bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of 12-week pulmonary rehabilitation on cognitive function in patients with stable chronic obstructive pulmonary disease: study protocol for a single-center randomised controlled trial
Authors: Duan Hongxia , Li Peijun , Wang Zhenwei , Chen Haixia , Wang Ting , Wu Weibing , Liu Xiaodan
Published: October 2020

Introduction

Cognitive impairment, an important complication in patients with chronic obstructive pulmonary disease (COPD), seriously affects self-management of the disease and quality of life (QoL). As an exercise-based intervention programme, pulmonary rehabilitation (PR)—especially aerobic exercise (mainly mind–body exercise) and resistance exercise (RE)—has been proposed for its potential effectiveness in improving cognitive function. However, there is still a lack of strong evidence for PR’s effectiveness. In this study, we expect to clarify the effects of pulmonary-based Qigong exercise and elastic band-based RE on cognitive function in patients with COPD and to fill in the relevant evidence blanks.

Methods and analysis

This study is a single-centre randomised controlled trial with assessor and data analyst blinding. We will recruit 108 participants with stable COPD starting on 23 December 2019, and randomly allocate them into the pulmonary-based Qigong exercise group, elastic band-based RE group, pulmonary-based Qigong exercise and elastic band-based RE combined group, or control group at a 1:1:1:1 ratio. Participants in intervention groups will perform 30 min of exercise two times per day, 5 days a week, for 12 weeks. The primary outcome will be the global cognitive function as assessed by the Montreal Cognitive Assessment and auditory event-related potential P300. Secondary outcomes will include the specific cognitive domains—attention, memory, executive function, verbal fluency and mental-processing speed; psychological functions and QoL. Exploratory outcomes will include grey matter volume and levels of inflammatory mediators. Outcomes will be measured before and after the interventions.

Ethics and dissemination

Ethics approval has been granted by the Ethics Committee of Yue-Yang Integrative Medicine Hospital, an affiliate of Shanghai University of Traditional Chinese Medicine, Shanghai, China (Grant No. 2019-141). Written informed consent will be obtained from each participant before any procedures are performed. The findings will be published in peer-reviewed journals and presented at academic conferences.

Trial registration number

ChiCTR1900026869; pre-results.
Cohort protocol: Guangzhou High-Risk Infant Cohort study
Authors: Hu Pian , Han Azhu , Hu Yan , Wen Yuqi , Liang Jingjing , Xiao Wanqi , Lin Suifang , Song Yanyan , Tan Xuying , Zhao Xiaopeng , Dong Haipeng , Liu Qianyun , Zhang Huayan , Tao Li , Yuan Yuan
Published: October 2020

Introduction

Despite the increase in the survival rate of high-risk infants (HRIs) worldwide, the prevalence of motor and neurodevelopmental sequelae in such newborns has not shown concomitant improvement. Meanwhile, there are few cohorts that explore factors related to the development of HRIs in China. Therefore, the Guangzhou High-Risk Infant Cohort (GHRIC) has been designed to examine the complex relationships among a myriad of factors influencing growth and development in such children.

Methods and analysis

The GHRIC study is a prospective cohort study that by the year 2023 will enrol an estimated total of 3000 HRIs from Guangzhou Women and Children’s Medical Center (GWCMC) in Guangzhou, China. This study is designed to assess the growth and cognitive characteristics of HRIs and the risk factors affecting their development and prognoses. Data on risk factors, neurodevelopmental and cognitive-function evaluations, laboratory results, and specimens will be collected and analysed. Information on perinatal and clinical interventions for these infants will also be recorded during regular follow-up visits until age 6.

Ethics and dissemination

The protocol for this study has been approved by the Research Ethics Committee of GWCMC, which accepted responsibility for supervising all of the aspects of the study (No. 2017102712). Study outcomes will be disseminated through conference presentations, peer-reviewed publications, the Internet and social media.

Trial registration number

ChiCTR-EOC-17013236
Perspectives on life participation by young adults with chronic kidney disease: an interview study
Authors: Kerklaan Jasmijn , Hannan Elyssa , Hanson Camilla , Guha Chandana , Cho Yeoungjee , Christian Martin , Hamiwka Lorraine , Ryan Jessica , Sinha Aditi , Wong Germaine , Craig Jonathan , Groothoff Jaap , Tong Allison
Published: October 2020

Objective

To describe the perspectives on life participation by young adults with childhood-onset chronic kidney disease (CKD).

Design

Semi-structured interviews; thematic analysis.

Setting

Multiple centres across six countries (Australia, Canada, India, UK, USA and New Zealand).

Participants

Thirty young adults aged 18 to 35 years diagnosed with CKD during childhood.

Results

We identified six themes: struggling with daily restrictions (debilitating symptoms and side effects, giving up valued activities, impossible to attend school and work, trapped in a medicalised life, overprotected by adults and cautious to avoid health risks); lagging and falling behind (delayed independence, failing to keep up with peers and socially inept); defeated and hopeless (incapacitated by worry, an uncertain and bleak future, unworthy of relationships and low self-esteem and shame); reorienting plans and goals (focussing on the day-to-day, planning parenthood and forward and flexible planning); immersing oneself in normal activities (refusing to miss out, finding enjoyment, determined to do what peers do and being present at social events); and striving to reach potential and seizing opportunities (encouragement from others, motivated by the illness, establishing new career goals and grateful for opportunities).

