bluuebunny/crossref_metadata_2025 huggingface dataset:
Family Systems Thinking as a Guide for Theory Integration: Conceptual Overlaps of Differentiation, Attachment, Parenting Style, and Identity Development in Families With Adolescents
Authors: Bortz Patrick , Berrigan Miranda , VanBergen Alexandra , Gavazzi Stephen M.
Published: December 2019

There is both the necessity and the capacity for unification across the discipline of family science. This article offers another step toward a comprehensive, integrated body of theory and research shared across our discipline. Specifically, we address how family systems thinking has been reflected in attachment, parenting, and adolescent identity literature, and we present bidimensional models and integrated spectrums emphasizing how levels of differentiation, adolescent internal working models of attachment, parenting styles, and adolescent identity statuses are conceptually intertwined as systemic intrapsychic and interpersonal processes. These theories and concepts, when considered as an integrated whole, invite theoretical complexity that advances the understanding of family processes and guides new research questions. We propose that family systems theory is a holistic framework that is ideal for integrating these concepts in a way that goes beyond highlighting their common factors. We conclude with the benefits and barriers to comprehensive integration across family science.
Intensive vs Standard Blood Pressure Control in Adults 80 Years or Older: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial
Authors: Pajewski Nicholas M. , Berlowitz Dan R. , Bress Adam P. , Callahan Kathryn E. , Cheung Alfred K. , Fine Larry J. , Gaussoin Sarah A. , Johnson Karen C. , King Jordan , Kitzman Dalane W. , Kostis John B. , Lerner Alan J. , Lewis Cora E. , Oparil Suzanne , Rahman Mahboob , Reboussin David M. , Rocco Michael V. , Snyder Joni K. , Still Carolyn , Supiano Mark A. , Wadley Virginia G. , Whelton Paul K. , Wright Jackson T. , Williamson Jeff D.
Published: December 2019

OBJECTIVES

To evaluate the effect of intensive systolic blood pressure (SBP) control in older adults with hypertension, considering cognitive and physical function.

DESIGN

Secondary analysis.

SETTING

Systolic Blood Pressure Intervention Trial (SPRINT)

PARTICIPANTS

Adults 80 years or older.

INTERVENTION

Participants with hypertension but without diabetes (N = 1167) were randomized to an SBP target below 120 mm Hg (intensive treatment) vs a target below 140 mm Hg (standard treatment).

MEASUREMENTS

We measured the incidence of cardiovascular disease (CVD), mortality, changes in renal function, mild cognitive impairment (MCI), probable dementia, and serious adverse events. Gait speed was assessed via a 4‐m walk test, and the Montreal Cognitive Assessment (MoCA) was used to quantify baseline cognitive function.

RESULTS

Intensive treatment led to significant reductions in cardiovascular events (hazard ratio [HR] = .66; 95% confidence interval [CI] = .49‐.90), mortality (HR = .67; 95% CI = .48‐.93), and MCI (HR = .70; 95% CI = .51‐.96). There was a significant interaction (P < .001) whereby participants with higher baseline scores on the MoCA derived strong benefit from intensive treatment for a composite of CVD and mortality (HR = .40; 95% CI = .28‐.57), with no appreciable benefit in participants with lower scores on the MoCA (HR = 1.33 = 95% CI = .87‐2.03). There was no evidence of heterogeneity of treatment effects with respect to gait speed. Rates of acute kidney injury and declines of at least 30% in estimated glomerular filtration rate were increased in the intensive treatment group with no between‐group differences in the rate of injurious falls.

CONCLUSION

In adults aged 80 years or older, intensive SBP control lowers the risk of major cardiovascular events, MCI, and death, with increased risk of changes to kidney function. The cardiovascular and mortality benefits of intensive SBP control may not extend to older adults with lower baseline cognitive function.

Trial Registration

Clinicaltrials.gov identifier: NCT01206062. J Am Geriatr Soc 68:496–504, 2020
Familial chylomicronemia syndrome: an under‐recognized cause of severe hypertriglyceridaemia
Authors: Baass A. , Paquette M. , Bernard S. , Hegele R.A.
Published: December 2019

Familial chylomicronemia syndrome (FCS) is a rare autosomal recessive disorder of chylomicron metabolism causing severe elevation of triglyceride (TG) levels (>10 mmol L−1). This condition is associated with a significant risk of recurrent acute pancreatitis (AP). AP caused by hypertriglyceridaemia (HTG) has been associated with a worse prognosis and higher mortality rates compared to pancreatitis of other aetiology. Despite its association with poor quality of life and increased lifelong risk of HTG‐AP, few healthcare providers are familiar with FCS. Because this condition is under‐recognized, the majority of FCS patients are diagnosed after age 20 often after consulting several physicians. Although other forms of severe HTG such as multifactorial chylomicronemia have been associated with high atherosclerotic cardiovascular disease (ASCVD) risk and metabolic abnormalities, ASCVD and metabolic syndrome are not usually observed in FCS patients. Because FCS is a genetic condition, the optimal diagnosis strategy remains genetic testing. The presence of bi‐allelic pathogenic mutations in LPL, APOC2, GPIHBP1, APOA5 or LMF1 genes confirms the diagnosis. However, some cases of FCS caused by autoantibodies against LPL or GPIHBP1 proteins have also been reported. Furthermore, a clinical score for the diagnosis of FCS has been proposed but needs further validation. Available treatment options to lower triglycerides such as fibrates or omega‐3 fatty acids are not efficacious in FCS patients. Currently, the cornerstone of treatment remains a lifelong very low‐fat diet, which prevents the formation of chylomicrons. Finally, inhibitors of apo C‐III and ANGPTL3 are in development and may eventually constitute additional treatment options for FCS patients.
Self‐distancing promotes positive emotional change after adversity: Evidence from a micro‐longitudinal field experiment
Authors: Dorfman Anna , Oakes Harrison , Santos Henri C. , Grossmann Igor
Published: December 2019

Objective

This research examines changes in emotionality following adverse experiences in daily life. We tested whether daily self‐distancing (vs. self‐immersing) in reflections on adversity results in positive change in emotionality. Additionally, we probed the “dosage” effect of repeated self‐distancing.

