bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of the novel HLA‐B*15:547 allele by next‐generation sequencing
Authors: Genebrier Steve , Elsermans Vincent , Nivet Carl , Chérel Mathilde , Renac Virginie
Published: August 2020

B*15:547 differs from B*15:01:01:04 by one nucleotide substitution at position 1051 in exon 7.
High-resolution acoustic localization of changes in spatially-distributed coherent sources for structural health monitoring
Authors: Flynn Tyler J. , Dowling David R.
Published: August 2020

Localization of acoustic sources is a common remote sensing goal. When multiple sources are present and coherent, high-resolution localization typically becomes more challenging. The spectral estimation method with additive noise (SEMWAN) is an existing technique for high-resolution localization of incoherent monopole sources in low-signal-to-noise environments. SEMWAN utilizes a reference measurement to incoherently suppress background noise, but its performance suffers in applications involving spatially-distributed coherent sources, such as like a vibrating plate. However, by subtracting a reference measurement and using subarray averaging, SEMWAN can be extended to localization of small changes in distributed coherent sources. This revised approach, the spectral estimation method with coherent background removal (SEMCBR), permits remote acoustic localization of damage in a vibrating structure. A simple multi-source experiment using an 8-by-8 planar square microphone array with 6-cm spacing in both horizontal directions was performed to validate SEMCBR at a frequency of 5.0 kHz. Additional SEMCBR experimental results are reported for the same array placed 1.0 m above a 30 cm × 30 cm vibrating plate with and without damage. Cuts, boundary failures and delamination of a composite plate were successfully located with conventional spherical-wave beamforming and SEMCBR using a 0.1 to 6.0 kHz bandwidth. However, SEMCBR provides 4 to 6 times better resolution.
Bistatic scattering of an elastic object using the structural admittance and noise-based holographic measurements
Authors: Sternini Simone , Rakotonarivo Sandrine T. , Sarkar Jit , Bottero Alexis , Kuperman W. A. , Williams Earl G.
Published: August 2020

This paper presents a method to calculate the bistatic response of an elastic object immersed in a fluid using its structural Green's function (in vacuo structural admittance matrix), calculated by placing the object in a spatially random noise field in air. The field separation technique and equivalent source method are used to reconstruct pressure and velocity fields at the object's surface from pressure measurements recorded on two conformal holographic surfaces surrounding the object. Accurate reconstruction of the surface velocity requires subtraction of the rigid body response computed using a finite element approach. The velocity and pressure fields on the surface lead to the extraction of the in vacuo structural admittance matrix of the elastic object, which is manipulated to yield the farfield bistatic response for a fluid-loaded target for several angles of incidence. This method allows the computation of the scattering properties of an elastic object using exclusive information calculated on its surface (no knowledge of the internal structure required). A numerical experiment involving a cylindrical shell with hemispherical caps is presented, and its bistatic response in water shows excellent agreement with a finite element solution.
Dynamic acoustic-articulatory relations in back vowel fronting: Examining the effects of coda consonants in two dialects of British English
Authors: Gorman Emily , Kirkham Sam
Published: August 2020

This study examines dynamic acoustic-articulatory relations in back vowels, focusing on the effect of different coda consonants on acoustic-articulatory dynamics in the production of vowel contrast. This paper specifically investigates the contribution of the tongue and the lips in modifying F2 in the foot-goose contrast in English, using synchronized acoustic and electromagnetic articulography data collected from 16 speakers. The vowels foot and goose were elicited in pre-coronal and pre-lateral contexts from two dialects that are reported to be at different stages of back vowel fronting: Southern Standard British English and West Yorkshire English. The results suggest similar acoustic and articulatory patterns in pre-coronal vowels, but there is stronger evidence of vowel contrast in articulation than acoustics for pre-lateral vowels. The lip protrusion data do not help to resolve these differences, suggesting that the complex gestural makeup of a vowel-lateral sequence problematizes straightforward accounts of acoustic-articulatory relations. Further analysis reveals greater between-speaker variability in lingual advancement than F2 in pre-lateral vowels.
Influence of the Menstrual Cycle Phase on Marathon Performance in Recreational Runners
Authors: Greenhall M. , Taipale R.S. , Ihalainen J.K. , Hackney A.C.
Published: August 2020

Purpose: To examine the potential impact of fluctuations in sex steroid hormones across the menstrual cycle (MC) on marathon running performance of recreational female athletes. Methods: A survey questionnaire was administered to recreational, nonelite runners who had completed multiple marathons within the last 18 months. Results: A total of 599 questionnaires were returned and deemed viable for review. From these, 185 survey participants were found to have complete information and eligibility to have their surveys used in the statistical analysis. A total of 106 women had their best marathon performance in the luteal phase (high sex steroid hormones) of the MC, and 79 had their best performance in the follicular phase (low sex steroid hormones) of the MC (responses were significantly different; z-score value = 1.11; P < .05). Conclusion: Recreational female runners have varying performances in the marathon across their MC phases, specifically performing better in the luteal phase of the cycle.
Effects of Increased Step-Width on Knee Biomechanics During Inclined and Declined Walking
Authors: Sample Daniel W. , Thorsen Tanner A. , Weinhandl Joshua T. , Strohacker Kelley A. , Zhang Songning
Published: August 2020

