bluuebunny/crossref_metadata_2025 huggingface dataset:
Lung separation in children: Options and impact on gas exchange and lung compliance
Authors: Hale Jason E. , Meador Marcie R. , Mossad Emad B.
Published: July 2019

Background

One‐lung ventilation is a challenging airway technique in the pediatric population. Multiple airway devices can be employed, but there is no consensus as to the most reliable and physiologically advantageous method. This report is a review of the methods of one‐lung ventilation in children in our practice, as well as an analysis of the impact of airway device type, patient age, and duration of lung separation on respiratory mechanics and gas exchange.

Methods

The records of all pediatric patients undergoing procedures requiring one‐lung ventilation in a single center over an 18‐month period were reviewed. Demographics, time required to achieve lung separation (anesthesia ready‐time), and duration of one‐lung ventilation were collected. Data from arterial blood gas analysis and ventilator parameters were collected at three time points: 15 minutes prior to one‐lung ventilation (pre–OLV), 15 minutes after initiation of one‐lung ventilation (during OLV), and 15 minutes after one‐lung ventilation was ended (post–OLV). Standard equations for calculating compliance, the ratio of arterial partial pressure of oxygen to the fraction of inspired oxygen, and the alveolar‐arterial oxygen gradient were used.

Results

Forty‐six patients were identified with a mean age of 9.3 (inner quartile range 3‐15) years. All patients had significant changes in pulmonary function when comparing pre–OLV with during OLV and when comparing during OLV with post–OLV. There were no significant changes from pre– to post–OLV. On further analysis, there were more pronounced changes in compliance and gas exchange in older patients (P = 0.003; 95% CI: −0.62 to −0.14). There was also a significant decrease in post–OLV compliance with a longer duration of OLV (P = 0.018; 95% CI: −0.02 to <−0.01). Airway device type did not have significant impact on the parameters examined.

Conclusion

Our report demonstrates significant changes in lung function during one‐lung ventilation. One particular device does not seem to be superior. Though pre–OLV measures of pulmonary function correlate closely with post–OLV, older age and a prolonged duration of one‐lung ventilation did impact compliance.
Use of public health service increased risk kidneys in pediatric renal transplant recipients
Authors: Meyers Melissa R. , Shults Justine , Laskin Benjamin , Porrett Paige , Levine Matthew , Abt Peter , Amaral Sandra , Goldberg David S.
Published: July 2019

With the opioid epidemic and expansion of “IR” classification, 25% of deceased donors are categorized PHS‐IR. Studies have assessed utilization of PHS‐IR organs among adults, but little is known about pediatric recipients. This retrospective cohort study from 2004‐2016 (IR period) aimed to: (a) assess IR kidney utilization patterns between adults and children; (b) identify recipient factors associated with transplant from IR donors among pediatric kidney recipients; and (c) determine geography's role in IR kidney utilization for children. The proportion of pediatric recipients receiving IR kidneys was significantly lower than adults (P < 0.001), even when stratified by donor mechanism of death (non‐overdose/overdose) and era. In mixed effects models accounting for clustering within centers and regions, older recipient age, later era (post‐PHS‐IR expansion), and blood type were associated with significantly higher odds of receiving an IR kidney (17 years era 5: OR 5.16 [CI 2.05‐13.1] P < 0.001; 18‐21 years era 5: OR 2.72 [CI 1.05‐7.06] P = 0.04; blood type O: OR 1.32 [CI 1.06‐1.64] P = 0.013). The median odds ratio for center within region was 1.77 indicating that when comparing two patients in a region, the odds of receiving an IR kidney were 77% higher for a patient from a center with higher likelihood of receiving an IR kidney. Utilization of PHS‐IR kidneys is significantly lower among pediatric recipients versus adult counterparts. More work is needed to understand the reasons for these differences in children in order to continue their access to this life‐prolonging therapy.
Human Factors and Cybersecurity in Online Game Addiction: An Analysis of the Relationship Between High School Students' Online Game Addiction and the State of Providing Personal Cybersecurity and Representing Cyber Human Values in Online Games
Authors: Yildiz Durak Hatice
Published: July 2019

Objective

The number of users of online games is increasing day by day due to their constantly developing features. Users who have access to online games at all times are in a constant interaction with other users. In this regard, it can be suggested the interaction carries human values and does not contain information security threats. As a matter of fact, the virtual world presented in online gaming environments has evolved into an alternative survival area for individuals. On the other hand, the massive time spent in online environments leads to game addiction. This article seeks to determine the relationship between online game addiction (OGA) and the state of providing personal cybersecurity and representing cyber human values of high school students who actively play online games.

Methods

In accordance with this purpose, 212 high school students playing online games and using various applications have been surveyed.

Results and Conclusion

As a result of this study in which relational screening method was employed, a significant relationship was found between OGA and behaviors that focus on human values of truth and tolerance. In this study, which is aimed to expand existing knowledge, variables identified in this study and providing predictability of OGA can be used to prevent and alleviate gaming addiction in high school students.
Usutu virus infection in Dutch blood donors
Authors: Zaaijer Hans L. , Slot Ed , Molier Michel , Reusken Chantal B.E.M. , Koppelman Marco H.G.M.
Published: July 2019

BACKGROUND

The screening of Dutch blood donations for West Nile virus (WNV) may be imminent, as WNV emerges in nearby countries and more donors travel to WNV‐affected regions. Since 2016 the related, mosquito‐borne Usutu virus (USUV) causes seasonal mortality in Dutch birds. To what extent will human USUV infections affect Dutch WNV donor screening?