Conclusions

Young adults encounter lifestyle limitations and missed school and social opportunities as a consequence of developing CKD during childhood and as a consequence lack confidence and social skills, are uncertain of the future, and feel vulnerable. Some re-adjust their goals and become more determined to participate in ‘normal’ activities to avoid missing out. Strategies are needed to improve life participation in young adult ‘graduates’ of childhood CKD and thereby strengthen their mental and social well-being and enhance their overall health.
Hospital readmission after anterior cruciate ligament reconstruction: protocol for a systematic review and meta-analysis
Authors: Shao Long , Wu Di , Li Jia-Ying , Wu Xiang-Dong , Zhou Xi , Qiu Gui-Xing , Luo Changqi , Xiao Peng-Cheng , Liu Jia-Cheng , Huang Wei
Published: October 2020

Introduction

Anterior cruciate ligament (ACL) injury is one of the most common injuries of the knee. ACL reconstruction (ACLR) has been widely performed as a safe and effective treatment for ACL injuries. As there is an increasing trend in the incidence of ACL injury, hospital readmission after ACLR has attracted renewed attention for the financial burden to both patients and the healthcare system. However, information about hospital readmission after ACLR remains fragmented. Therefore, we plan to systematically review the literature to investigate the rate of, causes and risk factors for hospital readmission after ACLR, and summarise interventions to reduce hospital readmission. This article is to provide the protocol for an upcoming systematic review and meta-analysis on this important issue.

Methods and analysis

Reporting of this protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist. Electronic databases, including PubMed, Embase and the Cochrane Library, will be systematically searched from inception to June 2020. No language restrictions will be applied. Studies will be included if they reported hospital readmission or explored the associated potential causes and risk factors for hospital readmission after ACLR. The primary outcome will be the number and time frame of hospital readmission after ACLR. Secondary outcomes will be reasons for readmission, number and types of complications, risk factors for readmission and preventive measures for readmission after ACLR. Quality assessments will be performed by using the Newcastle-Ottawa Scale (NOS). If possible, study results will be summarised in a forest plot, and heterogeneity will be tested by using the Cochran’s Q and I2 statistics.

Ethics and dissemination

No ethical approval is required because our study is not related to patients or animals. The results will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42020058624.
Cohort profile: the mature adults cohort of the Malawi longitudinal study of families and health (MLSFH-MAC)
Authors: Kohler Iliana V , Bandawe Chiwoza , Ciancio Alberto , Kämpfen Fabrice , Payne Collin F , Mwera James , Mkandawire James , Kohler Hans-Peter
Published: October 2020

Purpose

The Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health (MLSFH-MAC) contributes to global ageing studies by providing a rare opportunity to study the processes of individual and population ageing, the public health and social challenges associated with ageing and the coincident shifts in disease burdens, in a low-income, high HIV prevalence, sub-Saharan African (SSA) context.

Participants

The MLSFH-MAC is an open population-based cohort study of mature adults aged 45+ years living in rural communities in three districts in Malawi. Enrolment at baseline is 1266 individuals in 2012. Follow-ups were in 2013, 2017 and 2018 when the cohort size reached 1626 participants in 2018.

Findings to date

Survey instruments cover ageing-related topics such as cognitive and mental health, non-communicable diseases (NCDs) and related health literacy, subjective survival expectations, measured biomarkers including HIV, grip strength, hypertension, fasting glucose, body mass index (BMI), broad individual-level and household-level social and economic information, a 2018 qualitative survey of mature adults and community officials, 2019 surveys of village heads, healthcare facilities and healthcare providers in the MLSFH-MAC study areas. Across many domains, MLSFH-MAC allows for comparative research with global ageing studies through harmonised measures and instruments. Key findings to date include a high prevalence of depression and anxiety among older adults, evidence for rapid declines in cognitive health with age, a low incidence of HIV among mature adults, rising prevalence of HIV due to increased survival of HIV-positive individuals and poor physical health with high NCD prevalence.

Future plans

An additional wave of MLSFH-MAC is forthcoming in 2021, and future expansions of the cohort are planned. MLSFH-MAC data will also be publicly released and will provide a wealth of information unprecedented for ageing studies in a low-income SSA context that broadly represents the socioeconomic environment of millions of individuals in south-eastern Africa.
Effect of N-acetylcysteine on prevention of contrast-associated acute kidney injury in patients with STEMI undergoing primary percutaneous coronary intervention: a systematic review and meta-analysis of randomised controlled trials
Authors: Guo Zhaodong , Liu Jin , Lei Li , Xue Yan , Liu Liwei , Huang Hao , Chen Shiqun , Liu Yong , Lin Yingzhong , Tao Jianhong , Xu Qingbo , Wu Keng , Zhang Lingyu , Chen Ji-Yan
Published: October 2020

Objective

Several studies evaluating the preventive effect of N-acetylcysteine (NAC) on contrast-associated acute kidney injury (CA-AKI) among patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) have suggested inconsistent results and that a systematic review and meta-analysis should be performed.