Method

A micro‐longitudinal field experiment combined 4‐week daily diary and experimental manipulation of perspective during diary‐based reflections on adverse experiences to explore the trajectory of change in emotionality. Each day, participants (N = 149) described and reflected on one significant event from that day and rated emotionality. We randomly assigned participants to reflect from a self‐immersed or self‐distanced perspective.

Results

Self‐distanced participants showed a change toward positive emotionality while maintaining the same level of negative emotionality, whereas self‐immersed participants did not show changes in positive or negative emotionality. We also observed that self‐distancing reached its maximum effect (“dosage”) for positive emotionality in the third week of the diary.

Conclusions

Repeated self‐distanced reflections can promote positive change in emotionality in the face of everyday adversity. Notably, repeated self‐distancing effectiveness has a saturation point. In contrast, self‐immersed reflections on adversity do not promote positive emotional change. Together, these observations raise the question how the default self‐immersed reflection on traumatic experiences impacts personal growth.
Optimal sustainable fishery management of the Black Sea anchovy with food chain modeling framework
Authors: Demir Mahir , Lenhart Suzanne
Published: December 2019

Food chain models with interactions between key species are useful tools for ecological conservation and economic sustainability in commercial fisheries. In this study, we build a food chain model coupled with optimal control theory and focus on the Black Sea anchovy population in the southern part of the Black Sea. Our objective is to find the optimal harvesting strategy that maximizes the discounted net profit value of the anchovy fishery with seasonal harvesting, and that offers sustainable anchovy fishery. As a result, we obtain profitable and sustainable harvesting strategies. We also discuss the benefits of using food chain models in fishery management rather than using single‐species models. Finally, we derive a schedule for the number of fishing vessels that are needed in the implementation of the optimal harvesting strategy.

Recommendations for Resource Managers

Food chain modeling framework offers more reliable harvesting strategies than single‐species modeling framework.

Managing the harvest effort using optimal control theory results in a more profitable anchovy fishery on the southern part of the Black Sea.

By quantifying the relationship between the annual landing and the number of fishing vessels, we can approximate the needed number of fishing vessels to achieve an optimal landing.

Applying an optimal control strategy yields more anchovy landing and profit in the long term, when we compare with the current harvesting strategy used in the anchovy fishery. These strategies also offer a sustainable anchovy fishery, which is crucial for the fate of this fishery.
Ethanol lock therapy in pediatric patients: A multicenter prospective study
Authors: Chiba Masahiro , Yonekura Takeo , Kaji Tatsuru , Amae Shintaro , Tazuke Yuko , Oowari Mitsugu , Obana Kazuko , Nakano Miwako , Kuroda Tasuo , Fukumoto Kouzi , Yamane Yusuke , Yoshino Hiroaki , Hebiguchi Tatsuzo , Toki Akira
Published: December 2019

Background

Ethanol lock therapy (ELT) has been performed for the purpose of preserving central venous catheters (CVC) in central venous catheter‐related blood stream infection (CRBSI), but evidence for its effectiveness is not established. We conducted a multicenter, prospective study on the ELT protocol to ascertain its safety and effectiveness against CRBSI.

Methods

The subjects were patients aged over 1 year with potential for developing CRBSI who had long‐term indwelling silicone CVCs. After culturing the catheterized blood, a 70% ethanol lock was performed daily for 2–4 h for 7 days. The effectiveness rate of ELT for single and multiple courses, the presence or absence of relapse of CRBSI within 4 weeks of treatment, and whether the CVC could be salvaged after 4 weeks were examined.

Results

From September 2014 to August 2018, 49 cases from six hospitals were enrolled in the study. Catheter blockage was seen in one case and the CVC was removed. A single course of ELT was effective in episodes 88% (42/48). In the remaining three episodes that failed after a single course of ELT, a second ELT was performed; however, all were ineffective. In episodes 93% (40/42), no CRBSI relapse was seen up to 4 weeks after the end of treatment. In episodes 84% (41/49), the catheter could be preserved for 4 weeks or more after the end of treatment. Facial flushing was seen in two cases as an adverse event; however, this was transient and soon disappeared.

Conclusion

ELT is effective for 88% of CRBSI and 84% of catheters can be salvaged; therefore, this protocol is considered useful. Trial registration: UMIN000013677.
Psychopathology, quality of life, and related factors in pediatric liver transplantation candidates and recipients
Authors: Ünay Mihriban , Önder Arif , Gizli Çoban Özge , Atalay Atike , Sürer Adanir Aslı , Artan Reha , Özatalay Esin
Published: December 2019

Background

Liver transplantation (LT) has been accepted as a standard treatment of pediatric liver diseases that can progress to end‐stage liver disease or lead to acute liver failure. However, there is a lack of studies clarifying quality of life (QoL) and the characteristics and the prevalence of common psychiatric disorders in children before and/or after LT. Thus, this study aimed to investigate QoL and the prevalence of anxiety, depression, and post‐traumatic stress disorder (PTSD) in children and adolescents before and after LT and to compare them with healthy controls.