The purpose of this study was to investigate effects of preferred step width and increased step width modification on knee biomechanics of obese and healthy-weight participants during incline and decline walking. Seven healthy-weight participants and 6 participants who are obese (body mass index ≥ 30) performed 5 walking trials on level ground and a 10° inclined and declined instrumented ramp system at both preferred and wide step-widths. A 2 × 2 (step-width × group) mixed-model analysis of variance was used to examine selected variables. There were significant increases in step-width between the preferred and wide step-width conditions for all 3 walking conditions (all P < .001). An interaction was found for peak knee extension moment (P = .048) and internal knee abduction moment (KAM) (P = .025) in uphill walking. During downhill walking, there were no interaction effects. As step-width increased, KAM was reduced (P = .007). In level walking, there were no interaction effects for peak medial ground reaction force and KAM (P = .007). There was a step-width main effect for KAM (P = .007). As step-width increased, peak medial ground reaction force and peak knee extension moment increased, while KAM decreased for both healthy weight and individuals who are obese. The results suggest that increasing step-width may be a useful strategy for reducing KAM in healthy and young populations.
All the News That’s Fit to Print? How the Media Frames Professional Athlete Philanthropy
Authors: Babiak Kathy , Sant Stacy-Lynn
Published: August 2020

Professional athletes are increasingly engaged in social impact efforts via charitable endeavors. Despite seemingly good intentions in these efforts, the media’s representation of athlete philanthropy varies widely. This study examines how discourses of athlete charity are represented in U.S. media coverage. Over 100 newspaper articles were obtained for the period of 2005–2017. The authors conducted a qualitative analysis which consisted of attribute coding for basic article characteristics, identification of both framing and reasoning devices, and deductive coding to identify generic media frames. The authors present an adapted frame matrix highlighting the salient frames in media coverage of athlete philanthropy. Our results show that athlete charitable efforts are related to a personal or emotional connection or linked to an economic perspective around philanthropy. A third frame reflected a moral underpinning to athletes’ charitable work. The authors discuss managerial implications for teams and leagues that provide support for athletes’ charitable work, as well as for the athletes themselves.
Targeting the kinase insert loop of PERK selectively modulates PERK signaling without systemic toxicity in mice
Authors: Hughes Daniel T. , Halliday Mark , Smith Heather L. , Verity Nicholas C. , Molloy Colin , Radford Helois , Butcher Adrian J. , Mallucci Giovanna R.
Published: August 2020

Targeting a phosphosite in the kinase PERK may protect neurons and avoid toxicity in prion disease.
Clinical
Candida albicans
Vaginal Isolates and a Laboratory Strain Show Divergent Behaviors during Macrophage Interactions
Authors: Gerwien Franziska , Dunker Christine , Brandt Philipp , Garbe Enrico , Jacobsen Ilse D. , Vylkova Slavena
Published: August 2020

Vulvovaginal candidiasis is one of the most common fungal infections in humans with
Candida albicans
as the major causative agent. This study is the first to compare clinical vaginal isolates of defined patient groups in their interaction with macrophages, highlighting the vastly different outcomes in comparison to a laboratory strain using commonly applied virulence-determining assays.
Characterization of Extracellular Vesicles Produced by Aspergillus fumigatus Protoplasts
Authors: Rizzo Juliana , Chaze Thibault , Miranda Kildare , Roberson Robert W. , Gorgette Olivier , Nimrichter Leonardo , Matondo Mariette , Latgé Jean-Paul , Beauvais Anne , Rodrigues Marcio L.
Published: August 2020

Fungal cells use extracellular vesicles (EVs) to export biologically active molecules to the extracellular space. In this study, we used protoplasts of
Aspergillus fumigatus
, a major fungal pathogen, as a model to evaluate the role of EV production in cell wall biogenesis. Our results demonstrated that wall-less
A. fumigatus
exports plasma membrane-derived EVs containing a complex combination of proteins and glycans. Our report is the first to characterize fungal EVs in the absence of a cell wall. Our results suggest that protoplasts represent a promising model for functional studies of fungal vesicles.
Root Microbiome Modulates Plant Growth Promotion Induced by Low Doses of Glyphosate
Authors: Ramirez-Villacis Dario X. , Finkel Omri M. , Salas-González Isai , Fitzpatrick Connor R. , Dangl Jeffery L. , Jones Corbin D. , Leon-Reyes Antonio
Published: August 2020

Since the introduction of glyphosate-resistant crops, glyphosate has become the most common and widely used herbicide around the world. Due to its intensive use and ability to bind to soil particles, it can be found at low concentrations in the environment. The effect of these remnants of glyphosate in plants has not been broadly studied; however, glyphosate 1,000 to 100,000 times less concentrated than the recommended field dose promoted growth in several species in laboratory and greenhouse experiments. However, this effect is rarely observed in agricultural fields, where complex communities of microbes have a central role in the way plants respond to external cues. Our study reveals how root-associated bacteria modulate the responses of
Arabidopsis
to low doses of glyphosate, shifting between growth promotion and growth inhibition.
Outcomes of outborn very-low-birth-weight infants in Japan
Authors: Hirata Katsuya , Kimura Takeshi , Hirano Shinya , Wada Kazuko , Kusuda Satoshi , Fujimura Masanori
Published: August 2020

Background

Outcomes of prenatal covariate-adjusted outborn very-low-birth-weight infants (VLBWIs) (≤1500 g) remain uncertain.