Design

Systematic review and meta-analysis.

Data sources

PubMed, MEDLINE, EMBASE, ClinicalTrials.gov and the Cochrane Central databases were searched from inception to 15 November 2019.

Eligibility criteria

Randomised controlled trials assessing use of NAC compared with non-use of NAC (eg, placebo) in preventing CA-AKI in patients with STEMI following PPCI were included.

Data synthesis

Relative risks with 95% CIs were pooled using a random-effects model. Evidence level of conclusions was assessed by Cochrane GRADE measure.

Results

Seven trials including 1710 patients were identified. Compared with non-use of NAC, use of NAC significantly reduced the incidence of CA-AKI by 49% (risk ratio (RR) 0.51, 95% CI 0.31 to 0.82, p<0.01) and all-cause in-hospital mortality by 63% (RR 0.37, 95% CI 0.17 to 0.79, p=0.01). The estimated effects on the requirement for dialysis (RR 0.61, 95% CI 0.11 to 3.38, p=0.24) were not statistically significant. Trial sequential analysis conﬁrmed the true positive of NAC in reducing risk of CA-AKI. Subgroup analyses suggested that the administration of NAC had greater benefits in patients with renal dysfunction and in those receiving oral administration and higher dosage of NAC.

Conclusions

NAC intake reduces the risk of CA-AKI and all-cause in-hospital mortality in patients with STEMI undergoing PPCI. The estimated potential benefit of NAC in preventing dialysis was ambiguous, and further high-quality studies are needed.

PROSPERO registration number

CRD42020155265.
Platelet transfusion for neonates with thrombocytopaenia: protocol for a systematic review
Authors: Liu Dengjun , Wu Jinlin , Xiong Tao , Yue Yan , Tang Jun
Published: October 2020

Introduction

Thrombocytopaenia is one of the most common haemostatic abnormalities among neonates. It affects approximately one-quarter of neonates admitted into neonatal intensive care units and may lead to a high risk of bleeding and mortality, which are substantial causes for concern by neonatologists. Platelet transfusion (PT) is a specific treatment for thrombocytopaenia. To date, PT thresholds are diverse since the associations between low platelet count and negative outcomes are not clear. We propose this protocol for a systematic review to collect and assess evidence concerning the best PT threshold to reduce mortality, bleeding and major morbidity among neonates with thrombocytopaenia.

Methods and analysis

The systematic review will be performed according to the Cochrane Handbook for Systematic Review of Interventions, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and the Grading of Recommendations Assessment, Development and Evaluation system. Two independent researchers will perform the study selection, data extraction/coding, quality assessment and further analyses of the included studies, with disagreements being resolved by a third researcher. A systematic search of the literature will be conducted in the PubMed, Cochrane Library and Embase databases from database inception through 13 October 2020. All randomised controlled trials, cohort studies and case–control studies will be included without any restrictions regarding publication date or language. The primary outcomes will comprise in-hospital mortality and bleeding episodes. Endnote X9 and Review Manager V.5.3 software will be used to manage the selection process and statistical analysis, respectively. If the included studies are sufficient and homogeneous for any of the outcomes, a quantitative synthesis (meta-analysis) may be performed. Otherwise, we will conduct a narrative systematic review of the results.

Ethics and dissemination

Ethical approval is not required for this study because the data will be obtained from published studies and will not include individual patient data. The results of this study are anticipated to be published in a peer-reviewed journal.

PROSPERO registration number

CRD42020169262.
Advanced consent for participation in acute care randomised control trials: protocol for a scoping review
Authors: Niznick Naomi , Lun Ronda , Dewar Brian , Dowlatshahi Dar , Shamy Michel
Published: October 2020

Introduction

Informed consent is essential to clinical research, though obtaining informed consent for participation in research for emergency conditions is challenging. Adapted consent methods include consent from a substitute-decision maker, deferral of consent and waiver of consent. A novel approach is to use advanced consent, where a potential participant provides consent in the present in the event that they become eligible for enrolment into a future study. This scoping review will map and synthesise the literature on the use of advanced consent for participation and enrolment in randomised control trials for emergency conditions.

Methods and analysis

Guided by Arksey and O'Malley’s scoping review methodology framework, we will search electronic databases (Medline, Embase, Web of Science and the Cochrane Register of Clinical Trials), the grey literature sources and reference lists of relevant studies. Eligible studies will include English language articles that discuss, examine or employ the use of advanced consent for enrolment in randomised control trials, specifically related to emergency conditions or emergency treatment. Diverse types of articles will be eligible for inclusion, including peer-reviewed qualitative and quantitative studies such as randomised control trials, observational studies, surveys, systematic reviews, as well as narrative reviews and ethics papers. Studies will be screened by two independent reviewers to determine eligibility for inclusion. Data on bibliographic information, study characteristics and methodology, and reported results, specifically author disposition, will be extracted and described using qualitative analysis.