Methods

The study included 30 children aged 5‐18 years who were waiting for LT (pTx group) or had undergone LT (Tx group) as the study groups and 20 children for the control group. The PedsQL was used to evaluate QoL, and SCARED, CDI, and the CPTSD‐RI were used to evaluate psychopathology.

Results

The QoL scores were higher in the control group compared with the study groups in all or most of the dimensions, depending on the reporter. The mean scores of anxiety, depression, and PTSD of the control group were significantly lower than those of the Tx and pTx groups. A significant positive correlation was found between depression, anxiety, and PTSD scores, and a negative correlation was observed between depression, anxiety, and PTSD scores and QoL.

Conclusion

Waiting for LT and the transplantation process itself seem to be psychologically traumatic for children. Healthcare providers need to be trained to recognize the symptoms of the main psychiatric disorders.
Pre‐positioning and Deployment of Reserved Inventories in a Supply Network: Structural Properties
Authors: Guo Pengfei , Liu Fang , Wang Yulan
Published: December 2019

We study a two‐stage decision problem, namely, the allocation and deployment of reserved inventories (RIs) in a supply network with random demand surges. The demand surge follows a time‐dependent stochastic process and our objective is to minimize the expected total unmet demand in the presence of positive transshipment lead times. We first solve the optimal deployment problem given that the demand surges have occurred at some locations. We show that the optimal deployment policy is a “nested” policy with respect to the shadow price at each location, where a shadow price represents the marginal reduction of the expected total unmet demand due to a marginal increase of RIs. Specifically, locations with higher shadow prices have higher priority in inventory allocation. We then consider the optimal allocation problem in the pre‐positioning stage. We show that under certain conditions the optimal allocation is increasing in the total amount of RIs. We introduce a new stochastic order for distributions defined on sets called the first‐order stochastic dominance and use it to show that the expected total unmet demand is higher when one of the following is true: the demand surges tend to occur simultaneously at more locations, the post‐surge delivery takes a longer time, more demand arrives earlier, or the demand has a higher volatility.
Robust Vehicle Pre‐Allocation with Uncertain Covariates
Authors: Hao Zhaowei , He Long , Hu Zhenyu , Jiang Jun
Published: December 2019

Motivated by a leading taxi operator in Singapore, we consider the idle vehicle pre‐allocation problem with uncertain demands and other uncertain covariate information such as weather. In this problem, the operator, upon observing its distribution of idle vehicles, proactively allocates the idle vehicles to serve future uncertain demands. With perfect information of demand distribution, the problem can be formulated as a stochastic transportation problem. Yet, the non‐stationarity and spatial correlation of demands pose significant challenges in estimating its distribution accurately from historical data. We employ a novel distributionally robust optimization approach that can utilize covariate information as well as the moment information of demand to construct a scenario‐wise ambiguity set. We further illustrate how the key parameters required by the new ambiguity set, such as the scenarios and their probabilities, can be estimated via multivariate regression tree. Although information about uncertain covariates provides no value when there is perfect knowledge of demand distribution, we show that it could alleviate the over‐conservativeness of the robust solution. The resulting distributionally robust optimization problem can be exactly and tractably solved using linear decision rule technique. We further validate the performance of our solution via extensive numerical simulations, and a case study using trip and vehicle status data from our partner taxi operator, paired with the rainfall data from the Meteorological Service Singapore.
The effect of web‐based pediatric palliative care education on the palliative care knowledge level and practices of nursing students
Authors: Akdeniz Kudubes Aslı , Bektas Murat
Published: December 2019

Purpose

This study is aimed to investigate the effect of web‐based pediatric palliative care education on nursing students’ knowledge level and practices related to palliative care.

Methods

The study was conducted with 265 nursing students including an intervention and a control group. The intervention group was given web‐based pediatric palliative care education.

Findings

A statistically significant difference was found between the total and subscale pretest and posttest scores of the students in the intervention and control groups regarding the palliative care knowledge level and self‐reported palliative care practices.

Practical Implications

The web‐based pediatric palliative care education is an effective training model for nursing students to improve palliative care knowledge level and practices of the students.
Controlling the uncontrolled: Are there incidental experimenter effects on physiologic responding?
Authors: Thorson Katherine R. , Mendes Wendy Berry , West Tessa V.
Published: December 2019

The degree to which experimenters shape participant behavior has long been of interest in experimental social science research. Here, we extend this question to the domain of peripheral psychophysiology, where experimenters often have direct, physical contact with participants, yet researchers do not consistently test for their influence. We describe analytic tools for examining experimenter effects in peripheral physiology. Using these tools, we investigate nine data sets totaling 1,341 participants and 160 experimenters across different roles (e.g., lead research assistants, evaluators, confederates) to demonstrate how researchers can test for experimenter effects in participant autonomic nervous system activity during baseline recordings and reactivity to study tasks. Our results showed (a) little to no significant variance in participants’ physiological reactivity due to their experimenters, and (b) little to no evidence that three characteristics of experimenters that are well known to shape interpersonal interactions—status (using five studies with 682 total participants), gender (using two studies with 359 total participants), and race (in two studies with 554 total participants)—influenced participants’ physiology. We highlight several reasons that experimenter effects in physiological data are still cause for concern, including the fact that experimenters in these studies were already restricted on a number of characteristics (e.g., age, education). We present recommendations for examining and reducing experimenter effects in physiological data and discuss implications for replication.
Home economics for COPD care
Authors: Calverley Peter M.A.
Published: December 2019

