bluuebunny/crossref_metadata_2025 huggingface dataset:
Should minors and young adults qualify as potential live kidney donors? The views of international transplant professionals
Authors: Thys Kristof , Borry Pascal , Schotsmans Paul , Dobbels Fabienne
Published: June 2019

Although live kidney donation (LD) has become an increasingly common procedure, European and US transplant centres disagree as to whether minors and young adults should qualify as donor candidates. Therefore, we aimed to better understand the attitudes and viewpoints of transplant professionals. We conducted fourteen in‐depth interviews with a purposive sample of international transplant professionals from various professional backgrounds. Data analysis was guided by QUAGOL, a systematic approach based on the constant‐comparative method. Professionals expressed a cautionary view, worrying about the uncertain long‐term medical and psychosocial consequences of LD at a young age. They also worried that young individuals’ decisions are more likely to be influenced by their psychosocial developmental stage or family pressure. As these concerns were more significant for minors as compared to young adults, minors were deemed ineligible for LD except for in highly exceptional circumstances. Professionals’ attitudes were also influenced by the expected benefits for the recipient and the availability of therapeutic alternatives, as well as the strength of the donor‐recipient relationship. More prospective research on the long‐term medical and psychological outcomes in young adult donors is likely to shed more light on the acceptability of LD by adolescents and young adults.
Photogrammetric water level determination using smartphone technology
Authors: Elias Melanie , Kehl Christian , Schneider Danilo
Published: June 2019

Rapid technological progress has made mobile devices increasingly valuable for scientific research. This paper outlines a versatile camera‐based water gauging method, implemented on smartphones, which is usable almost anywhere if 3D data is available at the targeted river section. After analysing smartphone images to detect the present water line, the image data is transferred into object space. Using the exterior orientation acquired by smartphone sensor fusion, a synthetic image originating from the 3D data is rendered that represents the local situation. Performing image‐to‐geometry registration using the true smartphone camera image and the rendered synthetic image, image parameters are refined by space resection. Moreover, the water line is transferred into object space by means of the underlying 3D information. The algorithm is implemented in the smartphone application “Open Water Levels”, which can be used on both high‐end and low‐cost devices. In a comprehensive investigation, the methodology is evaluated, demonstrating both its potential and remaining issues.
Duct‐obstructive pancreatitis with granulocytic epithelial lesion in a patient with ulcerative colitis: An atypical manifestation of type 2 autoimmune pancreatitis?
Authors: Ahn Soomin , Lee Jong‐chan , Hwang Jin‐Hyeok , Yoon Yoo‐Seok , Lee Kyoung Ho , Zen Yoh
Published: June 2019

Type 2 autoimmune pancreatitis (AIP) typically presents with diffuse or focal enlargement of the pancreas; however, its diverse clinical presentation has not yet been clarified. We herein described a 46‐year‐old man with a 1‐month history of ulcerative colitis who presented with imaging features of a mass‐like lesion in the pancreatic body with upstream duct dilatation and serum CA19‐9 elevation. He underwent laparoscopic distal pancreatectomy with splenectomy for suspected malignancy. Histologically, the area radiologically suspected to be duct dilatation consisted of necrotic tissue, in which the disrupted main pancreatic duct was involved. The area radiologically suspected to be the mass lesion showed features of pancreatitis without discrete mass. In addition, several ducts showed neutrophilic duct injury similar to granulocytic epithelial lesions observed in type 2 AIP. Immunohistochemistry revealed the aberrant expression of IL‐8 in the pancreatic ductules and infiltrating CD3‐positive T‐lymphocytes, findings recently identified in type 2 AIP. The present case is not typical for either type 2 AIP or other known conditions, but extreme examples of type 2 AIP may present with ductal obstruction because of severe neutrophilic duct injury. IL‐8 immunostaining may also assist in establishing a diagnosis of type 2 AIP with an atypical presentation.
Effect of Financing Costs and Constraints on Real Investments: The Case of Inventories
Authors: Wu Qi , Muthuraman Kumar , Seshadri Sridhar
Published: June 2019

This paper studies the effects of bank credit availability, trade credit and the capital cost on inventory decisions. There are two competing theories on the effect of bank credit lines on investments. While one (Lins et al. 2010) suggests that the primary role played by undrawn credit is to finance new opportunities, the other (Acharya et al. 2014) suggests that undrawn credit serves primarily as a bank monitored liquidity insurance. We attempt to resolve these two conflict views in the context of inventory investments. Using empirical data, we show that the primary role of undrawn credit depends on the individual firm’s financial status. When a firm is financially constrained, its inventory decisions are linked to the additional bank credit available to the firm—echoing the insurance nature of bank credits. On the other hand, when a firm is financially healthy, two other inventory financing factors play more significant roles than undrawn credits. For financially healthy firms, inventory investments are significantly negatively related to the financial cost of inventory and positively related to the credit offered by suppliers. Additionally, we study the financial crisis of 2007–2008 as a systematic shock in the credit market to identify the effects of a firm’s financial credits. We show that during the financial crisis, the inventory turnover and working capital levels of US retailers were related to the availability of bank credit. However, immediately after the crisis, the evidence demonstrates the positive relationship between firms’ inventory level and the trade credit they are offered.
Working a Third Shift: Physical Activity and Embodied Motherhood
Authors: Maddox Callie Batts , DeLuca Jaime R. , Bustad Jacob J.
Published: June 2019