Objective

To compare morbidity and mortality between outborn and inborn VLBWIs.

Design

Observational cohort study using inverse-probability-of-treatment weighting.

Setting

Neonatal Research Network of Japan.

Patients

Singleton VLBWIs with no major anomalies admitted to a neonatal intensive care unit from 2012 to 2016.

Methods

Inverse-probability-of-treatment weighting with propensity scores was used to reduce imbalances in prenatal covariates (gestational age (GA), birth weight, small for GA, sex, maternal age, premature rupture of membranes, chorioamnionitis, preeclampsia, maternal diabetes mellitus, antenatal steroids and caesarean section). The primary outcome was severe intraventricular haemorrhage (IVH). The secondary outcomes were outcomes at resuscitation, other neonatal morbidities and mortality.

Results

The full cohort comprised 15 842 VLBWIs (668 outborns). The median (IQR) GA and birth weight were 28.9 (26.4–31.0) weeks and 1128 (862–1351) g for outborns and 28.7 (26.3–30.9) weeks and 1042 (758–1295) g for inborns. Outborn VLBWIs had a higher incidence of severe IVH (8.2% vs 4.1%; OR, 3.45; 95% CI 1.16 to 10.3) and pulmonary haemorrhage (3.7% vs 2.8%; OR, 5.21; 95% CI 1.41 to 19.2). There were no significant differences in Apgar scores, oxygen rates at delivery, intubation ratio at delivery, persistent pulmonary hypertension of the newborn, IVH of any grade, periventricular leukomalacia, chronic lung disease, oxygen at discharge, patent ductus arteriosus, retinopathy of prematurity, necrotising enterocolitis, sepsis or mortality.

Conclusion

Outborn delivery of VLBWIs was associated with an increased risk of severe IVH.
Miller Fisher syndrome and COVID-19: is there a link?
Authors: Ray Amanda
Published: August 2020

Beyond the typical respiratory symptoms and fever associated with severe acute respiratory syndrome, we may still have much to learn about other manifestations of the novel SARS-CoV-2 infection. A patient presented with Guillain-Barré syndrome in China with a concurrent SARS-CoV-2 infection. The following case report looks at a patient presenting with the rare Miller Fisher syndrome, a variant of Guillain-Barré while also testing positive for COVID-19.
Extensive cerebral venous sinus thrombosis: a potential complication in a patient with COVID-19 disease
Authors: Bolaji Paul , Kukoyi Babatunde , Ahmad Nasar , Wharton Chris
Published: August 2020

A 63-year-old man was admitted with left-sided weakness and subsequent focal seizures following a recent diagnosis of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia in a nearby hospital. He developed status epilepticus and became comatose, requiring intensive care unit admission for invasive ventilation. Imaging done at admission confirmed extensive cerebral venous sinus thrombosis (CVST) with bilateral venous cortical infarcts and acute cortical haemorrhage. No known risk factor for CVST could be identified. He improved with anticoagulation and antiepileptic therapy. He was subsequently transferred to an inpatient rehabilitation facility. Although Coronavirus disease 19 (COVID-19) infection has been previously associated with thrombotic complications, these mostly relate to the pulmonary vasculature. We present this case as a potential association between CVST and COVID-19 infection.
Catheter-directed thrombolysis to treat acute pulmonary thrombosis in a patient with COVID-19 pneumonia
Authors: Pendower Laura , Benedetti Giulia , Breen Karen , Karunanithy Narayan
Published: August 2020

We describe a case of a patient who presented to the emergency department with severe shortness of breath and was diagnosed with mild COVID-19 pneumonia and concomitant intermediate-high risk saddle pulmonary thromboembolism. Additionally, the patient had sustained a significant head injury 2 days prior due to a syncopal episode. The patient was treated successfully with catheter-directed thrombolysis (CDT). The case highlights the importance of considering thromboembolic complications in COVID-19 infection, independent of the severity of the associated pneumonia. The case also demonstrates the potential benefit of CDT in treating COVID-19-related thromboembolism.
SARS-CoV-2 serological testing changes disease management in a PCR-negative patient
Authors: Knight Dacre , Irizarry-Alvarado Joan
Published: August 2020

Since the beginning of the COVID-19 pandemic, healthcare providers worldwide have faced many obstacles in the diagnostic evaluation of patients for severe acute respiratory syndrome coronavirus 2, the causative virus. Even with the application of statistical inference by Bayes’ theorem to estimate the probability of a diagnosis, with and without testing capabilities, some cases may still carry a degree of uncertainty. This has important implications for limiting the spread of disease. The basis for isolation and quarantine is a known diagnosis. This case is an example of a diagnostic conundrum that required more thorough use of testing methods, particularly serological testing, to guide the isolation recommendations for a patient with COVID-19. This will be helpful to other diagnosticians by providing an example of how serological findings may be effectively applied in the course of individual COVID-19 management.
Relationship between peripapillary vessel density and visual field in glaucoma: a broken-stick model
Authors: Song Min Kyung , Shin Joong Won , Jo Younhye , Won Hun Jae , Kook Michael S
Published: August 2020

Background/Aims

To determine the tipping point at which peripapillary vessel density (pVD), measured using optical coherence tomography angiography (OCT-A), is associated with detectable visual field (VF) loss in cases of open-angle glaucoma (OAG).

