bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of exercising before breakfast on the health of T2DM patients—A randomized controlled trial
Authors: Brinkmann Christian , Weh‐Gray Olivier , Brixius Klara , Bloch Wilhelm , Predel Hans-Georg , Kreutz Thorsten
Published: August 2019

This is the first study to examine whether training before breakfast in the overnight‐fasted state is more effective in improving the health of patients with type 2 diabetes mellitus (T2DM) than after breakfast in the fed state. Thirty T2DM patients (60 ± 8 years, 33.7 ± 4.6 kg/m2) were randomly assigned to the F group (training in the overnight‐fasted state (n = 15)) and to the C group (training in the fed state (control group, n = 15)). All patients completed an 8‐week combined endurance/strength training program. Physical training significantly increased time to physical exhaustion during an endurance test (+10.4%), power output during strength tests (chest presses: +36.7% and seated rows: +37.8%), and fat‐free mass (+1.7 kg). Body fat mass (−1.9 kg), glycated hemoglobin (HbA1c) values (absolute change: −0.3%), serum insulin values (−2.5 microU/mL), the homeostatic model assessment for insulin resistance (HOMA‐IR) index (−1.1), and circulating triglyceride levels (−31 mg/dL) decreased significantly from pre‐ to post‐training. The training had no effect on body mass index, serum fasting glucose, total cholesterol, low‐density lipoprotein/high‐density lipoprotein ratio or interleukin (IL)‐6, IL‐10 and tumor necrosis factor (TNF)α levels. Analyses of variance revealed no time × group interaction for any variable (P > .05). The training was effective in improving the health of T2DM patients. However, the preliminary study's data do not provide any evidence that the nutritional state (overnight‐fasted or fed) in regular physical training plays a significant role for training‐induced adaptations in T2DM patients. Full trials (using other training protocols as well) should be conducted to gain further knowledge about the relevance of pre‐exercise breakfast ingestion.
The coordinated action of PPR4 and EMB2654 on each intron half mediates trans‐splicing of rps12 transcripts in plant chloroplasts
Authors: Lee Kwanuk , Park Su Jung , Colas des Francs‐Small Catherine , Whitby Michael , Small Ian , Kang Hunseung
Published: August 2019

The pentatricopeptide repeat proteins PPR4 and EMB2654 have been shown to be required for the trans‐splicing of plastid rps12 transcripts in Zea mays (maize) and Arabidopsis, respectively, but their roles in this process are not well understood. We investigated the functions of the Arabidopsis and Oryza sativa (rice) orthologs of PPR4, designated AtPPR4 (At5g04810) and OsPPR4 (Os4g58780). Arabidopsis atppr4 and rice osppr4 mutants are embryo‐lethal and seedling‐lethal 3 weeks after germination, respectively, showing that PPR4 is essential in the development of both dicot and monocot plants. Artificial microRNA‐mediated mutants of AtPPR4 displayed a specific defect in rps12 trans‐splicing, with pale‐green, yellowish or albino phenotypes, according to the degree of knock‐down of AtPPR4 expression. Comparison of RNA footprints in atppr4 and emb2654 mutants showed a similar concordant loss of extensive footprints at the 3′ end of intron 1a and at the 5′ end of intron 1b in both cases. EMB2654 is known to bind within the footprint region in intron 1a and we show that AtPPR4 binds to the footprint region in intron 1b, via its PPR motifs. Binding of both PPR4 and EMB2654 is essential to juxtapose the two intron halves and to maintain the RNAs in a splicing‐competent structure for the efficient trans‐splicing of rps12 intron 1, which is crucial for chloroplast biogenesis and plant development. The similarity of EMB2654 and PPR4 orthologs and their respective binding sites across land plant phylogeny indicates that their coordinate function in rps12 trans‐splicing has probably been conserved for 500 million years.
Instrumented cervical fusion in nine dogs with caudal cervical spondylomyelopathy
Authors: Reints Bok Tjarda E. , Willemsen Koen , van Rijen Mattie H. P. , Grinwis Guy C. M. , Tryfonidou Marianna A. , Meij Björn P.
Published: August 2019

Objective

To report the long‐term outcome of nine dogs treated for caudal cervical spondylomyelopathy (CCSM) with surgical spinal fusion.

Study design

Short case series.

Animals

Nine large‐breed dogs.

Methods

Medical records of dogs treated for disc‐associated CCSM (2013‐2016) were reviewed. The surgery objective was spinal distraction by implantation of a SynCage and fixation with two Unilock plates. Follow‐up included the Helsinki pain score questionnaire, neurological grading, radiography, computed tomography (CT), and micro‐CT (μCT) with subsequent histopathology (two dogs).

Results

Clinical follow‐up was obtained between 9 and 51 months (27.4 ± 13.4 months). The Helsinki pain score and neurological Griffith score improved (P < .01) in all dogs and in eight of nine dogs, respectively. According to CT, the volume of bone (mean ± SD) through the cage was 79.5% ± 14.3%, including compact bone (53.0% ± 23.4%). Subsidence was seen in one of nine dogs. Implant failure was evident in four dogs, and plates were removed in two dogs. In seven of nine dogs, infraclinical pathology was observed in adjacent segment, associated with implants engaging adjacent intervertebral discs. Radiographic evidence of bony fusion between vertebral bodies was noted in all dogs. Spinal fusion was confirmed by μCT and histopathology in two cervical spine segments that became available at 22 and 40 months postoperatively.

