bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of the Sepsis-3 definition on ICU admission of patients with infection
Authors: Klimpel Jenny , Weidhase Lorenz , Bernhard Michael , Gries André , Petros Sirak
Published: November 2019

Background

Sepsis is defined as a life-threatening organ dysfunction due to a dysregulated inflammation following an infection. However, the impact of this definition on patient care is not fully clear. This study investigated the impact of the current definition on ICU admission of patients with infection.

Methods

We performed a prospective observational study over twelve months on consecutive patients presented to our emergency department and admitted for infection. We analyzed the predictive values of the quick sequential organ failure assessment (qSOFA) score, the SOFA score and blood lactate regarding ICU admission.

Results

We included 916 patients with the diagnosis of infection. Median age was 74 years (IQR 62–82 years), and 56.3% were males. There were 219 direct ICU admissions and 697 general ward admissions. A qSOFA score of ≥2 points had 52.9% sensitivity and 98.3% specificity regarding sepsis diagnosis. A qSOFA score of ≥2 points had 87.2% specificity but only 39.9% sensitivity to predict ICU admission. A SOFA score of ≥2 points had 97.4% sensitivity, but only 17.1% specificity to predict ICU admission, while a SOFA score of ≥4 points predicted ICU admission with 82.6% sensitivity and 71.7% specificity. The area under the receiver operating curve regarding ICU admission was 0.81 (95 CI, 0.77–0.86) for SOFA score, 0.55 (95% CI, 0.48–0.61) for blood lactate, and only 0.34 (95% CI, 0.28–0.40) for qSOFA on emergency department presentation.

Conclusions

While a positive qSOFA score had a high specificity regarding ICU admission, the low sensitivity of the score among septic patients as well as among ICU admissions considerably limited its value in routine patient management. The SOFA score was the better predictor of ICU admission, while the predictive value of blood lactate was equivocal.
Time to recovery and determinants of severe acute malnutrition among 6–59 months children treated at outpatient therapeutic programme in North Gondar zone, Northwest Ethiopia: a prospective follow up study
Authors: Mamo Worku Nigussu , Derso Terefe , Gelaye Kassahun Alemu , Akalu Temesgen Yihunie
Published: November 2019

Background

Despite the available interventions to tackle nutritional problems, there is scarce information on time to recovery and its determinants among children with SAM in Ethiopia.

Objective

This study was aimed at finding the time to recovery and determinants among 6–59 months children with severe acute malnutrition treated at an outpatient therapeutic programme in North Gondar zone, northwest Ethiopia.

Methods

Facility based prospective follow up study was conducted from March 24 to May 24, 2017. A total of 408 children with the age of 6–59 months were included in the study. Structured interviewer administered questionnaire was used. Anthropometric measurements were conducted every week. The median time of recovery, Kaplan Meier (KM) curve, and log rank test were computed. Both bi-variable and multivariable Cox regression model was fitted. To establish an association between time to recovery and its determinants 95% confidence interval (CI) and p-value < 0.05 were used. Proportional hazard assumption was checked graphically and using Schoenfeld residual test.

Results

Out of 389 children, 254 (65.3%) recovered. The median time to recovery was 38.5 ± IQR of 14 days. Children with diarrhoea AHR = 0.81 with 95% CI (0.73, 0.99), children taken amoxicillin AHR = 2.304 with 95% CI (1.68–3.161), and had vomiting at admission AHR = 0.430 with 95% CI (0.205, 0.904) were significant predictors of time to recovery.

Conclusions and recommendations

The overall time to recovery has not met the minimum sphere international standard which was lower than 75%. It is advisable to give emphasis to patients with diarrhoea and vomiting.
Whole-genome sequencing of ocular Chlamydia trachomatis isolates from Gadarif State, Sudan
Authors: Alkhidir Abdulazeem Abdulsalam Ibrahim , Holland Martin J. , Elhag Wafa Ibrahim , Williams Charlotte A. , Breuer Judith , Elemam Abdah Elfatih , El Hussain Khalid Mohamed Khalid , Ournasseir Mohammed Elfatih Hussein , Pickering Harry
Published: November 2019

Background

Trachoma, caused by ocularChlamydia trachomatis, is the leading infectious cause of blindness worldwide. Sudan first reported trachoma in the 1930s and has since been consistently endemic. OcularC. trachomatispreviously isolated from trachoma patients in Sudan in 1963 was antigenically identical to an isolate from Saudi Arabia (A/SA1). No contemporary ocularC. trachomatiswhole genome sequences have been reported from Sudan.

Methods

This study sequenced twenty ocularC. trachomatisisolates to improve understanding of pathogen diversity in North-East Africa and examine for genomic variation specific to Sudan, possibly related to the persistence of trachoma in surveyed communities. High quality, whole genome sequences were obtained from 12/20 isolates.

Results

All isolates were serovar A and hadtarPandtrpAsequences typical of classical, ocularC. trachomatisisolates. The Sudanese isolates formed a closely related subclade within the T2-trachoma clade ofC. trachomatisphylogeny distinct from geographically disparate ocular isolates, with little intra-population diversity. We found 333 SNPs that were conserved in Sudanese ocular isolates but rare compared to other ocularC. trachomatispopulations, which were focused in two genomic loci (CTA0172-CTA0173andCTA0482).

