bluuebunny/crossref_metadata_2025 huggingface dataset:
The roles of community health workers who provide maternal and newborn health services: case studies from Africa and Asia
Authors: Olaniran Abimbola , Madaj Barbara , Bar-Zev Sarah , van den Broek Nynke
Published: August 2019

Introduction

A variety of community health workers (CHWs) provide maternal and newborn health (MNH) services in low-income and middle-income settings. However, there is a need for a better understanding of the diversity in type of CHW in each setting and responsibility, role, training duration and type of remuneration.

Methods

We identified CHWs providing MNH services in Bangladesh, India, Kenya, Malawi and Nigeria by reviewing 23 policy documents and conducting 36 focus group discussions and 131 key informant interviews. We analysed the data using thematic analysis.

Results

Irrespective of training duration (8 days to 3 years), all CHWs identify pregnant women, provide health education and screen for health conditions that require a referral to a higher level of care. Therapeutic care, antenatal care and skilled birth attendance, and provision of long-acting reversible contraceptives are within the exclusive remit of CHWs with training greater than 3 months. In contrast, community mobilisation and patient tracking are often done by CHWs with training shorter than 3 months. Challenges CHWs face include pressure to provide MNH services beyond their scope of practice during emergencies, and a tendency in some settings to focus CHWs on facility-based roles at the expense of their traditional community-based roles.

Conclusion

CHWs are well positioned geographically and socially to deliver some aspects of MNH care. However, there is a need to review and revise their scope of practice to reflect the varied duration of training and in-country legislation.
Pathways to optimising antibiotic use in rural China: identifying key determinants in community and clinical settings, a mixed methods study protocol
Authors: Zhao Linhai , Kwiatkowska Rachel Marie , Chai Jing , Cabral Christie , Chen Meixuan , Bowker Karen , Coope Caroline , Shen Jilu , Shen XingRong , Cheng Jing , Feng Rui , Kadetz Paul , MacGowan Alasdair , Oliver Isabel , Hickman Matthew , Wang Debin , Lambert Helen
Published: August 2019

Introduction

This study aims to investigate patterns of antibiotic treatment-seeking, describe current levels of and drivers for antibiotic use for common infections (respiratory tract and urinary tract infections) and test the feasibility of determining the prevalence and epidemiology of antimicrobial resistance (AMR) in rural areas of Anhui province, in order to identify potential interventions to promote antibiotic stewardship and reduce the burden of AMR in China.

Methods and analysis

We will conduct direct observations, structured and semistructured interviews in retail pharmacies, village clinics and township health centres to investigate treatment-seeking and antibiotic use. Clinical isolates from 1550 sputum, throat swab and urine samples taken from consenting patients at village and township health centres will be analysed to identify bacterial pathogens and ascertain antibiotic susceptibilities. Healthcare records will be surveyed for a subsample of those recruited to the study to assess their completeness and accuracy.

Ethics and dissemination

The full research protocol has been reviewed and approved by the Biomedical Ethics Committee of Anhui Medical University (reference number: 20170271). Participation of patients and doctors is voluntary and written informed consent is sought from all participants. Findings from the study will be disseminated through academic routes including peer-reviewed publications and conference presentations, via tailored research summaries for health professionals, health service managers and policymakers and through an end of project impact workshop with local and regional stakeholders to identify key messages and priorities for action.
Association between normal triglyceride and insulin resistance in US adults without other risk factors: a cross-sectional study from the US National Health and Nutrition Examination Survey, 2007–2014
Authors: Bi Chunli , Wang Lijuan , Sun Chong , Sun Mengzi , Zheng Pingping , Xue Zhiqiang , Shen Li , Pan Pan , Li Jiagen , Lv Yaogai , Zhang Anning , Li Bo , Zhang Xinyao , Yao Yan , Jin Lina
Published: August 2019

Objective

Traditionally, the absence of insulin resistance risk factors (IRRFs) was considered a low risk for insulin resistance (IR). However, IR also existed in certain individuals without IRRFs; thus this study aims to explore predictors of IR targeted at the population without IRRFs.

Design

Cross-sectional survey.

Setting

National Health and Nutrition Examination Survey.

Participants

Participants without regular IRRFs (IRRF-Free, n=2478) and a subgroup without optimal IRRFs (IRRF-Optimal, n=1414) were involved in this study.

Primary and secondary outcome measure

IRRFs and the optimal cut-off value of triglyceride (TG) to predict IR.

Results

Overall, the prevalence of IR was 6.9% and 5.7% in the IRRF-Free group and the IRRF-Optimal group, respectively. TG and waist circumference were independently associated with the prevalence of IR in both the groups (OR=1.010 to 10.20; p<0.05 for all), where TG was positively associated with IR. The area under the receiver operating characteristic curve of TG was 0.7016 (95% CI: 0.7013 to 0.7018) and 0.7219 (95% CI: 0.7215 to 0.7222), and the optimal cut-off value of TG to predict IR was 79.5 mg/dL and 81.5 mg/dL in the IRRF-Free group and the IRRF-Optimal group, respectively.

Conclusion

There is an association between TG and IR even in the normal range of TG concentration. Therefore, normal TG could be used as an important indicator to predict the prevalence of IR in the absence of IRRFs.
What causes prescribing errors in children? Scoping review
Authors: Conn Richard L , Kearney Orla , Tully Mary P , Shields Michael D , Dornan Tim
Published: August 2019

Objectives

(1) Systematically assemble, analyse and synthesise published evidence on causes of prescribing error in children. (2) Present results to a multidisciplinary group of paediatric prescribing stakeholders to validate findings and establish how causative factors lead to errors in practice.