Methods

Peripapillary retinal nerve fibre layer (pRNFL) thickness and pVD were measured using OCT and OCT-A in 166 healthy participants, those with suspected glaucoma and patients with early-stage OAG. All participants were Koreans. A broken-stick model was used to determine the tipping points below which pRNFL thickness (pRNFLT) or pVD reduction was associated with significant VF loss. The slopes were computed above and below the tipping points for the relationship between pVD, pRNFLT and VF sensitivity (VFS).

Results

Tipping points were detected for pRNFLT globally and in the inferior and superior quadrants, at which there were significant differences between the slopes above and below the tipping points. The slopes above the tipping points were approximately zero. However, no tipping point was found for pVD in the global area or regional sectors.

Conclusion

The relationship between pVD and VFS does not show a tipping point. This suggests that the correlation between pVD-VFS may be linear and stronger than that of pRNFLT-VFS, even at the early stage of glaucoma.
Ultra-wide-field scanning laser ophthalmoscopy and optical coherence tomography in FEVR: findings and its diagnostic ability
Authors: Zhang Ting , Wang Zhirong , Sun Limei , Li Songshan , Huang Li , Liu Chengxi , Chen Chonglin , Luo Xiaoling , Yu Bilin , Ding Xiaoyan
Published: August 2020

Background/Aims

To describe some novel vitreoretinal microstructural findings in patients with mild familial exudative vitreoretinopathy (FEVR) on ultra-wide-field scanning laser ophthalmoscopy (UWF-SLO) and UWF optical coherence tomography (UWF-OCT) and to evaluate their clinical significance.

Methods

A total of 32 patients and 32 healthy controls were studied. An additional independent 40 FEVR patients, 44 patients with non-FEVR retinopathies and 40 healthy controls participated in a diagnostic test to validate the abilities of novel findings in FEVR screening.

Results

A novel anatomic change, named Temporal Mid-Peripheral Vitreoretinal Interface Abnormality (TEMPVIA), was found on UWF-SLO in 88.3% of FEVR patients and in none of the healthy controls. The clinical significance of TEMPVIA was further validated by a diagnostic test in new independent cases, with satisfying sensitivity (91.5%) and specificity (98.8%) and Youden Index 0.90. In addition to foveal hypoplasia, some previously unrecognised, novel clinical changes in FEVR, for instance, retinoschisis, focal retinal thickening, sudden thinning of the retina and retinal ridge, were identified using UWF-OCT.

Conclusion

The results of this study have led to an update of the clinical spectrum of FEVR and have improved our understanding of its pathogenesis. TEMPVIA is therefore suggested to be a useful biomarker in the screening strategy for mild FEVR.
SARS-CoV-2 on the ocular surface: is it truly a novel transmission route?
Authors: Chen Xuhui , Yu Huimin , Mei Ting , Chen Bo , Chen Liwen , Li Shanling , Zhang Xian , Sun Xufang
Published: August 2020

Since December 2019, the novel COVID-19 outbreak has spread rapidly around the globe and infected millions of people. Although the major transmission route of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered to be airborne droplets and close contact, the ocular transmission route has been reported with great concern. The current work summarises the characteristics of SARS-CoV-2, the ocular distribution of the major SARS-CoV-2 binding protein, and the experimental and clinical evidence of the ocular transmission route. Although it seems that the likelihood of the ocular surface being an infection gateway is low, SARS-CoV-2 infection or transmission via the ocular surface may cause conjunctivitis and other ocular discomfort. Therefore, good eye protection is an essential safeguard procedure, especially for medical staff.
Heritability of macular ganglion cell inner plexiform layer thickness as determined by optical coherence tomography: the Healthy Twin Study
Authors: Kong Mingui , Hwang Sungsoon , Ko Hyeonyoung , Lee Ga-In , Kang Moonil , Sung Joohon , Song Yun-Mi , Ham Don-Il
Published: August 2020

Purpose

To evaluate genetic influence on macular ganglion cell inner plexiform layer (GCIPL) thickness.

Methods

Macular GCIPL thickness was measured with optical coherence tomography in nine macular subfields defined by the E TDRS. Intraclass correlation coefficients (ICC) of GCIPL thickness by different types of family relationships were estimated to assess intrafamilial resemblance. Then, heritability of GCIPL thickness was estimated.