Conclusions

Limited intra-population diversity and geographical clustering of ocularC. trachomatissuggests minimal transmission between and slow diversification within trachoma-endemic communities. However, diversity may have been higher pre-treatment in these communities. Over-representation of Sudan-specific SNPs in three genes suggests they may have an impact onC. trachomatisgrowth and transmission in this population.
Reanalysis of the physical and mental health summary scores of dialysis versus conservative care in older patients with advanced chronic kidney disease: a critical appraisal
Authors: Verberne Wouter R. , Dijkers Janneke , Kelder Johannes C. , Jellema Wilbert T. , van Delden Johannes J. M. , Bos Willem Jan W.
Published: November 2019

Objective

Non-dialytic conservative care is argued to be a reasonable treatment alternative for dialysis in selected older patients with advanced chronic kidney disease. We evaluated patient-relevant outcomes including health-related quality of life in a previous study. However, the scoring algorithm we used to calculate the physical and mental component summary scores of the Short Form-36 (SF-36) turned out to differ from comparable studies on this topic. The aim of this critical appraisal was to reanalyze the SF-36 summary scores in our patient cohort (≥ 70 years) using the more widely used scoring algorithm.

Results

Patients on conservative care (n = 23) had lower physical and mental component summary scores compared to patients not yet started on dialysis (n = 39), but similar compared to patients on dialysis (n = 34). These findings were similar to our original findings and did not change the conclusions. Several scoring algorithms are used for the SF-36 summary scores. Researchers should be aware of this fact and should use the same scoring algorithm across similar studies in a specific field to increase comparability. Using the more widely used scoring algorithm, the recalculated SF-36 summary scores of our patient cohort can now be compared to other studies.
A genome-wide DNA methylation signature for SETD1B-related syndrome
Authors: Krzyzewska I. M. , Maas S. M. , Henneman P. , Lip K. v. d. , Venema A. , Baranano K. , Chassevent A. , Aref-Eshghi E. , van Essen A. J. , Fukuda T. , Ikeda H. , Jacquemont M. , Kim H.-G. , Labalme A. , Lewis S. M. E. , Lesca G. , Madrigal I. , Mahida S. , Matsumoto N. , Rabionet R. , Rajcan-Separovic E. , Qiao Y. , Sadikovic B. , Saitsu H. , Sweetser D. A. , Alders M. , Mannens M. M. A. M.
Published: November 2019

SETD1B is a component of a histone methyltransferase complex that specifically methylates Lys-4 of histone H3 (H3K4) and is responsible for the epigenetic control of chromatin structure and gene expression. De novo microdeletions encompassing this gene as well as de novo missense mutations were previously linked to syndromic intellectual disability (ID). Here, we identify a specific hypermethylation signature associated with loss of function mutations in theSETD1Bgene which may be used as an epigenetic marker supporting the diagnosis of syndromicSETD1B-related diseases. We demonstrate the clinical utility of this unique epi-signature by reclassifying previously identifiedSETD1BVUS (variant of uncertain significance) in two patients.
Physiologic expansion of human heart-derived cells enhances therapeutic repair of injured myocardium
Authors: Mount Seth , Kanda Pushpinder , Parent Sandrine , Khan Saad , Michie Connor , Davila Liliana , Chan Vincent , Davies Ross A. , Haddad Haissam , Courtman David , Stewart Duncan J. , Davis Darryl R.
Published: November 2019

Background

Serum-free xenogen-free defined media and continuous controlled physiological cell culture conditions have been developed for stem cell therapeutics, but the effect of these conditions on the relative potency of the cell product is unknown. As such, we conducted a head-to-head comparison of cell culture conditions on human heart explant-derived cells using established in vitro measures of cell potency and in vivo functional repair.

Methods

Heart explant-derived cells cultured from human atrial or ventricular biopsies within a serum-free xenogen-free media and a continuous physiological culture environment were compared to cells cultured under traditional (high serum) cell culture conditions in a standard clean room facility.

Results

Transitioning from traditional high serum cell culture conditions to serum-free xenogen-free conditions had no effect on cell culture yields but provided a smaller, more homogenous, cell product with only minor antigenic changes. Culture within continuous physiologic conditions markedly boosted cell proliferation while increasing the expression of stem cell-related antigens and ability of cells to stimulate angiogenesis. Intramyocardial injection of physiologic cultured cells into immunodeficient mice 1 week after coronary ligation translated into improved cardiac function and reduced scar burden which was attributable to increased production of pro-healing cytokines, extracellular vesicles, and microRNAs.

Conclusions

Continuous physiological cell culture increased cell growth, paracrine output, and treatment outcomes to provide the greatest functional benefit after experimental myocardial infarction.
Disruptive behaviors among nurses in Israel – association with listening, wellbeing and feeling as a victim: a cross-sectional study
Authors: Tikva Sigal Shafran , Kluger Avraham N. , Lerman Yulia
Published: November 2019

Objectives

To examine the association between listening and disruptive behaviors and the association between disruptive behavior and the wellbeing of the nurse. To test whether constructive and destructive listening has an incremental validity.

Methods

A structured questionnaire survey that measured the (constructive & destructive) listening climate at work, exposure to disruptive behaviors, well-being and feeling as a victim. We presented this survey using the Qualtrics software.

Results

Of the final sample of 567 respondents who reported that they were nurses, MAge = 38.41, 67% indicated that they were exposed to some form of disruptive behavior. Experiencing listening in the ward was associated with low levels of exposure to disruptive behaviors; exposure to disruptive behaviors, in turn, predicted reduction in the nurses’ wellbeing; the reduction in wellbeing was especially pronounced among nurses who felt like a victim. Each of the facets of the listening measure—constructive listening and destructive listening—had incremental validity in predicting exposure to disruptive behaviors. Finally, the effect of exposure to disruptive behavior on wellbeing was curvilinear.