Design

Scoping review using Arksey and O’Malley’s framework, including stakeholder consultation; qualitative evidence synthesis.

Methods

We followed the six scoping review stages. (1) Research question—the research question was ‘What is known about causes of prescribing error in children?’ (2) Search strategy—we searched MEDLINE, EMBASE, CINAHL (from inception to February 2018), grey literature and reference lists of included studies. (3) Article selection—all published evidence contributing information on the causes of prescribing error in children was eligible for inclusion. We included review articles as secondary evidence to broaden understanding. (4) Charting data—results were collated in a custom data charting form. (5) Reporting results—we summarised article characteristics, extracted causal evidence and thematically synthesised findings. (6) Stakeholder consultation—results were presented to a multidisciplinary focus group of six prescribing stakeholders to establish validity, relevance and mechanisms by which causes lead to errors in practice.

Results

68 articles were included. We identified six main causes of prescribing errors:children’s fundamental differencesled toindividualised dosing and calculations; off-licence prescribing; medication formulations; communication with children; andexperience working with children. Primary evidence clarifying causes was lacking.

Conclusions

Specific factors complicate prescribing for children and increase risk of errors. Primary research is needed to confirm and elaborate these causes of error. In the meantime, this review uses existing evidence to make provisional paediatric-specific recommendations for policy, practice and education.
Support to informal caregivers of patients with severe chronic obstructive pulmonary disease: a qualitative study of caregivers’ and professionals’ experiences in Swedish hospitals
Authors: Strang Susann , Fährn Josefin , Strang Peter , Ronstad Agneta , Danielsson Louise
Published: August 2019

Objectives

Informal caregivers of patients with chronic obstructive pulmonary disease (COPD) experience a heavy caregiver burden, but few studies have explored what support they need. The aim of this study was to describe perceptions of healthcare support to informal caregivers, both from the family caregiver’s and the staff’s perspective.

Design

A qualitative interview study involving semi-structured interviews and analysed with content analysis.

Participants

In total, 54 participated: 36 informal caregivers of patients with severe (stage 3–4) COPD and 17 healthcare staff.

Results

Two main themes emerged from the analysis: (1) Ambiguity impedes provision of support. Both caregivers and staff experienced ambiguity. The informal caregivers needed emotional, practical and informational support but talked about unclear expectations, while the staff described an uncertainty about their duties regarding the families. There were no routines to unburden the families. Moreover, language and cultural barriers hampered their efforts. (2) Knowledgeable and perceptive communication is key to support. Both caregivers and staff described positive experiences of dialogue. The dialogue may facilitate means to caregiver support and was a support in itself.

Conclusions

Our findings suggest that strategies and routines for caregiver support, including communication skills among the staff, should be developed, to move toward the family perspective advocated in palliative- and nursing family care.
Understanding pathways to stimulant use: a mixed-methods examination of the individual, social and cultural factors shaping illicit stimulant use across Europe (ATTUNE): study protocol
Authors: Rosenkranz Moritz , O'Donnell Amy , Verthein Uwe , Zurhold Heike , Addison Michelle , Liebregts Nienke , Rowicka Magdalena , Barták Miroslav , Petruželka Benjamin , Kaner Eileen FS , Martens Marcus-Sebastian
Published: August 2019

Introduction

Amphetamine-type stimulants (ATS) including amphetamine, methylenedioxymethamphetamine/‘ecstasy’, methamphetamine, synthetic cathinones and ‘Ritalin’ are the second most commonly used illicit drugs globally. Yet, there is little evidence on which factors are associated with the development of different patterns of ATS use over the life course. This study aims to examine which individual, social and environmental factors shape different pathways and trajectories of ATS consumption. The study will be conducted in five European countries: Germany, the Netherlands, Poland, Czech Republic and the UK.

Methods and analysis

We will use a sequential mixed-methods study design to investigate the multiple factors (familial, social and occupational situation, critical life events, general risk behaviour, mental and physical health, satisfaction with life) that shape individual ATS use pathways. A systematic literature review will be performed to provide an overview of the current academic literature on the topic. In module 1, qualitative semistructured interviews (n=ATS users and non-users) will be conducted to explore individual experiences of, and perspectives on, dynamics of change in stimulant consumption patterns. In module 2, structured questionnaires (n=2000 ATS users and non-users) will be administered via tablet computers to validate and enhance the generalisability of the interview findings. Data integration will take place at two key points. First, during the study, where the findings from the first qualitative interviews will inform the design of the structured questionnaire. Second, at the end of the study, where mixed methods data will be brought together to generate an in-depth, contextualised understanding of the research topic.

