bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of platelet‐rich fibrin and cellulose in palatal wounds after graft harvesting
Authors: Patarapongsanti Arada , Bandhaya Panwadee , Sirinirund Benyapha , Khongkhunthian Sakornratana , Khongkhunthian Pathawee
Published: September 2019

Aim

The aim of the present study was to compare patient morbidity and healing outcomes of free gingival graft (FGG) harvesting at palatal donor sites and after using platelet‐rich fibrin (PRF) and oxidized regenerated cellulose (ORC). FGG harvesting leaves open palatal wounds, which heal by secondary intention. Patients might experience discomfort or pain during the first 2 weeks of healing.

Methods

Eighteen participants requiring two FGG were recruited. The test and control sites were covered with PRF membrane and ORC. The complete epithelialization of the palatal wound, the percentage of wound healing, and postoperative pain were evaluated, 1, 3, and 7 days and 2, 3, and 4 weeks after surgery.

Results

Similar wound size reduction at 1 week (test: 36.87%, control: 38.78%) was found. At 2 weeks, the majority of the test group (88.89%) showed complete epithelialization, whereas 66.67% of the control group had complete epithelialization (P = .228). Pain was more prevalent in the control group (27.77%) than in the test group (11.1%) on day 1. None of the participants reported any pain or discomfort at the test sites on day 3.

Conclusions

PRF seems to reduce patient morbidity, but there is no difference in palatal wound healing (P > .05).
A novel 3‐oxoacyl‐ACP reductase (FabG3) is involved in the xanthomonadin biosynthesis of Xanthomonas campestris pv. campestris
Authors: Yu Yonghong , Ma Jianrong , Guo Qiaoqiao , Ma Jincheng , Wang Haihong
Published: September 2019

Xanthomonas campestris pv. campestris (Xcc), the causal agent of black rot in crucifers, produces a membrane‐bound yellow pigment called xanthomonadin to protect against photobiological and peroxidative damage, and uses a quorum‐sensing mechanism mediated by the diffusible signal factor (DSF) family signals to regulate virulence factors production. The Xcc gene XCC4003, annotated as Xcc fabG3, is located in the pig cluster, which may be responsible for xanthomonadin synthesis. We report that fabG3 expression restored the growth of the Escherichia coli fabG temperature‐sensitive mutant CL104 under non‐permissive conditions. In vitro assays demonstrated that FabG3 catalyses the reduction of 3‐oxoacyl‐acyl carrier protein (ACP) intermediates in fatty acid synthetic reactions, although FabG3 had a lower activity than FabG1. Moreover, the fabG3 deletion did not affect growth or fatty acid composition. These results indicate that Xcc fabG3 encodes a 3‐oxoacyl‐ACP reductase, but is not essential for growth or fatty acid synthesis. However, the Xcc fabG3 knock‐out mutant abolished xanthomonadin production, which could be only restored by wild‐type fabG3, but not by other 3‐oxoacyl‐ACP reductase‐encoding genes, indicating that Xcc FabG3 is specifically involved in xanthomonadin biosynthesis. Additionally, our study also shows that the Xcc fabG3‐disrupted mutant affects Xcc virulence in host plants.
Transcriptome reprogramming in the shoot apical meristem of CymRSV‐infected Nicotiana benthamiana plants associates with viral exclusion and the lack of recovery
Authors: Medzihradszky Anna , Gyula Péter , Sós‐Hegedűs Anita , Szittya György , Burgyán József
Published: September 2019

In some plant–virus interactions plants show a sign of healing from virus infection, a phenomenon called symptom recovery. It is assumed that the meristem exclusion of the virus is essential to this process. The discovery of RNA silencing provided a possible mechanism to explain meristem exclusion and recovery. Here we show evidence that silencing is not the reason for meristem exclusion in Nicotiana benthamiana plants infected with Cymbidium ringspot virus (CymRSV). Transcriptome analysis followed by in situ hybridization shed light on the changes in gene expression in the shoot apical meristem (SAM) on virus infection. We observed the down‐regulation of meristem‐specific genes, including WUSCHEL (WUS). However, WUS was not down‐regulated in the SAM of plants infected with meristem‐invading viruses such as turnip vein‐clearing virus (TVCV) and cucumber mosaic virus (CMV). Moreover, there is no connection between loss of meristem function and fast shoot necrosis since TVCV necrotized the shoot while CMV did not. Our findings suggest that the observed transcriptional changes on virus infection in the shoot are key factors in tip necrosis and symptom recovery. We observed a lack of GLYCERALDEHYDE 3-PHOSPHATE DEHYDROGENASE (GAPDH) expression in tissues around the meristem, which likely stops virus replication and spread into the meristem.
Early unplanned return visits to a pediatric emergency department in Israel
Authors: Reiser Or , Diamand Raz , Shavit Itai
Published: September 2019

Background

Early unplanned return visits (EURV) to the emergency department (ED) are stressful for children and caregivers. Dissatisfaction with the first ED visit could influence the decision to revisit the ED. The aim was to evaluate comprehensively parents’ satisfaction with the first ED visit.