Conclusion

Instrumented spinal fusion in dogs with disc‐associated CCSM resulted in owner satisfaction and radiographic evidence of interbody spinal fusion in all dogs.

Clinical significance

The fusion distraction technique reported here can be used to achieve spinal fusion with a good long‐term outcome.
Momentum as a Maintaining Agency: A Different Approach to Teaching Force
Authors: Wannous Jarier , Horváth Peter
Published: August 2019

A power supply is needed to maintain the function of a computer, heat is needed to keep food from cooling down, and a force is needed to maintain motion. Those are notions that seem very natural to many people as they are based on everyday experiences. However, when it comes to motion, it is not force that maintains motion but momentum. Students in our classrooms are often introduced first to force and to its affects, and later they learn about momentum. This paper discusses a different approach from a phenomenological primitives (p-prims) perspective, where we start with momentum and only then continue with force. The reasons for this change are discussed as well as a brief description of the proposed approach.
Adapting RealTime Physics for Distance Learning with the IOLab
Authors: Bodegom Erik , Jensen Erik , Sokoloff David
Published: August 2019

The IOLab is a versatile and inexpensive data acquisition device in a cart that can roll on its three wheels. It has numerous sensors for a variety of physical quantities. We adapted RealTime Physics, Module 1: Mechanics active learning labs for use with the IOLab. We tested these labs both on campus and with distance learners at Portland State University and Chemeketa Community College for three years, consistently obtaining significant conceptual learning gains on the Force and Motion Conceptual Evaluation (FMCE). Student attitudes towards the labs, the device, and distance learning—as measured by post-course evaluations—were generally very positive.
Five Tips for Integrating Khan Academy in Your Course
Authors: Gray James , Lindstrøm Christine
Published: August 2019

Khan Academy (KA) is one of the world’s most popular open educational resources (OER), with more than 57 million registered users and 15 million monthly site visits as of May 2016. It is popular with students seeking additional resources for their math studies, and gaming features (in the form of points, badges, and missions) add to its appeal. As yet, there is little research-based advice on how such a system (of which KA is not the only one) can be effectively integrated into a course.
A comparison of ear-canal-reflectance measurement methods in an ear simulator
Authors: Nørgaard Kren Rahbek , Charaziak Karolina K. , Shera Christopher A.
Published: August 2019

Ear-canal reflectance has been researched extensively for diagnosing conductive hearing disorders and compensating for the ear-canal acoustics in non-invasive measurements of the auditory system. Little emphasis, however, has been placed on assessing measurement accuracy and variability. In this paper, a number of ear-canal-reflectance measurement methods reported in the literature are utilized and compared. Measurement variation seems to arise chiefly from three factors: the residual ear-canal length, the ear-probe insertion angle, and the measurement frequency bandwidth. Calculation of the ear-canal reflectance from the measured ear-canal impedance requires estimating the ear-canal characteristic impedance in situ. The variability in ear-canal estimated characteristic impedance and reflectance due to these principal factors is assessed in an idealized controlled setup using a uniform occluded-ear simulator. In addition, the influence of this measurement variability on reflectance-based methods for calibrating stimulus levels is evaluated and, by operating the condenser microphone of the occluded-ear simulator as an electro-static speaker, the variability in estimating the emitted pressure from the ear is determined. The various measurement methods differ widely in their robustness to variations in the three principal factors influencing the accuracy and variability of ear-canal reflectance.
The Initial Intentions for Social Leveraging of a Mega Sport Event Among Stakeholders of a Newly Formed Interorganizational Relationship
Authors: Gao Fei , Heere Bob , Todd Samuel Y. , Mihalik Brian
Published: August 2019

Although the concept of social leverage has been a key component of research on mega sport events, authors know little about how the initial partnership between stakeholders of the event allows for social leveraging prior to the event. Thus, the purpose of this study is to understand what intentions stakeholders of a newly formed interorganizational relationship for the 2019 Federation of International Basketball Associations World Cup have toward social leverage initiatives and whether they coordinate such efforts with other stakeholders. Data were collected through two rounds of interviews with high-ranking leaders in the stakeholder organizations. The authors found that social leverage is not part of the early planning for the event because (a) different stakeholders/organizations have little knowledge of social leverage, (b) the media amplifies current values and beliefs of the interorganizational relationship stakeholders, and (c) the Chinese culture has an implicit/explicit influence on the interorganizational relationship. The study contributes to our understanding of challenges surrounding social leveraging.
Rational synthesis of an atomically precise carboncone under mild conditions
Authors: Zhu Zheng-Zhong , Chen Zuo-Chang , Yao Yang-Rong , Cui Cun-Hao , Li Shu-Hui , Zhao Xin-Jing , Zhang Qianyan , Tian Han-Rui , Xu Piao-Yang , Xie Fang-Fang , Xie Xiao-Ming , Tan Yuan-Zhi , Deng Shun-Liu , Quimby Jennifer M. , Scott Lawrence T. , Xie Su-Yuan , Huang Rong-Bin , Zheng Lan-Sun
Published: August 2019

A carboncone[1,2] molecule was rationally synthesized, pushing the study on all-carbon allotropes into a new dimension.
Ultrafast extreme rejuvenation of metallic glasses by shock compression
Authors: Ding G. , Li C. , Zaccone A. , Wang W. H. , Lei H. C. , Jiang F. , Ling Z. , Jiang M. Q.
Published: August 2019