Ethics and dissemination

Formal ethics review is not required as primary data will not be collected. The findings of this study will be disseminated through a peer-reviewed publication. The findings of this study will help identify knowledge gaps that may guide areas for future research and may aid in the design of future clinical trials using advanced consent.
School-based, two-arm, parallel, controlled trial of a culturally adapted resilience intervention to improve adolescent mental health in Vietnam: study protocol
Authors: Tran Thach , Nguyen Huong Thanh , Shochet Ian , Wurfl Astrid , Orr Jayne , Nguyen Nga , La Nga , Nguyen Hau , Stocker Ruby , Nguyen Trang , Le Minh , Fisher Jane
Published: October 2020

Introduction

The Resourceful Adolescent Program (RAP) is an evidence-based resilience intervention for adolescents. Operating in a strength-focused paradigm, the programme uses an integration of cognitive behavioural therapy and interpersonal psychotherapy to improve coping skills and build resilience. This study aims to establish whether a culturally and linguistically adapted intervention informed by RAP principles is effective in increasing resilience, enhancing coping skills and preventing symptoms of depression and anxiety.

Methods and analysis

We will translate, back-translate and culturally adapt the RAP for adolescents and training materials for facilitators, and the adapted intervention will be called Happy House. A two-arm parallel controlled trial will be conducted in eight high schools in the north of Vietnam. In each of the selected schools, all students from four randomly selected grade 10 classes (an estimation of about 1204 students) will be invited to participate. The control group will receive the usual curriculum. The intervention group will receive six weekly 90 min school-based group sessions of Happy House in addition to the usual curriculum. The primary outcome, depressive symptoms, will be measured using a locally validated version of the Centre for Epidemiologic Studies Depression Scale Revised. Secondary outcomes are mental well-being, coping self-efficacy, school connectedness, anger management and health risk behaviours. Data will be collected at recruitment, and at two weeks and six months post intervention. Mixed-effect logistic regression for the main outcome and mixed-effect linear and logistic regression models for the secondary outcomes will be conducted to estimate the effects of the intervention on the outcomes.

Ethics and dissemination

This trial has been approved by Monash University Human Research Ethics Committee (No. 21455) and the Institutional Review Board of the Hanoi School of Public Health (488/2019/YTCC-HD3). Dissemination of findings will include peer-reviewed publications, international and national conferences, seminar and media presentations, national policy briefings in Vietnam, local language reports and lay language summaries for participants.

Trial registration numbers

Registered with the Australian New Zealand Clinical Trials Registry, registration number: ACTRN12620000088943 (3/2/2020).

WHO Universal Trial Number: U1111-1246-4079.
Internet-based patient– primary care physician–cardiologist integrated management model of hypertension in China: study protocol for a multicentre randomised controlled trial
Authors: Ye Runyu , Shi Rufeng , Liu Kai , Zhang Xin , Wang Si , Liao Hang , Li Xinran , Gou Qiling , Rong Xi , Zhang Zhipeng , Yang Changqiang , Yang Xiangyu , Chen Xiaoping
Published: October 2020

Introduction

The control rate of hypertension is low in China, especially in rural, western and minority areas. This is related to poor medical skills among physicians in primary care institutions and low levels of trust among patients. However, primary healthcare institutions are the main battleground for the prevention and treatment of hypertension. It is worth exploring how to most effectively integrate patients, primary care physicians and cardiologists in tertiary hospitals, to build a long-term mechanism for the prevention and treatment of hypertension. In this study, we aim to evaluate the clinical effectiveness and conduct a health economic evaluation of an internet-based patient–primary care physician–cardiologist integrated management model of hypertension in areas of China with different socioeconomic levels.

Methods and analysis

This is a 12-month, multicentre, randomised controlled trial involving patients with hypertension in urban communities and rural areas of Sichuan Province, China. Each primary healthcare institution will cooperate with their tertiary hospital through the Red Shine Chronic Disease Management System (RSCDMS). Patients will be randomly assigned 1:1 to two groups: (1) a traditional care group; (2) an intervention group in which primary care physicians and cardiologists can share patient data and manage patients together through the RSCDMS. Patients can upload their blood pressure (BP) values and communicate with physicians using the system. The primary outcome is the change in systolic BP over a 12-month period. Secondary outcomes are changes in diastolic BP, BP control rate, values of 24-hour ambulatory BP monitoring, difference in cost-effectiveness between the groups, patient satisfaction, medication adherence and home BP monitoring compliance. All data will be recorded and stored in the RSCDMS and analysed using IBM SPSS V.26.0.

Ethics and dissemination

This study has been approved by the Biomedical Research Ethics Committee of the West China Hospital of Sichuan University in Sichuan, China (No. 2020-148). Written informed consent will be obtained from all participants. The results of this study will be disseminated to the public through academic conferences and peer-reviewed journals.

Trial registration number

ChiCTR2000030677.
Deaths in people from Black, Asian and minority ethnic communities from both COVID-19 and non-COVID causes in the first weeks of the pandemic in London: a hospital case note review
Authors: Perkin Michael Richard , Heap Sarah , Crerar-Gilbert Agatha , Albuquerque Wendy , Haywood Serena , Avila Zoe , Hartopp Richard , Ball Jonathan , Hutt Kate , Kennea Nigel
Published: October 2020

Objective

To undertake a case review of deaths in a 6-week period during the COVID-19 pandemic commencing with the first death in the hospital from COVID-19 on 12th of March 2020 and contrast this with the same period in 2019.