STUDY DESIGN AND METHODS

From April through September 2018, plasma samples from blood donations in blackbird‐rich regions were stored. When increased bird mortality was reported in August, samples from July, August, and September were tested for USUV‐RNA in pools of eight, using a home‐brew combined WNV/USUV‐PCR assay. Reactive pools were deconstructed. Original plasma units and samples of previous and follow‐up donations of reactive donors were tested for USUV‐ and WNV‐RNA, and for antibody responses.

RESULTS

The number of USUV RNA‐positive, WNV RNA‐negative donations was 0 of 2688 donations in July, 6 of 4416 in August (1:736), and 1 of 4936 in September. The seven infected donors tested negative for USUV‐RNA in preceding and follow‐up donations. For 6 donors, seroconversion for USUV‐antibodies was demonstrated. All index donations tested positive in a commonly used PCR‐assay for WNV donor screening. Three exposed recipients did not show signs of infection. Screening a random subset of 1092 donations from September for USUV‐IgG antibodies showed that 22 donors tested reactive; for three donors retrospective testing identified an USUV PCR‐positive pre‐seroconversion donation.

CONCLUSION

Seasonal USUV infection in Dutch blood donors is common. Cross‐reactivity in molecular assays for WNV‐screening occurs, but can be resolved using USUV‐ and WNV‐specific PCR‐primers and sequencing of viral RNA.
Urocortin 3 signalling in the auditory brainstem aids recovery of hearing after reversible noise‐induced threshold shift
Authors: Fischl Matthew J. , Ueberfuhr Margarete A. , Drexl Markus , Pagella Sara , Sinclair James L. , Alexandrova Olga , Deussing Jan M. , Kopp‐Scheinpflug Conny
Published: July 2019

Key points

Ongoing, moderate noise exposure does not instantly damage the auditory system but may cause lasting deficits, such as elevated thresholds and accelerated ageing of the auditory system.

The neuromodulatory peptide urocortin‐3 (UCN3) is involved in the body's recovery from a stress response, and is also expressed in the cochlea and the auditory brainstem.

Lack of UCN3 facilitates age‐induced hearing loss and causes permanently elevated auditory thresholds following a single 2 h noise exposure at moderate intensities.

Outer hair cell function in mice lacking UCN3 is unaffected, so that the observed auditory deficits are most likely due to inner hair cell function or central mechanisms.

Highly specific, rather than ubiquitous, expression of UCN3 in the brain renders it a promising candidate for designing drugs to ameliorate stress‐related auditory deficits, including recovery from acoustic trauma.

Environmental acoustic noise is omnipresent in our modern society, with sound levels that are considered non‐damaging still causing long‐lasting or permanent changes in the auditory system. The small neuromodulatory peptide urocortin‐3 (UCN3) is the endogenous ligand for corticotropin‐releasing factor receptor type 2 and together they are known to play an important role in stress recovery. UCN3 expression has been observed in the auditory brainstem, but its role remains unclear. Here we describe the detailed distribution of UCN3 expression in the murine auditory brainstem and provide evidence that UCN3 is expressed in the synaptic region of inner hair cells in the cochlea. We also show that mice with deficient UCN3 signalling experience premature ageing of the auditory system starting at an age of 4.7 months with significantly elevated thresholds of auditory brainstem responses (ABRs) compared to age‐matched wild‐type mice. Following a single, 2 h exposure to moderate (84 or 94 dB SPL) noise, UCN3‐deficient mice exhibited significantly larger shifts in ABR thresholds combined with maladaptive recovery. In wild‐type mice, the same noise exposure did not cause lasting changes to auditory thresholds. The presence of UCN3‐expressing neurons throughout the auditory brainstem and the predisposition to hearing loss caused by preventing its normal expression suggests UCN3 as an important neuromodulatory peptide in the auditory system's response to loud sounds.
Synonymy of the genus Arisocerus Brennan, 1970 with the genus Herpetacarus Vercammen-Grandjean, 1960 (Trombidiformes: Trombiculidae)
Authors: Jacinavicius Fernando De Castro , Bassini-Silva Ricardo , Welbourn Cal , Ochoa Ronald , Barros-battesti Darci Moraes
Published: July 2019

The genus Arisocerus is synonymized with Herpetacarus. Redescriptions of Herpetacarus amapensis comb. nov. and Herpetacarus hertigi comb. nov., are provide with new Brazilian locality and host records for H. hertigi comb. nov.
Restoring forests as a means to many ends
Authors: Chazdon Robin , Brancalion Pedro
Published: July 2019

An urgent need to replenish tree canopy cover calls for holistic approaches
Unsettling robots and the future of art
Unsecured Futures
Lucy Seal, curator
The Barn Gallery, St John's College, University of Oxford Through 6 July 2019
Authors: Ambrosio Chiara
Published: July 2019

An AI-driven artist's exhibition hints at, but never fully explores, the ethics of algorithms
Inserting DNA with CRISPR
Authors: Hou Zhonggang , Zhang Yan
Published: July 2019

Inserting large DNA segments with CRISPR holds great promise for genetic engineering
Chinese scientists and security
Authors: Zerhouni Elias
Published: July 2019

