bluuebunny/crossref_metadata_2025 huggingface dataset:
Mitigation of IV Abuse Through the Use of Abuse‐Deterrent Opioid Formulations: An Overview of Current Technologies
Authors: Rauck Richard L.
Published: December 2018

Providers who treat patients with chronic pain face a dual challenge: providing adequate access to opioid therapies for appropriate pain management while adopting strategies to minimize the risk for abuse. Commonly prescribed opioids have substantial abuse potential when administered intravenously, and extended‐release (ER)/long‐acting (LA) opioids may be targeted for intravenous (IV) abuse because of the higher per‐dose medication level. The consequences of IV opioid abuse are severe and increase the risks for adverse outcomes, including mortality due to acute health events, serious infections, and deep vein thrombosis, to name a few. To reduce the potential for abuse of prescription opioids by both recreational and experienced drug abusers, abuse‐deterrent formulations (ADFs) of opioid medications employ either physical/chemical barriers or agonist‐antagonist combinations. Here we review the development and use of opioid ADFs as a harm‐reduction strategy, and their potential for mitigating IV opioid abuse. The approved ER/LA opioids with ADF labeling in the United States include formulations of oxycodone, hydrocodone, and morphine. Findings from in vitro laboratory tests of abuse deterrence for opioid ADFs are described herein, as are data from human abuse potential studies for IV abuse of those ADF products, for which such studies are feasible (ie, abuse‐deterrent agonist‐antagonist formulations). The available ADF opioids may decrease both the attractiveness and the feasibility of IV abuse. The adoption of ADF opioids represents one tactic for providing access to needed medication for patients with chronic pain, while potentially reducing the risk for opioid abuse, in a comprehensive effort to combat the opioid epidemic.
Depressive symptoms in adolescents in Kuching, Malaysia: Prevalence and associated factors
Authors: Ang Ai Ling , Wahab Suzaily , Abd Rahman Fairuz Nazri , Hazmi Helmy , Md Yusoff Rosliwati
Published: December 2018

Background

The trend of depression is rising worldwide. There are limited studies on depression in adolescents. The aim of this study was to estimate the prevalence of and identify the factors associated with depressive symptoms in adolescents in Kuching, Malaysia, and to analyze the relationship between depressive symptoms and suicidal ideation.

Methods

A cross‐sectional study was conducted in 320 students from urban and rural secondary schools. The participants were randomly selected via multi‐stage sampling. They completed the Malay versions of the Children's Depression Inventory (CDI) and Beck Scale for Suicide Ideation (BSS).

Results

The prevalence of depressive symptoms was 26.2%. On binary logistic regression analysis, variables with significant association with depressive symptoms were race (P = 0.028), type of class (P < 0.001), mother's education level (P = 0.036), type of housing (P = 0.036), parents’ marital status (P = 0.012), alcohol intake (P = 0.005), stealing (P < 0.001) and history of disciplinary record (P = 0.005). Variables that remained significant on multivariable logistic regression were type of class (P = 0.004), parents’ marital status (P = 0.017) and stealing (P < 0.001). Students from the Arts stream (OR, 2.43) with parents who were separated, divorced or widowed (OR, 3.13) and who had experience of stealing (OR, 3.27) were predicted to be at risk of developing depressive symptoms. There was a significant correlation between total CDI score and total BSS score (P < 0.001).

Conclusions

The prevalence of depressive symptoms in adolescents was high. Depressive symptoms are significantly correlated with suicidal ideation. Greater collaboration between the education and health agencies is essential for mental health promotion in schools and early detection of depression, especially in at‐risk adolescents.
Acute‐on‐chronic liver failure in children with biliary atresia awaiting liver transplantation
Authors: D’Souza Rashmi , Grammatikopoulos Tassos , Pradhan Akhilesh , Sutton Harry , Douiri Abdel , Davenport Mark , Verma Anita , Dhawan Anil
Published: December 2018

Objectives

Acute‐on‐chronic liver failure (ACLF) is an acute decompensation of cirrhosis complicated by other organ failure and is associated with increased mortality and morbidity. ACLF has not been studied in children with biliary atresia (BA), which is the commonest indication for pediatric liver transplantation (LT) worldwide. This study aims to evaluate ACLF and outcomes in children with BA while awaiting deceased donor LT.

Methods

This was a subanalysis of the dataset from a prospective cohort study of patients aged 0‐18 years who underwent portoenterostomy for BA and were listed for LT at King's College Hospital, London, between 1999 and 2003. Outcomes included the development of ACLF, mortality, and complications.

Results

Ninety‐nine (41 male) children were included, and follow‐up was 10 [6.0‐15.0] years. A total of 20/99 children developed ACLF. ACLF was associated with increased mortality while awaiting LT (20% vs 4%; P = 0.03). There were no associations between biochemical parameters at listing and death. Increased bilirubin levels 3 months post‐portoenterostomy was predictive of development of ACLF (AUROC = 0.72, P < 0.01). Age at LT and time on the waiting list in the ACLF subgroup were both lower compared to the non‐ACLF group (P > 0.05). Sepsis and gastrointestinal bleeding were the commonest precipitants of ACLF. Complications included ascites, hepatic encephalopathy, and hepatorenal syndrome; the ACLF subgroup required multisystem support and longer intensive care unit stay.