Extreme rejuvenation of bulk metallic glasses is successfully achieved in the ever-known shortest time scale of about 365 ns.
Current-driven magnetization switching in a van der Waals ferromagnet Fe
3
GeTe
2
Authors: Wang Xiao , Tang Jian , Xia Xiuxin , He Congli , Zhang Junwei , Liu Yizhou , Wan Caihua , Fang Chi , Guo Chenyang , Yang Wenlong , Guang Yao , Zhang Xiaomin , Xu Hongjun , Wei Jinwu , Liao Mengzhou , Lu Xiaobo , Feng Jiafeng , Li Xiaoxi , Peng Yong , Wei Hongxiang , Yang Rong , Shi Dongxia , Zhang Xixiang , Han Zheng , Zhang Zhidong , Zhang Guangyu , Yu Guoqiang , Han Xiufeng
Published: August 2019

Spin-orbit torque flips the perpendicular magnetic moment of a 2D van der Waals magnet.
Ionic liquid–based click-ionogels
Authors: Ren Yongyuan , Guo Jiangna , Liu Ziyang , Sun Zhe , Wu Yiqing , Liu Lili , Yan Feng
Published: August 2019

Click chemistry can create freeze/heat-resistant, nonflammable, and highly robust ionic liquid–based click-ionogels.
Antimicrobial Treatment Provides a Competitive Advantage to Mycobacterium abscessus in a Dual-Species Biofilm with Pseudomonas aeruginosa
Authors: Rodríguez-Sevilla Graciela , Crabbé Aurélie , García-Coca Marta , Aguilera-Correa John Jairo , Esteban Jaime , Pérez-Jorge Concepción
Published: August 2019

The physiological factors that contribute to
Mycobacterium abscessus
lung infections remain unclear. We determined whether antibiotic treatment targeting a major cystic fibrosis pathogen (i.e.,
Pseudomonas aeruginosa
) could provide the ideal conditions for the establishment of
M. abscessus
infection. Our data showed that
P. aeruginosa
inhibited
M. abscessus
biofilm formation under control conditions and that antimicrobial therapy selectively targeting
P. aeruginosa
diminished this competitive interaction, thereby increasing
M. abscessus
survival.
Microbially Influenced Corrosion of Stainless Steel by Acidithiobacillus ferrooxidans Supplemented with Pyrite: Importance of Thiosulfate
Authors: Inaba Yuta , Xu Shirley , Vardner Jonathan T. , West Alan C. , Banta Scott
Published: August 2019

MIC of industrial equipment, gas pipelines, and military material leads to billions of dollars in damage annually. Thus, there is a clear need to better understand MIC processes and chemistries as efforts are made to ameliorate these effects. Additionally,
A. ferrooxidans
is a valuable acidophile with high metal tolerance which can continuously generate ferric iron, making it critical to copper and other biomining operations as well as a potential biocatalyst for electronic waste recycling. New MIC mechanisms may expand the utility of these cells in future metal resource recovery operations.
Placing education at the centre of the outpatient clinic improves learning and experiences for everyone using the multilevel attainment of learning, teaching and support (MALTS) approach
Authors: Blair Mitch , Wortley Elizabeth , McGuff Kirsty
Published: August 2019

A large proportion of consultant time is spent in outpatient practice. This setting provides an excellent learning environment for different levels of a trainee if well organised. This article describes an evidence-based teaching approach and its evaluation by trainees, patients and carers in a typical district general hospital setting which it is hoped others might find helpful.
Liquid gold: the cost-effectiveness of urine sample collection methods for young precontinent children
Authors: Kaufman Jonathan , Knight Andrew Joshua , Bryant Penelope A , Babl Franz E , Dalziel Kim
Published: August 2019

Background

Urinary tract infection (UTI) is a common childhood infection. Many febrile children require a urine sample to diagnose or exclude UTI. Collecting urine from young children can be time-consuming, unsuccessful or contaminated. Cost-effectiveness of each collection method in the emergency department is unknown.

Objective

To determine the cost-effectiveness of urine collection methods for precontinent children.

Methods

A cost-effectiveness analysis was conducted comparing non-invasive (urine bag, clean catch and 5 min voiding stimulation for clean catch) and invasive (catheterisation and suprapubic aspirate (SPA)) collection methods, for children aged 0–24 months in the emergency department. Costs included equipment, staff time and hospital bed occupancy. If initial collection attempts were unsuccessful subsequent collection using catheterisation was assumed. The final outcome was a definitive sample incorporating progressive dipstick, culture and contamination results. Average costs and outcomes were calculated for initial collection attempts and obtaining a definitive sample. One-way and probabilistic sensitivity analyses were performed.

Results

For initial collection attempts, catheterisation had the lowest cost per successful collection (GBP£25.98) compared with SPA (£37.80), voiding stimulation (£41.32), clean catch (£52.84) and urine bag (£92.60). For definitive collection, catheterisation had the lowest cost per definitive sample (£49.39) compared with SPA (£51.84), voiding stimulation (£52.25), clean catch (£64.82) and urine bag (£112.28). Time occupying a hospital bed was the most significant determinant of cost.