Results

Three hundred and sixty-one Korean adults from 89 families with normal healthy eyes were included. GCIPL thickness was highest in inner subfields and lowest in fovea. Monozygotic twin pairs showed significantly higher ICCs of GCIPL thickness in all subfields compared to those in parent–offspring pairs and sibling pairs. GCIPL thickness was highly heritable in the centre (0.71) and outer subfields but moderate to highly heritable in inner subfields. Heritability of GCIPL thickness in outer subfields was 0.69, 0.67, 0.72 and 0.68 for superior, inferior, temporal and nasal fields, respectively. Heritability of GCIPL thickness in inner subfields was 0.55, 0.56, 0.75 and 050 for superior, inferior, temporal and nasal subfields, respectively.

Conclusion

Macular GCIPL thickness is significantly influenced by genetic factors. It varies according to subfields with moderate to high heritability in all subfields.
Consent, capacity and compliance in concussion management: cave ergo medicus (let the doctor beware)
Authors: Turner Michael , Maddocks David , Hassan Majid , Anderson Adrian , McCrory Paul
Published: August 2020

While the acute effects of concussion and mild traumatic brain injury (TBI) are well understood, the certainty in the medical literature regarding the long-term outcomes of sports-related concussion is limited. Long-term deficits that may result from single, repeated concussions, and possibly subconcussive impacts, include cognitive dysfunction, depression and executive dysfunction. Perhaps most troublingly, repetitive head impacts have been linked to neurodegenerative diseases, including chronic traumatic encephalopathy (CTE), although the precise risk of long-term consequences remains unknown. CTE represents a distinct tauopathy with an unknown incidence in athletic populations; however, a cause and effect relationship has not yet been demonstrated between CTE and concussions or between CTE and exposure to contact sports, as no prospective longitudinal studies have been performed to address that question. Studies of high-school sports exposure and long-term outcomes have not demonstrated consistent findings.

Medical advice regarding return to play and the risk of acute and/or long-term consequences is therefore problematic. It is important that the individual’s right to make their own choices regarding their health is respected. Team, coach, parental, peer or financial pressures should not influence this decision. The choice to return to play after a concussion or mild TBI injury is the athlete’s decision once they have (1) recovered from their injury and have the legal capacity to make an informed decision; (2) been medically assessed and (3) been informed of any possible long-term risks in a language that they can understand.

Given the current lack of certainty in relation to long-term outcomes from concussion, is it possible to provide a framework to inform players of current evidence, as part of a consent process, even if the information upon which the decision to return to sport is based remains uncertain and evolving?
Islet inflammation is associated with pancreatic fatty infiltration and hyperglycemia in type 2 diabetes
Authors: Horii Tomomi , Fujita Yukari , Ishibashi Chisaki , Fukui Kenji , Eguchi Hidetoshi , Kozawa Junji , Shimomura Iichiro
Published: August 2020

Introduction

Chronic inflammation is observed in type 2 diabetes islets, and fat deposition in the pancreas affects insulin secretion and glucose tolerance. However, the relationship between this inflammation and pancreatic fat deposition has not been elucidated.

Research design and methods

We examined pancreatic sections from 60 Japanese patients obtained by pancreatectomy. We evaluated pancreatic fat-cell area (%) and CD68-positive (CD68+) cells per islet histologically and examined the relationships between these histological findings and various clinical parameters.

Results

The number of CD68+cells per islet in the diabetes group was significantly higher than that in the normal glucose tolerance group (p=0.026). Moreover, CD68+cells per islet were significantly correlated with body mass index (r=0.33, p=0.0080), fasting C-peptide immunoreactivity (r=0.46, p=0.0042), homeostasis model assessment insulin resistance (r=0.38, p=0.016), C-peptide index (r=0.38, p=0.018), the area under the glucose concentration curve (AUCglucose) at the 75 g oral glucose tolerance test (r=0.49, p=0.0065) and fat-cell area (r=0.51, p<0.0001). In multiple regression analyses, fat-cell area (β=0.600, p=0.0027) and AUCglucose(β=0.453, p=0.0042) were the independent and significant determinants of CD68+cells per islet.

Conclusion

The inflammation of islets is associated with pancreatic fatty infiltration and hyperglycemia, which may further aggravate glucose tolerance.
Association of non-alcoholic fatty liver disease and polycystic ovarian syndrome
Authors: Asfari Mohammad Maysara , Sarmini Muhammad Talal , Baidoun Firas , Al-Khadra Yasser , Ezaizi Yamen , Dasarathy Srinivasan , McCullough Arthur
Published: August 2020

Background

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder in women. Women with PCOS have androgen excess as a defining feature. They also have increased insulin resistance and obesity, which are also risk factors for non-alcoholic fatty liver disease (NAFLD). However, published data regarding PCOS as independent risk factor for NAFLD remain controversial. Therefore, we conducted this study to evaluate the association between PCOS and NAFLD using a large national database.

Methods

We identified adult female patients (≥18 years) with PCOS using the National Inpatient Sample database between 2002 and 2014. The control group included patients who did not have a diagnosis of PCOS. Multivariate logistic regression analysis was performed to study the association of NAFLD with PCOS.

