bluuebunny/crossref_metadata_2025 huggingface dataset:
The Application of the Integral Momentum Balance on the Pressure Drop of a Sudden Contraction
Authors: Malcherek Andreas , Müller Sebastian
Published: August 2020

A new approach based on the momentum balance to calculate the pressure drop in turbulent flow through sharp-edged axisymmetric sudden contractions is presented. The momentum balance needs the velocity as well as the pressure distributions on the boundaries of the control volume. These distributions are obtained by a series of numerical simulations with different settings for the discharge, as well as the contraction ratio. The numerical model itself is validated by the comparison of the simulated and measured pressure drops in a laboratory experiment at different positions. To get easily applicable hydraulic formulations for the pressure drop depending on the discharge and the contraction ratio, the missing momentum and pressure coefficients are determined from the simulated velocity and pressure distributions. Only the pressure coefficient shows a dependency on the contraction ratio. After fitting the dependency by a simple analytical expression, a new formulation for the hydraulics of a sharp-edged sudden contraction based solely on momentum balance was obtained. The comparison with own experimental results as well as the classical parameterization of Idelchik show in both cases very good agreement.
Antifouling silicone hydrogel contact lenses via densely grafted phosphorylcholine polymers
Authors: Spadafora Alysha , Korogiannaki Myrto , Sheardown Heather
Published: August 2020

Silicone hydrogel contact lenses (CLs) permit increased oxygen permeability through their incorporation of siloxane functional groups. However, contact lens biofouling can be problematic with these materials; surface modification to increase lens compatibility is necessary for acceptable properties. This work focuses on the creation of an antifouling CL surface through a novel grafting method. A polymer incorporating 2-methacryloyloxyethyl phosphorylcholine (MPC), well known for its antifouling and biomimetic properties, was grafted to the model lens surfaces using surface-initiated atom transfer radical polymerization (SI-ATRP). The SI-ATRP modification generated a unique double-grafted polymeric architecture designed to resist protein adsorption through the presence of a surrounding hydration layer due to the PC groups and steric repulsion due to the density of the grafted chains. The polymer was grafted from model silicone hydrogel CL using a four-step SI-ATRP process. Attenuated total reflectance-Fourier transform infrared spectroscopy and XPS were used to confirm the surface chemical composition at each step of the synthesis. Both the surface wettability and equilibrium water content of the materials increased significantly upon polyMPC modification. The surface water contact angle was as low as 16.04 ± 2.37° for polyMPC-50 surfaces; complete wetting (∼0°) was observed for polyMPC-100 surfaces. A decrease in the protein adsorption by as much as 83% (p < 0.000 36) for lysozyme and 73% (p < 0.0076) for bovine serum albumin was observed, with no significant difference between different polyMPC chain lengths. The data demonstrate the potential of this novel modification process for the creation of extremely wettable and superior antifouling surfaces, useful for silicone hydrogel CL surfaces.
Prescribing Physical Activity in Parks and Nature: Health Care Provider Insights on Park Prescription Programs
Authors: Besenyi Gina M. , Hayashi Emi B. , Christiana Richard W.
Published: August 2020

Background: Health care providers (HCPs) promoting physical activity (PA) through programs such as Park Prescriptions (ParkRx) are gaining momentum. However, it is difficult to realize provider PA practices and program interest, and differences in program success exist by provider type (eg, primary vs secondary). This study explored HCPs’ (1) PA counseling practices, (2) knowledge/interest in ParkRx, (3) barriers and resources needed to implement PA counseling and ParkRx programs, and (4) differences in primary versus secondary HCPs. Methods: An e-survey administered in Spring/Summer 2018 to HCPs in 3 states examined study objectives. Results: Respondents (n = 278) were mostly primary (58.3%) HCPs. The majority asked about patient PA habits and offered PA counseling (mean = 5.0, SD = 1.5; mean = 4.8, SD = 1.5), but few provided written prescriptions (mean = 2.5, SD = 1.6). Providers were satisfied with their PA counseling knowledge (mean = 3.8, SD = 1.0) but not with prescribing practices (mean = 3.2, SD = 1.1). Secondary HCPs placed higher importance (P = .012) and provided significantly more written PA prescriptions (P = .005). Time was a common barrier to prescribing PA (mean = 3.4, SD = 1.2), though more so for primary HCPs (P = .000). Although few HCPs knew about ParkRx programs, 81.6% expressed interest. Access to park information and community partnerships was an important resource for program implementation. Conclusions: HCPs underutilize PA prescriptions. Despite little awareness, HCPs were interested in ParkRx programs.
How the effects of actions become our own
Authors: Zapparoli L. , Seghezzi S. , Zirone E. , Guidali G. , Tettamanti M. , Banfi G. , Bolognini N. , Paulesu E.
Published: August 2020