See related Article
Textured growth of polycrystalline MAX phase carbide coatings via thermal annealing of M/C/Al multilayers
Authors: Tang Chongchong , Steinbrück Martin , Klimenkov Michael , Jäntsch Ute , Seifert Hans Jürgen , Ulrich Sven , Stüber Michael
Published: December 2019

Mn + 1AXn (MAX; n = 1–3) phases are ternary layered nitride and carbide compounds featuring a combination of metallic and ceramic properties. Highly basal-plane textured and polycrystalline Cr2AlC, Ti2AlC, and Ti3AlC2 single-phase coatings have been synthesized on both amorphous and polycrystalline substrates via controlled thermal annealing of magnetron-sputtered nanoscale multilayers built by individual transition metal, carbon, and aluminum layers. Formation of substitutional solid solution carbide phases was triggered via solid-state diffusion reactions during annealing. Lower ordered Ti2AlC initially crystallized at an intermediate temperature range and was recognized as an intermediate reactant in the case of synthesizing the Ti3AlC2 312 MAX phase via annealing corresponding stoichiometric multilayers. The crystallization onset temperatures identified via in-situ high-temperature x-ray diffraction measurements were approximately 480, 660, and 820 °C for Cr2AlC, Ti2AlC, and Ti3AlC2, respectively. Contrary to the usually observed columnar structure representative of magnetron-sputtered coatings, the coatings synthesized via the current approach are composed of plateletlike, elongated crystallites. The nanoscale multilayered design stimulates the textured growth of MAX structures during thermal annealing. More specifically, the preferred crystallographic orientation relationships among the as-deposited transition metal layers, the intermediate solid solution phases, and the end-product MAX phases facilitate the growth of textured MAX phase films.
Transferable Multidrug-Resistance Plasmid Carrying a Novel Macrolide-Clindamycin Resistance Gene,
erm
(50), in Cutibacterium acnes
Authors: Aoki Sae , Nakase Keisuke , Nakaminami Hidemasa , Wajima Takeaki , Hayashi Nobukazu , Noguchi Norihisa
Published: December 2019

Antimicrobial-resistant
Cutibacterium acnes
strains have emerged and disseminated throughout the world. The 23S rRNA mutation and
erm
(X) gene are known as the major resistance determinants of macrolides and clindamycin in
C. acnes
. We isolated eight high-level macrolide-clindamycin-resistant
C. acnes
strains with no known resistance determinants, such as 23S rRNA mutation and
erm
(X), from different acne patients in 2008 between 2013 and 2015.
Characterization of FliL Proteins in Bradyrhizobium diazoefficiens: Lateral FliL Supports Swimming Motility, and Subpolar FliL Modulates the Lateral Flagellar System
Authors: Mengucci Florencia , Dardis Carolina , Mongiardini Elías J. , Althabegoiti María J. , Partridge Jonathan D. , Kojima Seiji , Homma Michio , Quelas Juan I. , Lodeiro Aníbal R.
Published: December 2019

Bacterial motility propelled by flagella is an important trait in most environments, where microorganisms must explore the habitat toward beneficial resources and evade toxins. Most bacterial species have a unique flagellar system, but a few species possess two different flagellar systems in the same cell. An example is
Bradyrhizobium diazoefficiens
, the N
2
-fixing symbiont of soybean, which uses both systems for swimming. Among the less-characterized flagellar proteins is FliL, a protein typically associated with a flagellum-driven surface-based collective motion called swarming. By using deletion mutants in each flagellar system’s
fliL
, we observed that one of them (lateral) was required for swimming, while the other (subpolar) took part in the control of lateral flagellum synthesis. Hence, this protein seems to participate in the coordination of activity and production of both flagellar systems.
CXCR4-Using HIV Strains Predominate in Naive and Central Memory CD4
+
T Cells in People Living with HIV on Antiretroviral Therapy: Implications for How Latency Is Established and Maintained
Authors: Roche Michael , Tumpach Carolin , Symons Jori , Gartner Matthew , Anderson Jenny L. , Khoury Gabriela , Cashin Kieran , Cameron Paul U. , Churchill Melissa J. , Deeks Steven G. , Gorry Paul R. , Lewin Sharon R.
Published: December 2019

In people living with HIV (PLWH) on suppressive ART, latent HIV can be found in a diverse range of CD4
+
T cells, including quiescent naive and central memory cells that are typically difficult to infect
in vitro
. It is currently unclear how latency is established in these cells
in vivo
. We show that in CD4
+
T cells from PLWH on suppressive ART, the use of the coreceptor CXCR4 was prevalent among viruses amplified from naive and central memory CD4
+
T cells. Furthermore, we found that expanded numbers of identical viral sequences were most common in the effector memory population, and these identical sequences were also found in multiple different CD4
+
T cell subsets. Our results help to shed light on how a range of CD4
+
T cell subsets come to harbor HIV DNA, which is one of the major barriers to eradicating the virus from PLWH.
The Aminoalkylindole BML-190 Negatively Regulates Chitosan Synthesis via the Cyclic AMP/Protein Kinase A1 Pathway in Cryptococcus neoformans
Authors: Maybruck Brian T. , Lam Woei C. , Specht Charles A. , Ilagan Ma. Xenia G. , Donlin Maureen J. , Lodge Jennifer K.
Published: December 2019

