content Validity Index was calculated as 0.86. The Cronbach’s alpha values ranged between 0.83 and 0.94. The item-total correlation coefficients ranged between 0.36 and 0.72, and the test–retest reliability was 0.96 for the overall scale and its subscales (p<0.05). The total variance revealed by five factors was 75%. Confirmatory factor analysis of the scale revealed an acceptable compliance level (root mean square error of approximation=0.092, χ2/df=2.91, Goodness of Fit Index=0.831, Comparative Fit Index=0.928, p<0.001).

Conclusions

The results suggest that this scale has the potential for use in research and clinical settings to measure abortion stigma among women.
From pain treatment to opioid dependence: a qualitative study of the environmental influence on codeine use in UK adults
Authors: Kinnaird Emma , Kimergård Andreas , Jennings Stacey , Drummond Colin , Deluca Paolo
Published: April 2019

Objectives

To investigate the views and experiences of people who use codeine in order to describe the ‘risk environment’ capable of producing and reducing harm.

Design

This was a qualitative interview study. Psychological dependence on codeine was measured using the Severity of Dependence Scale. A cut-off score of 5 or higher indicates probable codeine dependence.

Setting

Participants were recruited from an online survey and one residential rehabilitation service.

Participants

16 adults (13 women and 3 men) from the UK who had used codeine in the last 12 months other than as directed or as indicated. All participants began using codeine to treat physical pain. Mean age was 32.7 years (SD=10.1) and mean period of codeine use was 9.1 years (SD=7.6).

Results

Participants’ experiences indicated that they became dependent on codeine as a result of various environmental factors present in a risk environment. Supporting environments to reduce risk included: medicine review of repeat prescribing of codeine, well-managed dose tapering to reduce codeine consumption, support from social structures in form of friends and online and access to addiction treatment. Environments capable of producing harm included: unsupervised and long-term codeine prescribing, poor access to non-pharmacological pain treatments, barriers to provision of risk education of codeine related harm and breakdown in structures to reduce the use of over the counter codeine other than as indicated.

Conclusion

The study identified microenvironments and macroenvironments capable of producing dependence on codeine, including repeat prescribing and unsupervised use over a longer time period. The economic environment was important in its influence on the available resources for holistic pain therapy in primary care in order to offer alternative treatments to codeine. Overall, the goal is to create an environment that reduces risk of harm by promoting safe use of codeine for treatment of pain, while providing effective care for those developing withdrawal and dependence.
A prospective, cross-sectional study to establish age-specific reference intervals for neonates and children in the setting of clinical biochemistry, immunology and haematology: the HAPPI Kids study protocol
Authors: Hoq Monsurul , Karlaftis Vicky , Mathews Susan , Burgess Janet , Donath Susan M , Carlin John , Monagle Paul , Ignjatovic Vera
Published: April 2019

Introduction

The clinical interpretation of laboratory tests is reliant on reference intervals. However, the accuracy of a reference interval is dependent on the selected reference population, and in paediatrics, the ability of the reference interval to reflect changes associated with growth and age, as well as sex and ethnicity. Differences in reagent formulations, methodologies and analysers can also impact on a reference interval. To date, no direct comparison of reference intervals for common analytes using different analysers in children has been published. The Harmonising Age Pathology Parameters in Kids (HAPPI Kids) study aims to establish age-appropriate reference intervals for commonly used analytes in the routine clinical care of neonates and children, and to determine the feasibility of paediatric reference interval harmonisation by comparing age-appropriate reference intervals in different analysers for multiple analytes.

Methods and analysis

The HAPPI Kids study is a prospective cross-sectional study, collecting paediatric blood samples for analysis of commonly requested biochemical, immunological and haematological tests. Venous blood samples are collected from healthy premature neonates (32–36 weeks of gestation), term neonates (from birth to a maximum of 72 hours postbirth) and children aged 30 days to ≤18 years (undergoing minor day surgical procedures). Blood samples are processed according to standard laboratory procedures and, if not processed immediately, stored at –80°C. A minimum of 20 samples is analysed for every analyte for neonates and then each year of age until 18 years. Analytical testing is performed according to the standard operating procedures used for clinical samples. Where possible, sample aliquots from the same patients are analysed for an analyte across multiple commercially available analysers.