Methods

A prospective questionnaire‐based study of parents of EURV patients was conducted in a pediatric ED. Participants were enrolled based on convenience sampling. The study instrument was the parental satisfaction questionnaire (PSQ). The 27 PSQ items evaluate four themes related to satisfaction: attitude and respect, information provided, continuity of care, and waiting times. Items are rated on a five‐point Likert scale.

Results

During the 18‐month study, 101 parents of EURV patients were surveyed and 98 agreed to participate. On the return visit, 63 EURV patients were discharged and 35 EURV patients were hospitalized. Eighty‐seven (88.7%) caregivers scored an overall level of satisfaction with the first visit of 8–10 on a 10‐point Likert scale. Median scores in 22 PSQ items were 4 (interquartile range [IQR] 4–5) or 4 (IQR 3–4). Median scores for “physicians attention and answering questions and concern” and “physicians clear and understood explanations” were 3 (IQR 3–4) and 2 (IQR 2–3), respectively. The PSQ scores were similar for patients who were discharged on the return visit and patients who were hospitalized.

Conclusions

Parents were satisfied with the care provided at the first ED visit. There was a lower level of satisfaction with physician interaction.
The effects of bosentan on hyperoxia‐induced lung injury in neonatal rats
Authors: Özdemir Özmert MA , Taban Özgün , Enli Yaşar , Bir Ferda , Şahin Barbaros , Ergin Hacer
Published: September 2019

Background

Bronchopulmonary dysplasia (BPD) remains an important cause of morbidity and mortality in premature infants. There is currently no proven effective treatment modality for BPD, and inflammation and oxidative injury play an important role in the pathogenesis of this disease. This study investigated the histopathological and biochemical effects of bosentan, which is a non‐specific endothelin receptor antagonist with known antioxidant and anti‐inflammatory properties, on hyperoxia‐induced lung injury (HILI) in neonatal rats.

Methods

The experiment was performed on newborn rats from the 3rd to the 13th postnatal day. The rats were randomly divided into six groups: Group 1 (air‐exposed + saline, n = 6); Group 2 (HILI, n = 8); Group 3 (air‐exposed + bosentan, n = 7); Group 4 (HILI + saline, n = 7); Group 5 (HILI + early bosentan‐treated group, n = 6), and Group 6 (HILI + late bosentan‐treated group, n = 7). Bosentan was administered (30 mg/kg/day) intraperitoneally. The histopathological effects of bosentan on lung tissue were assessed by their alveolar surface area, fibrosis, and smooth muscle actin (SMA) scores, and the biochemical effects on lung tissue were assessed by interleukin‐1 beta (IL‐1β), IL‐6, IL‐10, and tumor necrosis factor‐alpha (TNF‐α).

Results

The alveolar surface area and fibrosis scores were found to be significantly higher in HILI groups compared with Group 1 (P < 0.01). The SMA scores in HILI groups were also significantly higher than Group 1 (P < 0.01). Bosentan treatment, especially late therapy, reduced all of these histopathological scores and the levels of IL‐6 and TNF‐α in the hyperoxia groups (P < 0.01).

Conclusion

This experimental study showed that bosentan had a protective effect on hyperoxic lung injury through its anti‐inflammatory properties.
Proportion of goblet cell is associated with malignant potential in invasive mucinous adenocarcinoma of the lung
Authors: Oki Tomonari , Aokage Keiju , Ueda Takuya , Sugano Masato , Tane Kenta , Miyoshi Tomohiro , Kojima Motohiro , Fujii Satoshi , Kuwata Takeshi , Ochiai Atsushi , Funai Kazuhito , Tsuboi Masahiro , Ishii Genichiro
Published: September 2019

Invasive mucinous adenocarcinoma (IMA) is a newly classified variant of lung adenocarcinoma. The aim of this study was to examine the correlation between the proportion of goblet cells and the clinicopathological characteristics of IMA. Ninety‐nine patients with stage I IMA were included in this study. We estimated prognostic impact of goblet cell proportion. We classified them into two groups: the cases with a high goblet cell proportion (HGP, goblet cell proportion ≥80%) and the cases with a low goblet cell proportion (LGP, goblet cell proportion ≤30%), and compared the expression levels of five cancer progression markers and the number of tumor‐promoting stromal cells between the two groups. Univariate and multivariate analysis revealed that the goblet cell proportion was a prognostic factor for recurrence free survival (P < 0.01) and overall survival (P = 0.01). The expression levels of the cancer stem cell‐related marker, ALDH‐1, and proliferation‐related marker, geminin were significantly higher in the LGP group than in the HGP group. CD204+ tumor‐associated macrophages were significantly more in the LGP stroma than the HGP stroma. Our current study indicated that the proportion of goblet cells was correlated with the malignant potential in surgically resected IMA.
Targeting the Motivated? Ethnicity and the Pre‐emptive Use of Government Repression
Authors: Beiser‐McGrath Janina
Published: September 2019