In their conception of the “third shift,” Dworkin and Wachs argue that working mothers engage in fitness and bodywork in addition to the first shift of professional work and the second shift of household labor and childcare. Within this third shift, the goal for women is to “erase physical evidence of motherhood” and return to the pre‐pregnancy self. The cultivation of a body socially defined as “good” and “attractive” thus serves as a visible illustration of an embodied subjectivity anchored in morality and neoliberal personal responsibility, signifying a strong woman who has her body and her life under control. Utilizing thematic analysis to examine dominant constructions of embodied motherhood in popular texts and products, this article offers five conceptual categories to explore why and how women in engage in bodywork. Understanding how women operationalize the third shift of fitness and bodywork is important because it helps to unpack the struggles of contemporary motherhood and the competing realities of home, work, and self‐care.
When medicine transforms art
Authors: Belga Sara , MacDonald Clayton , Kabbani Dima , Roelofs Kelsey , Hussain Mohammed Wasif , Cervera Carlos
Published: June 2019

A 40‐year‐old female with a history of type 1 diabetes mellitus and solitary pancreas transplant, presented with pancreatic graft rejection 1‐year post‐transplant. Incidentally, a 1.1 cm right lower lobe cavity was identified during her workup. Given the augmentation of immunosuppression, voriconazole was empirically started for possible invasive pulmonary aspergillosis. As the patient was a painter, this resulted in a significant change in the colors of her paintings. Ultimately, she was diagnosed with pulmonary coccidioidomycosis and her visual disturbances resolved after the voriconazole was changed to fluconazole. Voriconazole causes visual disturbances in 20%‐30% of the patients most commonly phototopsias; dyschromatopsias typically involving the tritan axis have also been reported. This case illustrates well the potential impact of voriconazole on spectral sensitivity and color perception.
An unusual case of Kaposi sarcoma masquerading as cystitis in a kidney transplant recipient
Authors: Nair Vinay , Sheikh Fatima , Hirschwerk David , Fahmy Ahmed , Bhaskaran Madhu , Grodstein Elliot , Winnick Aaron , Maki Robert , Teperman Lewis , Molmenti Ernesto
Published: June 2019

Human Herpes Virus‐8 (HHV‐8) may reactivate in immunocompromised patients including recipients of solid organ transplants. Reactivation of HHV‐8 may result in Kaposi sarcoma (KS). KS typically occurs with dermatologic involvement but can affect virtually any other organ; most commonly the gastrointestinal tract. We present a diagnostically challenging case of KS in a South American woman 7 months after kidney transplant. She presented with recurrent urinary tract infection manifested by pelvic pain and dysuria. Imaging studies revealed bladder thickening with pelvic lymphadenopathy. Findings on tissue biopsied from the bladder and lymph nodes were consistent with KS. Her skin was not affected. This case illustrates that KS and other HHV‐8–related diseases should be on the differential diagnosis as a cause of mass lesions as well as lymphadenopathy in transplant recipients. The case exemplifies the need to pursue a tissue diagnosis in immunocompromised patients when a diagnosis is uncertain.
PRECOCIOUS1 (POCO1), a mitochondrial pentatricopeptide repeat protein affects flowering time in Arabidopsis thaliana
Authors: Emami Hossein , Kempken Frank
Published: June 2019

Flowering is a vital developmental shift in plants from vegetative to reproductive phase. The timing of this shift is regulated by various linked genetic pathways including environmental cues and internal regulation. Here we report a role for an Arabidopsis gene, AT1G15480, which encodes a P‐class pentatricopeptide repeat (PPR) protein, affecting flowering time. We show that AT1G15480 is localized to mitochondria. An AT1G15480 T‐DNA insertion line exhibits an early‐flowering phenotype, which is quite a rare phenotype among PPR mutants. The early‐flowering phenotype was observed under both long and short days compared with wild type plants. Genetic complementation confirmed the observed phenotype. We therefore named the PPR protein PRECOCIOUS1 (POCO1). poco1 plants showed lower respiration, ATP content and higher accumulation of superoxide. Importantly, the quantitative reverse transcription polymerase chain reaction (qRT‐PCR) analysis showed that the expression of FLOWERING LOCUS C (FLC), which is a key floral repressor, was strongly downregulated in the poco1. Likewise, the expression level of the FLC positive regulator ABSCISIC ACID‐INSENSITIVE 5 (ABI5) was reduced in the poco1. Consistent with the qRT‐PCR results, poco1 plants showed reduced sensitivity to abscisic acid compared with wild type with respect to primary root growth and days to flowering. Furthermore, the poco1 mutation enhances the sensitivity to drought stress. Further analysis showed that POCO1 affects mitochondrial RNA editing. Taken together, our data demonstrate a remarkable function of POCO1 in flowering time and the abscisic acid signalling pathway.
Alterations in circulating concentrations of IL‐17, IL‐31 and total IgE in dogs with atopic dermatitis
Authors: Chaudhary Sujeet K. , Singh Shanker K. , Kumari Priyambada , Kanwal Sarita , Soman Sandeep P. , Choudhury Soumen , Garg Satish K.
Published: June 2019

Background

The pathogenesis of canine atopic dermatitis (AD) is complex. Dysregulation of the cutaneous immune system is considered an important regulator of the allergic response. Exploration of association of interleukin‐17 (IL‐17), IL‐31, IgE and leukogram attributes with canine AD could provide novel insights into its immunopathology.