Results

Out of a total of 50 785 354 women, 77 415 (0.15%) had PCOS. These patients were younger (32.7 vs 54.8; p<0.001) and more likely to be obese (29.4% vs 8.6%; p<0.001) compared with non-PCOS patients. However, the PCOS group had less hypertension (23.2% vs 39.8%), dyslipidaemia (12% vs 17.8%) and diabetes mellitus (18.1% vs 18.3%) (p<0.001 for all). Using multivariate logistic regression, patients with PCOS had significantly higher rate of NAFLD (OR 4.30, 95% CI 4.11 to 4.50, p<0.001).

Conclusion

Our study showed that patients with PCOS have four times higher risk of developing NAFLD compared with women without PCOS. Further studies are needed to assess if specific PCOS treatments can affect NAFLD progression.
Healthcare-related cost of oropharyngeal dysphagia and its complications pneumonia and malnutrition after stroke: a systematic review
Authors: Marin Sergio , Serra-Prat Mateu , Ortega Omar , Clavé Pere
Published: August 2020

Objectives

To assess the healthcare costs associated with poststroke oropharyngeal dysphagia (OD) and its complications (malnutrition, dehydration, pneumonia and death).

Design

Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations.

Data sources

MEDLINE, Embase and the National Health Service Economic Evaluation Database were searched up to 31 December 2019.

Participants

Patients with poststroke.

Primary outcome measures

The costs associated to poststroke OD and its complications.

Data analysis

Data were synthetised narratively, quality evaluation was done using an adaptation of Drummond’s checklist and Grading of Recommendations Assessment, Development and Evaluation recommendations were used to assess strength of evidence.

Results

A total of 166 articles were identified, of which 10 studies were included. The cost of OD during the hospitalisation was assessed in four studies. One prospective study showed an increase of US$6589 for patients requiring tube feeding. Two retrospective studies found higher costs for those patients who developed OD, (US$7329 vs US$5939) among patients with haemorrhagic stroke transferred to inpatient rehabilitation and an increase of €3000 (US$3950) and SFr14 000 (US$15 300) in hospitalisation costs. One study did not found OD as a predictor for total medical costs in the multivariate analysis. One retrospective study showed an increase of US$4510 during the first year after stroke for those patients with OD. For pneumonia, five retrospective studies showed an increase in hospitalisation costs after stroke of between US$1456 and US$27 633. One prospective study showed an increase in hospitalisation costs during 6 months after stroke in patients at high malnutrition risk. Strength of evidence was considered moderate for OD and pneumonia and low for malnutrition.

Conclusions

This systematic review shows moderate evidence towards higher costs for those patients who developed OD after stroke. The available literature is heterogeneous, and some important aspects have not been studied yet. Further studies are needed to define the specific cost of poststroke OD.

PROSPERO registration number

CRD42018099977.
Mixed methods study to develop the content validity and the conceptual framework of the electronic patient-reported outcome measure for vascular conditions
Authors: Aber Ahmed , Phillips Patrick , Lumley Elizabeth , Radley Stephen , Thomas Steven M , Nawaz Shah , Jones Georgina , Michaels Jonathan
Published: August 2020

Objective

The aim of this paper is to describe the stages undertaken to generate the items and conceptual framework of a new electronic personal assessment questionnaire for vascular conditions.

Design

A mixed methods study: First a survey of vascular clinicians was completed to identify the most common conditions treated in vascular clinics and wards. Quantitative systematic reviews were done to identify validated patient-reported outcome measures (PROMs) for direct inclsuion in the new instrument. However, due to scarcity of validated PROMs, the items of the new instrument were mainly based on a large qualitative study of patients and systematic reviews of the qualitative evidence . This was followed by a quantitative clinicians’ consensus study and, finally, a qualitative face validity study with patients.

Participants

Vascular patients participated in the primary qualitative study and the face validity study. In the qualitative study, 55 patients were interviewed, and for the face validity, 19 patients gave feedback. Twelve clinicians completed the survey and 13 completed two cycles of the clinicians’ consensus study.

Results

The items and scales in the electronic personal assessment questionnaire for vascular conditions (ePAQ-VAS) were generated based on the results of five systematic reviews evaluating existing PROMs for possible inclusion in ePAQ-VAS, five systematic reviews of qualitative evidence, a primary qualitative study involving 55 patients and clinicians’ input. One hundred and sixty-eight items were initially generated, of which 59 were eliminated by the expert panel due to repetition. The instrument was divided into one generic and three disease-specific sections (abdominal aortic aneurysm, carotid artery disease and lower limb vascular conditions). In each section, items were grouped together into putative scales. Fifty-five items were grouped across eight scales; the remaining items were kept as individual items, because of relevance to service users.

Conclusions

This multidimensional electronic questionnaire covers the most common vascular conditions. This is particularly important for patients presenting with mixed symptoms or multiple conditions. This tool captures symptomatology, health related quality of life (HRQoL) and other clinically relevant data, such as experience with services and comorbidities.
Youth participatory research evidence to inform health policy: a systematic review protocol
Authors: Njelesani Janet , Hunleth Jean
Published: August 2020

Introduction

Young people’s participation in health research produces knowledge that is indispensable for creating appropriate and effective policies. However, how best to disseminate youth participatory research evidence to impact health policy is not known. Therefore, the objectives of this systematic review are to describe the evidence produced through youth participatory research, including the strategies used to disseminate youth participatory research evidence to health policymakers. These are necessary to improve policymakers’ use of youth participatory research evidence and, thereby, make programmes more impactful for young people.