Cryptococcus neoformans
is a fungal pathogen that kills ∼200,000 people every year. The cell wall is an essential organelle that protects fungi from the environment. Chitosan, the deacetylated form of chitin, has been shown to be an essential component of the cryptococcal cell wall during infection of a mammalian host. In this study, we screened a set of 480 compounds, which are known to have defined biological activities, for activity that reduced chitosan production in
C. neoformans
. Two of these compounds were confirmed using an alternative method of measuring chitosan, and one of these was demonstrated to impact the cAMP signal transduction pathway. This work demonstrates that the cAMP pathway regulates chitosan biosynthesis in
C. neoformans
and validates that this screening approach could be used to find potential antifungal agents.
Reassessing the Role of the Type II MqsRA Toxin-Antitoxin System in Stress Response and Biofilm Formation:
mqsA
Is Transcriptionally Uncoupled from
mqsR
Authors: Fraikin Nathan , Rousseau Clothilde J. , Goeders Nathalie , Van Melderen Laurence
Published: December 2019

There is growing controversy regarding the role of chromosomal toxin-antitoxin systems in bacterial physiology.
mqsRA
is a peculiar toxin-antitoxin system, as the gene encoding the toxin precedes that of the antitoxin. This system was previously shown to play a role in stress response and biofilm formation. In this work, we identified two promoters specifically driving the constitutive expression of the antitoxin, thereby decoupling the expression of antitoxin from the toxin. We also showed that
mqsRA
contributes neither to the regulation of biofilm formation nor to the sensitivity to oxidative stress and bile salts. Finally, we were unable to confirm that the MqsA antitoxin is a global regulator. Altogether, our data are ruling out the involvement of the
mqsRA
system in
Escherichia coli
regulatory networks.
Novel approach to locating a hypoplastic kidney in a unique variant of uterine didelphys syndrome presenting with continuous incontinence
Authors: Lockhart Kathleen Rebecca , Saul Megan , Blatt Allison
Published: December 2019

Mullerian abnormalities such as uterine didelphys have an association with renal abnormalities. Ureteric ectopia must be considered as a differential diagnosis of incontinence. We describe the case of a 21-year-old woman who presented with low volume continuous incontinence with a history of right renal agenesis and uterus didelphys. A right kidney was not identified on CT intravenous pyelogram but excretory phase images suggested the presence of a right ureter. Diethylenetriaminepentaacetic acid renogram confirmed an area of perfusion consistent with a poorly functioning right kidney remnant. Cystoscopic investigation demonstrated an orthotopic left ureteric orifice, and an ectopic right ureteric orifice was identified in the posterior fornix of the right vagina. A laparoscopic right nephrectomy was performed, with a new application of indocyanine green aiding in identification of the right hypoplastic kidney with fluorescence imaging. The patient recovered well postoperatively and experienced complete resolution of incontinence, with preserved normal renal function.
Subcutaneous fat necrosis of the newborn
Authors: O' Brien Niamh , Hayes Breda
Published: December 2019

A term infant developed subcutaneous fat necrosis of the newborn (SFNN) 17 days following completion of therapeutic hypothermia for hypoxic ischaemic encephalopathy. Initial calcium was normal, however hypercalcaemia requiring hyperhydration and furosemide developed at 4 weeks. Parathyroid hormone and vitamin D were suppressed. At 13 months, she remains on low calcium formula, and has gross motor delay, central hypotonia and early hand preference. Review of 102 articles yielded 119 SFNN cases. Asphyxia was reported in 78%. Twenty-one per cent had hypoglycaemia. Twenty per cent underwent therapeutic hypothermia. Median onset of skin lesions was day 6 (range: 1–70), with a median duration of 62 days (range: 14–390). Hypercalcaemia developed in 53% (median onset day 28, range: 1–210). Fifty-two per cent of hypercalcaemia was asymptomatic. Outcome information was provided in 106/119 cases; 87% reported a full resolution. Persistent calcinosis was present in 6%. Babies treated with therapeutic hypothermia should be closely monitored for SFNN, and development of hypercalcaemia.
Rare case of a proximal descending thoracic aorta mycotic aneurysm following intravesical BCG injections for the treatment of bladder cancer
Authors: Ribeiro Luis , Rajendran Saissan , Stenson Katherine , Loftus Ian
Published: December 2019

A 79-year-old man presented with an enlarging thoracic aneurysm on the background of superficial bladder cancer treated with intravesical bacillus Calmette-Guérin (BCG) injections. Following the injections, he developed deranged liver function tests and hepatomegaly. Liver biopsy revealed granulomatous hepatitis compatible with disseminated mycobacterial infection (BCG-osis) and was treated with anti-tuberculosis agents for 12 months. A surveillance CT scan performed as a follow-up for his bladder cancer in 2018 revealed a saccular thoracic aneurysm at the ligamentum arteriosum, which was metabolically active on positron emission tomography (PET) scan. Given the timeframe from intravesical instillation of BCG and the metabolic activity on PET scan, the lesion was consistent with a mycotic aneurysm secondary to disseminated mycobacterial infection. Following multidisciplinary team discussion, a thoracic endovascular aneurysm repair was performed. The stent grafts were placed distal to the left subclavian artery with good angiographic results and no immediate postoperative complications. He was initiated on long-term antibiotics to cover potential bacterial pathogens including mycobacterium.
Laparoscopic reduction and repair of a left paraduodenal hernia
Authors: Sakamoto Takashi , Lefor Alan Kawarai
Published: December 2019