Research on government repression often focuses on the comparison between states over time and provides little insight about the targets of repression within a state. This article unpacks government repression against different ethnic groups. It argues that non‐democratic governments use pre‐emptive and targeted repression against ethnic groups that are discriminated, strong, or have a history of protest or rebellion in order to prevent future ethnic rebellions. For democratic governments, on the other hand, the cost of pre‐emptive repression is too high. The article tests this argument in a quantitative analysis of government‐group dyads. It finds at least partial support for some implications of the argument: Autocratic governments use more repression than democracies against discriminated groups, but only when they are also weak, and against groups with a history of protest. There is little evidence that regimes of either type respond to previous violent mobilization or group strength with repression.
Characterization of repeat arrays in ultra‐long nanopore reads reveals frequent origin of satellite DNA from retrotransposon‐derived tandem repeats
Authors: Vondrak Tihana , Ávila Robledillo Laura , Novák Petr , Koblížková Andrea , Neumann Pavel , Macas Jiří
Published: September 2019

Amplification of monomer sequences into long contiguous arrays is the main feature distinguishing satellite DNA from other tandem repeats, yet it is also the main obstacle in its investigation because these arrays are in principle difficult to assemble. Here we explore an alternative, assembly‐free approach that utilizes ultra‐long Oxford Nanopore reads to infer the length distribution of satellite repeat arrays, their association with other repeats and the prevailing sequence periodicities. Using the satellite DNA‐rich legume plant Lathyrus sativus as a model, we demonstrated this approach by analyzing 11 major satellite repeats using a set of nanopore reads ranging from 30 to over 200 kb in length and representing 0.73× genome coverage. We found surprising differences between the analyzed repeats because only two of them were predominantly organized in long arrays typical for satellite DNA. The remaining nine satellites were found to be derived from short tandem arrays located within LTR‐retrotransposons that occasionally expanded in length. While the corresponding LTR‐retrotransposons were dispersed across the genome, this array expansion occurred mainly in the primary constrictions of the L. sativus chromosomes, which suggests that these genome regions are favourable for satellite DNA accumulation.
A Course-Based Undergraduate Research Experience in Biofluid Mechanics
Authors: Clyne Alisa Morss , Shieh Adrian C. , Stanford Jennifer S.
Published: September 2019

Course-based undergraduate research experiences (CURE) are a valuable tool to increase research exposure for larger undergraduate cohorts. We implemented a CURE within a senior-level biofluid mechanics course that was primarily taught using a flipped classroom approach. Due to the large class size, the students analyzed data that was publicly available and produced by one of our laboratories. Student teams then developed hypotheses based on the data analysis and designed a set of in vitro and in vivo experiments to test those hypotheses. The hypotheses and experiments that were most highly rated by the class were then tested in our laboratory. At the end of the class, student gains were assessed by self-report and compared to those self-reported by students engaging in a traditional freshman undergraduate summer research experience. While the students in the CURE reported moderate gains in self-assessment of research-based skills, their self-reported gains were statistically significantly lower than those reported by students who participated in the traditional research experience. We believe that the CURE could be improved through implementation in a lower level class, enabling students to observe laboratory experiments, and providing additional feedback throughout the hypothesis development and experimental design process. Overall, the CURE is an innovative way to expand research experiences, in particular for engineering students who often do not participate in hypothesis-driven research during their undergraduate education.
On Bore Dynamics and Pressure: RANS, Green-Naghdi, and Saint-Venant Equations
Authors: Liu Jiaqi , Hayatdavoodi Masoud , Ertekin R. Cengiz
Published: September 2019

Propagation and impact of two- and three-dimensional bores generated by breaking of a water reservoir is studies by use of three theoretical models. These include the Reynolds-averaged Navier–Stokes (RANS) equations, the level I Green-Naghdi (GN) equations, and the Saint-Venant (SV) equations. Two types of bore generations are considered, namely, (i) bore generated by dam-break, where the reservoir water depth is substantially larger than the downstream water depth, and (ii) bore generated by an initial mound of water, where the reservoir water depth is larger but comparable to the downstream water depth. Each of these conditions corresponds to different natural phenomena. This study shows that the relative water depth plays a significant role on the bore shape, stability, and impact. Particular attention is given to the bore pressure on horizontal and vertical surfaces. The effect of fluid viscosity is studied by use of different turbulence closure models. Both two- and three-dimensional computations are performed to study their effect on bore dynamics. Results of the theoretical models are compared with each other and with available laboratory experiments. Information is provided on bore kinematics and dynamics predicted by each of these models. Discussion is given on the assumptions made by each model and differences in their results. In summary, SV equations have substantially simplified the physics of the problem, while results of the GN equations compare well with the RANS equations, with incomparable computational cost. RANS equations provide further details about the physics of the problem.
Imaging the native inversion layer under buried oxide in silicon-on-insulator radio frequency device technology via scanning surface photovoltage microscopy
Authors: Dahanayaka Daminda H. , Kaszuba Philip V. , Moszkowicz Leon , Wells Randall H. , Alwine Franklin J. , Phelps Richard A. , Slinkman James A. , Wong Andrew A. , Bumm Lloyd A.
Published: September 2019