The feeling that physical events are caused by us is tied to our action planning rather than being a mere post hoc deduction.
In Vitro
Activity of the Ultra-Broad-Spectrum Beta-Lactamase Inhibitor QPX7728 in Combination with Meropenem against Clinical Isolates of Carbapenem-Resistant Acinetobacter baumannii
Authors: Nelson Kirk , Rubio-Aparicio Debora , Tsivkovski Ruslan , Sun Dongxu , Totrov Maxim , Dudley Michael , Lomovskaya Olga
Published: August 2020

QPX7728 is a recently discovered ultra-broad-spectrum beta-lactamase inhibitor (BLI) with potent inhibition of key serine and metallo-beta-lactamases. QPX7728 enhances the potency of many beta-lactams, including carbapenems, in beta-lactamase-producing Gram-negative bacteria, including
Acinetobacter
spp. The potency of meropenem alone and in combination with QPX7728 (1 to 16 μg/ml) was tested against 275 clinical isolates of
Acinetobacter baumannii
(carbapenem-resistant
A. baumannii
[CRAB]) collected worldwide that were highly resistant to carbapenems (MIC
50
and MIC
90
for meropenem, 64 and >64 μg/ml).
Assessment of Soil Features on the Growth of Environmental Nontuberculous Mycobacterial Isolates from Hawai'i
Authors: Glickman Cody M. , Virdi Ravleen , Hasan Nabeeh A. , Epperson L. Elaine , Brown Leeza , Dawrs Stephanie N. , Crooks James L. , Chan Edward D. , Strong Michael , Nelson Stephen T. , Honda Jennifer R.
Published: August 2020

Globally and in the United States, the prevalence of NTM pulmonary disease—a potentially life-threatening but underdiagnosed chronic illness—is prominently rising. While NTM are ubiquitous in the environment, including in soil, the specific soil components that promote or inhibit NTM growth have not been elucidated. We hypothesized that NTM culture-positive soil contains minerals that promote NTM growth
in vitro
. Because Hawai’i is a hot spot for NTM and a unique geographic archipelago, we examined the composition of Hawai’i soil and identified individual clay, iron, and manganese minerals associated with NTM. Next, individual components were evaluated for their ability to directly modulate NTM growth in culture. In general, gibbsite and some manganese oxides were shown to decrease NTM, whereas iron-containing minerals were associated with higher NTM counts. These data provide new information to guide future analyses of soil-associated factors impacting persistence of these soil bacteria.
Dietary Supplementation with Sodium Sulfate Improves Rumen Fermentation, Fiber Digestibility, and the Plasma Metabolome through Modulation of Rumen Bacterial Communities in Steers
Authors: Zhao Yuchao , Xie Biao , Gao Jian , Zhao Guangyong
Published: August 2020

Essential elements like nitrogen and sulfur greatly affect rumen fermentation and metabolism in ruminants. However, little knowledge is available on the effects of sulfur on the rumen microbiota and plasma metabolome. The results of the present trial demonstrated that supplementing the steer ration with sodium sulfate markedly improved rumen fermentation, fiber digestibility, and metabolism of amino acids, purine derivatives, and vitamins through effects on the ruminal microbiome. The facts obtained from the present trial clarified the possible mechanisms of the positive effects of sulfur on rumen fermentation and nutrient utilization.
Coinfection with Porcine Circovirus Type 2 (PCV2) and Streptococcus suis Serotype 2 (SS2) Enhances the Survival of SS2 in Swine Tracheal Epithelial Cells by Decreasing Reactive Oxygen Species Production
Authors: Wang Qing , Zhou Hong , Fan Hongjie , Wang Xiaomin
Published: August 2020

Porcine circovirus type 2 (PCV2) and
Streptococcus suis
serotype 2 (SS2) clinical coinfection cases have been frequently detected. The respiratory epithelium plays a crucial role in host defense against a variety of inhaled pathogens. Reactive oxygen species (ROS) are involved in killing of bacteria and host immune response. The aim of this study is to assess whether PCV2 and SS2 coinfection in swine tracheal epithelial cells (STEC) affects ROS production and investigate the roles of ROS in bacterial survival and the inflammatory response.
A Novel Mycovirus Evokes Transcriptional Rewiring in the Fungus
Malassezia
and Stimulates Beta Interferon Production in Macrophages
Authors: Applen Clancey Shelly , Ruchti Fiorella , LeibundGut-Landmann Salomé , Heitman Joseph , Ianiri Giuseppe
Published: August 2020