Conclusions

Disruptive behavior is a major challenge to the workplace well-being for nurses. The victim mentality has an adverse impact on nurses. Preventive efforts aimed at reducing disruptive behaviors among nurses and decreasing their sense of victimization are crucial for the well-being of nurses.
Choice of therapeutic interventions and outcomes for the treatment of infections caused by multidrug-resistant gram-negative pathogens: a systematic review
Authors: Nørgaard Sarah Melissa , Jensen Camilla Skaarup , Aalestrup Josefine , Vandenbroucke-Grauls Christina M. J. E. , de Boer Mark G. J. , Pedersen Alma Becic
Published: November 2019

Background

Antimicrobial resistance is an increasingly serious threat to public health, and the increased occurrence of multidrug-resistant (MDR) bacteria is a concern in both high-income and low- and middle-income countries. The purpose of this systematic review was to identify and critically appraise current antimicrobial treatment options for infections with MDR Gram-negative bacteria.

Methods

A literature search for treatment of MDR extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, A. baumannii, and P. aeruginosa was conducted in MEDLINE in January 2019. Relevant studies published in English, German, and French that evaluated clinical success, microbiological success, and 30-day mortality outcomes were included. The population of interest was adult patients.

Results

Of 672 studies, 43 met the inclusion criteria. Carbapenems are the most common antibiotics used for the treatment of ESBL-producing Enterobacteriaceae. The clinical and microbiological success was similar for group 1 carbapenems (imipenem, meropenem, or doripenem), group 2 carbapenems (ertapenem), and non-carbapenem antibiotics. Mortality data were contradictory for group 1 carbapenems compared to group 2 carbapenems. The most common treatment option for A. baumannii and P. aeruginosa infections was intravenous colistin, regardless of infection site. Clinical success and mortality were similar in A. baumannii infections treated with colistin combination therapy vs. colistin monotherapy, whereas heterogeneous results were found with respect to microbiological success. Monotherapy and colistin combination therapy were used against P. aeruginosa with clinical and microbiological success (70–100%) depending on the infection site and severity, and the antibiotic used. Ceftazidime-avibactam therapy for ESBL-producing Enterobacteriaceae and P. aeruginosa showed good clinical success in one study.

Conclusion

We did not find robust evidence for antibiotic treatment of any infection with MDR Gram-negative bacteria, including ESBL-producing Enterobacteriaceae, A. baumannii, and P. aeruginosa, that would lead to a firm recommendation for one specific antibiotic over another or for monotherapy over combination therapy. The choice of antibiotic treatment should be based on susceptibility testing balancing the expected clinical success rate against the risk of development of antibiotic resistance and the risk of severe side effects.
Lower serum expression of miR-181c-5p is associated with increased plasma levels of amyloid-beta 1–40 and cerebral vulnerability in normal aging
Authors: Manzano-Crespo Marta , Atienza Mercedes , Cantero Jose L.
Published: November 2019

Background

Previous studies have shown that expression levels of miR-181c are downregulated by amyloid-β (Aβ) deposition and chronic cerebral hypoperfusion, both factors largely associated with the development of AD. Moreover, reduced 2-[18F]fluoro-2-deoxy-D-glucose (FDG)-PET brain metabolism and volume loss of regions of the medial temporal lobe have been generally recognized as hallmarks of AD. Based on this evidence, we have here investigated potential associations between serum levels of miR-181c-5p and these AD signatures in asymptomatic elderly subjects.

Methods

Ninety-five normal elderly subjects underwent clinical, cognitive, structural MRI, and FDG-PET explorations. Serum expression levels of miR-181c-5p and plasma Aβ concentrations were further analyzed in this cohort. Regression analyses were performed to assess associations between serum miR-181c-5p levels and cognitive functioning, plasma Aβ, structural and metabolic brain changes.

Results

Decreased serum expression of miR-181c-5p was associated with increased plasma levels of Aβ1–40, deficits in cortical glucose metabolism, and volume reduction of the entorhinal cortex. No significant associations were found between lower miR-181c-5p levels and cognitive deficits or cortical thinning.

Conclusions

These findings suggest that deregulation of serum miR-181c-5p may indicate cerebral vulnerability in late life.
How alternative food networks work in a metropolitan area? An analysis of Solidarity Purchase Groups in Northern Italy
Authors: Baldi Lucia , Bertoni Danilo , Migliore Giuseppina , Peri Massimo
Published: November 2019

Our paper focuses on Solidarity Purchase Group (SPG) participants located in a highly urbanized area, with the aim to investigate the main motivations underlining their participation in a SPG and provide a characterization of them. To this end, we carried out a survey of 795 participants involved in 125 SPGs in the metropolitan area of Milan (Italy). Taking advantage of a questionnaire with 39 questions, we run a factor analysis and a two-step cluster analysis to identify different profiles of SPG participants. Our results show that the system of values animating metropolitan SPG practitioners does not fully conform to that traditionally attributed to an alternative food network (AFN). In fact, considerations linked to food safety and healthiness prevail on altruistic motives such as environmental sustainability and solidarity toward small producers. Furthermore, metropolitan SPGs do not consider particularly desirable periurban and local food products. Observing the SPGs from this perspective, it emerges as such initiatives can flourish also in those places where the lack of connection with the surrounding territory is counterbalanced by the high motivation to buy products from trusted suppliers who are able to guarantee genuine and safe products, not necessarily located nearby.
Comparison of three 3D scanning techniques for paintings, as applied to Vermeer’s ‘Girl with a Pearl Earring’
Authors: Elkhuizen Willemijn S. , Callewaert Tom W. J. , Leonhardt Emilien , Vandivere Abbie , Song Yu , Pont Sylvia C. , Geraedts Jo M. P. , Dik Joris
Published: November 2019