For radio frequency (RF) wireless integrated circuits and devices fabricated on silicon-on-insulator technologies, there has been indirect evidence of the presence of a parasitic native inversion layer, due to an effective trapped charge, “Q+,” at the interface of the buried oxide (BOX) and the underlying high resistivity p-type Si substrate in production level wafers. This inversion layer can have adverse implications for the RF performance of active devices fabricated for use in wireless technologies, notably the “RF switch.” In this study, the authors characterize the complementary-metal-oxide-semiconductor field effect RF transistor used in such a switch. The FET is built on the active epitaxial silicon layer on top of the BOX layer; its purpose is to control input and output RF signals in integrated wireless circuitry. Using scanning surface photovoltage microscopy, the authors present the first data to show quantitatively the extent of this inversion layer into the substrate. They also present device electrical performance data proving the effectiveness of the processes used to suppress the effects of Q+.
Electron beam lithography on curved or tilted surfaces: Simulations and experiments
Authors: Arat Kerim T. , Zonnevylle Aernout C. , Ketelaars Wilhelmus S. M. M. , Belic Nikola , Hofmann Ulrich , Hagen Cornelis W.
Published: September 2019

There is a growing interest for patterning on curved or tilted surfaces using electron beam lithography. Computational proximity correction techniques are well established for flat surfaces and perpendicular exposure, but for curved and tilted surfaces adjustments are needed as the dose distribution is no longer cylindrically symmetric with respect to the surface normal. A graphical processing unit -accelerated 3D Monte Carlo simulation, based on first-principle scattering models, is used to simulate the asymmetric dose distribution. Based on that, an approximate adjustment is made to an existing high-performance proximity effect correction (PEC) algorithm aimed at the correct exposure of a pattern of nanowires on a 17° tilted surface. It was experimentally verified that using the adjusted PEC indeed leads to a more uniform exposure on tilted surfaces.
“Learning the Hard Way”: Understanding the Workplace Learning of Sports Coach Mentors
Authors: Leeder Thomas M. , Russell Kate , Beaumont Lee C.
Published: September 2019

The purpose of this study was to understand the workplace learning of sports coach mentors. Semi-structured interviews were conducted with 18 coach mentors employed by a sport governing body (SGB) as part of a formalised mentoring programme. ‘Current’ coach mentors (n = 9) had been employed for a minimum of one year by the organisation and were all interviewed once. ‘New’ coach mentors (n = 9) were all interviewed twice, once at the start of their employment and once again 9 months later. Moreover, regional mentors (n = 8) who oversee the training and practice of the coach mentors participated in one focus group. Data were analysed thematically, with the sociology of Pierre Bourdieu and relevant workplace learning literature used to support the analytical process. The findings highlight how habitus structures coach mentors’ participation in learning opportunities afforded to them in the workplace. In addition, habitus and embodied capital will impact how coach mentors interact with and interpret mentor training, whilst influencing their level of engagement with other employees. It is argued SGB social fields are crucial in the production of promoted norms and ‘legitimate’ knowledge within workplaces, which subsequently influences mentor learning. Recommendations are made for critically transformative approaches to training coach mentors.
Scaffolding Women Coaches’ Development: A Program to Build Coaches’ Competence and Confidence
Authors: Allen Justine B. , Reid Colleen
Published: September 2019

Research continues to demonstrate the underrepresentation of women coaches and that barriers outweigh support. The purpose of this practical article is to describe the process undertaken by a National Governing Body of Sport to deliver a learning and development program to support women hockey coaches in Scotland, the Women in Coaching program. Our aim is to share understanding about this example of good practice to provide insight and direction for change that can enhance the experiences and provisions of coach education and development for women coaches. First, we explain the use of scaffolding as a concept to capture the approach adopted in the program to bring together a range of learning situations (e.g., coach education, workshops, systematic observation of coaching practice, mentoring). We then describe and discuss the evidence gathered to inform program development (i.e., workforce analysis, interviews with coaches). Next the delivery of the program and assessment of its impact are discussed (i.e., pre-post self-perceptions, players’ perceptions, coaching behaviors, reflective survey). Finally we present best practices based on the lessons learned from our involvement with the program over the past six years.
Escherichia coli B2 Phylogenetic Subgroups in the Infant Gut Microbiota: Predominance of Uropathogenic Lineages in Swedish Infants and Enteropathogenic Lineages in Pakistani Infants
Authors: Nowrouzian Forough L. , Clermont Olivier , Edin Mona , Östblom Anna , Denamur Erick , Wold Agnes E. , Adlerberth Ingegerd
Published: September 2019

The intestinal microbiota is an important reservoir for bacteria that cause extraintestinal infections.
Escherichia coli
is found ubiquitously in the gut microbiota, and it also causes urinary tract infections, infantile septicemia, and meningitis. Urinary tract infections are usually caused by
E. coli
strains that originate in the intestinal microbiota.
E. coli
also causes gastrointestinal infections and is a major cause of diarrhea in infants worldwide. The abilities of certain
E. coli
strains to cause infections are attributed to their virulence factors, i.e., bacterial components that contribute to the development of different diseases. Our study shows that different subtypes of potentially pathogenic
E. coli
strains dominate in the gut microbiota of infants in different geographical areas and expands our knowledge of the interplay between bacterial commensalism and pathogenicity.
Implication of Broadly Neutralizing Bovine Monoclonal Antibodies in the Development of an Enzyme-Linked Immunosorbent Assay for Detecting Neutralizing Antibodies against Foot-and-Mouth Disease Virus Serotype O
Authors: Cao Yimei , Li Kun , Wang Sheng , Fu Yuanfang , Sun Pu , Li Pinghua , Bai Xingwen , Zhang Jing , Ma Xueqing , Xing Xiangchuan , Zhou Shasha , Bao Huifang , Li Dong , Chen Yingli , Li Zhiyong , Lu Zengjun , Liu Zaixin
Published: September 2019