Conclusion

Catheterisation is the most cost-effective urine collection method, and voiding stimulation is the most cost-effective non-invasive method. Urine bags are the most expensive method. Although clinical factors influence choice of method, considering cost-effectiveness for this common procedure has potential for significant aggregate savings.
Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year single-centre experience
Authors: Badheka Aditya , Bloxham Jodi , Schmitz April , Freyenberger Barbara , Wang Tong , Rampa Sankeerth , Turi Jennifer , Allareddy Veerasathpurush , Auslender Marcelo , Allareddy Veerajalandhar
Published: August 2019

Objectives

The use of peripherally inserted central catheters (PICCs) are an integral part of caring for hospitalised children. We sought to estimate the incidence of and identify the risk factors for complications associated with PICCs in an advanced registered nurse practitioners (ARNP)-driven programme.

Design

Retrospective cohort study.

Setting

Single-centre, large quaternary children's hospital.

Participants

Hospitalised children who had PICC inserted from 1 January 2010 to 31 December 2016.

Interventions

None.

Measurement and main results

A total of 2558 PICCs were placed during the study period. Mean age at PICC insertion was 8.7 years, mean dwell time was 17.7 days. The majority of PICCs (97.8%) were placed by ARNP. Most were placed in a single attempt (79.6%). Mean PICC residual external length outside was 2.1±2.7 cm. The rate of central line-associated bloodstream infection (CLABSI), thrombosis and significant bleeding were 1.9%, 1% and 0.2%, respectively. The CLABSI rate in infants and early childhood was higher than those aged ≥5 years (2.8%, 3.1%, respectively vs 1.3%). In a multivariate analysis after adjustment of confounding effects of race and gender, infants (OR= 2.24, CI=1.14 to 4.39, p=0.02) and early childhood cohort (OR=2.37, CI=1.12 to 5.01, p=0.02) were associated with significantly higher odds of developing CLABSI compared with ≥5 years old. In the early childhood cohort, PICCs with longer residual external catheter length (OR=1.30, 95% CI=1.07 to 1.57, p=0.008) and those placed in the operating room (OR=5.49, 95% CI=1.03 to 29.19, p=0.04), were associated with significantly greater risk of developing CLABSI.

Conclusions

The majority of PICCs were successfully placed by ARNPs on the first attempt and had a low incidence of complications. Infants required more attempts for successful PICC placement than older children. The presence of residual external catheter length and placement in the operating room were independent predictors of CLABSI in younger children.
Physical activity, sedentary time and their associations with clustered metabolic risk among people with type 2 diabetes in Jiangsu province: a cross-sectional study
Authors: Chen Yijia , Yang Jie , Su Jian , Qin Yu , Shen Chong , Li Ying , Lu Shurong , Pan Enchun , Gao Yan , Miao Dandan , Zhang Ning , Zhou Jinyi , Wu Ming
Published: August 2019

Objective

Investigating the association between total physical activity, physical activity in different domains and sedentary time with clustered metabolic risk in patients with type 2 diabetes from Jiangsu province, China.

Design

Interview-based cross-sectional study conducted between December 2013 and January 2014.

Setting

44 selected townships across two cities, Changshu and Huai’an, in Jiangsu province.

Participants

20 340 participants selected using stratified cluster-randomised sampling and an interviewer-managed questionnaire.

Methods

We constructed clustered metabolic risk by summing sex-specific standardised values of waist circumference, fasting triacylglycerol, fasting plasma glucose, systolic blood pressure and the inverse of blood high-density lipoprotein cholesterol (HDL-cholesterol). Self-reported total physical activity included occupation, commuting and leisure-time physical activity. The un-standardised regression coefficient [B] and its 95% CI were calculated using multivariate linear regression analyses.

Results

This study included 17 750 type 2 diabetes patients (aged 21–94 years, 60.3% female). The total (B=−0.080; 95% CI: −0.114 to −0.046), occupational (B=−0.066; 95% CI: −0.101 to− 0.031) and leisure-time physical activity (B=−0.041; 95% CI: −0.075 to −0.007), and sedentary time (B=0.117; 95% CI: 0.083 to 0.151) were associated with clustered metabolic risk. Total physical activity, occupational physical activity and sedentary time were associated with waist circumference, triacylglycerol and HDL-cholesterol, but not with systolic blood pressure. Commuting physical activity and sedentary time were significantly associated with triacylglycerol (B=−0.012; 95% CI: −0.019 to −0.005) and fasting plasma glucose (B=0.008; 95% CI: 0.003 to 0.01), respectively. Leisure-time physical activity was only significantly associated with systolic blood pressure (B=−0.239; 95% CI: −0.542 to− 0.045).

Conclusions

Total, occupational and leisure-time physical activity were inversely associated with clustered metabolic risk, whereas sedentary time increased metabolic risk. Commuting physical activity was inversely associated with triacylglycerol. These findings suggest that increased physical activity in different domains and decreased sedentary time may have protective effects against metabolic risk in type 2 diabetes patients.
Individual and environmental factors associated with death of cyclists involved in road crashes in Spain: a cohort study
Authors: Molina-Soberanes Daniel , Martínez-Ruiz Virginia , Lardelli-Claret Pablo , Pulido-Manzanero José , Martín-delosReyes Luis Miguel , Moreno-Roldán Elena , Jiménez-Mejías Eladio
Published: August 2019

Objective

To quantify the magnitude of associations between cyclist fatalities and both cyclist and environment related characteristics in Spain during the first 24 hours after a crash.

Design

Cohort study.

Setting

Spain.

Participants

65 977 cyclists injured in road crashes recorded between 1993 and 2013 in the Spanish Register of Road Crashes with Victims.

Main outcome

Death within the first 24 hours after the crash.