A seventeenth-century canvas painting is usually comprised of varnish and (translucent) paint layers on a substrate. A viewer’s perception of a work of art can be affected by changes in and damages to these layers. Crack formation in the multi-layered stratigraphy of the painting is visible in the surface topology. Furthermore, the impact of mechanical abrasion, (photo)chemical processes and treatments can affect the topography of the surface and thereby its appearance. New technological advancements in non-invasive imaging allow for the documentation and visualisation of a painting’s 3D shape across larger segments or even the complete surface. In this manuscript we compare three 3D scanning techniques, which have been used to capture the surface topology of Girl with a Pearl Earring by Johannes Vermeer (c. 1665): a painting in the collection of the Mauritshuis, the Hague. These three techniques are: multi-scale optical coherence tomography, 3D scanning based on fringe-encoded stereo imaging (at two resolutions), and 3D digital microscopy. Additionally, scans were made of a reference target and compared to 3D data obtained with white-light confocal profilometry. The 3D data sets were aligned using a scale-invariant template matching algorithm, and compared on their ability to visualise topographical details of interest. Also the merits and limitations for the individual imaging techniques are discussed in-depth. We find that the 3D digital microscopy and the multi-scale optical coherence tomography offer the highest measurement accuracy and precision. However, the small field-of-view of these techniques, makes them relatively slow and thereby less viable solutions for capturing larger (areas of) paintings. For Girl with a Pearl Earring we find that the 3D data provides an unparalleled insight into the surface features of this painting, specifically related to ‘moating’ around impasto, the effects of paint consolidation in earlier restoration campaigns and aging, through visualisation of the crack pattern. Furthermore, the data sets provide a starting point for future documentation and monitoring of the surface topology changes over time. These scans were carried out as part of the research project ‘The Girl in the Spotlight’.
Temporal patterns of three sympatric pheasant species in the Nanling Mountains: N-mixture modeling applied to detect abundance
Authors: Zou Fasheng , Zhang Qiang , Zhang Min , Lee Myung-Bok , Wang Xincai , Gong Yuening , Yang Changteng
Published: November 2019

Background

The reliability of long-term population estimates is crucial for conservation and management purposes. Most previous studies assume that count indices are proportionally related to abundance; however, this assumption may not hold when detection varies spatially and temporally. We examined seasonal variations in abundance of three bird species (Cabot’s Tragopan Tragopan caboti, Silver Pheasant Lophura nycthemera, and White-necklaced Partridge Arborophila gingica) along an elevational gradient, using N-mixture models that take into account imperfect detection in our bird data.

Methods

Camera-trapping was used to monitor temporal activity patterns of these species at Guangdong Nanling National Nature Reserve from December 2013 to November 2017 (4 seasons per year). For abundance analysis (N-mixture modeling), we divided a year into 4 seasons, i.e. 3 months per season, and performed the analysis by season. Elevation was incorporated into the N-mixture model as a covariate that may affect abundance. We compared the N-mixture model with a null model (no covariate model) and selected the better model based on AIC values to make an inference.

Results

From 24 sampling sites, we obtained 6786 photographs of 8482 individuals of 44 bird species and 26 mammal species. Silver Pheasant was photographed much more frequently and showed higher temporal activity frequency than White-necklaced Partridge or Cabot’s Tragopan. Silver Pheasant was camera-captured most frequently in summer, and other two species in winters. All three species had two daytime activity peaks: between 6:00 a.m. and 10:00 a.m., and between 5:00 p.m. and 7:00 p.m., respectively. Our estimated abundance and detection probability from the N-mixture model were variable by season. In particular, all three species showed greater abundance in summer than in winter, and estimated abundance patterns of all three species were more similar with observed camera-trapping counts in summers. Moreover, in winter, elevation had a positive impact on abundance of Silver Pheasant and Cabot’s Tragopan, but not on White-necklaced Partridge.

Conclusions

Our results demonstrate that the N-mixture model performed well in the estimation of temporal population abundance at local fixed permanent plots in mountain habitat in southern China, based on the modeling of repeated camera-trapping counts. The seasonal differences in abundance of the three endemic bird species and the strong effect of elevation on abundance of two species in winter were only indicative of variations in spatio-temporal distribution within species and between species. In identifying suitable habitat for endemic pheasants, the positive elevational effect also suggests that more attention should be paid to conservation of areas with higher elevation in the Nanling Mountains.
Prediction of nutritive sucking in preterm babies (<34 weeks) and preterm sucking readiness scale
Authors: Kumari Nisha , Jain Ashish , Ramji Siddarth
Published: November 2019

Objective

To determine predictors of nutritive-sucking in babies < 34 weeks and estimate the appropriate preterm sucking readiness (PTSR) score as an indicator of readiness of nutritive-sucking.

Methods

Prospective longitudinal observational study conducted in Neonatal unit of a referral hospital attached to Medical College. Forty-nine inborn babies of 28-34 weeks’ gestation and on full gavage feeds were enrolled.