Conclusions

ACLF in children with BA awaiting deceased donor LT carries increased mortality and morbidity. This warrants stratification of patients for earlier wait‐listing and prioritization for LT.
Outcomes of kidney transplants in pediatric patients with the vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, limb abnormalities association
Authors: Diaz Jessica , Chavers Blanche , Chinnakotla Srinath , Verghese Priya
Published: December 2018

In this single‐center retrospective study, we analyzed kidney transplant outcomes in nine pediatric patients with VACTERL [vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, limb abnormalities] association—making this the largest study of its kind. Of 743 pediatric kidney transplant recipients at our center (1980‐2017), nine had documented diagnoses of VACTERL association. All nine had congenital anorectal malformations and renal anomalies, five had vertebral defects, and one had a bifid thumb and tracheoesophageal fistula. Renal anomalies included dysplasia (n = 6), aplasia (n = 3), and horseshoe kidney (n = 2). Congenital lower urinary tract anomalies included neurogenic bladder (n = 6), obstructive uropathy (n = 4), anovesicular fistula (n = 1), rectourethral fistula (n = 1), and posterior urethral valves (n = 1). Age at transplant ranged from 1.2 to 15 years (mean, 7.3; standard deviation [SD], 5.5); 6 (67%) were male, and 3 (33%) were female; 6 (67%) had a living related donor, and 3 (33%) had a deceased donor. The overall graft survival rate was 78% (range, 1.5 to 25.2 years; mean, 10.5; SD, 8.9). One month post‐transplant, one recipient died with a functioning graft. At 3.7 years post‐transplant, one graft failed because of recurrent pyelonephritis. Post‐transplant urologic complications included pyelonephritis (n = 6), vesicoureteral reflux (n = 5), and graft hydronephrosis (n = 4). We conclude that pediatric patients with VACTERL association can be safely transplanted—careful patient selection with vigilance and intervention for pre‐ and post‐transplant urologic complications is essential.
The effect of mothers’ emotion‐related responses to adolescent disclosures and adolescent perspective taking on the timing of future disclosures
Authors: Disla Janice , Main Alexandra , Kashi Smitha , Boyajian Jonathan
Published: December 2018

Adolescent disclosure to parents is an important feature of high‐quality parent–adolescent relationships and is associated with positive adolescent adjustment. However, no studies have examined parental emotion‐related responses (ERRs) to disclosures and adolescent dispositional characteristics that may facilitate or inhibit adolescent disclosures during real‐time conversations. The present study tested (a) which maternal ERRs to adolescent disclosures predicted quicker subsequent disclosures during mother–adolescent conversations, and (b) whether adolescent perspective taking moderated these associations. Adolescent disclosures and maternal ERRs were coded moment‐to‐moment during a problem‐solving discussion and adolescents reported on their perspective taking. Multilevel Generalized Linear Mixed‐Effects Models revealed that maternal interest and validation predicted the shortest lag times compared with other maternal ERRs, controlling for adolescent age, gender, total durations of maternal ERRs, and total frequency and duration of adolescent disclosures. Adolescent perspective taking moderated associations between maternal ERRs to adolescent disclosures and lag times. Specifically, adolescents high in perspective taking were most likely to make quicker subsequent disclosures when mothers responded to disclosures with interest. This is the first study to examine how contingent parental responses to adolescent disclosures in real time affect the timing of subsequent disclosures during parent–adolescent conversations.
Tumour-Immune Interaction Model with Cell Cycle Effects Including G0 Phase
Authors: Awang Nor Aziran , Maan Normah , Sul’ain Dasuki
Published: December 2018

Tumour cells behave differently than normal cells in the body. They grow and divide in an uncontrolled manner (actively proliferating) and fail to respond to signal. However, there are cells that become inactive and reside in quiescent phase (G0). These cells are known as quiescence cells that are less sensitive to drug treatments (radiotherapy and chemotherapy) than actively proliferation cells. This paper proposes a new mathematical model that describes the interaction of tumour growth and immune response by considering tumour population that is divided into three different phases namely interphase, mitosis and G0. The model consists of a system of delay differential equations where the delay, represents the time for tumour cell to reside interphase before entering mitosis phase. Stability analysis of the equilibrium points of the system was performed to determine the dynamics behaviour of system. Result showed that the tumour population depends on number of tumour cells that enter active (interphase and mitosis) and G0phases. This study is important for treatment planning since tumour cell can resist treatment when they refuge in a quiescent state.
Heat and Mass Transfer of Magnetohydrodynamics (MHD) Boundary Layer Flow using Homotopy Analysis Method
Authors: Nazari Nur Liyana , Abd Aziz Ahmad Sukri , David Vincent Daniel , Md Ali Zaileha
Published: December 2018

Heat and mass transfer of MHD boundary-layer flow of a viscous incompressible fluid over an exponentially stretching sheet in the presence of radiation is investigated. The two-dimensional boundary-layer governing partial differential equations are transformed into a system of nonlinear ordinary differential equations by using similarity variables. The transformed equations of momentum, energy and concentration are solved by Homotopy Analysis Method (HAM). The validity of HAM solution is ensured by comparing the HAM solution with existing solutions. The influence of physical parameters such as magnetic parameter, Prandtl number, radiation parameter, and Schmidt number on velocity, temperature and concentration profiles are discussed. It is found that the increasing values of magnetic parameter reduces the dimensionless velocity field but enhances the dimensionless temperature and concentration field. The temperature distribution decreases with increasing values of Prandtl number. However, the temperature distribution increases when radiation parameter increases. The concentration boundary layer thickness decreases as a result of increase in Schmidt number
First record of the genus Paracarophenax (Acari: Acarophenacidae) from China, with description of a new species
Authors: Xu Yun , Li Ye-Chen , Huang Bing-Rong , Cai Meng-Ling , Wu Song-Qing , Zhang Fei-Ping , Wu Jie-Qin
Published: December 2018