Left paraduodenal hernias are the most common type of congenital internal hernia, but they are difficult to diagnose without appropriate imaging. A 79-year-old man with a history of recurrent abdominal pain had another similar episode of abdominal pain, which prompted him to seek evaluation. The pain resolved spontaneously on arrival to the hospital. Enhanced CT scan showed the characteristic findings of a left paraduodenal hernia and laparoscopic repair was undertaken. The small intestine was reduced successfully, and the hernia orifice was approximated with a continuous closure. He was discharged uneventfully 4 days after admission. The characteristic clinical and imaging findings of paraduodenal hernias are reviewed. Laparoscopic repair is reasonable in patients who have a paraduodenal hernia without intestinal ischemia.
‘Never let a crisis go to waste’: post-Ebola agenda-setting for health system strengthening in Guinea
Authors: Kolie Delphin , Delamou Alexandre , van de Pas Remco , Dioubate Nafissatou , Bouedouno Patrice , Beavogui Abdoul Habib , Kaba Abdoulaye , Diallo Abdoulaye Misside , Put Willem Van De , Van Damme Wim
Published: December 2019

Introduction

Guinea is a country with a critical deficit and maldistribution of healthcare workers along with a high risk of epidemics' occurrence. However, actors in the health sector have missed opportunities for more than a decade to attract political attention. This article aims to explain why this situation exists and what were the roles of actors in the agenda-setting process of the post-Ebola health system strengthening programme. It also assesses threats and opportunities for this programme's sustainability.

Methods

We used Kingdon’s agenda-setting methodological framework to explain why actors promptly focused on the health sector reform after the Ebola outbreak. We conducted a qualitative explanatory study using a literature review and key informant interviews.

Results

We found that, in the problem stream, the Ebola epidemic caused considerable fear among national as well as international actors, a social crisis and an economic system failure. This social crisis was entertained by communities’ suspicion of an 'Ebola-business'. In response to these problems, policy actors identified three sets of solutions: the temporary external funds generated by the Ebola response; the availability of experienced health workers in the Ebola control team; and the overproduction of health graduates in the labour market. We also found that the politics agenda was dominated by two major factors: the global health security agenda and the political and financial interests of national policy actors. Although the opening of the policy window has improved human resources, finance and logistics, and infrastructures pillars of the health system, it, however, disproportionally focuses on epidemic preparedness and response. and neglects patients’ financial affordability of essential health services.

Conclusion

Domestic policy entrepreneurs must realise that agenda-setting of health issues in the Guinean context strongly depends on the construction of the problem definition and how this is influenced by international actors.
Association between hyperlipidemia and mortality after incident acute myocardial infarction or acute decompensated heart failure: a propensity score matched cohort study and a meta-analysis
Authors: Yousufuddin Mohammed , Takahashi Paul Y , Major Brittny , Ahmmad Eimad , Al-Zubi Hossam , Peters Jessica , Doyle Taylor , Jensen Kelsey , Al Ward Ruaa Y , Sharma Umesh , Seshadri Ashok , Wang Zhen , Simha Vinaya , Murad M Hassan
Published: December 2019

Objective

To examine the effect of HLP, defined as having a pre-existing or a new in-hospital diagnosis based on low density lipoprotein cholesterol (LDL-C) level ≥100 mg/dL during index hospitalisation or within the preceding 6 months, on all-cause mortality after hospitalisation for acute myocardial infarction (AMI) or acute decompensated heart failure (ADHF) and to determine whether HLP modifies mortality associations of other competing comorbidities. A systematic review and meta-analysis to place the current findings in the context of published literature.

Design

Retrospective study, 1:1 propensity-score matching cohorts; a meta-analysis.

Setting

Large academic centre, 1996–2015.

Participants

Hospitalised patients with AMI or ADHF.

Main outcomes and measures

All-cause mortality and meta-analysis of relative risks (RR).

Results

Unmatched cohorts: 13 680 patients with AMI (age (mean) 68.5 ± (SD) 13.7 years; 7894 (58%) with HLP) and 9717 patients with ADHF (age, 73.1±13.7 years; 3668 (38%) with HLP). In matched cohorts, the mortality was lower in AMI patients (n=4348 pairs) with HLP versus no HLP, 5.9 versus 8.6/100 person-years of follow-up, respectively (HR 0.76, 95% CI 0.72 to 0.80). A similar mortality reduction occurred in matched ADHF patients (n=2879 pairs) with or without HLP (12.4 vs 16.3 deaths/100 person-years; HR 0.80, 95% CI 0.75 to 0.86). HRs showed modest reductions when HLP occurred concurrently with other comorbidities. Meta-analyses of nine observational studies showed that HLP was associated with a lower mortality at ≥2 years after incident AMI or ADHF (AMI: RR 0.72, 95% CI 0.69 to 0.76; heart failure (HF): RR 0.67, 95% CI 0.55 to 0.81).