Ethics and dissemination

The study protocol was approved by The Royal Children’s Hospital, Melbourne, Ethics in Human Research Committee (34183 A). The study findings will be published in peer-reviewed journals and shared with clinicians, laboratory scientists and laboratories.
Determinants of undergoing thyroid cancer screening in Korean women: a cross-sectional analysis from the K-Stori 2016
Authors: Cho Ha Na , Choi Eunji , Seo Da Hea , Park Boyoung , Park Sohee , Cho Juhee , Kim Sue , Park Yeong-Ran , Rhee Yumie , Choi Kui Son
Published: April 2019

Objectives

Thyroid cancer is the most common cancer among Korean women. Studies suggest that the incidence of thyroid cancer might be associated with overdiagnosis resulting from thyroid cancer screening. The objective of this study was to identify the determinants of participation in thyroid cancer screening in Korean women.

Methods

Data were obtained from the 2016 Korean Study of Women’s Health-Related Issues, a nationwide cross-sectional survey of women according to the reproductive life cycle. A total of 8697 cancer-free women of ages between 20 and 79 years were included for analysis. Multivariable logistic regression analysis was applied to analyse factors associated with adherence to thyroid cancer screening based on Andersen’s health behavioural model.

Results

Over the last 2 years, the rate of thyroid cancer screening was 39.2%. In multivariable models, older age, higher household income, high school education level and higher perceived risk of cancer were positively associated with thyroid cancer screening participation. Moreover, women who underwent cervical cancer screening (adjusted OR [aOR] 3.67; 95% CI 2.90 to 4.64) and breast cancer screening (aOR 10.91; 95% CI 8.41 to 14.14) had higher odds of attending thyroid cancer screening than women who did not attend cancer screening.

Conclusions

These findings highlight the need to increase awareness of different recommendations on screening for various cancers to improve cost-effectiveness and to prevent unnecessary treatments.
Exploring the impact, response and preparedness to water-related natural disasters in the Barisal division of Bangladesh: a mixed methods study
Authors: Jagnoor Jagnoor , Rahman Aminur , Cullen Patricia , Chowdhury Fazlul Kader , Lukaszyk Caroline , Baset Kamran ul , Ivers Rebecca
Published: April 2019

Objectives

To investigate the impact of natural disasters on communities in the Barisal division of Bangladesh, exploring community approaches to disaster preparedness and mitigation.

Setting

Communities in all districts of the Barisal division of Bangladesh.

Participants

Quantitative data were collected through a cross-sectional household survey (n=9263 households; n=38 981 individuals). Qualitative data were collected through in-depth interviews (n=7) and focus group discussions (n=23) with key informants.

Outcome measures

Quantitative research recorded features of natural disaster events from the previous 5 years, documenting risk factors that increase vulnerability to disaster, use of disaster warning systems and evacuation processes. Qualitative research investigated disaster risk perceptions, experiences during and following disaster, and disaster preparedness practices.

Results

The survey response rate was 94.7%. Exposure to disaster in the last 5 years was high (82%) with flooding and cyclones considered the greatest threats. Awareness of evacuation processes was low; and only 19% of respondents evacuated their homes at the time of disaster. Drowning during disaster was the primary concern (87%), followed by debt, livestock and crop loss (78%). The qualitative findings indicated prevailing fatalistic perceptions towards natural disasters among community. The consequences of disasters included significant loss of livelihoods and exposure to infections due to poor sanitation. There was also insufficient support for the most vulnerable, particularly women, children and the elderly. Although several community preparedness and practices existed, there was a lack of response to early warning systems. Barriers to disaster response and resilience included financial insecurities, loss of livelihoods and cultural concerns regarding women’s privacy.

Conclusions

Critical to achieving disaster resilience is increased government investment in infrastructure and systems-level responses that empower communities. Further research can support this by addressing community challenges to promoting disaster resilience and how to leverage existing community strengths to implement locally owned solutions.
Evaluating costs and health consequences of sick leave strategies against pandemic and seasonal influenza in Norway using a dynamic model
Authors: Edwards Christina Hansen , Tomba Gianpaolo Scalia , Sonbo Kristiansen Ivar , White Richard , de Blasio Birgitte Freiesleben
Published: April 2019

Objectives

To quantify population-level health and economic consequences of sick leave among workers with influenza symptoms.