A new species Paracarophenax alternatus Xu and Zhang sp. nov. is described and illustrated based on phoretic females. The mites were found attached to the adult of Monochamus alternatus Hope (Coleoptera: Cerambycidae) collected from traps set in Minhou county, Fuzhou city, Fujian province, China. The new species is the eighth representative of the genus and also the first record of the Paracarophenax associated with the host family Cerambycidae. An updated the key to species of Paracarophenax is provided.
Characterization of the distribution of defects introduced by plasma exposure in Si substrate
Authors: Sato Yoshihiro , Shibata Satoshi , Uedono Akira , Urabe Keiichiro , Eriguchi Koji
Published: December 2018

Defects in a silicon (Si) substrate induced by plasma exposure—plasma-induced damage (PID)—were investigated using various techniques. The authors performed a comprehensive characterization of plasma induced damages, which will be indispensable for suppressing PID, by precisely assigning the density profile of defects in the region to ∼1016 cm−3. In this study, the Si substrate was damaged using an electron cyclotron resonance plasma system. Cathodoluminescence analysis was used to detect the defects in the damaged Si substrates. The thickness of the damaged layer in the Si substrates was determined to be approximately 1–2 nm by transmission electron microscopy and spectroscopic ellipsometry, while time-of-flight secondary ion mass spectrometry identified the presence of interstitial atoms to a depth of ∼20 nm. Positron annihilation spectroscopy showed that the structural changes related to vacancies interacting with C and F atoms were distributed from the substrate surface to a depth of approximately 130 nm. The authors further verified this finding by a technique using the PID-enhanced dechanneling of As atoms implanted with a projection range of 10 nm. After plasma exposure, the difference between the plasma-damaged and the nondamaged samples in the injected As profiles was identified to a depth of ∼130 nm with a density of ∼1016 cm−3. The comprehensive defect profiling performed in this study provides key guidelines for the introduction mechanism of defects in plasma exposed Si before designing future electronic devices.
Length computation of irradiated plasmid DNA molecules
Authors: Pachnerová Brabcová Kateřina , Sihver Lembit , Ukraintsev Egor , Štěpán Václav , Davídková Marie
Published: December 2018

Compromised detection of short DNA fragments can result in underestimation of radiation-induced clustered DNA damage. The fragments can be detected with atomic force microscopy (AFM), followed by image analysis to compute the length of plasmid molecules. Plasmid molecules imaged with AFM are represented by open or closed curves, possibly with crossings. For the analysis of such objects, a dedicated algorithm was developed, and its usability was demonstrated on the AFM images of plasmid pBR322 irradiated with 60Co gamma rays. The analysis of the set of the acquired AFM images revealed the presence of DNA fragments with lengths shorter than 300 base pairs that would have been neglected by a conventional detection method.
Photoluminescence properties of Eu-doped CaNb2O6 thin films grown by radio-frequency magnetron sputtering
Authors: Cho Shinho
Published: December 2018

Europium doped calcium niobate (CaNb2O6:Eu3+) phosphor thin films were deposited on quartz using a radio-frequency magnetron sputtering technique at different growth temperatures in the range of 100–400 °C. The phosphor films grown at different deposition temperatures showed different microstructural and optical properties. The structural characterization indicated that the phosphor films were preferentially (131) oriented. The surface morphology of the thin films exhibited spherical-shaped crystallite grains with an average diameter of 40 nm, and agglomerated islands were observed at a growth temperature of 400 °C. Increased growth temperature resulted in an increase in both the transmittance and photoluminescence intensity, arising from better crystallinity. The emission spectra of the films under excitation at 265 nm showed five dominant emission peaks centered at 541, 597, 618, 656, and 707 nm. The maximum intensity in orange-reddish emission at 618 nm was observed for the phosphor thin film deposited at 400 °C. These results suggest that the CaNb2O6:Eu3+ phosphor thin film is a promising candidate for use as a red-emitting phosphor thin film for displays and photonic device applications.
Properties of conductive nitride films prepared by plasma enhanced atomic layer deposition using quartz and sapphire plasma sources
Authors: Krylov Igor , Xu Xianbin , Weinfeld Kamira , Korchnoy Valentina , Ritter Dan , Eizenberg Moshe
Published: December 2018

The authors report on the properties of various conductive nitride (TiN, ZrN, and TaN) films prepared by plasma enhanced atomic layer deposition using either quartz or sapphire inductively coupled plasma (ICP) sources. Different reactive gases (N2, NH3, and H2) and various pressures during the plasma half-cycle were examined. The sapphire based ICP source enabled higher deposition rates, better crystallization, lower film resistivity, and lower oxygen contamination. The effect of the ICP source material depends strongly on the reactive gas species and pressure. Optimal deposition conditions for both ICP source materials are determined.
Low-k dielectric etch challenges at the 7 nm logic node and beyond: Continuous-wave versus quasiatomic layer plasma etching performance review
Authors: Lutker-Lee Katie M. , Lu Yen-Tien , Lou Qiaowei , Kaminsky Jake , Kikuchi Yuki , Raley Angelique
Published: December 2018