Malassezia
species represent the most common fungal inhabitant of the mammalian skin microbiome and are natural skin commensal flora. However, these fungi are also associated with a variety of clinical skin disorders. Recent studies have reported associations of
Malassezia
with Crohn’s disease and pancreatic cancer, further implicating this fungal genus in inflammatory and neoplastic disease states. Because
M. sympodialis
has lost genes involved in RNA interference (RNAi), we hypothesized
Malassezia
could harbor dsRNA mycoviruses. Indeed, we identified a novel mycovirus of the totivirus family in several
Malassezia
species and characterized the MsMV1 mycovirus of
M. sympodialis
. We found conditions that lead to curing of the virus and analyzed isogenic virus-infected/virus-cured strains to determine MsMV1 genetic and pathogenic impacts. MsMV1 induces a strong overexpression of transcription factors and ribosomal genes, while downregulating cellular metabolism. Moreover, MsMV1 induced a significantly higher level of beta interferon expression in cultured macrophages. This study sheds light on the mechanisms of pathogenicity of
Malassezia
, focusing on a previously unidentified novel mycovirus.
Aerobic Metabolism in Vibrio cholerae Is Required for Population Expansion during Infection
Authors: Van Alst Andrew J. , DiRita Victor J.
Published: August 2020

Vibrio cholerae
remains a challenge in the developing world and incidence of the disease it causes, cholera, is anticipated to increase with rising global temperatures and with emergent, highly infectious strains. At present, the underlying metabolic processes that support
V. cholerae
growth during infection are less well understood than specific virulence traits, such as production of a toxin or pilus. In this study, we determined that oxidative metabolism of host substrates such as mucin contribute significantly to
V. cholerae
population expansion
in vivo
. Identifying metabolic pathways critical for growth can provide avenues for controlling
V. cholerae
infection and the knowledge may be translatable to other pathogens of the gastrointestinal tract.
The Nucleoid Occlusion Protein SlmA Binds to Lipid Membranes
Authors: Robles-Ramos Miguel Ángel , Margolin William , Sobrinos-Sanguino Marta , Alfonso Carlos , Rivas Germán , Monterroso Begoña , Zorrilla Silvia
Published: August 2020

Successful bacterial proliferation relies on the spatial and temporal precision of cytokinesis and its regulation by systems that protect the integrity of the nucleoid. In
Escherichia coli
, one of these protectors is SlmA protein, which binds to specific DNA sites around the nucleoid and helps to shield the nucleoid from inappropriate bisection by the cell division septum. Here, we discovered that SlmA not only interacts with the nucleoid and septum-associated cell division proteins but also binds directly to cytomimetic lipid membranes, adding a novel putative mechanism for regulating the local activity of these cell division proteins. We find that interaction between SlmA and lipid membranes is regulated by SlmA’s DNA binding sites and protein binding partners as well as chemical conditions, suggesting that the SlmA-membrane interactions are important for fine-tuning the regulation of nucleoid integrity during cytokinesis.
Interplay of Cretaceous transpressional deformation and continental arc magmatism in a long-lived crustal boundary, central Fiordland, New Zealand
Authors: Blatchford Hannah J. , Klepeis Keith A. , Schwartz Joshua J. , Jongens Richard , Turnbull Rose E. , Miranda Elena A. , Coble Matthew A. , Kylander-Clark Andrew R. C.
Published: August 2020