Hypothesis/Objectives

To investigate possible associations of IL‐17, IL‐3, IgE and leukogram attributes of canine AD.

Animals

17 dogs diagnosed with AD and six healthy dogs.

Methods and materials

Circulating concentrations of IL‐17, IL‐31 and total IgE from sera samples were determined using commercial canine‐specific quantitative immunoassay kits. Complete blood cell counts were analysed by an automated haematology analyser. Statistical differences between the two groups were determined using an unpaired t‐test. The degree of relationship between the IL‐17, IL‐31, IgE, total leukocyte count (TLC) values and clinical signs scores (Canine Atopic Dermatitis Lesion Index and pruritus Visual Analog Scale pVAS) was determined by Pearson's r correlation statistic.

Results

Dogs with AD had significantly (P < 0.0001) higher circulating concentrations of IL‐17, IL‐31 and total IgE compared with healthy dogs. Dogs with AD also had significantly higher TLC (P < 0.0002), absolute neutrophils (P < 0.0001) and absolute eosinophils (P < 0.0001) counts, and percentage of neutrophils (P < 0.03) and eosinophils (P < 0.0001) compared with healthy controls. A significant positive correlation (r2 = 0.396; P < 0.007) between the pVAS and IL‐31 was observed in dogs with AD.

Conclusions and clinical importance

Marked elevation in circulating IL‐17, IL‐31 and total IgE along with the abnormalities in leukogram may be associated with canine AD and could be possible targets in the therapeutic management of canine AD.
Otitis externa in eight horses – clinical signs, treatment and prognosis
Authors: Odelros Emma , Kendall Anna , Wulcan Sofia , Bergvall Kerstin
Published: June 2019

Background

Otitis externa is rare in horses and the condition is poorly described in the literature.

Objective

To describe clinical signs, treatment regimens and prognosis of otitis externa in horses.

Animals

Eight horses diagnosed with otitis externa during 2011–2018.

Methods

Retrospective review of medical records and follow‐up contact with owners.

Results

Common clinical signs seen in affected horses were pruritus, ear discharge and ear droop of affected ears. The most common cytological findings were neutrophils, bacteria and yeast. All horses responded well to treatment; two horses were reported to have recurrent problems.

Conclusion and clinical importance

Otitis externa in horses is a rare and treatable condition. The condition may be present for prolonged periods before owners become aware, compromising the welfare of affected horses. Untreated otitis externa is a suggested cause of otitis media and temporohyoid osteoarthropathy, emphasizing the importance of identifying and treating this condition at an early stage. For this reason, clinicians should include a brief inspection of the pinnae and external ear canal in the clinical examination of horses.
The role of human CD46 in early xenoislet engraftment in a dual transplant model
Authors: Samy Kannan P. , Gao Qimeng , Davis Robert Patrick , Song Mingqing , Fitch Zachary W. , Mulvihill Michael S. , MacDonald Andrea L. , Leopardi Frank V. , How Tam , Williams Kyha D. , Devi Gayathri R. , Collins Bradley H. , Luo Xunrong , Kirk Allan D.
Published: June 2019

Background

Membrane cofactor protein CD46 attenuates the complement cascade by facilitating cleavage of C3b and C4b. In solid organ xenotransplantation, organs expressing CD46 have been shown to resist hyperacute rejection. However, the incremental value of human CD46 expression for islet xenotransplantation remains poorly defined.

Methods

This study attempted to delineate the role of CD46 in early neonatal porcine islet engraftment by comparing Gal‐knocked out (GKO) and hCD46‐transgenic (GKO/CD46) islets in a dual transplant model. Seven rhesus macaques underwent dual transplant and were sacrificed at 1 hour (n = 4) or 24 hours (n = 3). Both hemilivers were recovered and fixed for immunohistochemistry (CD46, insulin, neutrophil elastase, platelet, IgM, IgG, C3d, C4d, CD68, Caspase 3). Quantitative immunohistochemical analysis was performed using the Aperio Imagescope.

Results

Within 1 hour of intraportal infusion of xenografts, no differences were observed between the two types of islets in terms of platelet, antibody, or complement deposition. Cellular infiltration and islet apoptotic activity were also similar at 1 hour. At 24 hours, GKO/CD46 islets demonstrated significantly less platelet deposition (P = 0.01) and neutrophil infiltration (P = 0.01) compared to GKO islets. In contrast, C3d (P = 0.38) and C4d (P = 0.45) deposition was equal between the two genotypes.

Conclusions

Our findings suggest that expression of hCD46 on NPIs potentially provides a measurable incremental survival advantage in vivo by reducing early thrombo‐inflammatory events associated with instant blood‐mediated inflammatory reaction (IBMIR) following intraportal islet infusion.
Trends and challenges in robot manipulation
Authors: Billard Aude , Kragic Danica
Published: June 2019

Hand it to you

Our ability to grab, hold, and manipulate objects involves our dexterous hands, our sense of touch, and feedback from our eyes and muscles that allows us to maintain a controlled grip. Billard and Kragic review the progress made in robotics to emulate these functions. Systems have developed from simple, pinching grippers operating in a fully defined environment, to robots that can identify, select, and manipulate objects from a random collection. Further developments are emerging from advances in computer vision, computer processing capabilities, and tactile materials that give feedback to the robot.