For logic nodes of 7 nm and beyond, back-end-of-line (BEOL) trench patterns have a critical pitch of less than 40 nm, directly affecting the plasma etch process window of the dual damascene etch process. Feature size dependent etch depth (reactive ion etch, RIE lag), hard mask selectivity, and ultra-low-k (ULK) damage have become significant challenges that must be overcome in order to meet target device performance. Recently, atomic layer etching has been used to widen the plasma etch process window in terms of selectivity and process control [S. Sherpa, P. L. F. Ventzek, and A. Ranjan, J. Vac. Sci. Technol. A 35, 05C310 (2017); T. Tsutsumi, H. Kondo, M. Hori, M. Zaitsu, A. Kobayashi, T. Nozawa, and N. Kobayashi, J. Vac. Sci. Technol. A 35, 01A103 (2017)]. In this work, the impact of a quasiatomic layer etch (QALE) process, a conventional continuous wave plasma, and a pulsed plasma process on ULK materials were investigated to determine the benefits of an ALE process approach for BEOL etching. Both blanket ULK film and patterned ULK samples were used for this study. The ULK etch damage from each process was characterized using Fourier transform infrared spectroscopy and x-ray photoelectron spectroscopy on three different ULK films. From patterned samples, it was determined that QALE could be used to successfully suppress RIE lag in low-k materials at advanced pitches, while keeping low-k damage to a minimum. In addition, the QALE technique showed improved hard mask selectivity and resulted in lower line edge pattern roughness. Based on this study, the authors concluded that QALE is a powerful plasma etch method to overcome BEOL etch challenges at advanced pitches.
Iron–sepiolite magnetorheological fluids with improved performances
Authors: Marins Jessica A. , Plachý Tomáš , Kuzhir Pavel
Published: December 2018

This work is focused on the characterization and magnetorheological (MR) study of MR fluids composed of iron particles and sepiolite fibers, used as a thickening agent. The work is aimed at (a) understanding the effect of the sepiolite addition on the MR response and (b) finding an appropriate formulation allowing a good sedimentation stability keeping a relatively low off-state viscosity and providing an enhanced MR effect. In the presence of an applied magnetic field, the composite MR fluid exhibits a yielding behavior with a progressive enhancement of the field-induced static yield stress with increasing volume fractions of both iron and sepiolite. Such an effect is attributed to a friction between gap-spanning aggregates composed of iron particles and sepiolite–oil viscoplastic matrix. The field-induced dynamic yield stress shows an initial increase with the sepiolite concentration (explained by a partial expulsion of the sepiolite fibers from the aggregates) followed by a decrease. The proposed mechanisms are supported by developed qualitative theoretical models, one of which is based on the homogenization approach of Château et al. [J. Rheol. 52, 489–506 (2008)]. From the practical point of view, the formulation containing 10 vol. % of iron and 4 vol. % of sepiolite seems to combine a perfect sedimentation stability with moderate values of the plastic viscosity and of the off-state static yield stress (only ∼5 Pa) and with a relatively important static and dynamic yield stress enhancement (30% and 60%, respectively).
In-line rheological monitoring of fused deposition modeling
Authors: Coogan Timothy J. , Kazmer David O.
Published: December 2018

An in-line rheometer has been incorporated into a fused deposition modeling printer for the first time by designing a modified nozzle with a custom pressure transducer and a thermocouple for measuring the processed melt temperature. Additionally, volumetric flow rates and shear rates were monitored by counting the stepper motor pulses as well as the pulses from a custom filament encoder to account for filament slippage and skipped motor steps. The incorporation of the sensors and the design and development of the in-line rheometer are described; and pressures, temperatures, and viscosities within the 3D printing nozzle are presented. The in-line rheometer was validated against traditional, off-line rotational rheology and capillary rheology measurements by analyzing two polymeric materials: polycarbonate and high-impact polystyrene. A variety of rheological corrections were considered for the in-line rheometer, including entrance effects, non-Newtonian corrections, shear heating, pressure effects, and temperature fluctuations/inaccuracies. Excellent agreement was obtained between the in-line and off-line rheometers after applying the most critical corrections, which were found to be entrance effects, non-Newtonian corrections, and temperature inaccuracies. After applying the appropriate corrections, the in-line rheometer provides an accurate viscosity measurement that can be used for real-time monitoring and process control.
Mesenchymal chondrosarcoma metastasising to the pancreas
Authors: Paasch Christoph , De Santo Gianluca , Boettge Katherina Renate , Strik Martin W
Published: December 2018

The mesenchymal chondrosarcoma (MC) is a rare malignant tumour and accounts for less than 3% of primary chondrosarcomas. Mostly MC arises from the craniofacial bones, the ribs, the ilium, the femur and the vertebrae. A 54-year-old man was treated due to an icterus of unknown origin. The medical history of the patient consists of a multimodal treated MC of the thoracic vertebrae. A CT imaging identified a 2×4 cm sized mass of the pancreatic head. Suspecting a pancreatic head carcinoma surgical removal was performed. Histopathological a metastasis of MC was diagnosed. Our patient left the hospital after 17 days and died 23 month after surgery. Metastases of MC to the pancreas are rare. When detecting a mass of the pancreas in patients with a medical history of an MC, a metastasis of these tumour should be taken in consideration.
Rheumatoid meningitis: successful remission with rituximab
Authors: Harrison Nancy Salloum , Kishore Shweta , Majithia Vikas
Published: December 2018