Ethics and dissemination

The study has been approved by the respective responsible ethics committee in each participating country. Data will be treated confidentially to ensure participants’ anonymity. Findings will be disseminated in peer-reviewed scientific journals, national and international conferences, and in briefings for policy and practice.
Web-based and mHealth interventions for intimate partner violence prevention: a systematic review protocol
Authors: Anderson Elizabeth J , McClelland Jean , Meyer Krause Caitlin , Krause Keegan C , Garcia David O , Koss Mary P
Published: August 2019

Introduction

Victims of intimate partner violence (IPV), or those individuals susceptible to IPV victimisation or perpetration, may benefit from participation in primary, secondary or tertiary interventions to address or mitigate exposure to violence despite mixed evidence of IPV intervention effectiveness. However, participation in such programmes is limited by poor access, sociocultural barriers and programme cost. As the world fast approaches universal access to the internet, web-based technologies and low-cost smartphones, new avenues to provide preventive health services including mobile health (mHealth) tools, platforms and services have emerged. The objective of this systematic review is to assess current web-based and mHealth interventions, which include web-based or mobile-based delivery methods for IPV prevention. Interpersonal violence is defined as perpetration or victimisation of a physical, psychological or sexual nature among adults. Interventions may be at the primary, secondary or tertiary level of the public health model.

Methods and analysis

This systematic review will incorporate studies focused on any empirical prevention intervention intended for IPV victims or perpetrators of any gender where one or more components is web based or mobile based. Articles will be retrieved from the following academic databases: MEDLINE/PubMed, Embase, CINAHL, PsycInfo and Open Grey, as well Google Scholar. Results will be limited to articles reporting primary data, published since 1998, and in English, Spanish, Portuguese or French. Data extraction procedures will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. The Mixed Methods Appraisal Tool, a critical appraisal tool, will be used to record ratings of quality and risk of bias among studies selected for inclusion. Content analysis and between-study comparisons will be used to answer the objectives of this review.

Ethics and dissemination

Results from this review will be published in an open access format for the benefit of both academic and non-academic audiences, including community organisations and individuals seeking mHealth strategies to reduce and prevent IPV.

Trial registration number

CRD42019123006.
Effectiveness of omega-3 fatty acid administration on completion rate of adjuvant chemotherapy for biliary tract cancer: study protocol for a single-centre, open-label, single-arm, historically controlled study
Authors: Ueno Kimihiko , Ajiki Tetsuo , Tsugawa Daisuke , Akita Masayuki , Hashimoto Yu , Awazu Masahide , Mukubo Hideyo , Komatsu Shohei , Kuramitsu Kaori , Terai Sachio , Tanaka Motofumi , Toyama Hirichika , Kido Masahiro , Fukumoto Takumi
Published: August 2019

Introduction

Multimodal treatment prolongs the survival of patients with biliary tract cancer (BTC). However, the chemotherapy choices for this disease are few, and completing each chemotherapy session is important. Adjuvant chemotherapy has been attempted for BTC, but has only had a 75% completion rate. Body weight loss and cholangitis are reasons for the interruption of chemotherapy. Previous reports suggested that nutritional intervention with omega-3 fatty acids maintained body weight and improved the completion rate for chemotherapy. Moreover, omega-3 fatty acids have an anti-inflammatory effect. Therefore, we theorised that omega-3 fatty acids would improve the completion rate of adjuvant chemotherapy in patients with BTC. The aim of this study is thus to evaluate the effectiveness of omega-3 fatty acids for patients planning adjuvant chemotherapy for BTC.

Method and analysis

This study is a single-centre, open-label, single-arm, historically controlled study with a planned enrolment of 55 participants. Protocol treatment consists of four courses of S-1 adjuvant chemotherapy and an oral omega-3 fatty acid pharmaceutic adjuvant (LOTRIGA 2 g (Takeda Pharmaceutical Co.)), which includes 2 g of omega-3 fatty acids from day 1 until day 168 of the treatment period. The primary endpoint is the completion rate of four total courses of S-1. Secondary endpoints are postoperative cholangitis, time to recurrence or distant metastasis, changes in nutritional index, changes in the lymphocyte blast transformation test induced by phytohaemagglutinin, and concanavalin A and diamine oxidase serum activity during adjuvant chemotherapy. All adverse events will be evaluated.

Ethics and dissemination

This protocol was approved by the Institutional Review Board of Kobe University Hospital. The findings from this study will be presented at national and international conferences and published in peer-reviewed journals.

Trial registration number

UMIN000031247.
Links between arterial stiffness and bone mineral density in middle-aged and elderly Chinese individuals: a cross-sectional study
Authors: Zhang Meng , Bai Lijuan , Kang Jing , Ge Jing , Peng Wen
Published: August 2019

Objectives

To explore whether bone mineral density (BMD) is associated with arterial stiffness in middle-aged and elderly people with an advanced arterial stiffness index as indicated by the cardio-ankle vascular index (CAVI).

Design

A cross-sectional study.

Setting

This study was conducted from September 2015 to May 2017 at the geriatrics department of a provincial medical centre in China.

Participants

A total of 580 patients aged 50 and over were enrolled in the study. The mean age of the group was 64.82±11.4 years, and 63.1% were male.

Primary outcome measures

Associations of age with CAVI values and BMD. Associations between BMD and CAVI values.

Results

With increasing age, CAVI values gradually increased (p<0.001) and the femoral neck (FN) and total hip (TH) BMD gradually decreased (p<0.001, all). In the bivariate correlation analyses between the covariates and CAVI values, age and CAVI values showed the greatest positive correlation (r=0.631, p<0.001), and CAVI values were negatively correlated with FN BMD (r=−0.229, p<0.001) and TH BMD (r=−0.218, p<0.001). In the linear regression analyses, TH BMD (B=−1.812 (95% CI −2.475 to −1.149), p<0.001) and FN BMD (B=−1.968 (95% CI −2.651 to −1.284), p<0.001) were negatively correlated with CAVI values. After adjusting for age, gender, body mass index, smoking, history of cardiovascular or cerebrovascular disease, history of diabetes mellitus, systolic blood pressure, high-density lipoprotein cholesterol, blood uric acid, fibrinogen and estimated glomerular filtration rate, only TH BMD was still negatively correlated with CAVI values (B=−0.843 (95%CI −1.454 to −0.232), p=0.007). However, there was no consistent and significant correlation between lumbar spine BMD and CAVI values.