Many scientific and economic successes in the United States are owed to the work of foreign-born scientists. Today, a substantial percentage of U.S patents and scientific publications are contributed by Chinese-born scientists. But there is increasing concern that China is unfairly and systematically attempting to capture intellectual property, trade secrets, and advanced technologies from the United States, all detrimental to productive long-term relationships. As part of the U.S. response to these threats, tenured Chinese-American scientists at top institutions of biomedical research were recently dismissed for purported violations of disclosure rules, breaches of confidentiality, or outright suspicion of espionage. As Congress seeks to protect the open and collaborative approach to science and technology from nefarious activities of foreign states, the scientific community must weigh in on the path forward.
EUCAST Reference Testing of Rezafungin Susceptibility and Impact of Choice of Plastic Plates
Authors: Arendrup Maiken Cavling , Jørgensen Karin Meinike , Hare Rasmus Krøger , Cuenca-Estrella Manuel , Zaragoza Oscar
Published: July 2019

Rezafungin is a new long-acting echinocandin currently in phase 3 development. Epidemiological cutoff values are necessary for breakpoint setting but have not been established due to unexplained interlaboratory MIC variations observed in a prior multicenter study. Here we investigated if the choice of microtiter plates affected the variability when anidulafungin was included as a comparator.
Microbial Succession of Anaerobic Chitin Degradation in Freshwater Sediments
Authors: Wörner Susanne , Pester Michael
Published: July 2019

Chitin is the most abundant biopolymer in aquatic environments, with a direct impact on the carbon and nitrogen cycles. Despite its massive production as a structural element of crustaceans, insects, or algae, it does not accumulate in sediments. Little is known about its turnover in predominantly anoxic freshwater sediments and the responsible microorganisms. We proved that chitin is readily degraded under anoxic conditions and linked this to a succession of the members of the responsible microbial community over a 43-day period. While
Fibrobacteres
and
Firmicutes
members were driving the early and late phases of chitin degradation, respectively, a more diverse community was involved in chitin degradation in the intermediate phase. Entirely different microorganisms responded toward the chitin monomer
N
-acetylglucosamine, which underscores that soluble monomers are poor and misleading substrates to study polymer-utilizing microorganisms. Our study provides quantitative insights into the microbial ecology driving anaerobic chitin degradation in freshwater sediments.
Eosinophils and Macrophages within the Th2-Induced Granuloma: Balancing Killing and Healing in a Tight Space
Authors: Ariyaratne Anupama , Finney Constance A. M.
Published: July 2019

Granuloma formation is a key host immune response generated to confine invading pathogens and limit extensive host damage. It consists of an accumulation of host immune cells around a pathogen. This host response has been extensively studied in the context of inflammatory diseases. However, there is much less known about Th2-type granulomas generated in response to parasitic worms.
Gelatin tannate for acute diarrhoea and gastroenteritis in children: a systematic review and meta-analysis
Authors: Florez Ivan D , Sierra Javier M , Niño-Serna Laura F
Published: July 2019

Objective

To determine the effectiveness and safety of gelatin tannate (GT) for reducing the duration of the acute diarrhoea and gastroenteritis (ADG) in children.

Design

Systematic review and meta-analysis.

Data sources

MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, LILACS and grey literature, published from inception to October 2018. No language restrictions.

Eligibility criteria for selecting studies

Randomised controlled trials in children with ADG, comparing GT with placebo.

Results

Of 797 titles identified, we included three studies (276 children). We performed a random effects model meta-analysis for the main outcome (diarrhoea duration). We did not find significant differences between GT and placebo for diarrhoea duration (mean difference (MD)=−15.85 hours; 95% CI −42.24 to 14.82, I2=92%; three studies), stool frequency at day 2 (MD=0.11 stools/day; 95% CI −0.39 to 0.62: I2=26%; two studies), diarrhoea at day 3 (risk ratio [RR]=0.46; 95% CI 0.06 to 3.47: I2=73%; two studies), vomiting (RR=1.31; 95% CI 0.95 to 1.80: I2=0%; two studies) or adverse events (RR=0.86; 95% CI 0.27 to 2.66: I2=0%; two studies). Most common adverse events included abdominal pain and nausea.

Conclusion

The effect of GT was no different to placebo for mean diarrhoea duration (low certainty on the evidence) and stool frequency at day 2 (high certainty) and for the presence of diarrhoea at day 3 (very low certainty) of vomiting (moderate certainty) and of adverse events (low certainty).

PROSPERO registration number

CRD42018087902.
Identifying the factors for improving quality of oral fluorescein angiography
Authors: Amador-Patarroyo Manuel J , Lin Tiezhu , Meshi Amit , Dans Kunny C , Chen Kevin , Borooah Shyamanga , Molano-Gonzalez Nicolás , Díaz-Rojas Jorge A , Freeman William R
Published: July 2019

Aim

To evaluate the quality of oral fluorescein angiography (FA) in relation to food intake.

Methods

This is an observational, case-crossover study. We collected information from patients undergoing routine oral FA for retinal disease at the Shiley Eye Institute. Eighty patients (160 eyes) were analysed. Fasting and non-fasting images of the same patient were recorded, compared and analysed for different image quality parameters and clinical relevance by experienced retina specialists.