Vaccination with inactivated vaccines is still the main measure to control foot-and-mouth disease (FMD) in areas where the disease is endemic, and the level of neutralizing antibody in vaccinated animals is directly related to their protection against virus challenge. Currently, neutralizing antibody is mainly detected using the virus neutralization test (VNT) based on cell culture, which is laborious and time-consuming and requires restrictive biocontainment facilities.
Clearance of Chikungunya Virus Infection in Lymphoid Tissues Is Promoted by Treatment with an Agonistic Anti-CD137 Antibody
Authors: Hong Jun P. , McCarthy Mary K. , Davenport Bennett J. , Morrison Thomas E. , Diamond Michael S.
Published: September 2019

Although CHIKV causes persistent infection in lymphoid and musculoskeletal tissues in multiple animals, the basis for this is poorly understood, which has hampered pharmacological efforts to promote viral clearance. Here, we evaluated the therapeutic effects on persistent CHIKV infection of an agonistic anti-CD137 MAb that can activate T cell and natural killer cell responses to clear tumors. We show that treatment with anti-CD137 MAb promotes the clearance of persistent alphavirus RNA from lymphoid but not musculoskeletal tissues. This occurs because anti-CD137 MAb-triggered T cells reduce the numbers of target germinal center B cells and follicular dendritic cells, which are the primary reservoirs for CHIKV in the spleen and lymph nodes. Our studies help to elucidate the basis for CHIKV persistence and begin to provide strategies that can clear long-term cellular reservoirs of infection.
How effective are ‘age’ tools at changing patient behaviour? A rapid review
Authors: Kulendrarajah Bavidra , Grey Adam , Nunan David
Published: September 2019

Background

A common form of risk communication is to relay the relative risk (%) of an adverse outcome based on surrogate markers associated with the outcome. A novel way of communicating risk is through ‘effective age’ of a person or specific organ. These tools can be used to change patient behaviour.

Objective

To determine the effect of ‘effective age’ tools on patient behaviour as compared with more traditional methods of risk communication.

Study selection

We performed a search of the PubMed database up to February 2019 for systematic reviews and randomised controlled trials (RCT) that answered our question. Interventions were ‘effective age’ tools, comparators were usual care or alternative risk communication tools. Primary outcomes were behavioural change measures.

Findings

We included 1 overview of systematic reviews (level 1 evidence), 2 systematic reviews (level 1 evidence) and 13 RCTs (level 2 evidence). Both systematic reviews concluded the evidence base was not conclusive enough to make specific recommendations.

Age tools assessed in the 13 RCTs were: ‘lung age’ (n=5), ‘heart age’ (n=3), ‘health age’ (n=2), ‘cardiovascular age’ (n=1), ‘body age’ (n=1) and ‘net present value’ (n=1). 7/13 (54%) RCTs demonstrated a clinical effect on behaviour change favouring the ‘age’ tool; 2/13 (15%) demonstrated a null effect; 4/13 (31%) favoured control.

Conclusions

Our findings indicate that systematic review evidence needs updating. The evidence from RCTs on the effect of using age metrics on patient behaviour is poor. There is a need for high-quality trials to decrease uncertainty in the available evidence.
Understanding men’s psychological reactions and experience following a cardiac event: a qualitative study from the MindTheHeart project
Authors: Jbilou Jalila , Grenier Jean , Chomienne Marie-Helene , Talbot France , Tulloch Heather , D'Antono Bianca , Greenman Paul
Published: September 2019

Objectives

Emotional issues such as depression, anxiety and post-traumatic stress disorder are common following a cardiac event. Despite their high prevalence, they often go undiagnosed and research suggests that men in particular are at higher risk. Therefore, a better understanding of men’s experiences with a cardiac event and ensuing health services is key for adapting approaches that meet their needs. The aim of this study was to describe the self-reported emotional challenges that men face following a cardiac event and to understand their patterns of psychosocial adjustment.

Design

Qualitative study (focus groups and one-on-one interviews) using an interpretive phenomenal analysis.

Setting

Clinical settings (cardiac departments in hospitals, cardiac rehabilitation programme and family medicine clinics) and in the community in three Canadian provinces.

Participants

A total of 93 men participated in the study through 22 focus groups and 5 semi-structured interviews, none has been excluded based on comorbidities.

Results

Four major themes emerged: (1) managing uncertainty and adversity; (2) distancing, normalising and accepting; (3) conformity to traditional masculine norms and (4) social, literacy and communication challenges.

Conclusions

Healthcare professionals caring for men following a cardiac event must be aware of the psychological and social adjustments that accompany the physical challenges. However, there is a lack of explicit guidelines, tools and clinical training in men-sensitive approaches. Further research is required to better inform clinical practices and healthcare services.
Trends in socioeconomic inequalities in self-rated health in Germany: a time-trend analysis of repeated cross-sectional health surveys between 2003 and 2012
Authors: Wachtler Benjamin , Hoebel Jens , Lampert Thomas
Published: September 2019

Objectives

This study assessed the extent of educational and income inequalities in self-rated health (SRH) in the German adult population between 2003 and 2012 and how these inequalities changed over time.