Conclusion

In this cross-sectional study, a significant correlation between TH BMD and CAVI values was observed in middle-aged and elderly Chinese inpatients. However, our cohort was a small sample of inpatients, and prospective studies from more centres are expected.
Spatial distribution and correlates of smoking in Zambia
Authors: Nyirenda Herbert Tato , Mulenga David , Silitongo Moono , Nyirenda Herbert BC , Nyirenda Tambulani
Published: August 2019

Objective

The objective of the paper was to investigate the spatial distribution and correlates of tobacco smoking in various regions of Zambia.

Methods

This paper adopts a cross-sectional study design. The study used data from the 2013/2014 Zambia Demographic Health Survey which is a nationwide health survey conducted in all the 10 provinces. A random sample of men and women from 15 920 households was successfully selected and interviewed. All women aged 15–49 and men aged 15–59 who were either permanent residents of the households or visitors present in the households on the night before the survey were eligible to be interviewed.

Results

The results show that 8.2% and 11% of Zambians in urban and rural areas smoke, respectively. In urban areas, the risk of being a cigarette smoker was 2.31 (CI: 1.69 to 3.16) and 2.03 (CI: 1.36 to 3.02) times higher for the divorced and separated. However, the risk of being a cigarette smoker was lower for those with some formal education. In rural areas, the risk of being a cigarette smoker was lower for the married (relative risk ratios (RRR): 0.69, CI: 0.55 to 0.86) and those with a formal education. Nevertheless, in rural areas, the risk of being a pipe and other smoker was higher for those who were self-employed (RRR: 8.46, CI: 2.95 to 24.20) and with an occupation (RRR: 2.37, CI: 1.39 to 4.02) but was lower among women.

Conclusion

Tobacco smoking varies between and within regions as well as provinces. Therefore, interventions to curbsmoking should target specific demographic, socioeconomic and cultural factors and how they are spatially distributed.
Factors associated with hypertension among adults in Nepal as per the Joint National Committee 7 and 2017 American College of Cardiology/American Heart Association hypertension guidelines: a cross-sectional analysis of the demographic and health survey 2016
Authors: Das Gupta Rajat , Bin Zaman Sojib , Wagle Kusum , Crispen Reese , Hashan Mohammad Rashidul , Al Kibria Gulam Muhammed
Published: August 2019

Objectives

This study investigated the determinants of hypertension in Nepal according to both the Joint National Committee 7 (JNC7) and the American College of Cardiology/American Heart Association (2017 ACC/AHA) guidelines.

Design

Cross-sectional study.

Setting

This study used data collected from the 2016 Nepal Demographic and Health Survey data.

Participants

13 393 weighted adults aged ≥18 years enrolled by a stratified cluster sampling strategy were included in our analysis.

Primary and secondary outcome measures

The primary outcome was hypertension, which was defined according to JNC7 (systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg) and 2017 ACC/AHA guidelines (SBP ≥130 mm Hg and/or DBP ≥80 mm Hg). Antihypertensive medication users were also classified as hypertensive. After descriptive analysis, multilevel logistic regression was applied to obtain ORs.

Results

About 21% (n=2827) and 44% (n=5918) of the individuals aged ≥18 years were classified as hypertensive according to the JNC7 and 2017 ACC/AHA guidelines, respectively. Following factors were found to be significantly associated with hypertension according to the 2017 ACC/AHA guideline: ≥70 years (adjusted OR (AOR) 5.2; 95% CI 4.3 to 6.2), 50–69 years (AOR 3.9; 95% CI 3.4 to 4.4) and 30–49 years (AOR 2.7; 95% CI 2.4 to 3.0) age groups, male gender (AOR 1.7; 95% CI 1.6 to 1.9), being overweight/obese (AOR 3.0; 95% CI 2.7 to 3.3), residence in provinces 4 (AOR 1.5; 95% CI 1.2 to 2.0) and 5 (AOR 1.5; 95% CI 1.2 to 1.9). No significant association was identified with household wealth status and ecological regions of residence using the 2017 ACC/AHA guideline.

Conclusions

Per both guidelines, multiple factors were associated with hypertension. Public health programme aiming to prevent and control hypertension in Nepal should prioritise these factors and focus on individuals with a higher likelihood of hypertension irrespective of educational level, household wealth status and ecological regions of residence.
Comparison of amblyopia in schoolchildren in Ireland and Northern Ireland: a population-based observational cross-sectional analysis of a treatable childhood visual deficit
Authors: Harrington Siofra , Breslin Karen , O'Dwyer Veronica , Saunders Kathryn
Published: August 2019

Objectives

This study reports the prevalence of persistent amblyopia (post-traditional treatment age) in schoolchildren in the Republic of Ireland (henceforth Ireland) and Northern Ireland (NI), UK; populations with broadly similar refractive and genetic profiles but different eye-care systems.

Design

This is a population-based observational study of amblyopia and refractive error.