Results

When analysing the images, intergrader agreement was moderate to good with a Kappa averaging 0.60 (0.5–0.85). When patients were fasting pre-imaging, better angiography quality scores were achieved when compared with images taken when patients were non-fasting (mean 0.84 vs 0.72, p<0.001). Multivariate analysis showed that non-fasting patients with higher body mass index had the worst scores. Other clinical parameters, such as staining of drusen, staining of disciform scars or central and peripapillary atrophy, were also significantly better during the pre-fasting exam (p<0.001). Oral FA was approximately 22% faster (time to fluorescein dye appearance) under fasting conditions than non-fasting (mean±SD, minutes, 18.7±6.9 vs 25.14±8.1, p<0.001).

Conclusion

Fasting oral FA provided significantly better quality images as well as faster optimal imaging times when compared with non-fasting oral FA. By improving its overall quality, oral FA could be a useful adjunctive examination to optical coherence tomography (OCT) and OCT angiography in patients who require FA studies but who have difficult access or refuse an invasive procedure.
Integrated Disease Surveillance and Response (IDSR) strategy: current status, challenges and perspectives for the future in Africa
Authors: Fall Ibrahima Socé , Rajatonirina Soatiana , Yahaya Ali Ahmed , Zabulon Yoti , Nsubuga Peter , Nanyunja Miriam , Wamala Joseph , Njuguna Charles , Lukoya Charles Okot , Alemu Wondimagegnehu , Kasolo Francis Chisaka , Talisuna Ambrose Otau
Published: July 2019

In 1998, the WHO African region adopted a strategy called Integrated Disease Surveillance and Response (IDSR). Here, we present the current status of IDSR implementation; and provide some future perspectives for enhancing the IDSR strategy in Africa.

In 2017, we used two data sources to compile information on the status of IDSR implementation: a pretested rapid assessment questionnaire sent out biannually to all countries and quarterly compilation of data for two IDSR key performance indicators (KPI). The first KPI measures country IDSR performance and the second KPI tracks the number of countries that the WHO secretariat supports to scale up IDSR. The KPI data for 2017 were compared with a retrospective baseline for 2014.

By December 2017, 44 of 47 African countries (94%) were implementing IDSR. Of the 44 countries implementing IDSR, 40 (85%) had initiated IDSR training at subnational level; 32 (68%) had commenced community-based surveillance; 35 (74%) had event-based surveillance; 33 (70%) had electronic IDSR; and 32 (68%) had a weekly/monthly bulletin for sharing IDSR data. Thirty-two countries (68%) had achieved the timeliness and completeness threshold of at least 80% of the reporting units. However, only 12 countries (26%) had the desired target of at least 90% IDSR implementation coverage at the peripheral level.

After 20 years of implementing IDSR, there are major achievements in the indicator-based surveillance systems. However, major gaps were identified in event-based surveillance. All African countries should enhance IDSR everywhere.
Albuminuria: population epidemiology and concordance in Australian children aged 11–12 years and their parents
Authors: Larkins Nicholas G , Kim Siah , Carlin John B , Grobler Anneke C , Burgner David P , Lange Katherine , Craig Jonathan C , Wake Melissa
Published: July 2019

Objectives

To describe the distribution of albuminuria among Australian children aged 11–12 years and their parents, and assess its intergenerational concordance within parent–child dyads.

Design

Population-based cross-sectional study (the Child Health CheckPoint), nested within the Longitudinal Study of Australian Children.

Setting

Assessment centres (seven Australian cities and eight regional towns) and home visits across Australia, February 2015 to March 2016.

Participants

Of all participating CheckPoint families (n=1874), 1557 children (46.2% girls) and 1454 parents (85.5% mothers) provided random urine samples at the visit; samples from menstruating females were excluded.

Outcome measures

Urine albumin-to-creatinine ratio (ACR) and its components (urine albumin and creatinine concentration); albuminuria was defined as an ACR ≥3.4 mg/mmol. Pearson’s correlation coefficients and multivariable linear regression models assessed parent–child concordance, using log-transformed data due to skewing. Survey weights and methods were applied to account for the complex sample design.

Results

The median ACR for children was 1.03 mg/mmol (IQR 0.65–1.97) and 1.01 mg/mmol (IQR 0.60–2.09) for adults. The median ACR was higher in girls (1.20, IQR 0.71–2.65) than boys (0.90, IQR 0.61–1.65) and in mothers (1.13, IQR 0.63–2.33) than fathers (0.66, IQR 0.41–1.05). Albuminuria was detected in 15.1% of children (girls 20.8%, boys 10.1%) and 13.5% of adults (15.1% mothers, 4.0% fathers) had albuminuria. There was a small correlation between parent and child ACR (Pearson correlation coefficient 0.06, 95% CI 0.01 to 0.12).

Conclusions

Albuminuria is common among Australian children and adults, which is of concern because it predicts risk for kidney and cardiovascular disease, and mortality. The weak concordance among intergenerational pairs for urine ACR suggests either that genetic heritability is low or that it becomes evident only at later offspring life stages.
Carotid artery intima–media thickness, distensibility and elasticity: population epidemiology and concordance in Australian children aged 11–12 years old and their parents
Authors: Liu Richard S , Dunn Sophie , Grobler Anneke C , Lange Katherine , Becker Denise , Goldsmith Greta , Carlin John B , Juonala Markus , Wake Melissa , Burgner David P
Published: July 2019

Objectives

To describe a well-established marker of cardiovascular risk, carotid intima–media thickness (IMT) and related measures (artery distensibility and elasticity) in children aged 11–12 years old and mid-life adults, and examine associations within parent–child dyads.