Setting

A large London teaching hospital.

Participants

Three groups were compared: group 1—COVID-19-associated deaths in the 6-week period (n=243), group 2—non-COVID deaths in the same period (n=136) and group 3—all deaths in a comparison period of the same 6 weeks in 2019 (n=194).

Primary and secondary outcome measures

This was a descriptive analysis of death case series review and as such no primary or secondary outcomes were pre-stipulated.

Results

Deaths in patients from the Black, Asian and minority ethnic (BAME) communities in the pandemic period significantly increased both in the COVID-19 group (OR=2.43, 95% CI=1.60–3.68, p<0.001) and the non-COVID group (OR=1.76, 95% CI=1.09–2.83, p=0.02) during this time period and the increase was independent of differences in comorbidities, sex, age or deprivation. While the absolute number of deaths increased in 2020 compared with 2019, across all three groups the distribution of deaths by age was very similar. Our analyses confirm major risk factors for COVID-19 mortality including male sex, diabetes, having multiple comorbidities and background from the BAME communities.

Conclusions

There was no evidence of COVID-19 deaths occurring disproportionately in the elderly compared with non-COVID deaths in this period in 2020 and 2019. Deaths in the BAME communities were over-represented in both COVID-19 and non-COVID groups, highlighting the need for detailed research in order to fully understand the influence of ethnicity on susceptibility to illness, mortality and health-seeking behaviour during the pandemic.
Effect of wheelchair-modified rowing exercise on cardiometabolic risk factors in spinal cord injured wheelchair users: protocol for a randomised controlled trial
Authors: Hansen Rasmus Kopp , Samani Afshin , Laessoe Uffe , Handberg Aase , Larsen Ryan Godsk
Published: October 2020

Introduction

Cardiovascular and metabolic diseases are a growing concern for individuals with spinal cord injury (SCI). Physical inactivity contributes to cardiometabolic morbidity and mortality in the SCI population. However, previous studies have shown mixed results regarding the effects of exercise on cardiometabolic risk factors in individuals with SCI. This discrepancy could be influenced by insufficient exercise stimuli. Recent guidelines recommend 30 min of moderate-to-vigorous intensity aerobic exercise, three times per week, for improvement in cardiometabolic health in individuals with SCI. However, to date, no studies have implemented an exercise intervention matching the new recommendations to examine the effects on cardiometabolic risk factors. Therefore, the primary objective of this study is to determine the effects of 12 weeks of wheelchair user-modified upper-body rowing exercise on both traditional (constituents of the metabolic syndrome) and novel (eg, vascular structure and function) cardiometabolic risk factors in manual wheelchair users with SCI.

Methods and analysis

A randomised controlled trial will compare 12 weeks of upper-body rowing exercise, 30 min three times per week, with a control group continuing their normal lifestyle. Outcome measurements will be performed immediately before (baseline), after 6 weeks (halfway), 12 weeks of training (post) and 6 months after the termination of the intervention period (follow-up). Outcomes will include inflammatory (eg, C reactive protein) and metabolic biomarkers determined from venous blood (with serum fasting insulin as primary outcome), body composition, arterial blood pressure, cardiorespiratory fitness level, brachial artery vascular structure and function and autonomic nervous system function.

Ethics and dissemination

This trial is reported to the Danish Data Protection Agency (J.nr. 2019-899/10-0406) and approved by the Committees on Health Research Ethics in The North Denmark Region on 12 December 2019 (J.nr. N-20190053). The principal investigator will collect written informed consent from all participants prior to inclusion. Irrespective of study outcomes, the results will be submitted to peer-reviewed scientific journals for publication.

Trial registration number

NCT04390087.
Age-dependent seroprevalence of dengue and chikungunya: inference from a cross-sectional analysis in Esmeraldas Province in coastal Ecuador
Authors: Chis Ster Irina , Rodriguez Alejandro , Romero Natalia Cristina , Lopez Andrea , Chico Martha , Montgomery Joel , Cooper Philip
Published: October 2020

Objectives

There are few population-based estimates for prevalence of past exposure to dengue and chikungunya viruses despite common epidemiological features. Here, we have developed a novel statistical method to study patterns of age-dependent prevalence of immunity in a population following exposures to two viruses which share similar epidemiological features including mode of transmission and induction of long-lasting immunity. This statistical technique accounted for sociodemographic characteristics associated with individuals and households.

Settings

The data consist of a representative sample from an ongoing longitudinal birth cohort set-up in a tropical district in coastal Ecuador (Esmeraldas).

Participants

We collected data and blood samples from 319 individuals belonging to 152 households following epidemics of the infections in 2015 in Latin America.

Primary outcome

Plasma was tested for the presence of specific IgG antibodies to dengue and chikungunya viruses by commercial ELISA and defined a bivariate binary outcome indicating individuals’ past exposure status to dengue and chikungunya (ie, presence/absence of IgG antibodies to dengue or chikungunya or both).