Setting

Recruitment and testing in primary and post-primary schools in Ireland and NI.

Participants

Two groups identified through random cluster sampling to represent the underlying population; Ireland 898 participants (12–13 years old) and NI 723 participants (295 aged 9–10 years old, 428 aged 15–16 years old).

Main outcome measures

Monocular logMAR visual acuity (presenting and pinhole), refractive error (cycloplegic autorefraction), ocular alignment (cover test) and history of previous eye care. These metrics were used to determine prevalence and type of amblyopia and treatment histories.

Results

Children examined in NI between 2009 and 2011 had a significantly lower amblyopia prevalence than children examined in Ireland between 2016 and 2018 (two-sample test of proportions, p<0.001). Using a criteria of pinhole acuity 0.2logMAR (6/9.5 Snellen) plus an amblyogenic factor, 4 of 295 participants aged 9–10 years old (1.3%, 95% CIs 0.4 to 3.6) and 3 of 428 participants aged 15–16 years old (0.7%, 95%CIs 0.2 to 2.2) were identified in NI. The corresponding numbers in Ireland were 40 of 898 participants aged 12–13 years old (4.5%, 95% CI 3.2 to 6.1). In NI strabismic amblyopia was the most prevalent type of persistent amblyopia, whereas anisometropic was predominant in Ireland. In Ireland, amblyopia was associated with socioeconomic disadvantage (OR=2.2, 95%CIs 1.4 to 3.6, p=0.002) and poor spectacle compliance (OR 2.5, 95% CIs 2.0 to 3.2, p<0.001).

Conclusions

Amblyopia prevalence persisting beyond traditional treatment ages was significantly lower among NI children compared with Ireland. Uncorrected anisometropia, compliance with spectacle wear and socioeconomic disadvantage were contributing factors in Ireland. Children without obvious visible eye defects were less likely to access eye care in Ireland, resulting in missed opportunities for intervention where necessary.
Examining the predictive accuracy of metabolomics for small-for-gestational-age babies: a systematic review
Authors: Leite Debora Farias Batista , Morillon Aude-Claire , Melo Júnior Elias F , Souza Renato T , McCarthy Fergus P , Khashan Ali , Baker Philip , Kenny Louise C , Cecatti Jose Guilherme
Published: August 2019

Introduction

To date, there is no robust enough test to predict small-for-gestational-age (SGA) infants, who are at increased lifelong risk of morbidity and mortality.

Objective

To determine the accuracy of metabolomics in predicting SGA babies and elucidate which metabolites are predictive of this condition.

Data sources

Two independent researchers explored 11 electronic databases and grey literature in February 2018 and November 2018, covering publications from 1998 to 2018. Both researchers performed data extraction and quality assessment independently. A third researcher resolved discrepancies.

Study eligibility criteria

Cohort or nested case–control studies were included which investigated pregnant women and performed metabolomics analysis to evaluate SGA infants. The primary outcome was birth weight <10th centile—as a surrogate for fetal growth restriction—by population-based or customised charts.

Study appraisal and synthesis methods

Two independent researchers extracted data on study design, obstetric variables and sampling, metabolomics technique, chemical class of metabolites, and prediction accuracy measures. Authors were contacted to provide additional data when necessary.

Results

A total of 9181 references were retrieved. Of these, 273 were duplicate, 8760 were removed by title or abstract, and 133 were excluded by full-text content. Thus, 15 studies were included. Only two studies used the fifth centile as a cut-off, and most reports sampled second-trimester pregnant women. Liquid chromatography coupled to mass spectrometry was the most common metabolomics approach. Untargeted studies in the second trimester provided the largest number of predictive metabolites, using maternal blood or hair. Fatty acids, phosphosphingolipids and amino acids were the most prevalent predictive chemical subclasses.

Conclusions and implications

Significant heterogeneity of participant characteristics and methods employed among studies precluded a meta-analysis. Compounds related to lipid metabolism should be validated up to the second trimester in different settings.

PROSPERO registration number

CRD42018089985.
Reverse order method for teaching cataract surgery to residents
Authors: Malavazzi Gustavo Ricci , Lake Jonathan Clive , Soriano Eduardo Sone , Nose Walton
Published: August 2019

Objective

To implement a method to train residents in the performance of phacoemulsification surgery, with the steps completed in reverse chronological order and with the easiest step being undertaken first.

Methods and analysis

We created a method for training ophthalmology residents in which we taught phacoemulsification surgery in a series of steps learnt in reverse order. Each resident advanced through the teaching modules only after being approved in the final step and then progressed to the complete performance of surgeries. We analysed the rates of complications in the 2 years after introducing the new method.

Results

The new method allowed for a standardised approach that enabled replicated teaching of phacoemulsification regardless of instructor or student. After implementing the new method, residents performed 1817 phacoemulsification surgeries in the first year and 1860 in the second year, with posterior capsule rupture rates of 8.42% and 7.9%, respectively.

Conclusions

Teaching residents to perform the steps of phacoemulsification in a standardised reverse order resulted in low rates of complications.
The natural course of IgG4-related ophthalmic disease after debulking surgery: a single-centre retrospective study
Authors: Ominato Jun , Oyama Tokuhide , Cho Hiroyuki , Shiozaki Naoya , Umezu Hajime , Takizawa Jun , Fukuchi Takeo
Published: August 2019

Objective

This study aimed to examine the natural course and relapse rate of IgG4-related ophthalmic disease (IgG4-ROD) after debulking surgery in Japanese patients.