Design

Cross-sectional study (Child Health CheckPoint), nested within a prospective cohort study, the Longitudinal Study of Australian Children (LSAC).

Setting

Assessment centres in seven Australian major cities and eight selected regional towns, February 2015 to March 2016.

Participants

Of all participating CheckPoint families (n=1874), 1489 children (50.0% girls) and 1476 parents (86.8% mothers) with carotid IMT data were included. Survey weights and methods were applied to account for LSAC’s complex sample design and clustering within postcodes and strata.

Outcome measures

Ultrasound of the right carotid artery was performed using standardised protocols. Primary outcomes were mean and maximum far-wall carotid IMT, quantified using semiautomated edge detection software. Secondary outcomes were carotid artery distensibility and elasticity. Pearson’s correlation coefficients and multivariable linear regression models were used to assess parent–child concordance. Random effects modelling on a subset of ultrasounds (with repeated measurements) was used to assess reliability of the child carotid IMT measure.

Results

The average mean and maximum child carotid IMT were 0.50 mm (SD 0.06) and 0.58 mm (SD 0.05), respectively. In adults, average mean and maximum carotid IMT were 0.57 mm (SD 0.07) and 0.66 mm (SD 0.10), respectively. Mother–child correlations for mean and maximum carotid IMT were 0.12 (95% CI 0.05 to 0.23) and 0.10 (95% CI 0.03 to 0.21), respectively. For carotid artery distensibility and elasticity, mother–child correlations were 0.19 (95% CI 0.10 to 0.25) and 0.11 (95% CI 0.02 to 0.18), respectively. There was no strong evidence of father–child correlation in any measure.

Conclusions

We provide Australian values for carotid vascular measures and report a modest mother–child concordance. Both genetic and environmental exposures are likely to contribute to carotid IMT.
Sleep: population epidemiology and concordance in Australian children aged 11–12 years and their parents
Authors: Matricciani Lisa , Fraysse Francois , Grobler Anneke C , Muller Josh , Wake Melissa , Olds Timothy
Published: July 2019

Objectives

To describe objectively measured sleep characteristics in children aged 11–12 years and in parents and to examine intergenerational concordance of sleep characteristics.

Design

Population-based cross-sectional study (the Child Health CheckPoint), nested within the Longitudinal Study of Australian Children.

Setting

Data were collected between February 2015 and March 2016 across assessment centres in Australian major cities and selected regional towns.

Participants

Of the participating CheckPoint families (n=1874), sleep data were available for 1261 children (mean age 12 years, 50% girls), 1358 parents (mean age 43.8 years; 88% mothers) and 1077 biological parent–child pairs. Survey weights were applied and statistical methods accounted for the complex sample design, stratification and clustering within postcodes.

Outcome measures

Parents and children were asked to wear a GENEActive wrist-worn accelerometer for 8 days to collect objective sleep data. Primary outcomes were average sleep duration, onset, offset, day-to-day variability and efficiency. All sleep characteristics were weighted 5:2 to account for weekdays versus weekends. Biological parent–child concordance was quantified using Pearson’s correlation coefficients in unadjusted models and regression coefficients in adjusted models.

Results

The mean sleep duration of parents and children was 501 min (SD 56) and 565 min (SD 44), respectively; the mean sleep onset was 22:42 and 22:02, the mean sleep offset was 07:07 and 07:27, efficiency was 85.4% and 84.1%, and day-to-day variability was 9.9% and 7.4%, respectively. Parent–child correlation for sleep duration was 0.22 (95% CI 0.10 to 0.28), sleep onset was 0.42 (0.19 to 0.46), sleep offset was 0.58 (0.49 to 0.64), day-to-day variability was 0.25 (0.09 to 0.34) and sleep efficiency was 0.23 (0.10 to 0.27).

Conclusions

These normative values for objective sleep characteristics suggest that, while most parents and children show adequate sleep duration, poor-quality (low efficiency) sleep is common. Parent–child concordance was strongest for sleep onset/offset, most likely reflecting shared environments, and modest for duration, variability and efficiency.
Metabolomics: population epidemiology and concordance in Australian children aged 11–12 years and their parents
Authors: Ellul Susan , Wake Melissa , Clifford Susan A , Lange Katherine , Würtz Peter , Juonala Markus , Dwyer Terence , Carlin John B , Burgner David P , Saffery Richard
Published: July 2019

Objectives

Nuclear magnetic resonance (NMR) metabolomics is high throughput and cost-effective, with the potential to improve the understanding of disease and risk. We examine the circulating metabolic profile by quantitative NMR metabolomics of a sample of Australian 11–12 year olds children and their parents, describe differences by age and sex, and explore the correlation of metabolites in parent–child dyads.

Design

The population-based cross-sectional Child Health CheckPoint study nested within the Longitudinal Study of Australian Children.

Setting

Blood samples collected from CheckPoint participants at assessment centres in seven Australian cities and eight regional towns; February 2015–March 2016.