Results

Dengue seroprevalence increased rapidly with age reaching 97% (95% credible interval (CrI): 93%–99%) by 60 years. Chikungunya seroprevalence peaked at 42% (95% CrI: 18%–66%) around 9 years of age and averaged 27% (95% CrI: 8.7%–51.6%) for all ages. Rural areas were more likely to be associated with dengue-only exposure while urban areas and shorter distance to the nearest household were associated with exposures to both. Women living in urban settings were more likely to be chikungunya seropositive while rural men were more likely to be dengue seropositive.

Conclusion

Dengue seroprevalence was strongly age dependent consistent with endemic exposure while that of chikungunya peaked in childhood consistent with the recent emergence of the virus in the study area. Our findings will inform control strategies for the two arboviruses in Ecuador including recommendations by the WHO on dengue vaccination.
Incidence, comorbidity and mortality in patients with necrotising soft-tissue infections, 2005–2018: a Danish nationwide register-based cohort study
Authors: Hedetoft Morten , Madsen Martin Bruun , Madsen Lærke Bruun , Hyldegaard Ole
Published: October 2020

Objective

To assess the incidence, comorbidities, treatment modalities and mortality in patients with necrotising soft-tissue infections (NSTIs) in Denmark.

Design

Nationwide population-based registry study.

Setting

Denmark.

Participants

Danish residents with NSTI between 1 January 2005 and 31 August 2018.

Main outcome measure

Incidence of disease per 100 000 person/year and all-cause mortality at day 90 obtained from Danish National Patient Registry and the Danish Civil Registration System.

Results

1527 patients with NSTI were identified, yielding an incidence of 1.99 per 100 000 person/year. All-cause 30-day, 90-day and 1-year mortality were 19.4% (95% CI 17.4% to 21.5%), 25.2% (95% CI 23.1% to 27.5%) and 30.4% (95% CI 28.0% to 32.8%), respectively. Amputation occurred in 7% of the individuals. Diabetes was the most predominant comorbidity affecting 43% of the cohort, while 26% had no comorbidities. Higher age, female sex and increasing comorbidity index were found to be independent risk factors of mortality. Admission to high-volume hospitals was associated with improved survival (OR 0.59, 95% CI 0.45 to 0.77). Thirty-six per cent received hyperbaric oxygen therapy (HBOT) as an adjunctive therapy. No change in overall mortality was found over the studied time period.

Conclusion

The present study found that in Denmark, the incidence of NSTI increased; mortality rates remained high and largely unaltered. Diabetes was the most common comorbidity, while higher age, female sex and increasing comorbidity index were associated to increased mortality. Survival was improved in those admitted to hospitals with more expertise in treating NSTI. In high-volume hospital, HBOT was associated with decreased odds for mortality.
The Food provision, cUlture and Environment in secondary schooLs (FUEL) study: protocol of a mixed methods evaluation of national School Food Standards implementation in secondary schools and their impact on pupils’ dietary intake and dental health
Authors: Murphy Marie , Pallan Miranda , Lancashire Emma , Duff Rhona , Adamson Ashley J , Bartington Suzanne , Frew Emma , Griffin Tania , Hurley Kiya L , Parry Jayne , Passmore Sandra , Ravaghi Vahid , Sitch Alice J , Spence Suzanne , Rowland Maisie K , Wheeldon Scott , Adab Peymane
Published: October 2020

Introduction

Excess free sugar intake is associated with obesity and poor dental health. Adolescents consume substantially more free sugar than is recommended. National (UK) School Food Standards (SFS) are in place but are not mandatory in all schools, and their impact on the diets of secondary school pupils is unknown. We aim to evaluate how SFS and wider healthy eating recommendations (from the national School Food Plan (SFP)) are implemented in secondary schools and how they influence pupils’ diets and dental health.

Methods and analysis

Secondary-level academies/free schools in the West Midlands, UK were divided into two groups: SFS mandated and SFS non-mandated. Using propensity scores to guide sampling, we aim to recruit 22 schools in each group. We will compare data on school food provision and sales, school food culture and environment, and the food curriculum from each group, collected through: school staff, governor, pupil, parent surveys; school documents; and observation. We will explore the implementation level for the SFS requirements and SFP recommendations and develop a school food typology. We aim to recruit 1980 pupils aged 11–15 years across the 44 schools and collect dietary intake (24-hour recall) and dental health data through self-completion surveys. We will compare free sugar/other dietary intake and dental health across the two SFS groups and across the identified school types. School type will be further characterised in 4–8 case study schools through school staff interviews and pupil focus groups. Evaluation of economic impact will be through a cost-consequence analysis and an exploratory cost–utility analysis.

Ethics and dissemination

Ethical approval was obtained from the University of Birmingham Ethical Review Committee (ERN_18-1738). Findings will be disseminated to key national and local agencies, schools and the public through reports, presentations, the media and open access publications.