Results

(a) Nutritive-sucking was achieved at a median age of 14 days (Range 7–50). (b) Low birth weight (LBW) (< 1531.1 ± 142.8) and lesser gestational age (GA) (< 32.8 ± 1) were poor predictors (p < 0.05) and have a significant independent negative association (Correlation birth weight (BW) - 0.0222, GA − 2.2177) with age at which established nutritive-sucking was achieved. (c) PTSR score of ≥9 had the best prediction for achievement of nutritive-sucking at 14-days of life, with a sensitivity of 92.3% and specificity of 100%.

Conclusion

PTSR score is a sensitive and specific tool to predict the readiness for nutritive-sucking in preterm babies < 34 weeks.
The effect of image quality on the reliability of OCT angiography measurements in patients with diabetes
Authors: Czakó Cecília , István Lilla , Ecsedy Mónika , Récsán Zsuzsa , Sándor Gábor , Benyó Fruzsina , Horváth Hajnalka , Papp András , Resch Miklós , Borbándy Ágnes , Nagy Zoltán Zsolt , Kovács Illés
Published: November 2019

Background

This study aimed to determine the relationship between image quality and measurement repeatability of optical coherence tomography angiography (OCTA) parameters in patients with non-proliferative diabetic retinopathy.

Methods

A total of 100 eyes of 50 patients were included in the study. Three OCTA images were obtained consecutively during one session of imaging in all patients using the RTVue AngioVue OCTA device. We applied the signal strength index (SSI) provided by the RTVue system to define scan quality. Superficial vessel density (VD) in the central 3 × 3 mm macular and in the perifoveal region, as well as foveal avascular zone (FAZ) area were evaluated by the AngioAnalytics software for each scan from three consecutive measurements, whereby measurement repeatability of the OCTA parameters were calculated. The effect of SSI value on OCTA parameters, as well as on measurement errors was assessed.

Results

Values of SSI ranged from 30 to 85 with an overall mean of 61.79 ± 10.38. Mean SSI values showed significant positive correlation with the mean retinal capillary vessel density values, but not with non-flow area. Repeatability of OCTA parameters was generally improved with higher SSI values. We calculated a mean correction factor of 0.22% (95% CI 0.20–0.24 µm; p < 0.001) for VD at the 3 × 3 mm macular scan, 0.23% (95% CI 0.21–0.26%; p < 0.001) for perifoveal VD and − 0.001 mm2 (95% CI − 0.001 to 0.002; p = 0.001) for the non-flow area for each unit increase in SSI for the comparison of images with different SSI values.

Conclusions

The influence of image quality on OCTA metrics should be considered for image comparisons during follow-up to avoid misinterpretation of small changes in OCTA parameters in patients with diabetes.
Subgingival microbial profile of women with breast cancer: a cross-sectional study
Authors: Bernhard Vivian Rodrigues , Faveri Marcelo , Santos Marciel Silva , Gomes Maria da Conceição Machado , Batitucci Roberta Grasseli , Tanaka Caio Junji , Feres Magda , Feitosa Alfredo
Published: November 2019

Background

Some prospective studies have observed associations between periodontal disease and breast cancer. Therefore, the aim of the present study was to investigate the composition of the subgingival biofilm of women diagnosed with breast cancer, who also presented with chronic periodontitis.

Methods

All subjects underwent clinical and microbiological assessment. Subgingival biofilm samples were taken from at least three sites of 44 women who had breast cancer. The mean levels and proportions of 40 bacterial species were determined by checkerboard DNA-DNA hybridization. Spearman correlation was used to assess possible associations between the mean levels of bacterial species and clinical conditions.

Results

The five species found at the highest levels were Prevotella nigrescens, Actinomyces gerencseriae, Neisseria mucosa, Porphyromonas gingivalis and Tannerella forsythia. The species detected in the lowest counts were Propionibacterium acnes, Streptococcus constellatus, Streptococcus intermedius, Eubacterium saburreum and Streptococcus anginosus. No significant association between levels and proportion of bacterial species and clinical parameters were found.

Conclusion

In conclusion, the results of the present study found no direct association between the subgingival microbiota and breast cancer and an indirect pathway should be addressed in further studies.

Trial registration

Retrospectively registered.
Evaluation of the physical health of adolescent in-patients in generic and secure services: retrospective case-note review
Authors: Carney Rebekah , Imran Shermin , Law Heather , Folstad Siri , Parker Sophie
Published: November 2019

Aims and method

To assess physical health needs of adolescent in-patients by routine monitoring. A retrospective analysis of case notes was conducted on a 6-month intake to generic and secure adolescent mental health units in Greater Manchester, UK.

Results

Fifty individuals were admitted (52% female, average age 15.84 years). Diagnoses varied and 66% were prescribed medications before admission. All had a physical health assessment, which identified various physical health risk factors. Average body mass index was 25.99 (range 15.8–44), and increased during in-patient treatment for 84% of individuals who had their body mass recorded more than once. A total of 28% of individuals smoked. Lipids and prolactin levels were elevated across the sample.

Clinical implications

This evaluation strengthens the argument to optimise physical healthcare for adolescent in-patients and develop physical health interventions, particularly given that we observed elevated lipids and prolactin. Physical health and well-being may not be prioritised when assessing and managing young peoples' mental health, despite their increased vulnerability for comorbid conditions.
Well-being and mental health interventions for Indigenous people in prison: systematic review
Authors: Perdacher Elke , Kavanagh David , Sheffield Jeanie
Published: November 2019

Background

Indigenous people are overrepresented in prison populations of colonised justice systems, and Indigenous prisoners in these countries are at a particularly high risk of poor mental health and well-being. There is an acute need to ensure the access of these groups to culturally appropriate, evidence-based interventions.