Participants

1180 children and 1325 parents provided a blood sample and had metabolomics data available. This included 1133 parent–child dyads (518 mother–daughter, 469 mother–son, 68 father–daughter and 78 father–son).

Outcome measures

228 metabolic measures were obtained for each participant. We focused on 74 biomarkers including amino acid species, lipoprotein subclass measures, lipids, fatty acids, measures related to fatty acid saturation, and composite markers of inflammation and energy homeostasis.

Results

We identified differences in the concentration of specific metabolites between childhood and adulthood and in metabolic profiles in children and adults by sex. In general, metabolite concentrations were higher in adults than children and sex differences were larger in adults than in children. Positive correlations were observed for the majority of metabolites including isoleucine (CC 0.33, 95% CI 0.27 to 0.38), total cholesterol (CC 0.30, 95% CI 0.24 to 0.35) and omega 6 fatty acids (CC 0.28, 95% CI 0.23 to 0.34) in parent–child comparisons.

Conclusions

We describe the serum metabolite profiles from mid-childhood and adulthood in a population-based sample, together with a parent–child concordance. Differences in profiles by age and sex were observed. These data will be informative for investigation of the childhood origins of adult non-communicable diseases and for comparative studies in other populations.
Health-related quality of life: population epidemiology and concordance in Australian children aged 11–12 years and their parents
Authors: Catchpool Max , Gold Lisa , Grobler Anneke C , Clifford Susan A , Wake Melissa
Published: July 2019

Objectives

To describe the distribution of health-related quality of life (HRQL) in a national sample of Australian children aged 11–12 years and their parents, and examine associations within parent–child dyads.

Design

The Child Health CheckPoint, a population-based cross-sectional study nested between waves 6 and 7 of the Longitudinal Study of Australian Children (LSAC).

Setting

Assessment centres in seven Australian cities and eight regional towns, or home visit; February 2015 to March 2016.

Participants

Of all participating CheckPoint families (n=1874), 1853 children (49.0% girls) and 1863 parents (87.7% mothers) with HRQL data were included (1786 pairs).

Outcome measures

HRQL was self-reported using preference-based (Child Health Utility 9Dimension, CHU9D) and non-preference-based (Pediatric Quality of Life, PedsQL V.4.0) measures for children and preference-based measures for parents (CHU9D; Assessment of Quality of Life 8 Dimension, AQoL-8D). Utility scores from preference-based measures were calculated using existing Australian algorithms to present a score on a 0–1 scale, where 1 represents full health. Parent–child concordance was assessed using Pearson’s correlation coefficients and adjusted linear regression models. Survey weights and methods were applied to account for LSAC’s complex sample design, stratification and clustering within postcodes.

Results

Children’s means and SD were 0.81 (SD 0.16) for CHU9D and 78.3 (SD 13.03) for PedsQL. In adults, mean HRQL for AQoL-8D and CHU9D were 0.78 (SD 0.16) and 0.89 (SD 0.10), respectively. Mean HRQL was similar for boys and girls, but slightly higher for fathers than mothers. The Pearson correlation coefficient for parent–child CHU9D values was 0.13 (95% CI 0.09 to 0.18). Percentiles and concordance are presented for both samples for males and females separately and together.

Conclusions

We provide Australian paediatric population values for HRQL measures, and the first national CHU9D values for mid-life adults. At age 11–12 years in this relatively healthy sample, parent–child concordance in HRQL was small.
An Application-based programme to reinforce and maintain lower salt intake (AppSalt) in schoolchildren and their families in China
Authors: He Feng J , Zhang Puhong , Luo Rong , Li Yuan , Chen Fengge , Zhao Yuhong , Zhao Wei , Li Daoxi , Chen Hang , Wu Tianyong , Yao Jianyun , Li Jinbao , Zhou Siyuan , Liu Yu , Li Xian , Wang Changqiong , MacGregor Graham A
Published: July 2019

Introduction

Salt intake is very high in China, with ≈80% being added by the consumers. It is difficult to reduce salt in such settings. Our previous study (School-based Education programme to reduce Salt(School-EduSalt)) demonstrated that educating schoolchildren, who then instructed their families to reduce the amount of salt used at home, is effective in lowering salt intake in both children and adults. Our team also developed an app called ‘KnowSalt’, which could help individuals to estimate their salt intake and the major sources of salt in the diet. Building on School-EduSalt and KnowSalt, we propose to develop a new app (AppSalt) focusing on salt reduction through education, target setting, monitoring, evaluation, decision support and management to achieve a progressive lower salt intake for long term. To evaluate the effectiveness of the AppSalt programme, we will carry out a cluster randomised controlled trial.

Methods and analysis

We will recruit 54 primary schools from urban and rural areas of three provinces in China. A total of 594 children aged 8–9 years and 1188 adult family members will be randomly selected for evaluation. After baseline assessment, schools will be randomly allocated to either the intervention or control group. Children in the intervention group will be taught, with support of AppSalt, about salt reduction and assigned homework to get the whole family involved in the activities to reduce salt consumption. The duration of the intervention is two school terms (ie, 1 year). The primary outcome is the difference between the intervention and control group in the change of salt intake as measured by 24-hour urinary sodium.

Ethics and dissemination

The study has been approved by Queen Mary Research Ethics Committee and Peking University Health Science Centre IRB. Results will be disseminated through presentations, publications and social media.