Methods and analysis

The meta-narrative methodology will guide the systematic review to highlight the contrasting and complementary evidence on the use of engaging youth in research to affect health policymaking. Relevant studies will be identified by searching electronic databases, including but not limited to EBSCO, PROQUEST, OVID Medline, Sociological Abstracts and Google Scholar from inception to December 2020. The methodological quality of included quantitative, qualitative and mixed-methods research studies will be assessed using valid appraisal tools. The meta-narrative approach to analysis will include identifying meta-narratives of how youth participation informed the health research findings.

Ethics and dissemination

An advisory group of young people will advise on the study and dissemination of the findings. As part of our plan for active dissemination, we will produce a policy brief that builds the rationale for using research with and by youth as part of an evidence base necessary for achieving youth health outcomes.
Study protocol for the use of photobiomodulation with red or infrared LED on waist circumference reduction: a randomised, double-blind clinical trial
Authors: Marreira Marcelo , Rocha Mota Lidiane , Silva Daniela Fátima Teixeira , Pavani Christiane
Published: August 2020

Introduction

The search for non-invasive procedures to reduce localised adiposity in aesthetics clinics has recently been increasing. In this context, procedures, such as cryolipolysis, ultracavitation, photobiomodulation (PBM) and other techniques have been proposed. Some studies have shown that PBM can be used in body contouring. However, there is no standardisation of the protocol. More than that, as in other techniques for reducing adipose tissue, the availability of triacylglycerol may affect the lipid profile in the blood, bringing consequences to the general health of an individual. This work will aim to compare the light wavelengths when using PBM as a technique for reducing the abdominal waist circumference, while also evaluating the efficacy of the method. Changes in the lipid profile in the blood, with a long-term follow-up, will also be appraised.

Methods and analysis

This will be a controlled, randomised, double-blind, single-centred clinical trial. 174 patients will be recruited at the Nove de Julho University, Brazil, and then divided into three groups: Group A—RED PBM; Group B—INFRARED PBM; Group C—PLACEBO (Sham) treatment. The treatments will consist of eight sessions, two times a week, for 4 weeks. At each session, the participants will receive 30 minutes PBM (using a radiant exposure of 127 J/cm2), with an abdominal strap containing 4 LED clusters, with 72 devices each, following the indication of randomisation. All of the groups will receive 30 min of Aussie Current, at 4 kHz, modulated at 10 Hz, 40–60 mA. The main outcome of this study will be waist circumference reduction. The secondary variables will be anthropometric data, lipid profile, liver function and adipose tissue thickness, changes in the local microcirculation, and the quality of life and self-esteem. The analyses will be performed at four stages of the research, D0, end of the eighth session (D30), 15 days after the last session (FU15), 90 days after the last session (FU90) and 180 days after the last session (FU180).

Ethics and dissemination

The Ethics Committee of the Nove de Julho University, Brazil, approved the modified version of this project under No. 3414146 on 26 June 2019. This study is not yet recruiting. The results obtained will be published in a peer-reviewed journal in the related field.

Trial registration number

Brazilian Registry of Clinical Trials—ReBec (RBR-9bwxcx).
Occupational justice and social inclusion among people living with HIV and people with mental illness: a scoping review
Authors: Nhunzvi Clement , Langhaug Lisa , Mavindidze Edwin , Harding Richard , Galvaan Roshan
Published: August 2020

Objective

To explore ways in which occupational justice and social inclusion are conceptualised, defined and operationalised in highly stigmatised and chronic conditions of mental illness and HIV.

Design

This scoping review protocol followed Arksey and O’Malley’s (2005) Scoping Review Framework.

Data sources and eligibility

The following databases were searched for the period January 1997 to January 2019: Medline via PubMed, Scopus, Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Africa-Wide Information, Humanities International Complete, Web of Science, PsychInfo, SocINDEX and grey literature.

Eligible articles were primary studies, reviews or theoretical papers which conceptualised, defined and/or operationalised social inclusion or occupational justice in mental illness or HIV.

Study appraisal and synthesis

We undertook a three-part article screening process. Screening and data extraction were undertaken independently by two researchers. Arksey’s framework and thematic analysis informed the collation and synthesis of included papers.

Results

From 3352 records, we reviewed 139 full articles and retained 27 for this scoping review. Definitions of social inclusion and occupational justice in the domains of mental illness and HIV were heterogeneous and lacked definitional clarity. The two concepts were conceptualised as either processes or personal experiences, with key features of community participation, respect for human rights and establishment and maintenance of healthy relationships. Conceptual commonalities between social inclusion and occupational justice were premised on social justice.