Recovering the time-evolving relationship between arc magmatism and deformation, and the influence of anisotropies (inherited foliations, crustal-scale features, and thermal gradients), is critical for interpreting the location, timing, and geometry of transpressional structures in continental arcs. We investigated these themes of magma-deformation interactions and preexisting anisotropies within a middle- and lower-crustal section of Cretaceous arc crust coinciding with a Paleozoic boundary in central Fiordland, New Zealand. We present new structural mapping and results of Zr-in-titanite thermometry and U-Pb zircon and titanite geochronology from an Early Cretaceous batholith and its host rock. The data reveal how the expression of transpression in the middle and lower crust of a continental magmatic arc evolved during emplacement and crystallization of the ∼2300 km2 lower-crustal Western Fiordland Orthogneiss (WFO) batholith. Two structures within Fiordland’s architecture of transpressional shear zones are identified. The gently dipping Misty shear zone records syn-magmatic oblique-sinistral thrust motion between ca. 123 and ca. 118 Ma, along the lower-crustal WFO Misty Pluton margin. The subhorizontal South Adams Burn thrust records mid-crustal arc-normal shortening between ca. 114 and ca. 111 Ma. Both structures are localized within and reactivate a recently described >10 km-wide Paleozoic crustal boundary, and show that deformation migrated upwards between ca. 118 and ca. 114 Ma. WFO emplacement and crystallization (mainly 118–115 Ma) coincided with elevated (>750 °C) middle- and lower-crustal Zr-in-titanite temperatures and the onset of mid-crustal cooling at 5.9 ± 2.0 °C Ma−1 between ca. 118 and ca. 95 Ma. We suggest that reduced strength contrasts across lower-crustal pluton margins during crystallization caused deformation to migrate upwards into thermally weakened rocks of the mid-crust. The migration was accompanied by partitioning of deformation into domains of arc-normal shortening in Paleozoic metasedimentary rocks and domains that combined shortening and strike-slip deformation in crustal-scale subvertical, transpressional shear zones previously documented in Fiordland. U-Pb titanite dates indicate Carboniferous–Cretaceous (re)crystallization, consistent with reactivation of the inherited boundary. Our results show that spatio-temporal patterns of transpression are influenced by magma emplacement and crystallization and by the thermal structure of a reactivated boundary.
Fifteen-minute consultation: The overweight teenage girl with acne
Authors: Gubbin Jessica , Malbon Katie
Published: August 2020

Polycystic ovary syndrome (PCOS) is a common endocrine condition which often presents in adolescence. The symptoms and signs, which include obesity, acne, hirsutism and irregular menstrual periods, can have profound psychosocial, metabolic and reproductive consequences. Diagnosis in the adolescent population can be particularly difficult as there is significant overlap between the clinical features of PCOS and those of normal pubertal development. International guidelines published in 2018 have produced diagnostic criteria for adolescents to aid the physician, but there will still be many cases in which diagnostic uncertainty remains. In this article, we present a structured approach to adolescents with symptoms of PCOS, covering clinical assessment, investigation, diagnosis and management. We emphasise that intervention, with lifestyle advice and combined oral contraception should be considered even in the absence of a definitive diagnosis.
Conundrum of aortic stenosis in a case of multivalvular rheumatic heart disease: perspicuity is in the details
Authors: Ahmed Ahamed Shaheer , Kumar Rahul , Basha Aseem
Published: August 2020

A 36-year-old woman presented with dyspnoea on exertion for 5 years. She was evaluated elsewhere and diagnosed to have severe mitral stenosis. She was referred for mitral valve replacement to our centre. Echocardiography revealed a thickened aortic valve with mild aortic regurgitation, with transaortic gradient suggestive of mild aortic stenosis, in addition to severe rheumatic mitral stenosis. Detailed echocardiographic analysis and cardiac catheterisation revealed features suggestive of moderate to severe aortic stenosis. Detailed assessment of aortic valve needs to be done in patients with coexistent mitral stenosis. Each modality for assessment of aortic stenosis has its own limitations and a decision regarding treatment needs to be taken based on combined analysis of all the parameters. Dimensionless velocity index is a relatively less time-consuming, flow independent measure of aortic stenosis. Prompt recognition of this concealed aortic stenosis helps to avoid repeat valve surgery. Subsequently, patient was sent for dual valve replacement.
Conventional compared to network meta-analysis to evaluate antibiotic prophylaxis in patients with cancer and haematopoietic stem cell transplantation recipients
Authors: Martinez Juan Pablo Diaz , Robinson Paula D , Phillips Bob , Lehrnbecher Thomas , Koenig Christa , Fisher Brian , Egan Grace , Dupuis L Lee , Ammann Roland A , Alexander Sarah , Cabral Sandra , Tomlinson George , Sung Lillian
Published: August 2020