Trial registration number

ChiCTR1800017553.
Contribution of short-term global clinical health experience to the leadership competency of health professionals: a qualitative study
Authors: Hayashi Mikio , Son Daisuke , Onishi Hirotaka , Eto Masato
Published: July 2019

Objectives

Globalisation has increased the opportunities for health professionals working in developed countries to provide clinical and educational support in developing countries. However, how these experiences contribute to the leadership competency of health professionals is unclear; therefore, this study explored this with the objective of analysing the process of developing individual leadership competency.

Design

This is a qualitative descriptive study. Qualitative descriptive study is widely used in healthcare research, particularly to describe the nature of various healthcare phenomena. Qualitative descriptive data were collected in face-to-face, semistructured interviews.

Setting

The authors interviewed Japanese health professionals who participated in an international medical cooperation project as part of a multinational medical team between July 2017 and March 2018, and analysed and interpreted the data using a social constructivism paradigm.

Participants

The authors interviewed 20 research participants, including 5 nurses, 5 dentists and 10 physicians with an average of 15.3 years of clinical experience.

Results

The interviews identified 58 emergent themes related to their leadership competency, 23 of which affected the actual medical care in their own institutions. The authors categorised the 58 emergent themes into seven competency areas: leadership concepts, teambuilding, direction setting, communication, business skills, working with others and self-development. The authors identified the relationships among each competency and identified differences between professions: nurses particularly reflected on their empathic attitudes towards patient after global clinical health experience; dentists tended to reflect on their business skills; physicians tended to reflect on their leadership concepts and teambuilding.

Conclusions

This study clarified the leadership competency gained through short-term global clinical health experience and the process of individual leadership competency development. The findings provide expected learning competency for those considering medical practice in developing or other countries in the future.
Situation analysis for delivering integrated comprehensive sexual and reproductive health services in humanitarian crisis condition for Rohingya refugees in Cox’s Bazar, Bangladesh: protocol for a mixed-method study
Authors: Ahmed Rushdia , Farnaz Nadia , Aktar Bachera , Hassan Raafat , Shafique Sharid Bin , Ray Pushpita , Awal Abdul , Rahman Atiya , Urbaniak Veronique , Kobeissi Loulou Hassan , Rosie Jeffries , Say Lale , Hasan Md Tanvir , Quayyum Zahidul , Rashid Sabina Faiz
Published: July 2019

Introduction

Rohingya diaspora are one of the most vulnerable groups seeking refuge in camps of Cox’s Bazar, Bangladesh, arising an acute humanitarian crisis. More than half of the Rohingya refugees are women and adolescent girls requiring quality sexual and reproductive health (SRH) services. Minimum initial service package of SRH are being rendered in the refugee camps; however, WHO is aiming to provide integrated comprehensive SRH services to meet the unmet needs of this most vulnerable group. For sustainable and successful implementation of such comprehensive SRH service packages, a critical first step is to undertake a situation analysis and understand the current dimensions and capture the lessons learnt on their SRH-specific needs and implementation challenges. This situation analysis is pertinent in current humanitarian condition and will provide an overview of the needs, availability and delivery of SRH services for adolescent girls and women, barriers in accessing and providing those services in Rohingya refugee camps in Cox’s Bazar, Bangladesh, and similar humanitarian contexts.

Methods and analysis

A concurrent mixed-methods design will be used in this study. A community-based household survey coupled with facility assessments as well as qualitative in-depth interviews, key informant interviews and focus group discussions will be conducted with community people of Rohingya refugee camps and relevant stakeholders providing SRH services to Rohingya population in Cox’s Bazar, Bangladesh. Survey data will be analysed using univariate, bivariate and multivariable regression statistics. Descriptive analysis will be done for facility assessment and thematic analysis will be conducted with qualitative data.

Ethics and dissemination

Ethical approval from Institutional Review Board of BRAC James P Grant School of Public Health (2018-017-IR) has been obtained. Findings from this research will be disseminated through presentations in local, national and international conferences, workshops, peer-reviewed publications, policy briefs and interactive project report.
Effects of vaccines in protecting against Ebola virus disease: protocol for a systematic review
Authors: Mathebula Lindi , Ndwandwe Duduzile Edith , Pienaar Elizabeth , Wiysonge Charles Shey
Published: July 2019

Introduction

Ebola virus disease is one of the most devastating infectious diseases in the world with up to 90% case fatality observed. There are at least 13 candidate vaccines developed and being tested to prevent the occurrence of the Ebola virus disease. While none of these candidate vaccines has received regulatory approval for use, one candidate vaccine (rVSVΔG-ZEBOV-GP) has been granted access for emergency use. Two other candidate vaccines (GamEvac-Combi and Ad5-EBOV) have been licensed for emergency use in their countries of origin. The objective of this systematic review is to summarise the effects of the Ebola candidate vaccines in humans.

Methods and analysis

We will search for potentially eligible studies, with no language or date restrictions, in the Cochrane Central Register of Controlled Trials, PubMed, Scopus, the WHO International Clinical Trial Registry Platform, and reference lists of relevant publications. The Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effect (DARE) will be searched for related reviews. Two review authors will independently screen search records, assess study eligibility, perform data extraction, and assess the risk of bias; and reconcile their findings. We will pool data from similar studies using Mantel-Haenszel’s fixed-effect model.