Trial registration number

ISRCTN 68757496 (registered 17 October 2019).
COVID-19 lockdown and fatal motor vehicle collisions due to speed-related traffic violations in Japan: a time-series study
Authors: Inada Haruhiko , Ashraf Lamisa , Campbell Sachalee
Published: October 2020

Between March and May 2020, Japan experienced a lockdown due to the COVID-19 crisis. Empty roads possibly triggered speed-related traffic violations that caused fatal motor vehicle collisions (MVCs). Using police data on the monthly number of fatal MVCs between January 2010 and February 2020 in which motor vehicle drivers were at fault, we forecasted the numbers of fatal MVCs due to the speed-related violations during the lockdown and compared these with those observed. We also compared the observed to forecasted using the ratio of the number of speed-related fatal MVCs to that of non-speed related fatal MVCs. The observed numbers of speed-related fatal MVCs were within the 95% CIs of the forecasted numbers. The observed ratio was higher than the forecasted ratio in April (p=0.016). In the second month of the lockdown, drivers were more likely to commit speed-related violations that caused fatal MVCs than before the lockdown.
Management of a patient with mantle cell lymphoma who developed severe neurotoxicity after chimeric antigen receptor T-cell therapy in ZUMA-2
Authors: Wang Michael , Jain Preetesh , Chi T Linda , Chen Sheree E , Heimberger Amy , Weathers Shiao-Pei , Zheng Lianqing , Rao Arati V , Rossi John M
Published: October 2020

Cerebral edema following chimeric antigen receptor (CAR) T-cell therapy can be fatal. ZUMA-2 is a pivotal phase 2, multicenter study evaluating KTE-X19, an autologous anti-CD19 CAR T-cell therapy, in relapsed/refractory mantle cell lymphoma. We describe a 65-year-old patient in ZUMA-2 who developed cerebral edema following CAR T-cell therapy and had complete recovery after multimodality clinical intervention including rabbit antithymocyte globulin (ATG). Biomarker results show early and robust CAR T-cell expansion and related induction of inflammatory cytokines, followed by rapid declines in CAR T-cell and proinflammatory cytokine levels after ATG administration. This clinical profile highlights a potential relevance of ATG in treating severe CAR T-cell-related neurotoxicity.
Targeted deep sequencing of DNA from multiple tissue types improves the diagnostic rate and reveals a highly diverse phenotype of mosaic neurofibromatosis type 2
Authors: Teranishi Yu , Miyawaki Satoru , Hongo Hiroki , Dofuku Shogo , Okano Atsushi , Takayanagi Shunsaku , Ota Takahiro , Yoshimura Jun , Qu Wei , Mitsui Jun , Nakatomi Hirofumi , Morishita Shinichi , Tsuji Shoji , Saito Nobuhito
Published: October 2020

Background

Although 60% of patients with de novo neurofibromatosis type 2 (NF2) are presumed to have mosaic NF2, the actual diagnostic rate of this condition remains low at around 20% because of the existing difficulties in detecting NF2 variants with low variant allele frequency (VAF). Here, we examined the correlation between the genotype and phenotype of mosaic NF2 after improving the diagnostic rate of mosaic NF2.

Methods

We performed targeted deep sequencing of 36 genes including NF2 using DNA samples from multiple tissues (blood, buccal mucosa, hair follicle and tumour) of 53 patients with de novo NF2 and elucidated their genotype–phenotype correlation.

Results

Twenty-four patients (45.2%) had the NF2 germline variant, and 20 patients with NF2 (37.7%) had mosaic NF2. The mosaic NF2 phenotype was significantly different from that in patients with NF2 germline variant in terms of distribution of NF2-related disease, tumour growth rate and hearing outcome. The behaviour of schwannoma correlated to the extent of VAF with NF2 variant in normal tissues unlike meningioma.

Conclusion

We have improved the diagnostic rate of mosaic NF2 compared with that of previous studies by targeted deep sequencing of DNA from multiple tissues. Many atypical patients with NF2 diagnosed with ‘unilateral vestibular schwannoma’ or ‘multiple meningiomas’ presumably have mosaic NF2. Finally, we suggest that the highly diverse phenotype of NF2 could result not only from the type and location of NF2 variant but also the extent of VAF in the NF2 variant within normal tissue DNA.
A germline 1;3 translocation disrupting the VHL gene: a novel genetic cause for von Hippel-Lindau
Authors: Ricketts Christopher J , Vocke Cathy D , Lang Martin , Chen Xiongfong , Zhao Yongmei , Tran Bao , Tandon Mayank , Schmidt Laura S , Ball Mark W , Linehan W Marston
Published: October 2020

Von Hippel-Lindau (VHL) disease is an autosomal dominant hereditary tumour susceptibility disease caused by germline pathogenic variation of the VHL tumour suppressor gene. Affected individuals are at risk of developing multiple malignant and benign tumours in a number of organs.

In this report, a male patient in his 20s who presented to the Urologic Oncology Branch at the National Cancer Institute with a clinical diagnosis of VHL was found to have multiple cerebellar haemangioblastomas, bilateral epididymal cysts, multiple pancreatic cysts, and multiple, bilateral renal tumours and cysts. The patient had no family history of VHL and was negative for germline VHL mutation by standard genetic testing. Further genetic analysis demonstrated a germline balanced translocation between chromosomes 1 and 3, t(1;3)(p36.3;p25) with a breakpoint on chromosome 3 within the second intron of the VHL gene. This created a pathogenic germline alteration in VHL by a novel mechanism that was not detectable by standard genetic testing.