Design

Repeated cross-sectional health interview surveys conducted in 2003, 2009, 2010 and 2012.

Setting and participants

The study population was the German adult population aged 25–69, living in private households in Germany. In total 54 197 randomly selected participants (2003: 6890; 2009: 16 418; 2010: 17 145; 2012: 13 744) were included.

Main outcome measures

SRH was assessed with one single question. Five answer categories were dichotomised into good (‘very good’ and ‘good’) versus poor (‘moderate’, ‘poor’, ‘very poor’) SRH. To estimate the extent of the correlation between absolute and relative inequalities in SRH on the one hand, and income and education on the other; slope indices of inequality (SII) and relative indices of inequality (RII) were estimated using linear probability and log-binomial regression models.

Results

There were considerable and persisting educational and income inequalities in SRH in every survey year. Absolute educational inequalities were largely stable (2003: SII=0.25, 95% CI 0.21 to 0.30; 2012: 0.29, 95% CI 0.25 to 0.33; p trend=0.359). Similarly, absolute income inequalities were stable (2003: SII=0.22, 95% CI 0.17 to 0.27; 2012: SII=0.26, 95% CI 0.22 to 0.30; p trend=0.168). RII by education (2003: 2.53, 95% CI 2.11 to 3.03; 2012: 2.72, 95% CI 2.36 to 3.13; p trend=0.531) and income (2003: 2.09. 95% CI 1.75 to 2.49; 2012: 2.53, 95% CI 2.19 to 2.92; p trend=0.051) were equally stable over the same period.

Conclusions

We found considerable and persisting absolute and relative socioeconomic inequalities in SRH in the German adult population between 2003 and 2012, with those in lower socioeconomic position reporting poorer SRH. These findings should be a concern for both public health professionals and political decision makers.
Delivering the right information to the right person at the right time to facilitate deprescribing in hospital: a mixed methods multisite study to inform decision support design in Australia
Authors: Baysari Melissa T , Duong Mai , Zheng Wu Yi , Nguyen Amy , Lo Sarita , Ng Brendan , Ritchie Angus , Le Couteur David , McLachlan Andrew , Bennett Alexandra , Hilmer Sarah
Published: September 2019

Objectives

To inform the design of electronic decision support (EDS) to facilitate deprescribing in hospitals we set out to (1) explore the current processes of in-hospital medicines review, deprescribing and communication of deprescribing decisions with the patient’s general practitioner (GP), (2) identify barriers to undertaking these tasks and (3) determine user preferences for EDS.

Design

Multimethod, multisite study comprising observations, semistructured interviews and focus groups.

Setting

General medicine, geriatric medicine and rehabilitation wards at six hospitals in two local health districts in Sydney, Australia and primary care practices in one primary healthcare district in Sydney, Australia.

Participants

149 participants took part in observations, interviews and focus groups, including 69 hospital doctors, 13 nurses, 55 pharmacists and 12 GPs.

Main outcome measures

Observational data on who was involved in medicines review and deprescribing, when medicines review took place, and what artefacts (eg, forms) were used. Participants reported perceptions of medicines review, polypharmacy and deprescribing and preferences for EDS.

Results

Deprescribing, undertaken during medicines review, was typically performed by a junior doctor, following a decision to deprescribe by a senior doctor. Key barriers to deprescribing included a perception that deprescribing was not the responsibility of hospital doctors, a lack of confidence among junior doctors and pharmacists in broaching this topic with senior doctors and a lack of patient engagement in the deprescribing process. In designing EDS, the tools, likely to be used by junior doctors, pharmacists and nurses, should be available throughout the hospitalisation and should comprise non-interruptive evidence-based guidance on why and how to deprescribe.

Conclusions

Deprescribing decisions are complex and influenced by multiple factors. The implementation of EDS alone is unlikely to address all barriers identified. To achieve sustained improvements in monitoring of polypharmacy and subsequent deprescribing, a multifaceted intervention is needed.
Non-medical determinants of perinatal health: protocol for a systematic review with meta-analysis
Authors: Daalderop Leonie A , de Groot Marjolein W , van der Meer Lindsey , Steegers Eric A P , Bertens Loes C M
Published: September 2019

Introduction

Research focusing on the associations between non-medical determinants and unfavourable perinatal health outcomes is increasing. Despite increasing knowledge on this theme, it still remains unclear to what extent social, environmental and lifestyle factors contribute to these unfavourable outcomes. Therefore, we aim to provide a systematic review, preferably with meta-analysis, in order to provide insight into the associations between non-medical determinants and perinatal mortality, preterm birth and being small for gestational age (SGA).

Methods and analysis

Observational studies performed in European countries studying the associations between non-medical determinants and unfavourable perinatal health outcomes will be included. Primary outcomes of interest are perinatal mortality, preterm birth and SGA. To retrieve potential eligible articles, a systematic literature search was performed in the following online databases on 5 October 2018: MEDLINE, Embase, Web of Science, Cochrane and Google Scholar. Additionally, a reference list check and citation search will be performed. Data of the included articles will be extracted using a standardised and piloted data extraction form. Risk of bias will be assessed using the Newcastle-Ottawa Scale. The study selection and data extraction process will be performed by two reviewers independently. Disagreements will be resolved through discussion with a third reviewer. The pooled effects will be calculated separately for each association found between one of the outcome measures and the non-medical determinants using a random effects model. Heterogeneity of the studies will be assessed using the I2statistic.