Methods and analysis

This retrospective review included patients with IgG4-ROD who did not undergo further treatment following debulking surgery. The patients were diagnosed between January 2009 and December 2018 at the Department of Ophthalmology and Pathology, Niigata University Medical and Dental Hospital. The main outcome measures included postoperative IgG4-ROD recurrence rate and differences between patients with and without recurrent disease.

Results

Fifteen patients (six male, 9 female; 61.8±16.2 years) were included. Twelve patients (80.0%) had dacryoadenitis disease and three patients (20.0%) had orbital fat tissue disease. About 70%–100% of the lesion was resected in the debulking surgery and the pathological diagnosis was rendered. A definitive diagnosis was made in 13 cases (86.7%) and a probable diagnosis in 2 cases (13.3%). Patients were followed up for 39.0±25.5 months following operation. All patients had lesion volume reduction and patients with dacryoadenitis had eyelid swelling improvement after surgery. Two patients (13.3%) had disease recurrence and six patients (40.0%) had extraophthalmic lesions. There was no statistically significant difference in clinical features between relapsed and non-recurring cases.

Conclusion

We observed a 13.3% relapse rate following debulking surgery in patients with IgG4-ROD who did not undergo further treatment. This rate is lower than the documented relapse rate of 30%–70% following oral prednisolone therapy. Therefore, debulking surgery may be a treatment option for IgG4-ROD.
Exome sequencing reveals a novel variant inNFX1causing intracranial aneurysm in a Chinese family
Authors: Ding Xinghuan , Zhao Sen , Zhang Qianqian , Yan Zihui , Wang Yang , Wu Yong , Li Xiaoxin , Liu Jian , Niu Yuchen , Zhang Yisen , Zhang Mingqi , Wang Huizi , Zhang Ying , Chen Weisheng , Yang Xin-Zhuang , Liu Pengfei , Posey Jennifer E , Lupski James R , Wu Zhihong , Yang Xinjian , Wu Nan , Wang Kun
Published: August 2019

Background

Genetic risk factors play an important role in the pathogenesis of familial intracranial aneurysms (FIAs); however, the molecular mechanisms remain largely unknown.

Objective

To investigate potential FIA-causing genetic variants by rare variant interrogation and a family-based genomics approach in a large family with an extensive multigenerational pedigree with FIAs.

Method

Exome sequencing (ES) was performed in a dominant likely family with intracranial aneurysms (IAs). Variants were analyzed by an in-house developed pipeline and prioritized using various filtering strategies, including population frequency, variant type, and predicted variant pathogenicity. Sanger sequencing was also performed to evaluate the segregation of the variants with the phenotype.

Results

Based on the ES data obtained from five individuals from a family with 7/21 living members affected with IAs, a total of 14 variants were prioritized as candidate variants. Familial segregation analysis revealed thatNFX1c.2519T>C (p.Leu840Pro) segregated in accordance with Mendelian expectations with the phenotype within the family—that is, present in all IA-affected cases and absent from all unaffected members of the second generation. This missense variant is absent from public databases (1000genome, ExAC, gnomAD, ESP5400), and has damaging predictions by bioinformatics tools (Gerp ++ score = 5.88, CADD score = 16.43, MutationTaster score = 1, LRT score = 0). In addition, 840Leu in NFX1 is robustly conserved in mammals and maps in a region before the RING-type zinc finger domain.

Conclusion

NFX1c.2519T>C (p.Leu840Pro) may contribute to the pathogenetics of a subset of FIAs.
Mechanical thrombectomy in patients with acute ischemic stroke and ASPECTS ≤6: a meta-analysis
Authors: Cagnazzo Federico , Derraz Imad , Dargazanli Cyril , Lefevre Pierre-Henri , Gascou Gregory , Riquelme Carlos , Bonafe Alain , Costalat Vincent
Published: August 2019

Background

It is uncertain whether mechanical thrombectomy (MT) increases the probability of a good outcome (modified Rankin Scale (mRS) 0–2) in patients with Alberta Stroke Program Early CT Score (ASPECTS) 0–6.

Objective

To assess the impact of MT in patients with pretreatment ASPECTS 0–6.

Methods

According to PRISMA guidelines, we performed a systematic search of three databases for series of patients with ASPECTS 0–6 treated by MT. Random-effects meta-analysis was used to pool the following: rate of mRS 0–2 at 3 months follow-up, symptomatic intracranial hemorrhage (sICH), and mortality rates.

Results

We included 17 studies and 1378 patients with ASPECTS 0–6 (1194 MT, 184 medical management). The rate of mRS 0–2 was 30.1% and 3.2% after MT and medical management, respectively. MT gave higher odds of mRS 0–2 (OR 4.76, p=0.01). Patients with ASPECTS 6 and 5 had comparable rates of good outcome (37.7% and 33.3%, respectively). Overall, the rate of mRS 0–2 was 17.1% in patients with ASPECTS 0–4: 22.1% and 13.9% of patients with ASPECTS 4 and 0–3 were functionally independent, respectively. Successful recanalization (Thrombolysis in Cerebral Infarction grade 2b–3) gave higher odds of mRS 0–2 than unsuccessful reperfusion (OR 5.2, p=0.001). The MT group tended to have lower odds of sICH compared with the controls (OR 0.48, p=0.06). Patients aged <70 years had higher rates of mRS 0–2 than those aged >70 years (40.3% vs 16.2%).