A 53-year-old male with rheumatoid arthritis presented with recurrent headaches, seizures and right-sided lower extremity paralysis while on antiepileptic medications. Work up revealed pachymeningeal and leptomeningeal enhancement on brain MRI. Differential diagnosis included a variety of infections, neoplasm and vasculitis. Histopathology showed findings consistent with rheumatoid meningitis (RM). Ultimately based on symptoms, MRI findings and tissue pathology, he was diagnosed with RM. Intravenous pulse dose steroids were initiated followed by rituximab every 6 months, resulting in significant improvement of the brain MRI findings. Patient has remained seizure free.
Health facility structure and maternal characteristics related to essential newborn care in Brazil: a cross-sectional study
Authors: Menezes Maria Alexsandra Silva , Gurgel Ricardo , Bittencourt Sonia Duarte Azevedo , Pacheco Vanessa Eufrazino , Cipolotti Rosana , Leal Maria do Carmo
Published: December 2018

Objectives

To assess the use of the WHO’s Essential Newborn Care (ENC) programme items and to investigate how the non-use of such technologies associates with the mothers' characteristics and hospital structure.

Design

A cross-sectional observational health facility assessment.

Setting

This is a secondary analysis of the ‘Birth in Brazil’ study, a national population-based survey on postnatal women/newborn babies and of 266 publicly and privately funded health facilities (secondary and tertiary level of care).

Participants

Data on 23 894 postnatal women and their newborn babies were analysed.

Main outcome measures

The facility structure was assessed by evaluating the availability of medicines and equipment for perinatal care, a paediatrician on call 24/7, a neonatal intensive care unit (NICU) and kangaroo mother care. The use of each ENC item was assessed according to the health facility structure and the mothers’ sociodemographic characteristics.

Results

The utilisation of ENC items is low in Brazil. The factors associated with failure in pregnant woman reference were: pregnant adolescents (ORadj1.17; 95% CI 1.06 to 1.29), ≤7 years of schooling (ORadj1.47; 95% CI 1.22 to 1.78), inadequate antenatal care (ORadj1.67; 95% CI 1.47 to 1.89). The non-use of corticosteroids was more frequently associated with the absence of an NICU (ORadj3.93; 95% CI 2.34 to 6,66), inadequate equipment and medicines (ORadj2.16; 95% CI 1.17 to 4.01). In caesarean deliveries, there was a less frequent use of a partograph (ORadj4,93; 95% CI 3.77 to 6.46), early skin-to-skin contact (ORadj3.07; 95% CI 3.37 to 4.90) and breast feeding in the first hour after birth (ORadj2.55; 95% CI 2.21 to 2.96).

Conclusions

The coverage of ENC technologies use is low throughout Brazil and shows regional differences. We found a positive effect of adequate structure at health facilities on antenatal corticosteroids use and on partograph use during labour. We found a negative effect of caesarean section on early skin-to-skin contact and early breast feeding.
Preventing PTSD, depression and associated health problems in student paramedics: protocol for PREVENT-PTSD, a randomised controlled trial of supported online cognitive training for resilience versus alternative online training and standard practice
Authors: Wild Jennifer , El-Salahi Shama , Tyson Gabriella , Lorenz Hjördis , Pariante Carmine M , Danese Andrea , Tsiachristas Apostolos , Watkins Edward , Middleton Benita , Blaber Amanda , Ehlers Anke
Published: December 2018

Introduction

Emergency workers dedicate their lives to promoting public health and safety, yet suffer higher rates of post-traumatic stress disorder (PTSD) and major depression (MD) compared with the general population. They also suffer an associated increased risk for physical health problems, which may be linked to specific immunological and endocrine markers or changes in relevant markers. Poor physical and mental health is costly to organisations, the National Health Service and society. Existing interventions aimed at reducing risk of mental ill health in this population are not very successful. More effective preventative interventions are urgently needed. We first conducted a large-scale prospective study of newly recruited student paramedics, identifying two cognitive factors (rumination and resilience appraisals) that predicted episodes of PTSD and MD over a 2-year period. We then developed internet-delivered cognitive training for resilience (iCT-R), a supported online intervention, to modify cognitive predictors. This protocol is for a randomised controlled trial to evaluate the efficacy of the resilience intervention.

Methods and analysis

570 student paramedics will be recruited from participating universities. They will be randomly allocated to iCT-R or to supported online training of an alternative, widely available intervention or to training-as-usual. Follow-up will occur after the intervention/standard practice period and at 6, 12 and 24 months. Primary outcomes include rates of PTSD and MD and subsydnromal PTSD and MD, measured by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, the Patient-Health Questionnaire-9 and the Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Secondary outcomes include measures of resilience, rumination, anxiety, psychological distress, well-being, salivary cortisol, plasma levels of C-reactive protein, smoking and alcohol use, weight gain, sleep problems, health-related quality of life, health resource utilisation and productivity.

Ethics and dissemination

The Medical Sciences Inter-Divisional Research Ethics Committee at the University of Oxford granted approval, reference: R44116/RE001. The results will be published in a peer-reviewed journal. Access to raw data and participant information will be available only to members of the research team.