Aims

To conduct a systematic review, evaluating quantitative and qualitative evaluations of mental health and well-being interventions designed for Indigenous people in custody.

Method

A search of relevant peer-reviewed journal articles to August 2019 was conducted. The focus was on colonised countries under a Western model of justice and health, including Canada, Australia, New Zealand and the USA. The review utilised Scopus, Web of Science, PubMed, PsycNET, EBSCO, Proquest Criminal Justice Database and Informit.

Results

Of the 9283 articles initially found, only three quantitative and two qualitative evaluations of mental health or well-being interventions for Indigenous people in custody were identified. None were randomised controlled trials. Culturally based interventions appeared to have high acceptability and potential for increased recovery from trauma, reduced alcohol-related problems and lower reoffending. However, no studies quantitatively assessed mental health or well-being outcomes.

Conclusions

As yet there is no high-quality evidence on the impact on mental health and well-being from interventions specifically for Indigenous prisoners, although existing studies suggest programme features that may maximise acceptability and impact. There is a moral, social and practical imperative to build a strong evidence base on this topic.
Efficacy of Pembrolizumab in Patients With Noncolorectal High Microsatellite Instability/Mismatch Repair–Deficient Cancer: Results From the Phase II KEYNOTE-158 Study
Authors: Marabelle Aurelien , Le Dung T. , Ascierto Paolo A. , Di Giacomo Anna Maria , De Jesus-Acosta Ana , Delord Jean-Pierre , Geva Ravit , Gottfried Maya , Penel Nicolas , Hansen Aaron R. , Piha-Paul Sarina A. , Doi Toshihiko , Gao Bo , Chung Hyun Cheol , Lopez-Martin Jose , Bang Yung-Jue , Frommer Ronnie Shapira , Shah Manisha , Ghori Razi , Joe Andrew K. , Pruitt Scott K. , Diaz Jr Luis A.
Published: November 2019

PURPOSE

Genomes of tumors that are deficient in DNA mismatch repair (dMMR) have high microsatellite instability (MSI-H) and harbor hundreds to thousands of somatic mutations that encode potential neoantigens. Such tumors are therefore likely to be immunogenic, triggering upregulation of immune checkpoint proteins. Pembrolizumab, an anti‒programmed death-1 monoclonal antibody, has antitumor activity against MSI-H/dMMR cancer. We report data from the phase II KEYNOTE-158 study of pembrolizumab in patients with previously treated, advanced noncolorectal MSI-H/dMMR cancer.

PATIENTS AND METHODS

Eligible patients with histologically/cytologically confirmed MSI-H/dMMR advanced noncolorectal cancer who experienced failure with prior therapy received pembrolizumab 200 mg once every 3 weeks for 2 years or until disease progression, unacceptable toxicity, or patient withdrawal. Radiologic imaging was performed every 9 weeks for the first year of therapy and every 12 weeks thereafter. The primary end point was objective response rate per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, as assessed by independent central radiologic review.

RESULTS

Among 233 enrolled patients, 27 tumor types were represented, with endometrial, gastric, cholangiocarcinoma, and pancreatic cancers being the most common. Median follow up was 13.4 months. Objective response rate was 34.3% (95% CI, 28.3% to 40.8%). Median progression-free survival was 4.1 months (95% CI, 2.4 to 4.9 months) and median overall survival was 23.5 months (95% CI, 13.5 months to not reached). Treatment-related adverse events occurred in 151 patients (64.8%). Thirty-four patients (14.6%) had grade 3 to 5 treatment-related adverse events. Grade 5 pneumonia occurred in one patient; there were no other treatment-related fatal adverse events.

CONCLUSION

Our study demonstrates the clinical benefit of anti–programmed death-1 therapy with pembrolizumab among patients with previously treated unresectable or metastatic MSI-H/dMMR noncolorectal cancer. Toxicity was consistent with previous experience of pembrolizumab monotherapy.
A Comprehensive Cohort Analysis Comparing Growth and GH Therapy Response in IGF1R Mutation Carriers and SGA Children
Authors: Göpel Eric , Rockstroh Denise , Pfäffle Heike , Schlicke Marina , Pozza Susanne Bechtold-Dalla , Gannagé-Yared Marie-Hélène , Gucev Zoran , Mohn Angelika , Harmel Eva-Maria , Volkmann Julia , Weihrauch-Blüher Susann , Gausche Ruth , Bogatsch Holger , Beger Christoph , Klammt Jürgen , Pfäffle Roland
Published: November 2019

Context

IGF1 receptor mutations (IGF1RM) are rare; however, patients exhibit pronounced growth retardation without catch-up. Although several case reports exist, a comprehensive statistical analysis investigating growth profile and benefit of recombinant human growth hormone (rhGH) treatment is still missing.

Objective and methods

Here, we compared IGF1RM carriers (n = 23) retrospectively regarding birth parameters, growth response to rhGH therapy, near final height, and glucose/insulin homeostasis to treated children born small for gestational age (SGA) (n = 34). Additionally, health profiles of adult IGF1RM carriers were surveyed by a questionnaire.

Results

IGF1RM carriers were significantly smaller at rhGH initiation and had a diminished first-year response compared to SGA children (Δ height standard deviation score: 0.29 vs. 0.65), resulting in a lower growth response under therapy. Interestingly, the number of poor therapy responders was three times higher for IGF1RM carriers than for SGA patients (53 % vs. 17 %). However, most IGF1RM good responders showed catch-up growth to the levels of SGA patients. Moreover, we observed no differences in homeostasis model assessment of insulin resistance before treatment, but during treatment insulin resistance was significantly increased in IGF1RM carriers compared to SGA children. Analyses in adult mutation carriers indicated no increased occurrence of comorbidities later in life compared to SGA controls.