Science
, this issue p.
eaat8414
Biological adaptations in the Arctic cervid, the reindeer (
Rangifer tarandus
)
Authors: Lin Zeshan , Chen Lei , Chen Xianqing , Zhong Yingbin , Yang Yue , Xia Wenhao , Liu Chang , Zhu Wenbo , Wang Han , Yan Biyao , Yang Yifeng , Liu Xing , Sternang Kvie Kjersti , Røed Knut Håkon , Wang Kun , Xiao Wuhan , Wei Haijun , Li Guangyu , Heller Rasmus , Gilbert M. Thomas P. , Qiu Qiang , Wang Wen , Li Zhipeng
Published: June 2019

Phylogeny and characteristics of ruminants

Ruminants are a diverse group of mammals that includes families containing well-known taxa such as deer, cows, and goats. However, their evolutionary relationships have been contentious, as have the origins of their distinctive digestive systems and headgear, including antlers and horns (see the Perspective by Ker and Yang). To understand the relationships among ruminants, L. Chen
et al.
sequenced 44 species representing 6 families and performed a phylogenetic analysis. From this analysis, they were able to resolve the phylogeny of many genera and document incomplete lineage sorting among major clades. Interestingly, they found evidence for large population reductions among many taxa starting at approximately 100,000 years ago, coinciding with the migration of humans out of Africa. Examining the bony appendages on the head—the so-called headgear—Wang
et al.
describe specific evolutionary changes in the ruminants and identify selection on cancer-related genes that may function in antler development in deer. Finally, Lin
et al.
take a close look at the reindeer genome and identify the genetic basis of adaptations that allow reindeer to survive in the harsh conditions of the Arctic.

Science
, this issue p.
eaav6202
, p.
eaav6335
, p.
eaav6312
; see also p.
1130
Direct arene C–H fluorination with
18
F
−
via organic photoredox catalysis
Authors: Chen Wei , Huang Zeng , Tay Nicholas E. S. , Giglio Benjamin , Wang Mengzhe , Wang Hui , Wu Zhanhong , Nicewicz David A. , Li Zibo
Published: June 2019

A metal-free route to PET probes

Positron emission tomography (PET) is a widely used imaging technique for medical diagnostics and pharmaceutical development. As the name implies, it requires tracers that emit positrons, typically through labeling with fluorine or carbon radioisotopes. W. Chen
et al.
devised a versatile technique to incorporate radioactive fluoride into aromatic rings. The metal-free photochemical method directly substitutes aryl carbon-hydrogen bonds with [
18
F]fluoride and so is particularly well suited to late-stage transformation of complex molecules into tracers.

Science
, this issue p.
1170
Amyloid β oligomers constrict human capillaries in Alzheimer’s disease via signaling to pericytes
Authors: Nortley Ross , Korte Nils , Izquierdo Pablo , Hirunpattarasilp Chanawee , Mishra Anusha , Jaunmuktane Zane , Kyrargyri Vasiliki , Pfeiffer Thomas , Khennouf Lila , Madry Christian , Gong Hui , Richard-Loendt Angela , Huang Wenhui , Saito Takashi , Saido Takaomi C. , Brandner Sebastian , Sethi Huma , Attwell David
Published: June 2019

Pericytes put the squeeze on cognition

Like a computer, the brain needs a reliable source of power, which is provided as oxygen and glucose in the blood. However, in many neurological disorders this energy supply is disrupted. Brain blood flow is controlled by adjustment of the diameters of the vessels supplying the blood. Nortley
et al.
found that, both in humans developing Alzheimer's disease (AD) and in a mouse model of AD, brain capillaries become squeezed by pericytes (see the Perspective by Liesz). By defining the underlying mechanism, they suggest potential targets for therapy in early AD.

Science
, this issue p.
eaav9518
; see also p.
223
Photoexcitation of flavoenzymes enables a stereoselective radical cyclization
Authors: Biegasiewicz Kyle F. , Cooper Simon J. , Gao Xin , Oblinsky Daniel G. , Kim Ji Hye , Garfinkle Samuel E. , Joyce Leo A. , Sandoval Braddock A. , Scholes Gregory D. , Hyster Todd K.
Published: June 2019

Light teaches (co)enzymes new tricks

Light is widely used in organic synthesis to excite electrons in a substrate or catalyst, opening up reactive pathways to a desired product. Biology uses light sparingly in this way, but coenzymes such as flavin can be driven to excited states by light. Biegasiewicz
et al.
investigated this reactivity and found a suite of flavoenzymes that catalyze asymmetric radical cyclization when exposed to light. “Ene”-reductases, when reduced and illuminated, converted starting materials containing an α-chloroamide and an alkene into five-, six-, seven-, or eight-membered lactams. Different enzymes furnished different stereochemistry in the products, likely because of changes in active-site pocket geometry.

Science
, this issue p.
1166
Government-funded research increasingly fuels innovation
Authors: Fleming L. , Greene H. , Li G. , Marx M. , Yao D.
Published: June 2019

Nearly a third of U.S. patents rely directly on federal research
Quantum amplification of mechanical oscillator motion
Authors: Burd S. C. , Srinivas R. , Bollinger J. J. , Wilson A. C. , Wineland D. J. , Leibfried D. , Slichter D. H. , Allcock D. T. C.
Published: June 2019

Improving precision with quantum amplification

Quantum mechanically, an object can be described by a pair of noncommuting observables, typically by its position and momentum. The precision to which these observables can be measured is limited by unavoidable quantum fluctuations. However, the method of “squeezing” allows the fluctuations to be manipulated, while preserving the Heisenberg uncertainty relation. This allows improved measurement precision for one observable at the expense of increased fluctuations in the other. Burd
et al.
now show that an additional displacement of a trapped atom results in amplification of the squeezing and a further improvement in the precision with which the displacement can be determined (see the Perspective by Schleier-Smith). This technique should be useful for a number of applications in metrology.