Trial registration number

ISRCTN16493616; Pre-results.
“Tell them you smoke, you’ll get more breaks”: a qualitative study of occupational and social contexts of young adult smoking in Scotland
Authors: Delaney Hannah , MacGregor Andrew , Amos Amanda
Published: December 2018

Objective

To explore young adults’ perceptions and experiences of smoking and their smoking trajectories in the context of their social and occupational histories and transitions, in a country with advanced tobacco control.

Design

Indepth qualitative interviews using day and life grids to explore participants’ smoking behaviour and trajectories in relation to their educational, occupational and social histories and transitions.

Setting

Scotland.

Participants

Fifteen ever-smokers aged 20–24 years old in 2016–2017.

Results

Participants had varied and complex educational/employment histories. Becoming and/or remaining a smoker was often related to social context and educational/occupational transitions. In several contexts smoking and becoming a smoker had perceived benefits. These included getting work breaks and dealing with stress and boredom, which were common in the low-paid, unskilled jobs undertaken by participants. In some social contexts smoking was used as a marker of time out and sociability.

Conclusions

The findings indicate that while increased tobacco control, including smokefree policies, and social disapproval of smoking discourage smoking uptake and increase motivations to quit among young adults, in some social and occupational contexts smoking still has perceived benefits. This finding helps explain why smoking uptake continues into the mid-20s. It also highlights the importance of policies that reduce the perceived desirability of smoking and that create more positive working environments for young adults which address the types of working hours and conditions that may encourage smoking.
Evaluation of types of poisoning exposure calls managed by the Malaysia National Poison Centre (2006–2015): A retrospective review
Authors: Tangiisuran Balamurugan , Jiva Maryam , Ariff Adilah Mohamed , Abdul Rani Noor Afiza , Misnan Asdariah , Rashid Sazaroni Md , Majid Mohamed Isa Abdul , Dawson Andrew H
Published: December 2018

Objective

Accidental or intentional poisoning is a public health concern requiring intervention. The current study designs to evaluate the types of poisoning exposure calls received by the Malaysia National Poison Centre (NPC) over a 10-year period.

Settings and data sources

The poisoning enquiries database (2006–2015) from the Malaysia NPC was used for the analysis.

Participants

The NPC records all telephone calls that it manages using a validated and standardised form. Demographics and types of the poisoning exposure calls were extracted and descriptive analysis was applied.

Primary and secondary outcomes

The primary outcome of this study is to evaluate NPC data for trends in the poisoning exposure calls based on the types and modes of poisoning over a 10-year period. The secondary outcome is to evaluate the characteristics of human exposure cases based on the calls received by the NPC.

Results

There was a notable increase in the number of poisoning exposure calls noticed during the 10-year period but dropped significantly in 2012. The highest number of poisoning exposure calls came from Selangor (21.0%), Perak (18.0%) and Negeri Sembilan (9.8%). More than half of the exposure was intentional (53.8%) involving more women (50.3%) as compared with men (41.9%), and in the 20–29 years age group category (33.5%). Exposure mostly occurred at home (96%) through the ingestion route (94.1%). Pharmaceutical products (40.5%), pesticides (31.7%) and household products (20.1%) were the common agents implicated for intentional exposure.

Conclusions

There is an increasing trend in enquiries on poisoning exposure calls made to the NPC. Most of the intentional poisoning exposures occurred among younger women and involved pharmaceuticals, pesticides or household products. Poisoning safety education and other interventions are needed to curb poisoning incidents.
Efficacy of a guided internet-based intervention (iSOMA) for somatic symptoms and related distress in university students: study protocol of a randomised controlled trial
Authors: Hennemann Severin , Böhme Katja , Baumeister Harald , Bendig Eileen , Kleinstäuber Maria , Ebert David Daniel , Witthöft Michael
Published: December 2018

Introduction

Persistent and distressing somatic symptoms are common in younger age cohorts such as university students. However, the majority does not receive adequate psychosocial care. Internet-based and mobile-based interventions may represent low threshold and effective extensions to reduce somatic and associated mental symptom severity. The planned study aims to investigate the feasibility and efficacy of an internet-based intervention in reducing somatic and psychological symptoms in an international population of university students with somatic symptom burden.

Methods and analysis

This parallel two-armed randomised controlled trial evaluates an 8-week guided intervention, including web-based consecutive modules based on cognitive behavioural therapy (CBT) principles against a waitlist control group. Guidance will be provided by trained psychologists with weekly written supportive feedback. As part of the ‘Studicare’ project, the present study aims to recruit n=154 university students indicating somatic symptom burden at baseline in German-speaking universities. Self-report assessments will take place at baseline and after intervention completion (8, 16 weeks after randomisation). The primary outcome will be the severity of somatic symptoms and associated mental distress. Secondary outcomes include depression, (health) anxiety, disability, intervention satisfaction and adherence.

Ethics and dissemination

Ethics approval has been granted. Results from this study will be published in peer-reviewed journals and presented at international conferences.