Conclusion

In summary, IGF1RM carriers showed a more pronounced growth retardation and lower response to rhGH therapy compared to non-mutation carriers, with high individual variability. Therefore, a critical reevaluation of success should be performed periodically. In adulthood, we could not observe a significant influence of IGF1RM on metabolism and health of carriers.
Perioperative Management of Pediatric Patients With Type 1 Diabetes Mellitus, Updated Recommendations for Anesthesiologists
Authors: Martin Lizabeth D. , Hoagland Monica A. , Rhodes Erinn T. , Wolfsdorf Joseph I. , Hamrick Jennifer L. ,   on behalf of the Society for Pediatric Anesthesia Quality and Safety Committee Diabetes Workgroup
Published: November 2019

Approximately 1 of every 300 children in the United States has type 1 diabetes mellitus (T1D), and these patients may require anesthetics for a variety of procedures. Perioperative coordination is complex, and attention to perioperative fasting, appropriate insulin administration, and management of hypo- and hyperglycemia, as well as other metabolic abnormalities, is required. Management decisions may be impacted by the patient’s baseline glycemic control and home insulin regimen, the type of procedure being performed, and expected postoperative recovery. If possible, preoperative planning with input from the patient’s endocrinologist is considered best practice. A multi-institutional working group was formed by the Society for Pediatric Anesthesia Quality and Safety Committee to review current guidelines in the endocrinology and anesthesia literature and provide recommendations to anesthesiologists caring for pediatric patients with T1D in the perioperative setting. Recommendations for preoperative evaluation, glucose monitoring, insulin administration, fluid management, and postoperative management are discussed, with particular attention to increasingly prevalent insulin pumps and continuous glucose monitoring (CGM).
Bradycardic Arrest During Somatosensory-Evoked Potential Monitoring: A Case Report
Authors: Morano Jacqueline M. , Tung Avery
Published: November 2019

Intraoperative neurophysiological monitoring involves electrical stimulation of nerve pathways and is used to assess the integrity of both motor and sensory pathways. Whereas motor pathway monitoring involves transcranial stimulation and peripheral nerve monitoring, somatosensory monitoring involves peripheral nerve stimulation and cranial monitoring. Arrhythmias are a known complication of motor-evoked potential monitoring but have not been reported with somatosensory monitoring. We describe a case of bradycardic arrest with somatosensory-evoked potential monitoring using median nerve electrodes in a patient with no previous rhythm abnormality. Clinicians caring for patients receiving somatosensory monitoring should be aware of the potential for severe arrhythmias.
“Our Sense of Purpose”: Speculative Fiction and Systems Reading
Authors: Allan Angela S.
Published: November 2019

This article reads Michael Crichton's Jurassic Park (1990) and Chang-rae Lee's On Such a Full Sea (2014) as works of speculative fiction that engage with the scientific concept of “the system” that emerged during the latter half of the twentieth century. It tracks this history, showing how ecologists and engineers generated their own speculative fictions of possible dystopian futures—environmental collapse, depletion of resources, and overpopulation—through models of dynamic systems. In turn, works of speculative fiction also began to borrow these models for understanding their own relationship to the world around them. This article argues that Jurassic Park and On Such a Full Sea reject the possibility of representing reality as a way to understand what a novel is. While speculative fiction primarily has been read as a popular vehicle for political critique, this article suggests how genre fiction can also generate new forms of literary critique and systems of reading.
Passive Versus Mentally Active Sedentary Behaviors and Depression
Authors: Hallgren Mats , Dunstan David W. , Owen Neville
Published: November 2019

Detrimental associations of sedentary behaviors with depression have been identified, but findings are inconsistent. We propose a novel approach to the classification and analysis of sedentary behaviors, which differentiates between those that are passive (e.g., television viewing) and mentally active (e.g., reading). Available evidence is summarized, and research questions relating to measurement, causal relationships, and mechanisms are considered.
Baseline and Exercise Predictors of V˙O2peak in Systolic Heart Failure Patients: Results from SMARTEX-HF
Authors: KARLSEN TRINE , VIDEM VIBEKE , HALLE MARTIN , ELLINGSEN ØYVIND , STØYLEN ASBJØRN , DALEN HÅVARD , DELAGARDELLE CHARLES , LARSEN ALF INGE , HOLE TORSTEIN , MEZZANI ALESSANDRO , VAN CRAENENBROECK EMELINE M. , BECKERS PAUL , PRESSLER AXEL , CHRISTLE JEFFREY W. , WINZER EPHRAIM B. , MANGNER NORMAN , WOITEK FELIX J. , HÖLLRIEGEL ROBERT , SNOER MARTIN , FEIEREISEN PATRICK , VALBORGLAND TORSTEIN , LINKE AXEL , PRESCOTT EVA
Published: November 2019

Purpose

This study aimed to investigate baseline, exercise testing, and exercise training–mediated predictors of change in peak oxygen uptake (V˙O2peak) from baseline to 12-wk follow-up (ΔV˙O2peak) in a post hoc analysis from the SMARTEX Heart Failure trial.