Ethics and dissemination

This study is exempted from ethical consideration since the data collected are publicly available and at no point will confidential information from human participants be used. We will disseminate our results through publications in peer-reviewed journals and relevant conferences.

PROSPERO registration number

CRD42018110505.
Adherence to coronary artery disease secondary prevention medicines: exploring modifiable barriers
Authors: Khatib Rani , Marshall Kay , Silcock Jon , Forrest Claire , Hall Alistair S
Published: July 2019

Background

Non-adherence to secondary prevention medicines (SPMs) among patients with coronary artery disease (CAD) remains a challenge in clinical practice. This study attempted to identify actual and potential modifiable barriers to adherence that can be addressed in cardiology clinical practice.

Methods

This was a cross-sectional, postal survey-based study of the medicines-taking experience of patients with CAD treated at a secondary/tertiary care centre. All participants had been on SPM for ≥3 months.

Results

In total, 696 eligible patients were sent the survey and 503 responded (72.3%). The median age was 70 years, and 403 (80.1%) were male; the mediannumber of individual daily dosesof all medicines was 6. The rate of non-adherence to at least one SPM was 43.5% (n=219), but 53.3% of reported non-adherence was to only one SPM. Statins contributed to 66.7% and aspirin to 61.7% of overall non-adherence identified by the Single Question (SQ) tool. In 30.8% of non-adherent patients (n=65), this was at least partly intentional. Barriers included forgetfulness (84.9%; n=186), worry that medicines will do more harm than good (33.8%; n=74), feeling hassled about medicines taking (18.7%; n=41), feeling worse when taking medicines (14.2%; n=31) and not being convinced of the benefit of medicines (9.1%; n=20). In a multivariate analysis, modifiable factors associated with overall non-adherence included being prescribed aspirin (OR: 2.22; 95% CI: 1.18 to 4.17), havingspecific concernabout SPM (OR: 1.12; 95% CI: 1.07 to 1.18) and issues with repeat prescriptions (OR: 2.48; 95% CI: 1.26 to 4.90). Different factors were often associated with intentional versus unintentional non-adherence.

Conclusions

Using appropriate self-report tools, patients share actual and potential modifiable barriers to adherence that can be addressed in clinical practice. Non-adherence behaviour was selective. Most non-adherence was driven by forgetfulness, concern about the harm caused by SPM and practical barriers.
Multiple myeloma with multiple neurological presentations
Authors: Smith Nicholas , Kimberger Katja , Parrish Christopher , Currie Stuart , Butterworth Stephen , Alty Jane
Published: July 2019

Multiple myeloma is a haematological malignancy with clonal plasma cell proliferation and production of monoclonal immunoglobulins. Its neurological complications are relatively common, caused by both the disease and the treatment. Neurologists should therefore be familiar with its neurological manifestations and complications. We describe a 40-year-old woman who presented with lower cranial neuropathies mimicking variant Guillain-Barré syndrome, with normal brain and spinal cord imaging and cerebrospinal fluid (CSF) albuminocytological dissociation, and subsequently diagnosed with IgD myeloma. She relapsed repeatedly with differing neurological presentations: numb chin syndrome and twice with impaired vision, first from cerebral venous sinus thrombosis and later from leptomeningeal infiltration of the optic chiasm. We discuss the neurological complications of myeloma, emphasising the need to consider it in a wide variety of neurological presentations and repeatedly to reassess its associated neurological diagnoses. We also highlight the complexity of myeloma treatment.
Success of bedside ultrasound to identify puncture site for spinal anesthesia in neonates and infants
Authors: Cristiani Federico , Henderson Ronnie , Lauber Clarisa , Boretsky Karen
Published: July 2019

Spinal anesthesia (SA) may be difficult in small infants. Conceptual advantages of ultrasound imaging to view critical neuraxial structures and exploiting the acoustic window unique to infants have been described but not clinically verified. We present 14 preterm-infants aged 35–48 weeks, weighing 1575–5800 g, and describe ultrasound imaging to locate an appropriate puncture site for SA. The success rate for first puncture was 64%, and the overall success on three attempts was 86%. The mean dural depth was 8 mm (1.6). The inferior medullary cone location was just above L3–L4 in 85.7% of patients. Ultrasound imaging for SA in infants may offer advantages.
H2S-based therapies for ischaemic stroke: opportunities and challenges
Authors: Jia Jia , Li Jie , Cheng Jian
Published: July 2019

Stroke is a cerebrovascular disease displaying high mortality and morbidity. Despite extensive efforts, only very few therapies are available for stroke patients as yet. Hydrogen sulfide (H2S) is thought to be a signalling molecule that is endogenously produced and plays functional roles in the central nervous system. Currently, numerous studies show that H2S impacts stroke outcomes in animal and cellular models. Here, we review the recent research regarding the effects of endogenously produced H2S as well as exogenous H2S donors on stroke pathology, focusing on the potential of H2S-based therapies in treating ischaemic stroke. We also discuss the several issues that hinder the clinical translation of H2S-based therapies from the bench. Taken together, we think that H2S-based therapies are promising strategies for treating cerebral ischaemia if we successfully address these issues.
Alistair Robert Gibson
Authors: Crawford Paul
Published: July 2019

He was keen to share his invaluable knowledge and expertise in his field of small animal cardiology. A well educated, witty man, he had a wicked sense of humour and an infectious smile.