Methods

A multiple imputation procedure was used to mitigate the effect of missing values. Differences between regions were assumed and managed with multilevel analysis at the cyclist and province levels. Incidence density ratios (IDR) with 95% CI were calculated with a multivariate Poisson model.

Results

Non-use of a helmet was directly associated with death (IDR 1.43, 95% CI 1.25 to 1.64). Among other cyclist characteristics, age after the third decade of life was also directly associated with death, especially in older cyclists (‘over 74’ category, IDR 4.61, 95% CI 3.49 to 6.08). The association with death did not differ between work-related cycling and other reasons for cycling.

There was an inverse association with death for crashes in urban areas and on community roads. Any adverse meteorological condition also showed a direct association with death, whereas altered road surfaces showed an inverse association. Crashes during nighttime were directly associated with death, with a peak between 3:00 and 5:59 am (IDR 1.58, 95% CI 1.03 to 2.41).

Conclusions

We found strong direct and inverse associations between several cyclist and environment related variables and death. These variables should be considered in efforts to prioritise public health measures aimed at reducing the number of cycling-related fatalities.
An exploratory spatial analysis of overweight and obesity among children and adolescents in Shandong, China
Authors: Qin Wenzhe , Wang Lu , Xu Lingzhong , Sun Long , Li Jiajia , Zhang Jiao , Shao Hui
Published: August 2019

Objective

Identifying the spatial patterns of childhood overweight/obesity (OW/OB) can help to guide resource allocation for preventive intervention in China. This study aims to estimate rates of childhood OW/OB across counties within Shandong Province, using geographic techniques to identify sex-specific spatial patterns of childhood OW/OB as well as the presence of spatial clusters.

Design

Cross-sectional study.

Setting

Shandong Province in China.

Participants and methods

Data on 6 216 076 children and adolescents aged 7–18 years from the Primary and Secondary Schoolchildren Physical Examination Database for Shandong Province were used in this study. Spatial patterns of sex-specific prevalence of childhood OW/OB were mapped. Global autocorrelation statistic (Moran’s I) and the Local Indicator of Spatial Association (LISA) were applied to assess the degree of spatial autocorrelation.

Results

The overall prevalence of childhood OW/OB in Shandong province were 15.05% and 9.23%, respectively. Maps of the sex-specific prevalence of OW/OB demonstrate a marked geographical variation of childhood OW/OB in different regions. Prevalence of childhood OW/OB had a significant positive spatial autocorrelation among both boys and girls. LISA analysis identified significant clusters (or ‘hot spots’) of childhood OW/OB in the eastern coastal region, central region and southwestern region.

Conclusions

The prevalence of childhood OW/OB is highly spatially clustered. Geographically focused appropriate intervention should be introduced in current childhood OW/OB prevention and control strategy.
Clinical and cost-effectiveness of teen online problem-solving for adolescents who have survived an acquired brain injury in the UK: protocol for a randomised, controlled feasibility study (TOPS-UK)
Authors: Limond Jenny , Wade Shari L. , Vickery Patricia Jane , Jeffery A , Warren Fiona C , Hawton Annie , Smithson Janet , Ford Tamsin , Haworth Sarah , Adlam Anna-Lynne Ruth
Published: August 2019

Introduction

Paediatric acquired brain injury is a leading cause of mortality in children in the UK. Improved treatment during the acute phase has led to increased survival rates, although with life-long morbidity in terms of social and emotional functioning. This is the protocol for a feasibility randomised controlled trial with an embedded qualitative study and feasibility economic evaluation. If feasible, a later definitive trial will test the effectiveness and cost-effectiveness of an online intervention to enhance problem solving ability versus treatment as usual.

Methods and analysis

Twenty-five adolescents and their families identified by primary or secondary care clinicians at participating UK National Health Service Trusts will be recruited and individually randomised in a 1:1 ratio to receive the online intervention or treatment as usual. Participants will be followed up by online questionnaires 17 weeks after randomisation to capture acceptability of the study and intervention and resource use data. Qualitative interviews will capture participants’ and clinicians’ experiences of the study.

Ethics and dissemination

This study has been granted ethical approval by the South West-Exeter Research Ethics Committee (ref 17/SW/0083). Results will be disseminated via peer-reviewed publications and will inform the design of a larger trial.

Trial registration number

ISRCTN10906069
Choosing Healthy Eating for Infant Health (CHErIsH) study: protocol for a feasibility study
Authors: Matvienko-Sikar Karen , Toomey Elaine , Queally Michelle , Flannery Caragh , O Neill Kate , Dinan Ted G , Doherty Edel , Harrington Janas M , Hayes Catherine , Heary Caroline , Hennessy Marita , Kelly Colette , Mc Hugh Sheena M , McSharry Jenny , Stanton Catherine , Heffernan Tony , Byrne Molly , Kearney Patricia M
Published: August 2019

Introduction

Childhood obesity is a public health challenge. There is evidence for associations between parents’ feeding behaviours and childhood obesity risk. Primary care provides a unique opportunity for delivery of infant feeding interventions for childhood obesity prevention. Implementation strategies are needed to support infant feeding intervention delivery. The Choosing Healthy Eating for Infant Health (CHErIsH) intervention is a complex infant feeding intervention delivered at infant vaccination visits, alongside a healthcare professional (HCP)-level implementation strategy to support delivery.