Conclusions

Among matched AMI and ADHF cohorts, concurrent HLP, compared with no HLP, was associated with a lower mortality and attenuation of mortality associations with other competing comorbidities. These findings were supported by a systematic review and meta-analysis.
Demographics and health profile on precursors of non-communicable diseases in adults testing for HIV in Soweto, South Africa: a cross-sectional study
Authors: Hopkins Kathryn L , Hlongwane Khuthadzo , Otwombe Kennedy , Dietrich Janan , Cheyip Mireille , Khanyile Nompumelelo , Doherty Tanya , Gray Glenda E
Published: December 2019

Objectives

This cross-sectional study investigated the burden of HIV-non-communicable disease (NCD) precursor comorbidity by age and sex. Policies stress integrated HIV-NCD screenings; however, NCD screening is poorly implemented in South African HIV testing services (HTS).

Setting

Walk-in HTS Centre in Soweto, South Africa.

Participants

325 voluntary adults, aged 18+ years, who provided written or verbal informed consent (with impartial witness) for screening procedures were enrolled.

Primary and secondary outcomes

Data on sociodemographics, tuberculosis and sexually transmitted infection symptoms, blood pressure (BP) (≥140/90=elevated) and body mass index (<18.5 underweight; 18.5–25.0 normal; >25 overweight/obese) were stratified by age-group, sex and HIV status.

Results

Of the 325 participants, the largest proportions were female (51.1%; n=166/325), single (71.5%; n=231/323) and 25–34 years (33.8%; n=110/325). Overall, 20.9% (n=68/325) were HIV infected, 27.5% (n=89/324) had high BP and 33.5% (n=109/325) were overweight/obese. Among HIV-infected participants, 20.6% (14/68) had high BP and 30.9% (21/68) were overweight/obese, as compared with 29.3% (75/256) and 12.1% (31/256) of the HIV-uninfected participants, respectively. Females were more likely HIV-infected compared with males (26.5% (44/166) vs 15.1% (24/159); p=0.012). In both HIV-infected and uninfected groups, high BP was most prevalent in those aged 35–44 years (25% (6/24) vs 36% (25/70); p=0.3353) and >44 years (29% (4/14) vs 48% (26/54); p=0.1886). Males had higher BP than females (32.9% (52/158) vs 22.3% (37/166); p=0.0323); more females were overweight/obese relative to males (45.8% (76/166) vs 20.8% (33/159); p<0.0001). Females were more likely to be HIV infected and overweight/obese.

Conclusion

Among HTS clients, NCD precursors rates and co-morbidities were high. Elevated BP occurred more in older participants. Targeted integrated interventions for HIV-infected females and HIV-infected people aged 18–24 and 35–44 years could improve HIV public health outcomes. Additional studies on whether integrated HTS will improve the uptake of NCD treatment and improve health outcomes are required.
Economic evaluation of clinical quality registries: a systematic review
Authors: Lee Peter , Chin Ken , Liew Danny , Stub Dion , Brennan Angela L , Lefkovits Jeffrey , Zomer Ella
Published: December 2019

Objectives

The objective of this systematic review was to examine the existing evidence base for the cost-effectiveness or cost-benefit of clinical quality registries (CQRs).

Design

Systematic review and narrative synthesis.

Data sources

Nine electronic bibliographic databases, including MEDLINE, EMBASE and CENTRAL, in the period from January 2000 to August 2019.

Eligibility criteria

Any peer-reviewed published study or grey literature in English which had reported on an economic evaluation of one or more CQRs.

Data extraction and synthesis

Data were screened, extracted and appraised by two independent reviewers. A narrative synthesis was performed around key attributes of each CQR and on key patient outcomes or changes to healthcare processes or utilisation. A narrative synthesis of the cost-effectiveness associated with CQRs was also conducted. The primary outcome was cost-effectiveness, in terms of the estimated incremental cost-effectiveness ratio (ICER), cost savings or return-on-investment (ROI) attributed to CQR implementation.

Results

Three studies and one government report met the inclusion criteria for the review. A study of the National Surgical Quality Improvement Programme (NSQIP) in the USA found that the cost-effectiveness of this registry improved over time, based on an ICER of US$8312 per postoperative event avoided. A separate study in Canada estimated the ROI to be US$3.43 per US$1.00 invested in the NSQIP. An evaluation of a post-splenectomy CQR in Australia estimated that registry cost-effectiveness improved from US$234 329 to US$18 358 per life year gained when considering the benefits accrued over the lifetime of the population. The government report evaluating five Australian CQRs estimated an overall return of 1.6–5.5 times the cost of investment.

Conclusions

Available data indicate that CQRs can be cost-effective and can lead to significant returns on investment. It is clear that further studies that evaluate the economic and clinical impacts of CQRs are necessary.

PROSPERO registration number

CRD42018116807.
Prevalence and factors associated with health insurance coverage in resource-poor urban settings in Nairobi, Kenya: a cross-sectional study
Authors: Otieno Peter O , Wambiya Elvis Omondi Achach , Mohamed Shukri F , Donfouet Hermann Pythagore Pierre , Mutua Martin K
Published: December 2019

Objective

To determine the prevalence of health insurance and associated factors among households in urban slum settings in Nairobi, Kenya.

Design

The data for this study are from a cross-sectional survey of adults aged 18 years or older from randomly selected households in Viwandani slums (Nairobi, Kenya). Respondents participated in the Lown scholars’ study conducted between June and July 2018.