Karyotype analysis is not commonly performed in existing genetic screening protocols for patients with VHL. Based on this case, protocols should be updated to include karyotype analysis in patients who are clinically diagnosed with VHL but demonstrate no detectable mutation by existing genetic testing.
Tobacco industry targeting of health-conscious youth with ‘lighter’ cigarettes: the case of Singapore
Authors: van der Eijk Yvette , Tan Grace Ping Ping
Published: October 2020

Background

Despite Singapore’s strict tobacco control policies, smoking rates have not decreased since 2004. We examined the primary targets, motivations and strategies behind targeted marketing activities in Singapore from the tobacco industry’s perspective to understand how tobacco companies continue to target people in their marketing.

Methods

Snowball search in the Truth Tobacco Industry Documents Library for documents covering the industry’s targeted marketing activities in Singapore. Information from the documents was subsequently triangulated with market data obtained from the Euromonitor Passport database, analysed for trends by tar segment and data from cigarette packs purchased from Singapore retailers, analysed in terms of product positioning.

Results

In the 1970s and 1980s, as young people in Singapore became more health-conscious, tobacco companies positioned ‘light’ cigarettes for growth in the 1990s. Many of these ‘lights’ contained similar tar and nicotine levels as regular brands; they were only light in their branding. In the 1990’s, ‘lights’ became more popular in Singapore and this demand was largely youth driven. Into the 2010s, while the low tar (<6 mg) segment comprised only a small portion of Singapore’s cigarette market, most cigarette variants were marketed as ‘lighter’ or as having harm reductive benefits to appeal to more health-conscious people.

Conclusions

The differentiation of ‘lighter’ cigarettes remains an important marketing tool for tobacco companies amidst Singapore’s strict regulations. Legislation to remove all remaining avenues for tobacco companies to make harm reduction claims on their products, explicit or implicit, coupled with improving health literacy and exposing industry deception, could help to further bring down smoking prevalence in Singapore.
Genome size variation in natural populations of wild potato species from west Argentina
Authors: Kozub Perla Carolina , Masuelli Ricardo Williams , Marfil Carlos Federico
Published: October 2020

Wild potato species (Solanum, section Petota) have great ecological adaptability and represent essential genetic resources for the improvement of the third most important food crop worldwide. From more than 100 species described for this section, the genome size has been established for only 12. The aims of this work were to: contribute data on the C-values for Solanum species; assess the degree of interspecific and intraspecific genome size variation; investigate correlations between genome size and bioclimatic variables; and determine whether the data for genome size are helpful for delineating taxa. The DNA contents of 97 genotypes from 28 populations and two accessions of seven wild potato species, including diploids, triploids, and tetraploids, were measured by flow cytometry. Statistical genome size differences within and among species were found. The natural interploidal hybrid Solanum × rechei had the highest intraspecific genome size variation. The tetraploid S. acaule presented the smallest monoploid genome size (0.72 pg), whereas the triploid cytotype of S. microdontum was the largest (0.82 pg). Correlations among bioclimatic and geographic variables and genome size were found in most species. The roles of hybridisation and polyploidisation events on genome size variability are discussed.
Photo Sleuth
Authors: Mohanty Vikram , Thames David , Mehta Sneha , Luther Kurt
Published: October 2020

Identifying people in historical photographs is important for preserving material culture, correcting the historical record, and creating economic value, but it is also a complex and challenging task. In this article, we focus on identifying portraits of soldiers who participated in the American Civil War (1861--65), the first widely photographed conflict. Many thousands of these portraits survive, but only 10%--20% are identified. We created Photo Sleuth, a web-based platform that combines crowdsourced human expertise and automated face recognition to support Civil War portrait identification. Our mixed-methods evaluations of Photo Sleuth one month and 11 months after its public launch showed that it helped users successfully identify unknown portraits and provided a sustainable model for volunteer contribution. We also discuss implications for crowd-AI interaction and person identification pipelines.
Disambiguating Arabic Words According to Their Historical Appearance in the Document Based on Recurrent Neural Networks
Authors: Laatar Rim , Aloulou Chafik , Belguith Lamia Hadrich
Published: October 2020

How can we determine the semantic meaning of a word in relation to its context of appearance? We eventually have to grabble with this difficult question, as one of the paramount problems of Natural Language Processing (NLP). In other words, this issue is commonly defined as Word Sense Disambiguation (WSD). The latter is one of the crucial difficulties within the NLP field. In this respect, word vectors extracted from a neural network model have been successfully applied for resolving the WSD problem. Accordingly, this article presents an unprecedented method to disambiguate Arabic words according to both their contextual appearance in a source text and the era in which they emerged. In fact, in the few previous decades, many researchers have been grabbling with Arabic Word Sense Disambiguation.

It should be noted that the Arabic language can be divided into three major historical periods: old Arabic, middle-age Arabic, and contemporary Arabic. Actually, contemporary Arabic has proved to be the greatest concern of many researchers. The main gist of our work is to disambiguate Arabic words according to the historical period in which they appeared. To perform such a task, we suggest a method that deploys contextualized word embeddings to better gather valid syntactic and semantic information of the same word by taking into account its contextual uses. The preponderant thing is to convert both the senses and the contextual uses of an ambiguous item to vectors, then determine which of the possible conceptual meanings of the target word is closer to the given context.