Methods

We studied 215 patients with heart failure with left ventricular ejection fraction (LVEF) ≤35%, and New York Heart Association (NYHA) classes II–III who were randomized to either supervised high-intensity interval training with exercise target intensity of 90%–95% of peak heart rate (HRpeak) or supervised moderate continuous training (MCT) with target intensity of 60%–70% of HRpeak, or who received a recommendation of regular exercise on their own. Predictors of ΔV˙O2peak were assessed in two models: a logistic regression model comparing highest and lowest tertiles (baseline parameters) and a multivariate linear regression model (test/training/clinical parameters).

Results

The change in V˙O2peak in response to the interventions (ΔV˙O2peak) varied substantially, from −8.50 to +11.30 mL·kg−1·min−1. Baseline NYHA (class II gave higher odds vs III; odds ratio (OR), 7.1 (2.0–24.9); P = 0.002), LVEF (OR per percent, 1.1 (1.0–1.2); P = 0.005), and age (OR per 10 yr, 0.5 (0.3–0.8); P = 0.003) were associated with ΔV˙O2peak.

In the multivariate linear regression, 34% of the variability in ΔV˙O2peak was explained by the increase in exercise training workload, ΔHRpeak between baseline and 12-wk posttesting, age, and ever having smoked.

Conclusion

Exercise training response (ΔV˙O2peak) correlated negatively with age, LVEF, and NYHA class. The ability to increase workload during the training period and increased ΔHRpeak between baseline and the 12-wk test were associated with a positive outcome.
A Joint Power Approach to Define Countermovement Jump Phases Using Force Platforms
Authors: HARRY JOHN R. , BARKER LELAND A. , PAQUETTE MAX R.
Published: November 2019

Conflicting methodologies are used to define certain countermovement vertical jump (CMVJ) phases, which limits the identification of performance-enhancing factors (e.g., rate of force development).

Purpose

We (a) utilized a joint power approach to define CMVJ phases that accurately describe body weight unloading (i.e., unweighting) and eccentric (i.e., braking) actions, which were combined with the robustly defined concentric (i.e., propulsion) phase, and (b) determined whether the phases can be identified using only ground reaction force (GRF) data.

Methods

Twenty-one men performed eight maximal CMVJs while kinematic and GRF data were obtained. Hip, knee, and ankle joint powers were calculated by multiplying net joint moments (obtained using inverse dynamics) by joint angular velocities. The net sum of the joint powers (JPSUM) was calculated to define phases by the preeminence of negative (i.e., net eccentric actions) or positive (i.e., net concentric actions) power where appropriate. Unloading, eccentric, and concentric phases were identified using JPSUM and linked to GRF and center of mass velocity features.

Results

Bland and Altman plots of the bias and 95% confidence intervals for the limits of agreement (LOA), intraclass correlation coefficients (ICC), and coefficients of variation (CV) indicated precise agreement for detecting the unloading (bias, 0.060 s; LOA, −0.110 to 0.229 s) and eccentric (bias, 0.012 s; LOA, −0.010 to 0.040 s) phases with moderate (ICC, 0.578; CV, 40.72%) and excellent (ICC, 0.993; CV, 2.18%) reliability, respectively. The eccentric phase should be divided into yielding (eccentric actions while accelerating downward) and braking (eccentric actions while decelerating downward) subphases for detailed assessments.

Conclusion

CMVJ phases defined by combining joint and center of mass mechanics can be detected using only force platform data, enabling functionally relevant CMVJ assessments using instrumentation commonly available to practitioners.
Planned Aerobic Exercise Increases Energy Intake at the Preceding Meal
Authors: BARUTCU ASYA , TAYLOR SHELLEY , MCLEOD CHRIS J. , WITCOMB GEMMA L. , JAMES LEWIS J.
Published: November 2019

Purpose

Effects of exercise on subsequent energy intake are well documented, but whether preexercise energy intake is affected by future planned exercise is unknown. This study investigated the effect of planned late-afternoon exercise on appetite and energy intake before (breakfast and lunch) and after (evening meal/snacks) exercise.

Methods

Twenty healthy, active participants (10 male; age, 23 ± 5 yr; body mass index 23.7 ± 3.2 kg·m−2; V˙O2peak, 44.1 ± 5.4 mL·kg·−1·min−1) completed randomized, counterbalanced exercise (EX) and resting (REST) trials. After trial notification, participants were provided ad libitum breakfast (0800 h) and lunch (1200 h) in the laboratory, before completing 1-h exercise (30-min cycling, 30-min running) at 75%–80% maximal HR (EX, 2661 ± 783 kJ) or 1-h supine rest (REST, 310 ± 58 kJ) 3 h after lunch. Participants were provided a food pack (pasta meal/snacks) for consumption after exercise (outside laboratory). Appetite was measured regularly, and meal and 24-h energy intake were quantified.

Results

Ad libitum energy intake was greater during EX at lunch (EX, 3450 ± 1049 kJ; REST, 3103 ± 927 kJ; P = 0.004), but similar between trials at breakfast (EX, 2656 ± 1291 kJ; REST, 2484 ± 1156 kJ; P = 0.648) and dinner (EX, 6249 ± 2216 kJ; REST, 6240 ± 2585 kJ; P = 0.784). Total 24-h energy intake was similar between trials (P = 0.388), meaning that relative energy intake (24-h energy intake minus EX/REST energy expenditure) was reduced during EX (EX, 9694 ± 3313 kJ; REST, 11,517 ± 4023 kJ; P = 0.004).

Conclusion

Energy intake seems to be increased in anticipation of, rather than in response to, aerobic exercise, but the increase was insufficient to compensate for energy expended during exercise, meaning that aerobic exercise reduced energy balance relative to rest.