Science
, this issue p.
1163
; see also p.
1137
Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: repeat national cross sectional surveys
Authors: Hammond David , Reid Jessica L , Rynard Vicki L , Fong Geoffrey T , Cummings K Michael , McNeill Ann , Hitchman Sara , Thrasher James F , Goniewicz Maciej L , Bansal-Travers Maansi , O’Connor Richard , Levy David , Borland Ron , White Christine M
Published: June 2019

Objective

To examine differences in vaping and smoking prevalence among adolescents in Canada, England, and the United States.

Design

Repeat cross sectional surveys.

Setting

Online surveys in Canada, England, and the US.

Participants

National samples of 16 to 19 year olds in 2017 and 2018, recruited from commercial panels in Canada (n=7891), England (n=7897), and the US (n=8140).

Main outcome measures

Prevalence of vaping and smoking was assessed for use ever, in the past 30 days, in the past week, and on 15 days or more in the past month. Use of JUUL (a nicotine salt based electronic cigarette with high nicotine concentration) and usual vaping brands were also assessed. Logistic regression models examined differences in vaping and smoking between countries and over time.

Results

The prevalence of vaping in the past 30 days, in the past week, and on 15 days or more in the past month increased in Canada and the US between 2017 and 2018 (P<0.001 for all), including among non-smokers and experimental smokers, with no changes in England. Smoking prevalence increased in Canada (P<0.001 for all measures), with modest increases in England, and no changes in the US. The percentage of ever vapers who reported more frequent vaping increased in Canada and the US (P<0.01 for all), but not in England. The use of JUUL increased in all countries, particularly the US and Canada—for example, the proportion of current vapers in the US citing JUUL as their usual brand increased threefold between 2017 and 2018.

Conclusions

Between 2017 and 2018, among 16 to 19 year olds the prevalence of vaping increased in Canada and the US, as did smoking in Canada, with little change in England. The rapidly evolving vaping market and emergence of nicotine salt based products warrant close monitoring.
Motivation as a mechanism underpinning exercise-based falls prevention programmes for older adults with cognitive impairment: a realist review
Authors: Booth Vicky , Harwood Rowan , Hancox Jennie E , Hood-Moore Victoria , Masud Tahir , Logan Phillipa
Published: June 2019

Objectives

This review aimed to identify mechanisms underlying participation in falls prevention interventions, in older adults with cognitive impairment. In particular we studied the role of motivation.

Design

A realist review of the literature.

Data sources

EMBASE, MEDLINE, CINAHL, the Cochrane Library, PsycINFO and PEDRO.

Eligibility criteria

Publications reporting exercise-based interventions for people with cognitive impairment, including dementia, living in the community.

Data extraction and synthesis

A ‘rough programme theory’ (a preliminary model of how an intervention works) was developed, tested against findings from the published literature and refined. Data were collected according to elements of the programme theory and not isolated to outcomes. Motivation emerged as a key element, and was prioritised for further study.

Results

An individual will access mechanisms to support participation when they think that exercise will be beneficial to them. Supportive mechanisms include having a ‘gate-keeper’, such as a carer or therapist, who shares responsibility for the perception of exercise as beneficial. Lack of access to support decreases adherence and participation in exercise. Motivational mechanisms were particularly relevant for older adults with mild-to-moderate dementia, where the exercise intervention was multicomponent, in a preferred setting, at the correct intensity and level of progression, correctly supported and considered, and flexibly delivered.

Conclusion

Motivation is a key element enabling participation in exercise-based interventions for people with cognitive impairment. Many of the mechanisms identified in this review have parallels in motivational theory. Clinically relevant recommendations were derived and will be used to further develop and test a motivationally considered exercise-based falls intervention for people with mild dementia.

PROSPERO registration number

CRD42015030169.
Association of Parkinson’s disease and treatment with aminosalicylates in inflammatory bowel disease: a cross-sectional study in a Spain drug dispensation records
Authors: Pinel Ríos Javier , Madrid Navarro Carlos Javier , Pérez Navarro María José , Cabello Tapia María José , Piña Vera María José , Campos Arillo Víctor , Gómez García María Rosario , Mínguez Castellanos Adolfo , Escamilla Sevilla Francisco
Published: June 2019

Objectives

To analyse the association between aminosalicylate-treated inflammatory bowel disease (IBD) and Parkinson’s disease (PD) at population level.

Design

Cross-sectional study.

Setting

The study was performed based on electronic drug prescription and dispensation records of the Andalusian Public Health System.

Participants

All individuals aged ≥50 years with at least one drug dispensation during December 2014 were identified from the records.

Primary and secondary outcome measures

Groups were formed: ‘possible PD’ group, including all who received an anti-Parkinson agent; ‘possible IBD’ group, those treated with mesalazine and/or derivatives (5-aminosalicylic acid (5-ASA)); and ‘possible PD and IBD’, including those receiving both anti-Parkinson agent and 5-ASA. Prevalence of possible PD was determined among those with possible IBD and among those without this condition. The age-adjusted and sex-adjusted OR was calculated.