Trial registration number

DRKS00014375; Pre-results.
Association of autonomic symptoms with disease progression and survival in progressive supranuclear palsy
Authors: Oliveira Marcos C B , Ling Helen , Lees Andrew J , Holton Janice L , De Pablo-Fernandez Eduardo , Warner Thomas T
Published: December 2018

Background

Development of autonomic failure is associated with more rapid disease course and shorter survival in patients with Parkinson’s disease and multiple system atrophy. However, autonomic symptoms have not been specifically assessed as a prognostic factor in progressive supranuclear palsy (PSP). We evaluated whether development of autonomic symptoms is associated with disease progression and survival in PSP.

Methods

A retrospective review of clinical data from consecutive patients with autopsy-confirmed PSP from the Queen Square Brain Bank between January 2012 and November 2016 was performed. Time from disease onset to four autonomic symptoms (constipation, urinary symptoms, erectile dysfunction and orthostatic hypotension) were noted. Time from diagnosis to five disease milestones and survival were calculated to assess disease progression, and their risk was estimated through a Cox proportional hazards model.

Results

A total of 103 PSP patients were included. Urinary symptoms and constipation were present in 81% and 71% of cases, respectively. Early development of constipation and urinary symptoms were associated with higher risk of reaching the first disease milestone (respectively, HR: 0.88; 95% CI 0.83 to 0.92; p<0.001; and HR: 0.80; 95% CI 0.75 to 0.86; p<0.001) and with a shorter survival in these patients (respectively, HR: 0.73; 95% CI 0.64 to 0.84; p<0.001; and HR: 0.88; 95% CI 0.80 to 0.96; p=0.004). On multivariate analysis, Richardson syndrome phenotype was the other variable independently associated with shorter survival.

Conclusions

Earlier urinary symptoms and constipation are associated with a more rapid disease progression and reduced survival in patients with PSP.
Rationale and design of the Coronary Microvascular Angina Cardiac Magnetic Resonance Imaging (CorCMR) diagnostic study: the CorMicA CMR sub-study
Authors: Corcoran David , Ford Thomas J , Hsu Li-Yueh , Chiribiri Amedeo , Orchard Vanessa , Mangion Kenneth , McEntegart Margaret , Rocchiccioli Paul , Watkins Stuart , Good Richard , Brooksbank Katriona , Padmanabhan Sandosh , Sattar Naveed , McConnachie Alex , Oldroyd Keith G , Touyz Rhian M , Arai Andrew , Berry Colin
Published: December 2018

Introduction

Angina with no obstructive coronary artery disease (ANOCA) is a common syndrome with unmet clinical needs. Microvascular and vasospastic angina are relevant but may not be diagnosed without measuring coronary vascular function. The relationship between cardiovascular magnetic resonance (CMR)-derived myocardial blood flow (MBF) and reference invasive coronary function tests is uncertain. We hypothesise that multiparametric CMR assessment will be clinically useful in the ANOCA diagnostic pathway.

Methods/analysis

The Stratified Medical Therapy Using Invasive Coronary Function Testing In Angina (CorMicA) trial is a prospective, blinded, randomised, sham-controlled study comparing two management approaches in patients with ANOCA. We aim to recruit consecutive patients with stable angina undergoing elective invasive coronary angiography. Eligible patients with ANOCA (n=150) will be randomised to invasive coronary artery function-guided diagnosis and treatment (intervention group) or not (control group). Based on these test results, patients will be stratified into disease endotypes: microvascular angina, vasospastic angina, mixed microvascular/vasospastic angina, obstructive epicardial coronary artery disease and non-cardiac chest pain. After randomisation in CorMicA, subjects will be invited to participate in the Coronary Microvascular Angina Cardiac Magnetic Resonance Imaging (CorCMR) substudy. Patients will undergo multiparametric CMR and have assessments of MBF (using a novel pixel-wise fully quantitative method), left ventricular function and mass, and tissue characterisation (T1 mapping and late gadolinium enhancement imaging). Abnormalities of myocardial perfusion and associations between MBF and invasive coronary artery function tests will be assessed. The CorCMR substudy represents the largest cohort of ANOCA patients with paired multiparametric CMR and comprehensive invasive coronary vascular function tests.

Ethics/dissemination

The CorMicA trial and CorCMR substudy have UK REC approval (ref.16/WS/0192).

Trial registration number

NCT03193294.
Time is money: quantifying savings in outpatient appendectomy
Authors: Bernard Elise Taylor , Davenport Daniel L , Collins Courtney M , Benton Bethany A , Bernard Andrew C
Published: December 2018

Background

Laparoscopic appendectomy can be performed on a fast-track, short-stay, or outpatient basis with high success rates, low morbidity, low readmission rates, and shorter length of hospital stay. Cost savings from outpatient appendectomy have not been well described. We hypothesize that outpatient laparoscopic appendectomy is associated with cost savings.

Methods

We performed an original retrospective cohort analysis of patients undergoing laparoscopic appendectomy between June 2013 and April 2017 at our academic medical center before and after implementation of an outpatient protocol which began on January 1, 2016. We assessed appendicitis grade, length of stay (LOS), cost, net revenue, and profit margin.

Results

After protocol implementation, the percentage of patients discharged from the the postanesthesia care unit (PACU) increased from 3.7% to 29.7% (χ2 p<0.001). The proportion of inpatient admissions and admissions to observation decreased by 5.7% and 20.3%, respectively. On average, PACU-to-home patients had a total hospital cost of $4734 compared with $5781 in patients admitted to observation, for an estimated savings of $1047 per patient (p<0.001). Comparing the time periods, the mean LOS decreased for all groups (p<0.001). Appendicitis grade was higher in those who required inpatient admission, but could not distinguish which patients required an observation bed.