Conclusions

To address lack of clarity, we propose further and concurrent exploration of these concepts, specifically with reference to persons with comorbid mental health disorders such as substance use disorders and HIV living in low-income countries. This should reflect contextual realities influencing community participation, respect for human rights and meaningful occupational participation. From this broadened understanding, quantitative measures should be applied to improve the standardisation of measurements for occupational justice and social inclusion in policy, research and practice.
Protocol of an interdisciplinary consensus project aiming to develop an AGREE II extension for guidelines in surgery
Authors: Antoniou George A , Mavridis Dimitris , Tsokani Sofia , López-Cano Manuel , Flórez Iván D , Brouwers Melissa , Markar Sheraz R , Silecchia Gianfranco , Francis Nader K , Antoniou Stavros A
Published: August 2020

Introduction

Appraisal of Guidelines for Research and Evaluation (AGREE II) is an instrument that informs development, reporting and assessment of clinical practice guidelines. Previous research has demonstrated the need for improvement in methodological and reporting quality of clinical practice guidelines specifically in surgery. We aimed to develop an AGREE II extension document for application in surgical guidelines.

Methods and analysis

We have performed a structured literature review and assessment of guidelines in surgery using the AGREE II instrument. In exploratory analyses, we have identified factors associated with guideline quality. We have performed reliability and factor analyses to inform the development of an extension document. We will summarise this information and present it to a Delphi panel of stakeholders. We will perform iterative Delphi rounds and we will summarise the final results to develop the extension instrument in a dedicated consensus conference.

Ethics and dissemination

Funding bodies will not be involved in the development of the instrument. Research ethics committee and Health Research Authority approval was waived, since this is a professional staff study only and no duty of care lies with the National Health Service to any of the participants. Conflicts of interest, if any, will be addressed by reassigning functions or replacing participants with relevant conflicts. The results will be disseminated through publication in peer reviewed journals, the funders’ websites, social media and direct contact with guideline development organisations and peer-reviewed journals that publish guidelines.
Impact of the economic crisis on household health expenditure in Greece: an interrupted time series analysis
Authors: Crookes Catriona , Palladino Raffaele , Seferidi Paraskevi , Hirve Raeena , Siskou Olga , Filippidis Filippos T
Published: August 2020

Objectives and setting

The 2008 financial crisis had a particularly severe impact on Greece. To contain spending, the government capped public health expenditure and introduced increased cost-sharing. The Greek case is important for studying the impact of recessions on health systems. This study analysed changes in household health expenditure in Greece over the economic crisis and explored whether the impact differed across socioeconomic groups.

Participants

We used data from the Greek Household Budget Survey for the years 2004 and 2008–2017. The dataset comprised 51 654 households, with a total of 128 111 members.

Design

We compared pre-crisis and post-crisis trends in Greek household out-of-pocket payments for healthcare from 2004 to 2017 using an interrupted time series analysis. This study explored spending in euros and as a share of total household purchases.

Results

Our results indicated that the population level trend in household health spending was reversed after the crisis began (pre-crisis trend: €0.040 decrease per quarter (95% CI: −0.785 to −0.022), post-crisis trend: €0.315 increase per quarter (95% CI: −0.004 to 0.635)). We also found that spending on inpatient services and pharmaceuticals has been increasing since the start of the crisis, whereas outpatient services expenditure has been decreasing. Across all households, out-of-pocket payments incurred a greater financial burden after the crisis relative to pre-existing trends, but the poorest households incurred a disproportionately higher burden.

Conclusions

This was the first study to use an interrupted time series analysis to assess the impact of the economic crisis on household health expenditure in Greece. Our findings suggest that there was an erosion of financial protection for Greek households as a consequence of the economic crisis. This effect was particularly pronounced among poorer households, which is indicative of a regressive financing system.
Medication use in the last year of life: a cross-sectional hospice study
Authors: Scullion Liam , Dodds Hope , Liu Qinghao , Hunt Mary Elizabeth , Gordon Simon , Todd Adam
Published: August 2020

Objectives

The issue of polypharmacy and medication use in people with life limiting illness raises important questions from a clinical and ethical viewpoint. The objectives of our study were to (1) explore medication use among people with life limiting illness receiving hospice care; (2) apply consensus criteria to assess medication appropriateness; and (3) determine the overall pill burden in this patient population.

Methods

Six hospices in the North East of England were included. All deceased adult patients who received hospice care in 2018 were eligible for study inclusion. Descriptive statistics were used to report medication details; while medication appropriateness was assessed according to consensus criteria developed by Morin and colleagues.

Results

Six hundred and ninety patients were included in the study. Patients were using a mean number of 8.8 medications per day, while polypharmacy was evident in 80% of patients. In terms of potentially questionable medication, patients were prescribed a mean number of 1.3 per day. Common potentially questionable medications included vitamin and mineral supplements, antihypertensives, antiplatelets, lipid regulating agents and anticoagulants. The pill burden in this population was also high with, on average, people using 13.7 oral doses per day.

Conclusions

Polypharmacy is common in patients accessing hospice care, as is the use of potentially questionable medication. The pill burden in this patient population is also high, which may be an additional treatment burden to patients. Holistic deprescribing approaches for this population should be developed and implemented.