Methods and analysis

This protocol provides a description of a non-randomised feasibility study of an infant feeding intervention and implementation strategy, with an embedded process evaluation and economic evaluation. Intervention participants will be parents of infants aged ≤6 weeks at recruitment, attending a participating HCP in a primary care practice. The intervention will be delivered at the infant’s 2, 4, 6, 12 and 13 month vaccination visits and involves brief verbal infant feeding messages and additional resources, including a leaflet, magnet, infant bib and sign-posting to an information website. The implementation strategy encompasses a local opinion leader, HCP training delivered prior to intervention delivery, electronic delivery prompts and additional resources, including a training manual, poster and support from the research team. An embedded mixed-methods process evaluation will examine the acceptability and feasibility of the intervention, the implementation strategy and study processes including data collection. Qualitative interviews will explore parent and HCP experiences and perspectives of delivery and receipt of the intervention and implementation strategy. Self-report surveys will examine fidelity of delivery and receipt, and acceptability, suitability and comprehensiveness of the intervention, implementation strategy and study processes. Data from electronic delivery prompts will also be collected to examine implementation of the intervention. A cost–outcome description will be conducted to measure costs of the intervention and the implementation strategy.

Ethics and dissemination

This study received approval from the Clinical Research Ethics Committee of the Cork Teaching Hospitals. Study findings will be disseminated via peer-reviewed publications and conference presentations.
Readmission and processes of care across weekend and weekday hospitalisation for acute myocardial infarction, heart failure or stroke: an observational study of the National Readmission Database
Authors: Martin Glen Philip , Kwok Chun Shing , Van Spall Harriette Gillian Christine , Volgman Annabelle Santos , Michos Erin , Parwani Purvi , Alraies Chadi , Thamman Ritu , Kontopantelis Evangelos , Mamas Mamas
Published: August 2019

Objectives

Variation in hospital resource allocations across weekdays and weekends have led to studies of the ‘weekend effect’ for ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), heart failure (HF) and stroke. However, few studies have explored the ‘weekend effect’ on unplanned readmission. We aimed to investigate 30-day unplanned readmissions and processes of care across weekend and weekday hospitalisations for STEMI, NSTEMI, HF and stroke.

Design

We grouped hospitalisations for STEMI, NSTEMI, HF or stroke into weekday or weekend admissions. Multivariable adjusted ORs for binary outcomes across weekend versus weekday (reference) groups were estimated using logistic regression.

Setting

We included all non-elective hospitalisations for STEMI, NSTEMI, HF or stroke, which were recorded in the US Nationwide Readmissions Database between 2010 and 2014.

Participants

The analysis sample included 659 906 hospitalisations for STEMI, 1 420 600 hospitalisations for NSTEMI, 3 027 699 hospitalisations for HF, and 2 574 168 hospitalisations for stroke.

Main outcome measures

The primary outcome was unplanned 30-day readmission. As secondary outcomes, we considered length of stay and the following processes of care: coronary angiography, primary percutaneous coronary intervention, coronary artery bypass graft, thrombolysis, brain scan/imaging, thrombectomy, echocardiography and cardiac resynchronisation therapy/implantable cardioverter-defibrillator.

Results

Unplanned 30-day readmission rates were 11.0%, 15.1%, 23.0% and 10.9% for STEMI, NSTEMI, HF and stroke, respectively. Weekend hospitalisations for HF were associated with a statistically significant but modest increase in 30-day readmissions (OR of 1.045, 95% CI 1.033 to 1.058). Weekend hospitalisation for STEMI, NSTEMI or stroke was not associated with increased risk of 30-day readmission.

Conclusion

There was no clinically meaningful evidence against the supposition that weekend and weekday hospitalisations have the same 30-day unplanned readmissions. Thirty-day readmission rates were high, especially for HF, which has implications for service provision. Strategies to reduce readmission rates should be explored, regardless of day of hospitalisation.
Protocol for a prospective observational diagnostic study: intraoperative simultaneous limb pressure monitoring (INSTANT) study
Authors: Rockley Mark , Jetty Prasad , Wells George A
Published: August 2019

Introduction

Peripheral vascular disease (PVD) is a condition caused by arterial blockages causing inadequate blood flow, resulting in pain and gangrene of the legs. Endovascular therapy, such as angioplasty, can be used to treat PVD, however, the operator feedback during surgery is primarily anatomic based on the angiogram. Because physiologic blood perfusion can be difficult to determine based on anatomic images, we propose introducing physiological measurements into the operating room. This study will investigate whether the change in intraoperative monitoring of haemodynamic measurements such as the Toe-Brachial Index during endovascular surgery for lower extremity atherosclerotic PVD is associated with clinical outcomes such as major adverse limb events (MALEs).

Methods and analysis

This study will be a prospective, operator-blinded and blinded endpoint adjudicated observational diagnostic cohort study. A total of 80 legs will be enrolled in the study. Ankle and toe blood pressures will be measured non-invasively at predetermined time points before, during and after surgery, and we will assess associations between changes in intraoperative pressure measurements and postoperative clinical and haemodynamic outcomes. The primary outcome will be MALE within 1 year, and secondary outcomes include follow-up pressure measurements, vessel patency, reintervention, clinical staging improvement, amputation and death.

Ethics and dissemination

Regional hospital ethics approval has been granted (Ottawa Hospital Research Institute - Research Ethics Board, Protocol 20180656–01H). On completion of data analysis, the study will submitted for presentation at international vascular surgical society meetings, in addition to submission for publication in publicly accessible medical journals.