Interventions

Compared with current sick leave practice (baseline), we evaluated the health and cost consequences of: (1) increasing the proportion of workers on sick leave from 65% (baseline) to 80% or 90%; (2) shortening the maximum duration from symptom onset to sick leave from 4 days (baseline) to 2 days, 1.5 days, 1 day and 0.5 days; and (3) combinations of 1 and 2.

Methods

A dynamic compartmental influenza model was developed using Norwegian population data and survey data on employee sick leave practices. The sick leave interventions were simulated under 12 different seasonal epidemic and 36 different pandemic influenza scenarios. These scenarios varied in terms of transmissibility, the proportion of symptomatic cases and illness severity (risk of primary care consultations, hospitalisations and deaths). Using probabilistic sensitivity analyses, a net health benefit approach was adopted to assess the cost-effectiveness of the interventions from a societal perspective.

Results

Compared with current sick leave practice, sick leave interventions were cost-effective for 31 (65%) of the pandemic scenarios, and 11 (92%) of the seasonal scenarios. Economic benefits from sick leave interventions were greatest for scenarios with low transmissibility, high symptomatic proportions and high illness severity. Overall, the health and economic benefits were greatest for the intervention involving 90% of sick workers taking sick leave within one-half day of symptoms. Depending on the influenza scenario, this intervention resulted in a 44.4%–99.7% reduction in the attack rate. Interventions involving sick leave onset beginning 2 days or later, after the onset of symptoms, resulted in economic losses.

Conclusions

Prompt sick leave onset and a high proportion of sick leave among workers with influenza symptoms may be cost-effective, particularly during influenza epidemics and pandemics with low transmissibility or high morbidity.
Comparative long-term effectiveness and safety of primary bariatric surgeries in treating type 2 diabetes mellitus in adults: a protocol for systematic review and network meta-analysis of randomised controlled trials
Authors: Ding Li , Zhuo Chuanjun , Fan Yuxin , Zhang Yalan , Li Hui , Qi Dongwang , Tang Shaofang , Cui Jingqiu , He Qing , Liu Ming
Published: April 2019

Introduction

Bariatric surgeries are effective in treating obesity related comorbidities, including type 2 diabetes mellitus. More robust evidence is needed to facilitate choice of procedure. In this systemic review, we aim to investigate the comparative long-term effectiveness in inducing remission of type 2 diabetes, halting diabetic complications, reducing mortality and the safety of conventional and emerging bariatric surgeries.

Methods and analysis

Databases including Cochrane Central Register, EMBASE, MEDLINE and clinical trial registries will be searched for randomised controlled trials with at least 3 years of follow-up, including direct and/or indirect evidence regarding primary bariatric surgeries in overweight or obese adults with type 2 diabetes mellitus, from inception of each database to 2019, with no language or publication type limits imposed. Dual selection of studies, data extraction and risk of bias assessments will be performed. Primary outcomes include full diabetes remission, composite outcome of full or partial diabetes remission and adverse event profiles. Secondary outcomes include anthropometric measurements, cardiovascular risk factor burden, medication burden, diabetic complications and all-cause mortality. Given sufficient homogeneity, network meta-analyses will be performed in a random-effects model based on the Bayesian framework, while assessing for consistency between direct and indirect estimates. Heterogeneities of studies will be explored through meta-regression analysis, and robustness of findings will be checked by sensitivity analysis, and an alternative method under a frequentist framework. All statistical analysis and graphical presentations will be conducted by R software V.3.3.3 (The R Project for Statistical Computing). The overall quality of the evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation criteria for each outcome.

Ethics and dissemination

Ethics approval is not required as individual patient data will not be included. This review will be subject for publication in a peer reviewed journal.

PROSPERO registration number

CRD42018110775.
Impact of co-occurring hearing and visual difficulties in childhood on educational outcomes: a longitudinal cohort study
Authors: Hill Matilda , Hall Amanda , Williams Cathy , Emond Alan M
Published: April 2019

Background

Mild hearing and visual difficulties are common in childhood, and both may have implications for educational achievement. However, the impact of co-occurring common hearing and visual difficulties in childhood is not known.

Objective

To determine the prevalence and impact of co-occurring common hearing and visual difficulties of childhood on educational outcomes in primary and secondary school.