Ethics and dissemination

No ethical approval is necessary for a systematic review with meta-analysis. The findings will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42018056105.
Development and validation of multivariable clinical diagnostic models to identify type 1 diabetes requiring rapid insulin therapy in adults aged 18–50 years
Authors: Lynam Anita , McDonald Timothy , Hill Anita , Dennis John , Oram Richard , Pearson Ewan , Weedon Michael , Hattersley Andrew , Owen Katharine , Shields Beverley , Jones Angus
Published: September 2019

Objective

To develop and validate multivariable clinical diagnostic models to assist distinguishing between type 1 and type 2 diabetes in adults aged 18–50.

Design

Multivariable logistic regression analysis was used to develop classification models integrating five pre-specified predictor variables, including clinical features (age of diagnosis, body mass index) and clinical biomarkers (GADA and Islet Antigen 2 islet autoantibodies, Type 1 Diabetes Genetic Risk Score), to identify type 1 diabetes with rapid insulin requirement using data from existing cohorts.

Setting

UK cohorts recruited from primary and secondary care.

Participants

1352 (model development) and 582 (external validation) participants diagnosed with diabetes between the age of 18 and 50 years of white European origin.

Main outcome measures

Type 1 diabetes was defined by rapid insulin requirement (within 3 years of diagnosis) and severe endogenous insulin deficiency (C-peptide <200 pmol/L). Type 2 diabetes was defined by either a lack of rapid insulin requirement or, where insulin treated within 3 years, retained endogenous insulin secretion (C-peptide >600 pmol/L at ≥5 years diabetes duration). Model performance was assessed using area under the receiver operating characteristic curve (ROC AUC), and internal and external validation.

Results

Type 1 diabetes was present in 13% of participants in the development cohort. All five predictor variables were discriminative and independent predictors of type 1 diabetes (p<0.001 for all) with individual ROC AUC ranging from 0.82 to 0.85. Model performance was high: ROC AUC range 0.90 (95% CI 0.88 to 0.93) (clinical features only) to 0.97 (95% CI 0.96 to 0.98) (all predictors) with low prediction error. Results were consistent in external validation (clinical features and GADA ROC AUC 0.93 (0.90 to 0.96)).

Conclusions

Clinical diagnostic models integrating clinical features with biomarkers have high accuracy for identifying type 1 diabetes with rapid insulin requirement, and could assist clinicians and researchers in accurately identifying patients with type 1 diabetes.
Examining the effects of low back pain and mental health symptoms on healthcare utilisation and costs: a protocol for a population-based cohort study
Authors: Wong Jessica J , Côté Pierre , Tricco Andrea C , Rosella Laura C
Published: September 2019

Introduction

Low back pain (LBP) is a leading cause of disability associated with high healthcare utilisation and costs. Mental health symptoms are negative prognostic factors for LBP recovery; however, no population-based studies have assessed the joint effects of LBP and mental health symptoms on healthcare utilisation. This proposed study will characterise the health system burden of LBP and help identify priority groups to inform resource allocation and public health strategies. Among community-dwelling adult respondents of five cycles of the Canadian Community Health Survey (CCHS) in Ontario, we aim to assess the effect of self-reported LBP on healthcare utilisation and costs and assess whether this effect differs between those with and without self-reported mental health symptoms.

Methods and analysis

We designed a dynamic population-based cohort study using linkages of survey and administrative data housed at ICES. The Ontario sample of CCHS (2003–2004, 2005–2006, 2007/2008, 2009/2010, 2011/2012; total of ~1 30 000 eligible respondents) will be used to define the cohort of adults with self-reported LBP with and without mental health symptoms. Healthcare utilisation and costs will be assessed by linking health administrative databases. Follow-up ranges from 6 to 15 years (until 31 March 2018). Sociodemographic (eg, age, sex, education) and health behaviour (eg, comorbidities, physical activity) factors will be considered as potential confounders. Poisson and linear (log-transformed) regression models will be used to assess the association between LBP and healthcare utilisation and costs. We will assess effect modification with mental health symptoms on the additive and multiplicative scales and conduct sensitivity analyses to assess the impact of misclassification and residual confounding.

Ethics and dissemination

This study is approved by the University of Toronto Research Ethics Board. We will disseminate findings using a multifaceted knowledge translation strategy, including scientific conference presentations, publications in peer-reviewed journals and workshops with key knowledge users.
The association between nurse staffing levels and the timeliness of vital signs monitoring: a retrospective observational study in the UK
Authors: Redfern Oliver C , Griffiths Peter , Maruotti Antonello , Recio Saucedo Alejandra , Smith Gary B
Published: September 2019

Objectives

Omissions and delays in delivering nursing care are widely reported consequences of staffing shortages, with potentially serious impacts on patients. However, studies so far have relied almost exclusively on nurse self-reporting. Monitoring vital signs is a key part of nursing work and electronic recording provides an opportunity to objectively measure delays in care. This study aimed to determine the association between registered nurse (RN) and nursing assistant (NA) staffing levels and adherence to a vital signs monitoring protocol.