Trial registration number

NCT03875846
Effect of home-based high-intensity interval training and behavioural modification using information and communication technology on cardiorespiratory fitness and exercise habits among sedentary breast cancer survivors: habit-B study protocol for a randomised controlled trial
Authors: Tsuji Katsunori , Ochi Eisuke , Okubo Ryo , Shimizu Yoichi , Kuchiba Aya , Ueno Taro , Shimazu Taichi , Kinoshita Takayuki , Sakurai Naomi , Matsuoka Yutaka
Published: August 2019

Introduction

Maintaining high levels of physical activity helps to maintain and improve physical health and quality of life, and plays a role in reducing adverse effects due to cancer treatments. Moreover, a greater degree of cardiorespiratory fitness is associated with reduced risk of all-cause mortality. However, there are no home-based programme for improving cardiorespiratory fitness using body weight exercises for breast cancer survivors. This study will assess the efficacy of the newly developed habit-B programme on maximum oxygen uptake compared with treatment as usual with wearable device. The effects of this programme on exercise habits, level of physical activity, physical fitness and subjective indices will also be investigated.

Methods and analysis

This is a 12-week, parallel-group, single-blind, randomised controlled trial. Allocation will be managed by a central server using a computer-generated random allocation sequence provided by an independent data centre. Participants will be assigned to the habit-B programme (high-intensity interval training, exercise counselling + guidance, home-based exercise support using information and communication technology, and a wearable device) or treatment as usual with a wearable device. Subjects will be sedentary women aged 20–59 years who have received breast surgery in the past 2–13 months after the diagnosis of invasive breast cancer (stages I–IIa) and have never received chemotherapy except for hormone therapy. The primary endpoint is the change in peak oxygen uptake (VO2peak; mL/kg/min) between the groups after 12 weeks of intervention.

Ethics and dissemination

The study protocol was approved by the Institutional Review Board of the National Cancer Center Japan on 28 February 2019 (ID: 2018-347). The findings will be disseminated through peer-reviewed publications and conference presentations.

Trial registration number

UMIN000036400.
Addressing the polypharmacy challenge in older people with multimorbidity (APOLLO-MM): study protocol for an in-depth ethnographic case study in primary care
Authors: Swinglehurst Deborah , Fudge Nina
Published: August 2019

Introduction

Polypharmacy is on the rise. It is burdensome for patients and is a common source of error and adverse drug reactions, especially among older adults. Health policy advises clinicians to practicemedicines optimisation—a person-centred approach to safe, effective medicines use. There has been little research exploring older patients’ perspectives and priorities around medicines-taking or their actual practices of fitting medicines into their daily lives and how these are shaped by the wider context of healthcare.

Methods and analysis

We will conduct an in-depth multisite ethnographic case study. The study is based in seven clinical sites (three general practices and four community pharmacies) and includes longitudinal ethnographic follow-up of older adults, organisational ethnography and participatory methods. Main data sources include field notes of observations in the home and clinical settings; interviews with patients and professionals; cultural probe activities; video recordings of clinical consultations and interprofessional talk; documents. Our analysis will illuminate the everyday practices of polypharmacy from a range of lay and professional perspectives; the institutional contexts within which these practices play out and the sense-making work that sustains—or challenges—these practices. Our research will adopt a ‘practice theory’ lens, drawing on the sociology of organisational routines and other relevant social theory guided by ongoing iterative data analysis.

Ethics approval

The study has HRA approval and received a favourable ethical opinion from the Leeds West Research Ethics Committee (IRAS project ID: 205517; REC reference 16/YH/0462).

Dissemination

Aside from academic outputs, our findings will inform the development of recommendations for practice and policy including an interactive e-learning resource. We will also work with service users to co-design patient/public engagement resources.
Prognostic significance of cathepsin V (CTSV/CTSL2) in breast ductal carcinoma in situ
Authors: Toss Michael , Miligy Islam , Gorringe Kylie , Mittal Karuna , Aneja Ritu , Ellis Ian , Green Andrew , Rakha Emad
Published: August 2019

Aims

Cathepsin V (CTSV/CTSL2) is a lysosomal cysteine proteinase and plays a role in extracellular matrix degradation. It is associated with poor prognosis in invasive breast cancer (IBC), but its role in breast ductal carcinoma in situ (DCIS) remains unclear. In this study, we aimed to evaluate the prognostic significance of CTSV in DCIS.

Methods

CTSV protein expression was immunohistochemically assessed in a well-characterised and annotated cohort of DCIS comprising pure DCIS (n=776) and DCIS coexisting with IBC (n=239). CTSV expression was analysed in tumour cells and surrounding stroma, including its association with clinicopathological parameters and outcome.

Results

In pure DCIS, high CTSV expression was observed in 29% of epithelial tumour cells and 20% of surrounding stroma. High expression in both components was associated with features of poor prognosis including higher nuclear grade, hormone receptor negativity and HER2 positivity. In addition, stromal CTSV expression was associated with larger DCIS size, comedo-type necrosis and high proliferation index. DCIS associated with IBC showed higher CTSV expression than pure DCIS either within the epithelial tumour cells or surrounding stroma (p<0.0001 and p=0.001, respectively). In DCIS/IBC, CTSV expression was higher in the invasive component than DCIS component either in tumour cells or surrounding stroma (both p<0.0001). CTSV stromal expression was associated with invasive recurrence independent of other prognostic factors in patients treated with breast conserving surgery (HR=3.0, p=0.005).