Discussion

Outpatient appendectomy saves approximately $1000 per patient. Adoption of an outpatient appendectomy pathway is likely to be gradual, but will result in incremental improvement in resource utilization immediately. Grade does not predict which patients should be observed. Considering established safety, our data support widespread implementation of this protocol.

Level of evidence

III.
CT evaluation of mesenteric avulsion after abdominal blunt trauma in a dog
Authors: Nixon Rachel , Rossanese Matteo , Mesquita Luis , Burrow Rachel
Published: December 2018

A 10‐month‐old German shepherd dog was presented following blunt abdominal trauma with evidence of circulatory shock. Abdominal ultrasonography and abdominocentesis confirmed a haemoabdomen. CT findings were consistent with active arterial abdominal bleeding secondary to mesenteric or splenic vessel rupture with a large haematoma visible in the region of the mesenteric root. The dog was stabilised prior to exploratory coeliotomy. This confirmed active haemorrhage of the cranial mesenteric artery and devitalisation of a large section of jejunum and ilium. The affected mesenteric vessels were ligated, and the affected intestinal segment was resected. While recovering from anaesthesia, the dog developed ventricular fibrillation. Cardiopulmonary resuscitation was unsuccessfully attempted. With the increasing use of CT in veterinary trauma patients, the recognition of the features of blunt bowel and mesenteric injury is crucial for a successful diagnosis and management of these conditions.
Vertebral angiomatosis recurrence in a 14‐month‐old Maine Coon cat
Authors: Belluzzi Elena , Caraty Johan , Vincken Gaelle , Esmans Maya , Bongartz Alexandre
Published: December 2018

Vertebral angiomatosis in cats is a rare locally aggressive benign tumor‐like lesion that has been reported to have a good prognosis if surgically treated. This case reports a 14‐month‐old Maine Coon cat, who had a successful surgery for vertebral angiomatosis at the age of seven months, and represented with hindlimb ambulatory paraparesis seven months after the surgery. The CT scan confirmed the recurrence of vertebral angiomatosis, seven months postsurgery, showing more aggressive characteristics than the initial lesion and a poorer prognosis.
Giant fennel (Ferula communis L) intoxication in goats in Tunisia
Authors: Lahmar Rym , Mahjoub Tarek , Fourel Isabelle , Gault Gilbert , Grancher Denis
Published: December 2018

Giant fennel (Ferula communis L) toxicity has been commonly reported in different species, especially sheep, cattle, pig, horse and human but not in goat. A herd of 30 Damascus goats grazed during two days an area where F communis was very abundant. One week later, most animals presented clinical signs with locomotor disorders, anorexia and fever. Diagnosis of the intoxication was based on haematological parameters, toxicology research, necropsy and botanical investigation. Two goats survived following a treatment with vitamin K1. A total of 13 animals died of which most were young. The present study is the first report providing information about F communis intoxication in goat.
Impedance Spectroscopy and Cyclic Voltammetry to Determine Double Layer Capacitances and Electrochemically Active Surface Areas
Authors: Schalenbach Maximilian
Published: December 2018

The electrochemically active surface area (ECSA) of an electrode can be estimated by means of double layer capacitance (DLC) measurements using impedance spectroscopy and cyclic voltammetry. In this study, the responses of smooth and porous gold electrodes (chosen as model systems) to both methods are measured and described by physical models. I point out that diffusion limited adsorption processes significantly contribute to the measured responses and thus complicate the estimation of DLCs. Impedance is derived to be in most cases more suitable for measuring DLCs as higher frequencies are available and as contributions of serial resistances and capacitances can be separately evaluated in the frequency domain. The relaxation properties in the frequency domain are shown to display a useful tool to survey the accuracy of the DLC estimation. The DLCs of polished gold electrodes are shown to be proportional to their geometric surface area. From these measurements a specific DLC of 6±2 μF/cm² of gold in perchloric acid is determined, which agrees with the lowest reported values of strongly scattering data in the literature. A handy flow chart for experimentalists to determine electrode capacitances from impedance spectra is proposed.
A Case of Malignant Melanoma Arising in Mediastinal Malignant Teratoma
Authors: Nozaki Ikuma , Tone Yumi , Yamanaka Junko , Uryu Hideko , Shimizu-Motohashi Yuko , Sato Noriko , Matsushita Takeji
Published: December 2018

We report about a 14-year-old boy who presented with an anterior mediastinal mass that was diagnosed as malignant teratoma. Surgical resection was performed along with pre- and postoperative chemotherapy. Although elevated alpha-fetoprotein became negative, he experienced pain in his right hip joint 3 months after resection. Systematic evaluation revealed multiple locations of metastasis, and the pathological diagnosis based on bone biopsy was malignant melanoma originating from malignant teratoma, which rapidly progressed. He died 15 months after diagnosis of the original malignant teratoma. Diagnosing and treating malignant transformation of teratoma, including malignant melanoma, is difficult because it is very rare. To our knowledge, this is the second reported case of malignant melanoma arising from a mediastinum malignant teratoma, with both cases having a poor prognosis. In addition to the follow-up of tumor markers, systematic evaluation, including imaging, should be considered even after remission to monitor malignant transformation of teratoma. We expect to establish a successful therapy and improve mortality rate after more such cases are accumulated.