Conclusions

Patients with ASPECTS 0–6may benefit from MT. Successful reperfusion increases the probability of 3-month functional independence without increasing the risk of sICH. Patients with ASPECTS 5 and 6 have comparable outcomes. MT can still enable approximately one in four patients with ASPECTS 4 to be independent, whereas only 14% of subjects with ASPECTS 0–3 regain a good functional outcome.
Coatopathies: Genetic Disorders of Protein Coats
Authors: Dell'Angelica Esteban C. , Bonifacino Juan S.
Published: August 2019

Protein coats are supramolecular complexes that assemble on the cytosolic face of membranes to promote cargo sorting and transport carrier formation in the endomembrane system of eukaryotic cells. Several types of protein coats have been described, including COPI, COPII, AP-1, AP-2, AP-3, AP-4, AP-5, and retromer, which operate at different stages of the endomembrane system. Defects in these coats impair specific transport pathways, compromising the function and viability of the cells. In humans, mutations in subunits of these coats cause various congenital diseases that are collectively referred to as coatopathies. In this article, we review the fundamental properties of protein coats and the diseases that result from mutation of their constituent subunits.
Liver Progenitors and Adult Cell Plasticity in Hepatic Injury and Repair: Knowns and Unknowns
Authors: Ko Sungjin , Russell Jacquelyn O. , Molina Laura M. , Monga Satdarshan P.
Published: August 2019

The liver is a complex organ performing numerous vital physiological functions. For that reason, it possesses immense regenerative potential. The capacity for repair is largely attributable to the ability of its differentiated epithelial cells, hepatocytes and biliary epithelial cells, to proliferate after injury. However, in cases of extreme acute injury or prolonged chronic insult, the liver may fail to regenerate or do so suboptimally. This often results in life-threatening end-stage liver disease for which liver transplantation is the only effective treatment. In many forms of liver injury, bipotent liver progenitor cells are theorized to be activated as an additional tier of liver repair. However, the existence, origin, fate, activation, and contribution to regeneration of liver progenitor cells is hotly debated, especially since hepatocytes and biliary epithelial cells themselves may serve as facultative stem cells for one another during severe liver injury. Here, we discuss the evidence both supporting and refuting the existence of liver progenitor cells in a variety of experimental models. We also debate the validity of developing therapies harnessing the capabilities of these cells as potential treatments for patients with severe and chronic liver diseases.
The role of allopatric speciation and ancient origins of Bathynellidae (Crustacea) in the Pilbara (Western Australia): two new genera from the De Grey River catchment
Authors: Perina Giulia , Camacho Ana I. , Huey Joel , Horwitz Pierre , Koenders Annette
Published: August 2019

The stygofaunal family of Bathynellidae, is an excellent group to study the processes that shape diversity and distribution, since they have unknown surface or marine relatives, high level of endemism, and limited dispersal abilities. Recent research on Bathynellidae in Western Australia (Pilbara) has uncovered new taxa with unexpected distributions and phylogenetic relationships, but the biogeographical processes that drive their diversification on the continent are still unclear. By exploring the diversity, distribution, and divergence time of Bathynellidae in a setting such as the perched and isolated aquifers of the Cleaverville Formation in the north of the De Grey River catchment (Pilbara), we aim to test the hypothesis that vicariance has shaped the distribution of this family, specifically if one or multiple vicariant events were involved. We analysed the specimens collected from perched water in different plateaus of the Cleaverville Formation, combining morphological and molecular data from mitochondrial and nuclear genes. We described two new species and genera (Anguillanella callawaensis gen. et sp. nov. and Muccanella cundalinensis gen. et sp. nov.), and two additional taxa are recognised using morphology and/or Automatic Barcode Gap Discovery and Poisson Tree Processes species delimitation methods. New genera and species result restricted to isolate perched aquifers on single plateaus and their distributions, phylogenetic relationships, and divergence time estimates support multiple vicariant events and ancient allopatric speciation.
The impact of language contact on the Quechua varieties of Northern Peru
Authors: Urban Matthias
Published: August 2019

Studies of language contact in the Central Andes of Peru and Bolivia have focused strongly on the present-day contact situation between Quechua and Spanish, and the intricate and multilayered contact relationship between the Quechua and Aymara lineages. There are fewer studies of the influence of Quechua on minor non-Quechua languages of the Andes, and still fewer studies which, conversely, explore the influence of non-Quechua languages on Quechua. Focusing on the lexicon, this article explores the impact of the complex linguistic ecology of Northern Peru on the five Quechua varieties of that region—Lambayeque, Cajamarca, Chachapoyas, San Martín and Ancash Quechua. The study identifies lexical items that lack clear Quechua etymologies in the relevant varieties and carries out external comparisons of these items with the vocabulary of the non-Quechua languages of Northern Peru to identify possible sources. Results show that borrowing is mostly localized: that is, whereas influence from Amazonian lowland languages is almost exclusively found in the eastern varieties of Chachapoyas and San Martín, highland Quechua varieties have typically borrowed from neighboring highland languages.
Feeling the Beat (and Seeing It, Too): Vibrotactile, Visual, and Bimodal Rate Discrimination
Authors: Villalonga Mercedes B. , Sussman Rachel F. , Sekuler Robert
Published: August 2019