Results

We recorded 2 020 868 individuals (68±11 years, 56% female), 19 966 were included in possible PD group (75±9 years, 53% female) and 7485 in possible IBD group (64±10 years, 47% female); only 56 were included in both groups (76±8 years, 32% female). The prevalence of possible PD was 0.7% among those with possible IBD and 1% among those without this condition (adjusted OR=0.94; 95% CI 0.72 to 1.23; p=0.657). OR was 0.28 in individuals aged ≤65 years (95% CI 0.10 to 0.74; p=0.01) and 1.17 in older individuals (95% CI 0.89 to 1.54; p=0.257).

Conclusions

Within the limitations of this study, the results suggest a protective role for IBD and/or 5-ASA against PD development, especially among under 65-year olds. Further studies are warranted to explore this association given its scientific and therapeutic implications.
Functional health literacy in a population-based sample in Florence: a cross-sectional study using the Newest Vital Sign
Authors: Bonaccorsi Guglielmo , Lastrucci Vieri , Vettori Virginia , Lorini Chiara
Published: June 2019

Objectives

To assess the level of functional health literacy (HL) and its antecedents and consequences in an adult population-based sample, using the Italian version of Newest Vital Sign (NVS-IT).

Design

Cross-sectional study.

Setting

General population.

Participants

984 people were randomly selected from the resident registers of 11 general practitioners; a total of 452 (46.2%) of the selected people completed the study. Inclusion criteria were the following: 18–69 years of age and Italian speaking. Exclusion criteria included cognitive impairment, severe psychiatric diseases and end-stage diseases.

Outcome measures

HL levels as assessed by the NVS-IT and the following potential HL predictors and consequences were assessed using logistic regression models: sociodemographic characteristics, body mass index, presence of long-term illnesses, self-reported health status, health services use in the last 12 months.

Results

High likelihood of limited HL, possibility of limited HL and adequate HL were found in 11.5%, 24.6% and 63.9% of the sample, respectively. The results of the multivariate logistic model for the antecedents showed that the risk of having high likelihood or possibility of limited HL levels increases with age (OR 1.07, 95% CI 1.05 to 1.09), lower educational level (OR 4.03; 95% CI 3.41 to 7.49) and with worse financial situation (OR 1.64; 95% CI 1.17 to 2.63). As far as health outcomes are concerned, HL resulted to be positively associated with self-reported health status (OR 2.25, 95% CI 1.75 to 2.75).

Conclusions

Findings show a good level of functional HL in the population. However, older, less educated and poorer population groups showed to have a higher likelihood of suffering from limited or inadequate HL. Efforts should be made to design and implement public health policies and interventions tailored to different HL levels.

Trial registration number

CEAVC:10113.
Efficacy and safety of bronchial thermoplasty in clinical practice: a prospective, longitudinal, cohort study using evidence from the UK Severe Asthma Registry
Authors: Burn Julie , Sims Andrew J , Patrick Hannah , Heaney Liam G , Niven Robert M
Published: June 2019

Objectives

Use data from the UK Severe Asthma Registry (UKSAR) to assess the efficacy and safety of bronchial thermoplasty (BT) in routine UK clinical practice and to identify characteristics of ‘responders’.

Design

Prospective, longitudinal, cohort, multicentre registry study.

Setting

All (11) UK centres performing BT.

Participants and intervention

Patients receiving BT in the UK between 01/06/2011 and 30/09/2016 who had consented to data entry into UKSAR (n=133). Efficacy data were available for 86 patients with a BT baseline and at least one follow-up record. Safety data were available for 131 patients with at least one BT procedure record.

Primary and secondary outcome measures

Efficacy: AQLQ, ACQ, EuroQol, HADS anxiety and HADS depression scores, FEV1(% predicted), rescue steroid courses, unscheduled healthcare visits (A&E/Asthma clinic/GP), hospital admissions and days lost from work/school. Safety: peri-procedural events, device problems and any other safety-related findings. Responder analysis: differences in baseline characteristics of ‘responders’ (≥0.5 increase in AQLQ at 12 months) and ‘non-responders’.

Results

Following Bonferroni correction for paired comparisons, mean improvement in AQLQ at 12 months follow-up compared with BT baseline was statistically and clinically significant (0.75, n=28, p=0.0003). Median reduction in hospital admissions/year after 24 months follow-up was also significant (−1.0, n=26, p<0.0001). No deterioration in FEV1was observed. From 28 patients with AQLQ data at BTBL and 12-month follow-up, there was some evidence that lower age may predict AQLQ improvement. 18.9% (70/370) of procedures and 44.5% (57/128) of patients were affected by an adverse event; only a minority were considered serious.

Conclusions

Improvement in AQLQ is consistent with similar findings from clinical trials. Other efficacy outcomes demonstrated improving trends without reaching statistical significance. Missing follow-up data impacted this study but multiple imputation confirmed observed AQLQ improvement. The safety review suggested BT is being performed safely in the UK.
Cohort profile: the West Sweden Asthma Study (WSAS): a multidisciplinary population-based longitudinal study of asthma, allergy and respiratory conditions in adults
Authors: Nwaru Bright I , Ekerljung Linda , Rådinger Madeleine , Bjerg Anders , Mincheva Roxana , Malmhäll Carina , Axelsson Malin , Wennergren Göran , Lotvall Jan , Lundbäck Bo
Published: June 2019

Purpose

The West Sweden Asthma Study (WSAS) is a population-representative longitudinal study established to: (1) generate data on prevalence trends, incidence and remission of asthma, allergy and respiratory conditions, (2) elucidate on the risk and prognostic factors associated with these diseases, (3) characterise clinically relevant phenotypes of these diseases and (4) catalyse relevant mechanistic, genomic, genetic and translational investigations.