Methods

The sample was drawn from the Avon Longitudinal Study of Parents and Children, a longitudinal birth cohort study in England. The exposures were hearing and visual difficulties at age 7 (defined as conductive hearing loss or otitis media with effusion, and amblyopia, strabismus or reduced visual acuity, respectively). The outcomes measured were achievement of level 4 or above at Key Stage 2 (KS2) in English, Maths and Science, respectively, at age 11, and attainment of five or more General Certificate of Secondary Education (GCSEs) at grades A*–C at age 16. Multiple logistic regression models assessed the relationship between hearing and visual difficulties and educational outcomes, adjusting for potential confounding factors.

Results

2909 children were included in the study; 261 had hearing difficulties, 189 had visual difficulties and 14 children had co-occurring hearing and visual difficulties. Children with co-occurring hearing and visual difficulties were less likely to achieve the national target at KS2 compared with children with normal hearing and vision, even after adjustment for confounding factors (OR 0.30, CI 0.15 to 0.61 for KS2 English). Differences in IQ, behaviour, attention and social cognition did not account for this relationship. The impact of co-occurring hearing and visual difficulties on GCSE results was explained largely by poor performance at KS2.

Conclusions

Co-occurring hearing and visual difficulties in childhood have an enduring negative impact on educational outcomes. Identification of affected children and early intervention in primary school is essential.
Tai Chi for heart attack survivors: qualitative insights
Authors: Conboy Lisa , Krol Julie , Tomas Jose , Yeh Gloria Y , Wayne Peter , Salmoirago-Blotcher Elana
Published: April 2019

Objectives

Cardiac rehabilitation (CR) programmes are standard of care for patients following a coronary event. While such exercise-based secondary prevention programme do offer benefits, they are used by less than 30% of eligible patients and attrition within these programmes is high. This project is a nested qualitative assessment of a pilot programme considering Tai Chi (TC) as an alternative to CR. We hypothesised that TC may overcome several key barriers to CR.

Methods

A semistructured focus group agenda was used to assess three key domains of feasibility: (1) patients’ experiences, (2) reasons/barriers for not having attended CR and (3) any improvements in physical activity and other secondary outcomes (quality of life, weight, sleep). A thematic analysis was used to better understand the key concepts.

Results

This high-risk group of patients reported that they enjoyed TC exercise, and felt confident and safe doing it. TC practice was reported to support other types of physical activity allowing for a generalisation of positive effects.

Discussion

This analysis is consistent with published reports of TC practice improving mood and psychological well-being. Qualitative methods allowed us to find emergent experiential reports of behaviour change factors found in established behaviour change theories.
PP14 The feasibility and acceptability of a novel low tech intervention to improve pre-hospital data recording for pre-alert and handover to the emergency department
Authors: Fitzpatrick David , Maxwell Douglas , Craigie Alan
Published: April 2019

Background

Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Data used in handover is not always easily recorded using ambulance based tablets, particularly in time-critical cases. Paramedics have therefore developed pragmatic workarounds (writing on gloves or scrap paper) to record these data. However, such practices can conflict with policy, data recorded can be variable, easily lost and negatively impact on handover quality.

Aims

To measure the feasibility and acceptability of a novel, low-tech intervention introduced to support clinical information recording and delivery during pre-alert and handover. The intervention consisted of a reusable card with pre-alert/handover mnemonic and corresponding text boxes for data entry via pen.

Methods

A pre and post-test design was used. Paramedics (n=69) based at one city ambulance Station received the intervention. Pre-and post-test measures (12 weeks post-introduction) focussed on paramedic acceptability and utility of intervention, ED staff (n=99) perceptions of handover quality, and proportions of clinical variables documented by ED staff during pre-alert.

Results

Twenty-five (36%) paramedics responded to an intervention acceptability questionnaire. Most felt both the pre-alert (n=23 [92%]) and handover (n=18 [72%]) components of the card were ‘useful’ or ‘very useful’. Nineteen (76%) used the card to record clinical information, almost all (n=23 [92%]) felt it ‘useful’ to ‘very useful’ in supporting pre-alert. Similarly, 65% (n=16) stated they ‘often’ or ‘always’ used the card during handover. For pre-alert information there were improvements in the provision of 8/11 (72.7%) clinical variables measured. Results from the post-test survey evaluating ED staff (n=37 [37%]) perceptions of handover demonstrated perceived improvements in 3/5 domains measured (p<0.05).

Conclusion

This novel low-tech intervention was highly acceptable to paramedic participants, improving their data recording and information exchange processes. Further, well conducted studies are required to test the impact of this intervention on information exchange processes.