Beats are among the basic units of perceptual experience. Produced by regular, intermittent stimulation, beats are most commonly associated with audition, but the experience of a beat can result from stimulation in other modalities as well. We studied the robustness of visual, vibrotactile, and bimodal signals as sources of beat perception. Subjects attempted to discriminate between pulse trains delivered at 3 Hz or at 6 Hz. To investigate signal robustness, we intentionally degraded signals on two-thirds of the trials using temporal-domain noise. On these trials, inter-pulse intervals (IPIs) were stochastic, perturbed independently from the nominal IPI by random samples from zero-mean Gaussian distributions with different variances. These perturbations produced directional changes in the IPIs, which either increased or decreased the likelihood of confusing the two pulse rates. In addition to affording an assay of signal robustness, this paradigm made it possible to gauge how subjects’ judgments were influenced by successive IPIs. Logistic regression revealed a strong primacy effect: subjects’ decisions were disproportionately influenced by a trial’s initial IPIs. Response times and parameter estimates from drift-diffusion modeling showed that information accumulates more rapidly with bimodal stimulation than with either unimodal stimulus alone. Analysis of error rates within each condition suggested consistently optimal decision making, even with increased IPI variability. Finally, beat information delivered by vibrotactile signals proved just as robust as information conveyed by visual signals, confirming vibrotactile stimulation’s potential as a communication channel.
The Shepard–Risset Glissando: Identifying the Origins of Metaphorical Auditory Vection and Motion Sickness
Authors: Mursic Rebecca A. , Palmisano Stephen
Published: August 2019

We recently showed that auditory illusions of self-motion can be induced in the absence of physically accurate spatial cues (Mursic et al., 2017). The current study was aimed at identifying which features of this auditory stimulus (the Shepard–Risset glissando) were responsible for this metaphorical auditory vection, as well as confirming anecdotal reports of motion sickness for this stimulus. Five different types of auditory stimuli were presented to 31 blindfolded, stationary participants through a loudspeaker array: (1) a descending Shepard–Risset glissando; (2) a descending discrete Shepard scale; (3) a descending sweep signal; (4) a phase-scrambled version of (1) (auditory control type 1); and (5) white noise (auditory control type 2). We found that the auditory vection induced by the Shepard–Risset glissando was stronger than both types of auditory control, and the discrete Shepard scale stimulus. However, vection strength was not found to differ between the Shepard–Risset glissando and the sweep signal. This suggests that the continuous, gliding structure of both these auditory stimuli was integral to the induction of vection. Consistent with anecdotal reports that the Shepard–Risset glissando is also capable of generating motion sickness (as measured by the Fast Motion Sickness Scale and the Simulator Sickness Questionnaire), the likelihood and severity of sickness for these stimuli was found to increase with the strength of the auditory vection.
Abū Shādī, Tagore, and the Problem of World Literature at the Hinge of Afroeurasia
Authors: Tageldin Shaden M.
Published: August 2019

This essay traces the problem of world literature in key writings by the Egyptian scientist and littérateur Aḥmad Zakī Abū Shādī. Abū Shādī’s early nod to world literature (1908–1909) intimates the challenge of making literary particularity heard in the homogenizing harmonies of a world dominated by English. That problem persists in his account of a 1926 meeting with the Bengali polymath Rabindranath Tagore and in an essay of 1928 inspired by that meeting: one of the first manifestos of al-adab al-ʿālamī (world literature) in Arabic, predating the 1936 appearance of al-adab al-muqāran (comparative literature). While Abū Shādī lauds Tagore’s refusal to compare literatures East and West and insistence on the spiritual unity of all literatures, his struggles to articulate a world in which harmony is not an alibi for hierarchy suggest that neither comparative literature nor its would-be leveler – world literature – can shed the haunting specter of inequality.
The Small-Town Globalism of Ivo Andrić
Authors: Ćatović Vedran
Published: August 2019

This study situates the works of Ivo Andrić at the intersection of world literature and postcolonial studies. It argues that, rather than being opposed as two mutually exclusive critical paradigms, the two need to be tactfully combined in order to account for the artist’s treatment of the prolonged subjugation undergone by the former Ottoman province of Bosnia. Two contradictory trends are observed. Andrić represents Bosnian small towns as places of symbolic resistance and perseverance. His local themes and language undermine the hegemonic presence of the empire, and invite a reading through a postcolonial lens. At the same time, a strong cosmopolitan current runs through the same narratives, and shows a paradoxical urge of the artist to extend his local setting into the global and intercultural spheres. Andrić stages the world as a multifarious and enigmatic whole – a viewpoint that embraces world literature as its aesthetic and political shrine.
Multilingual Novel
Authors: Figlerowicz Matylda
Published: August 2019

This article proposes a model of world literature based on multilingualism, rather than translation or a series of monolingualisms. It analyzes three novels, positioned in uneven relationships to world literature: Ramon Saizarbitoria’s Hamaika pauso (Basque; Countless steps, 1995), Roberto Bolaño’s 2666 (Spanish; 2004), and Sol Ceh Moo’s Sujuy k’iin (Mayan; Unspoiled day, 2011). They can all be read as multilingual, and despite the differences of their contexts and the particular ways in which different languages intertwine in them, anticlimactic forms are an aesthetic solution they share. The model of world literature informed by this anticlimactic multilingualism could be called the Real of world literature, since it points to the traumatic core of world literature that disrupts the possibility of systematizing its literatures in a holistic structure.