Design

Retrospective observational study.

Setting

32 medical and surgical wards in an acute general hospital in England.

Participants

538 238 nursing shifts taken over 30 982 ward days.

Primary and secondary outcome measures

Vital signs observations were scheduled according to a protocol based on the National Early Warning Score (NEWS). The primary outcome was the daily rate of missed vital signs (overdue by ≥67% of the expected time to next observation). The secondary outcome was the daily rate of late vital signs observations (overdue by ≥33%). We undertook subgroup analysis by stratifying observations into low, medium and high acuity using NEWS.

Results

Late and missed observations were frequent, particularly in high acuity patients (median=44%). Higher levels of RN staffing, measured in hours per patient per day (HPPD), were associated with a lower rate of missed observations in all (IRR 0.983, 95% CI 0.979 to 0.987) and high acuity patients (0.982, 95% CI 0.972 to 0.992). However, levels of NA staffing were only associated with the daily rate (0.954, CI 0.949 to 0.958) of all missed observations.

Conclusions

Adherence to vital signs monitoring protocols is sensitive to levels of nurse and NA staffing, although high acuity observations appeared unaffected by levels of NAs. We demonstrate that objectively measured omissions in care are related to nurse staffing levels, although the absolute effects are small.

Study registration

The data and analyses presented here were part of the larger Missed Care study (ISRCTN registration: 17930973).
Effectiveness of interventions to improve hand motor function in individuals with moderate to severe stroke: a systematic review protocol
Authors: Wang Hewei , Arceo Ray , Chen Shugeng , Ding Li , Jia Jie , Yao Jun
Published: September 2019

Introduction

The human hand is extremely involved in our daily lives. However, the rehabilitation of hand function after stroke can be rather difficult due to the complexity of hand structure and function, as well as neural basis that supports hand function. Specifically, in individuals with moderate to severe impairment following a stroke, previous evidence for effective treatments that recover hand function in this population is limited, and thus has never been reviewed. With the progress of rehabilitation science and tool development, results from more and more clinical trials are now available, thereby justifying conducting a systematic review.

Methods and analysis

This systematic review protocol is consistent with the methodology recommended by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the Cochrane handbook for systematic reviews of interventions. Electronic searches will be carried out in the PubMed, CINAHL, Physiotherapy Evidence Database and Cochrane Library databases, along with manual searches in the reference lists from included studies and published systematic reviews. The date range parameters used in searching all databases is between January 1999 and January 2019. Randomised controlled trials (RCTs) published in English, with the primary outcome focusing on hand motor function, will be included. Two reviewers will screen all retrieved titles, abstracts and full texts, perform the evaluation of the risk bias and extract all data independently. The risk of bias of the included RCTs will be evaluated by the Cochrane Collaboration’s tool. A qualitative synthesis will be provided in text and table, to summarise the main results of the selected publications. A meta-analysis will be considered if there is sufficient homogeneity across outcomes. The quality of the included publications will be evaluated by the Grading of Recommendations Assessment, Development and Evaluation system from the Cochrane Handbook for Systematic Reviews of Interventions.

Ethics and dissemination

No ethical approval is needed, and the results of this review will be disseminated via peer-reviewed publications and conference presentations.

Trial registration number

CRD42019128285.
Effectiveness of digital technology interventions to reduce loneliness in adults: a protocol for a systematic review and meta-analysis
Authors: Shah Syed Ghulam Sarwar , Nogueras David , van Woerden Hugo , Kiparoglou Vasiliki
Published: September 2019

Introduction

Loneliness is an emerging public health problem that is associated with social, emotional, mental and physical health issues. The application of digital technology (DT) interventions to reduce loneliness has significantly increased in the recent years. The effectiveness of DT interventions needs to be assessed systematically.

Methods and analysis

Aim: To undertake a systematic review and meta-analysis on the effectiveness of DT interventions to reduce loneliness among adults.

Design: Systematic review and meta-analysis.

Data sources: PubMed, Medline, CINAHL, EMBASE and Web of Science.

Publication period: 1 January 2010 to 31 July 2019.

Inclusion criteria: Primary studies involving the application of DT interventions to reduce loneliness, involving adult participants (aged ≥18 years), follow-up period ≥3 months and published in the English language.

Synthesis and meta-analysis: A narrative summary of the characteristics of included studies, findings by the type of DT intervention, and the age, gender and ethnicity of participants. A meta-analysis by the study design and duration of follow-up and determination of random effects size using the RevMan V.5 software.

Quality of evidence and bias: Quality of evidence assessed the RoB V.2.0 (revised tool for Risk of Bias in randomized trials) and ROBINS-I (Risk Of Bias in Non-randomized Studies—of Interventions) tools for randomised control trials and non-randomised studies, respectively. Heterogeneity between studies will be determined by the I2and Cochran’s Q statistics and publication bias checked with funnel plots and the Egger’s test.

Ethics and dissemination

Ethics approval was not required for this protocol. The findings will be disseminated through journal articles and conference presentations.

PROSPERO registration number

CRD42019131524