Setting

The Lown scholars’ survey was nested in the Nairobi Urban Health and Demographic Surveillance System in Viwandani slums in Nairobi, Kenya.

Participants

A total of 300 randomly sampled households participated in the survey. The study respondents comprised of either the household head, their spouses or credible adult household members.

Primary outcome measure

The primary outcome of this study was enrolment in a health insurance programme. The households were classified into two groups: those having at least one member covered by health insurance and those without any health insurance cover.

Results

The prevalence of health insurance in the sample was 43%. Being unemployed (adjusted OR (aOR) 0.17; p<0.05; 95% CI 0.06 to 0.47) and seeking care from a public health facility (aOR 0.50; p<0.05; 95% CI 0.28 to 0.89) was significantly associated with lower odds of having a health insurance cover. The odds of having a health insurance cover were significantly lower among respondents who perceived their health status as good (aOR 0.62; p<0.05; 95% CI 1.17 to 5.66) and those who were unsatisfied with the cost of seeking primary care (aOR 0.34; p<0.05; 95% CI 0.17 to 0.69).

Conclusions

Health insurance coverage in Viwandani slums in Nairobi, Kenya, is low. As universal health coverage becomes the growing focus of Kenya’s ‘Big Four Agenda’ for socioeconomic transformation, integrating enabling and need factors in the design of the national health insurance package may scale-up social health protection.
Influence of severe knee pain, meniscus surgery and knee arthroplasty on physical ability: an observational study of 114 949 adults in the CONSTANCES cohort
Authors: Valter Remi , Godeau Diane , Leclerc Annette , Descatha Alexis , Fadel Marc
Published: December 2019

Background

The knee is one of the major sites of musculoskeletal pain, yet few large-scale studies have evaluated the impact of knee disorders on physical limitations. Our objective was to describe this impact in a large-scale population study.

Methods

We included subjects of working age from the CONSTANCES cohort, from its inception. Four groups were distinguished according to their medical history: whether they had knee arthroplasty (KA), meniscus surgery, severe knee pain, or none of these. Outcomes assessed for physical limitations were self-reported limitations in the last 6 months due to health problems, limitation on carrying 5 kg on 10 m and a 3-metre length rapid gait speed test (for participants aged >45). Associations between knee groups and patients’ characteristics and physical limitations were analysed using logistic regression. Robust associations were deemed relevant if their ORs were higher than 2 and their p value lower than 0.0001.

Results

Of the 114 949 individuals, 99 052 (86.2%) were in the ‘no pain and no surgery’ group, 14 740 (12.8%) were in the severe knee pain group, 1019 (0.89%) had meniscus surgery and 138 (0.12%) had KA. Severe knee pain and KA groups showed a similar profile (they were less at work, reported more deterioration in their health and had more limitations).

Conclusion

Almost 14% of the sample had knee disorders. Subjects reporting severe knee pain or who had KA reported more important physical limitations then subjects who reported neither severe knee pain nor knee surgery.
Preparation of the endometrium and timing of blastocyst transfer in modified natural cycle frozen-thawed embryo transfers (mNC-FET): a study protocol for a randomised controlled multicentre trial
Authors: Saupstad Marte , Freiesleben Nina La Cour , Skouby Sven Olaf , Andersen Lars Franch , Knudsen Ulla Breth , Petersen Kathrine Birch , Husth Merete , Egeberg Anne , Petersen Morten Rønn , Ziebe Søren , Andersen Anders Nyboe , Løssl Kristine , Pinborg Anja
Published: December 2019

Introduction

Despite the high number of frozen embryo transfer (FET) cycles being conducted (190 000 cycles/year) in Europe, the timing of blastocyst transfer and the use of luteal phase progesterone support in modified natural cycle FET (mNC-FET) in assisted reproductive technologies are controversial. In mNC-FET, the timing of blastocyst warming and transfer is determined according to the time of implantation in a natural cycle, aiming to reach blastocyst endometrial synchronicity. However, the optimal day of blastocyst transfer following ovulation trigger is not determined. In addition, the value of luteal phase support to maintain the endometrium remains uncertain. Thus, there is a need to identify the optimal timing of blastocyst warming and transfer and the effect of luteal phase support in a randomised controlled trial design. The aim of this randomised controlled trial is to investigate if progesterone supplementation from the early luteal phase until gestational age 8 weeks is superior to no progesterone supplementation and to assess if blastocyst warming and transfer 6 days after ovulation trigger is superior to 7 days after ovulation trigger in mNC-FET with live birth rates as the primary outcome.

Methods and analysis

Multicentre, randomised, controlled, single-blinded trial including 604 normo-ovulatory women aged 18–41 years undergoing mNC-FET with a high-quality blastocyst originating from their first to third in vitro fertilisation/intracytoplasmic sperm injection cycle. Participants are randomised (1:1:1:1) to either luteal phase progesterone or no luteal phase progesterone and to blastocyst warming and transfer on day 6 or 7 after human chorionic gonadotropin trigger. Only single blastocyst transfers will be performed.

Ethics and dissemination

The study is approved by the Danish Committee on Health Research Ethics (H-18025839), the Danish Medicines Agency (2018061319) and the Danish Data Protection Agency (VD-2018-381). The results of the study will be publicly disseminated.

Trial registration number

The study is registered in EudraCT (2018-002207-34) and on ClinicalTrials.gov (NCT03795220); Pre-results.