Participants

WSAS comprised of randomly selected individuals aged 16 to 75 years who are followed up longitudinally. The first stage involved a questionnaire survey (>42 000 participants) and was undertaken in 2008 and 2016. A random sample (about 8000) of participants in the initial survey undergoes extensive clinical investigations every 8 to 10 years (first investigations in 2009 to 2012, second wave currently ongoing). Measurements undertaken at the clinical investigations involve structured interviews, self-completed questionnaire on personality traits, physical measurements and extensive biological samples.

Findings to date

Some of our key findings have shown a 54% increase in the use of asthma medications between the 1990s and 2000s, primarily driven by a five-fold increase in the use of inhaled corticosteroids. About 36% of asthmatics expressed at least one sign of severe asthma indicator, with differential lung performance, inflammation and allergic sensitisation among asthmatics with different signs of severe asthma. Multi-symptom asthmatics were at greater risk of having indicators of severe asthma. In all adults, being raised on a farm was associated with a decreased risk of allergic sensitisation, rhinitis and eczema, but not asthma. However, among adolescents (ie, those 16 to 20 years of age), being raised on a farm decreased the risk of asthma. Personality traits were associated with both beliefs of asthma medication and adherence to treatment.

Future plans

Follow-up of the cohort is being undertaken every 8 to 10 years. The repeated clinical examinations will take place in 2019 to 2022. The cohort data are currently being linked to routine Swedish healthcare registers for a continuous follow-up. Mechanistic, genomic, genetic and translational investigations are ongoing.
Quality improvement measures for early detection of severe intravenous infiltration in infants
Authors: Sangam Subhasri Lakshmi
Published: June 2019

Intravenous infiltration is one of the most commonly seen morbidity in infants admitted to the neonatal intensive care unit (NICU). The risk of intravenous infiltration in preterm infants is probably due to prolonged peripheral intravenous access requirement for nutritional support and usage of other intravenous medications to support their growth. Infants are more likely to develop intravenous infiltrations due to the increased fragility of their blood vessels, deficient subcutaneous tissue and inability to express pain. As a result, the intravenous infiltrates in infants can rapidly progress to severe stage 3 and stage 4 infiltrates with necrosis if timely intervention is not provided. Also, factors obscuring to identify stage 1 and stage 2 infiltrates, may lead their progression to severe infiltration. Root cause analysis was performed following two severe intravenous infiltrates that required plastic surgery intervention in our level III NICU. Quality improvement measures were implemented. We developed a unique intravenous securing method, conducted educational programmes for NICU staff, increased intravenous site surveillance and ascertained to maintain the intravenous pump pressures in the reference range. The hospital NICU intravenous care policy was updated with quality improvement measures. Data were collected preintervention and postintervention. The incidence of intravenous infiltration in preterm infants varies widely in different places. This may be due to under-reporting of these relatively rare adverse events, but may also be due to the fact that the preterm infants represent a small portion of the patient population. The present study has shown that severe infiltration was associated with an increase in intravenous days. Following the quality improvement measures, there were no reported cases of severe intravenous infiltration. In conclusion, the awareness of the problem with evidence-based quality improvement measures may help in early detection of intravenous infiltrates and decrease the severe intravenous infiltration in infants.
Recognising bias in studies of diagnostic tests part 2: interpreting and verifying the index test
Authors: Kea Bory , Hall M Kennedy , Wang Ralph
Published: June 2019

Multiple pitfalls can occur with the conduct and analysis of a study of diagnostic tests, resulting in biased accuracy. Our conceptual model includes three stages: patient selection, interpretation of the index test and disease verification. In part 2, we focus on (1) Interpretation bias (or workup bias): where the classification of an indeterminate index test result can bias the accuracy of a test or how lack of blinding can bias a subjective test result, and (2) Disease verification bias: where the index test result is incorporated into the gold standard or when the gold standard is applied only to a select population as the gold standard is an invasive test. In an example with age-adjusted D-dimer for pulmonary embolism, differential verification bias was a limitation due to the use of two gold standards—CT for a high-risk population and follow-up for symptoms in a low-risk population. However, there are circumstances when certain choices in study design are unavoidable, and result in biased test characteristics. In this case, the informed reader will better judge the quality of a study by recognising the potential biases and limitations by being methodical in their approach to understanding the methods, and in turn, better apply studies of diagnostic tests into their clinical practice.
Socioeconomic position and alcohol-related harm in Danish adolescents
Authors: Møller Sanne Pagh , Pisinger Veronica Sofie Clara , Christensen Anne Illemann , Tolstrup Janne S
Published: June 2019

Background

In adults, it has consistently been observed that with equal alcohol consumption levels, alcohol harms individuals with low socioeconomic position (SEP) more than individuals with high SEP. It is unknown if this so-called alcohol harm paradox is also present in adolescents. We aim to test the hypothesis that low SEP is associated with more alcohol-related harm as compared with higher SEP in Danish adolescents.