Conclusion

High expression of CTSV is associated with poor outcome in DCIS and is a potential marker to predict DCIS progression to invasive disease.
Automatic radiomic feature extraction using deep learning for angiographic parametric imaging of intracranial aneurysms
Authors: Podgorsak Alexander R , Rava Ryan A , Shiraz Bhurwani Mohammad Mahdi , Chandra Anusha R , Davies Jason M , Siddiqui Adnan H , Ionita Ciprian N
Published: August 2019

Background

Angiographic parametric imaging (API) is an imaging method that uses digital subtraction angiography (DSA) to characterize contrast media dynamics throughout the vasculature. This requires manual placement of a region of interest over a lesion (eg, an aneurysm sac) by an operator.

Objective

The purpose of our work was to determine if a convolutional neural network (CNN) was able to identify and segment the intracranial aneurysm (IA) sac in a DSA and extract API radiomic features with minimal errors compared with human user results.

Methods

Three hundred and fifty angiographic images of IAs were retrospectively collected. The IAs and surrounding vasculature were manually contoured and the masks put to a CNN tasked with semantic segmentation. The CNN segmentations were assessed for accuracy using the Dice similarity coefficient (DSC) and Jaccard index (JI). Area under the receiver operating characteristic curve (AUROC) was computed. API features based on the CNN segmentation were compared with the human user results.

Results

The mean JI was 0.823 (95% CI 0.783 to 0.863) for the IA and 0.737 (95% CI 0.682 to 0.792) for the vasculature. The mean DSC was 0.903 (95% CI 0.867 to 0.937) for the IA and 0.849 (95% CI 0.811 to 0.887) for the vasculature. The mean AUROC was 0.791 (95% CI 0.740 to 0.817) for the IA and 0.715 (95% CI 0.678 to 0.733) for the vasculature. All five API features measured inside the predicted masks were within 18% of those measured inside manually contoured masks.

Conclusions

CNN segmentation of IAs and surrounding vasculature from DSA images is non-inferior to manual contours of aneurysms and can be used in parametric imaging procedures.
Presumptive pituitary macroadenoma in an English Setter resembling human bobble‐head doll syndrome
Authors: Fiorentino Erica , Falzone Cristian
Published: August 2019

Head bobbing (HB) or idiopathic head tremor is a benign condition characterised by episodic uncontrolled head tremors that start and stop spontaneously or when dogs are focused on a goal‐oriented task, such as eating or playing, or are distracted by the owner. Although the aetiopathogenesis of HB is still unknown, the idiopathic nature is generally accepted, whereas in Bulldogs and Dobermans, a hereditary basis has been suggested. In the case herein, we report for the first time a relationship between a presumptive pituitary macroadenoma, its compression on the thalamus and HB, as it has already been observed in humans.
Wind-resilient civil structures: What can we learn from nature
Authors: Zhang Wei , Gruber Petra
Published: August 2019

Owing to changing weather patterns, catastrophic natural disasters are expected to happen more frequently and cause dramatic life and economic losses worldwide. The United States experienced a historically high record of weather disasters in 2017, with the economic losses exceeding 300 billion dollars. A major contributor to economic loss and threat to public safety is damage, destruction, and failure of civil structures in the strong-wind dominated disasters. There is a pressing need for reconstruction and redesign of critical civil structures to better cope with high winds to mitigate the loss of lives and properties. This paper takes a biomimetic perspective to link problem areas with potential solutions for future bio-inspired technology development, by identifying the most vulnerable aspects of civil structures in strong winds on one side and wind-resilient examples of biological systems on the other side. Of particular interest are plants that thrive in high winds, as they have likely adapted to manage the harsh environment under pressure of natural selection. Specific biological examples include the Saguaro cactus (Carnegiea gigantean Britton & Rose), reed grass, and shape reconfiguration of leaves. A review of problem areas, abstracted principles, and exemplary biological role models shall inform and guide towards new designs of wind-resilient civil structures.
Petrophysical constraints on magnetic anomalies associated with metamorphic reactions in northern Saskatchewan, Canada
Authors: Webber Jeffrey R. , Brown Laurie L. , Williams Michael L.
Published: August 2019

The western Chipman domain of the east Athabasca mylonite triangle in northern Saskatchewan, Canada, displays a large positive aeromagnetic anomaly that is the result of retrograde magnetite production during exhumation. Petrologic, magnetic coercivity, and hysteresis analyses indicate that multidomain magnetite is the primary magnetic phase in rocks of the region. Measurements of magnetic susceptibility from the western Chipman domain document five orders of magnitude variation, while rocks from the eastern Chipman domain are paramagnetic. The distribution of Koenigsberger ratios is approximately a mixed bimodal lognormal distribution with peak ratios at 0.039 and 0.73, suggesting that magnetic susceptibility is more significant than remanent magnetization. However, remanent magnetization is an important contributor to total magnetization. Petrographic observations indicate that magnetite is primarily produced from the breakdown of hornblende. The consumption of hornblende is also texturally associated with the production of actinolite and the hydration-related breakdown of granulite facies mineral phases such as garnet and clinopyroxene. Based on the proximity of the positive aeromagnetic anomaly to the Cora Lake shear zone, late-stage deformation along the shear zone during exhumation of the east Athabasca mylonite triangle may have structurally controlled the infiltration of fluids resulting in the heterogeneous production of magnetite. These results document the utility of integrating aeromagnetic, petrologic, and rock magnetic data to transcend observational scales and better understand regional tectonometamorphic history.