Methods

We used survey data from the Danish National Youth Study 2014 including 70 566 students from 119 high schools. Alcohol-related harm was measured by self-report as having been in a fight, involved in an accident, had problems with parents or friends, had sex that was regretted afterwards and done drugs that was regretted afterwards, because of alcohol. Further, a combined measure was constructed defined as having experienced any harm more than once within the last year. SEP was measured as parents’ educational level, family income, parents’ employment status and experiencing financial strain in the family. Analyses were adjusted by age, sex, perceived ethnicity, class type and binge drinking.

Results

Lower SEP was associated with higher odds of experiencing alcohol-related harm more than once as compared with highest SEP, and lower SEP was associated with higher odds of having been in a fight, problems with parents or friends, sex and regretting afterwards or drugs and regretting afterwards, as compared with highest SEP. These associations were statistically significant. Adjustment for the frequency of binge drinking did not change results.

Conclusion

The alcohol harm paradox exists in Danish adolescents, and this should be addressed in future prevention strategies to reduce the risk of alcohol-related harm among adolescents.
Palliative opioid use, palliative sedation and euthanasia: reaffirming the distinction
Authors: Schofield Guy , Baker Idris , Bullock Rachel , Clare Hannah , Clark Paul , Willis Derek , Gannon Craig , George Rob
Published: June 2019

We read with interest the extended essay published from Riisfeldt and are encouraged by an empirical ethics article which attempts to ground theory and its claims in the real world. However, such attempts also have real-world consequences. We are concerned to read the paper’s conclusion that clinical evidence weakens the distinction between euthanasia and normal palliative care prescribing. This is important. Globally, the most significant barrier to adequate symptom control in people with life-limiting illness is poor access to opioid analgesia. Opiophobia makes clinicians reluctant to prescribe and their patients reluctant to take opioids that might provide significant improvements in quality of life. We argue that the evidence base for the safety of opioid prescribing is broader than that presented, restricting the search to palliative care literature produces significant bias as safety experience and literature for opioids and sedatives exists in many fields. This is not acknowledged in the synthesis presented. By considering additional evidence, we reject the need for agnosticism and reaffirm that palliative opioid prescribing is safe. Second, palliative sedation in a clinical context is a poorly defined concept covering multiple interventions and treatment intentions. We detail these and show that continuous deep palliative sedation (CDPS) is a specific practice that remains controversial globally and is not considered routine practice. Rejecting agnosticism towards opioids and excluding CDPS from the definition of routine care allows the rejection of Riisfeldt’s headline conclusion. On these grounds, we reaffirm the important distinction between palliative care prescribing and euthanasia in practice.
Responding to religious patients: why physicians have no business doing theology
Authors: Greenblum Jake , Hubbard Ryan K
Published: June 2019

A survey of the recent literature suggests that physicians should engage religious patients on religious grounds when the patient cites religious considerations for a medical decision. We offer two arguments that physicians ought to avoid engaging patients in this manner. The first is the Public Reason Argument. We explain why physicians are relevantly akin to public officials. This suggests that it is not the physician’s proper role to engage in religious deliberation. This is because the public character of a physician’s role binds him/her to public reason, which precludes the use of religious considerations. The second argument is the Fiduciary Argument. We show that the patient-physician relationship is a fiduciary relationship, which suggests that the patient has the clinical expectation that physicians limit themselves to medical considerations. Since engaging in religious deliberations lies outside this set of considerations, such engagement undermines trust and therefore damages the patient-physician relationship.
Latent classes of sexual risk and corresponding STI and HIV positivity among MSM attending centres for sexual health in the Netherlands
Authors: Slurink Isabel A L , van Benthem Birgit H B , van Rooijen Martijn S , Achterbergh Roel C A , van Aar Fleur
Published: June 2019

Objectives

Continuing high STI positivity among men who have sex with men (MSM) attending centres for sexual health (CSH) indicates that high-risk behaviour is ongoing. The objective of this study was to gain a better insight into risk behaviours among MSM attending CSH and to explore STI and HIV positivity by subgroups.

Methods

We used national data routinely collected during CSH consultations for this study. From September to December 2017, questions on group sex, substance use and sex with HIV-positive partners were asked at each CSH consultation. We analysed latent classes of client-related factors and sexual risk behaviour among MSM attending CSH in this period. We examined STI positivity and prevalence ratios by latent classes.

Results

A total of six classes were identified in order of increasing risk: ‘overall low-risk behaviour’ (n=2974; 22.0%), ‘Western origin and multiple sex partners’ (MSP) (n=4182; 30.9%), ‘Non-Western origin and MSP’ (n=2496; 18.5%), ‘living with HIV’ (n=827; 6.1%), ‘group sex and HIV-positive partners’ (n=1798; 13.3%) and ‘group sex and chemsex’ (n=1239; 9.2%). The any STI positivity ranged from 14.0% in the overall low-risk behaviour class to 35.5% in the group sex and chemsex class. HIV positivity did not differ significantly between classes. The Western origin and MSP class was largest and accounted for the majority of STI and HIV infections.

Conclusions

Although STI positivity increased with increased risky behaviours, considerable STI positivity was found in all six latent classes. Comparable HIV positivity between classes indicates risk reduction strategies among subgroups engaged in risky behaviours. The differences in risk behaviour and STI positivity require preventive strategies tailored to each subgroup.