Our purpose was to compare conventional meta-analysis and network meta-analysis to evaluate the efficacy of different prophylactic systemic antibiotic classes in patients undergoing chemotherapy or haematopoietic stem cell transplant (HSCT). We included randomised trials if patients had cancer or were HSCT recipients and the intervention was systemic antibacterial prophylaxis. Three types of control groups were used: (1) placebo, no antibiotic and non-absorbable antibiotic separately; (2) placebo and no antibiotic combined; and (3) all three combined. These gave different network geometries. Strategies synthesised were fluoroquinolone, trimethoprim-sulfamethoxazole, cephalosporin and parenteral glycopeptide versus control groups. In total 113 trials met the eligibility criteria. Where treatment effects could be estimated with both conventional and network meta-analysis, values were generally similar. However, where events were sparse, network meta-analysis could be more precise. For example, trimethoprim-sulfamethoxazole versus placebo for infection-related mortality showed a relative risk ratio (RR) of 0.55, 95% CI (0.21 to 1.44) with conventional, and RR 0.43, 95% credible region (0.20 to 0.82) with network meta-analysis. Cephalosporin versus fluoroquinolone was comparable only indirectly using the network approach and yielded RR 0.59, 95% credible region (0.28 to 1.20) to reduce bacteraemia. Incoherence (difference between direct and indirect estimates raising concerns about network meta-analysis validity) was observed with network geometry where control groups were separated, but not where control groups were combined. In this situation, conventional and network meta-analysis yielded similar results in general. Network meta-analysis results could be more precise when events were rare. Some analysis could only be performed with the network approach. These results identify scenarios in which network meta-analysis may be advantageous.
Transmission risk of respiratory viruses in natural and mechanical ventilation environments: implications for SARS-CoV-2 transmission in Africa
Authors: Sopeyin Anuoluwapo , Hornsey Emilio , Okwor Tochi , Alimi Yewande , Raji Tajudeen , Mohammed Abdulaziz , Moges Hiwot , Onwuekwe Ezinne V C , Minja Frank J , Gon Giorgia , Ogbuagu Onyema , Ogunsola Folasade , Paintsil Elijah
Published: August 2020

Respiratory viruses can be transmitted through contact, droplet and airborne routes. Viruses that are not naturally airborne may be aerosolised during medical procedures and transmitted to healthcare workers. Most resource-limited healthcare settings lack complex air handling systems to filter air and create pressure gradients that are necessary for minimising viral transmission. This review explores the association between ventilation and the transmission of respiratory viruses like SAR-CoV-2. When used appropriately, both natural and mechanical ventilation can decrease the concentration of viral aerosols, thereby reducing transmission. Although mechanical ventilation systems are more efficient, installation and maintenance costs limit their use in resource-limited settings, whereas the prevailing climate conditions make natural ventilation less desirable. Cost-effective hybrid systems of natural and mechanical ventilation may overcome these limitations.
Predicting the use of antibiotics after initial symptomatic treatment of an uncomplicated urinary tract infection: analyses performed after a randomised controlled trial
Authors: Vik Ingvild , Mdala Ibrahimu , Bollestad Marianne , Cordoba Gloria Cristina , Bjerrum Lars , Neumark Thomas , Damsgaard Eivind , Bærheim Anders , Grude Nils , Lindbaek Morten
Published: August 2020

Objective

To predict antibiotic use after initial treatment with ibuprofen using data from a randomised controlled trial comparing ibuprofen to pivmecillinam in the treatment of women with symptoms of an uncomplicated urinary tract infection (UTI).

Setting

16 sites in a primary care setting in Norway, Sweden and Denmark.

Participants

Data from 181 non-pregnant women aged 18–60 presenting with symptoms of uncomplicated UTI, initially treated with ibuprofen.

Methods

Using the least absolute shrinkage and selection operator logistic regression model, we conducted analyses to see if baseline information could help us predict which women could be treated with ibuprofen without risking treatment failure and which women should be recommended antibiotics.

Results

Of the 143 women included in the final analysis, 77 (53.8%) recovered without antibiotics and 66 (46.2 %) were subsequently prescribed antibiotics. In the unadjusted binary logistic regression, the number of days with symptoms before inclusion (<3 days) and feeling moderately unwell or worse (≥4 on a scale of 0–6) were significant predictors for subsequent antibiotic use. In the adjusted model, no predictors were significantly associated with subsequent antibiotic use. The area under the curve of the final model was 0.66 (95% CI: 0.57 to 0.74).

Conclusion

We did not find any baseline information that significantly predicted the use of antibiotic treatment. Identifying women who need antibiotic treatment to manage their uncomplicated UTI is still challenging. Larger data sets are needed to develop models that are more accurate.

Trial registration number

ClinicalTrials.gov (NCT01849926).
Half-dose fulvestrant plus anastrozole as a first-line treatment for hormone receptor-positive metastatic breast cancer: a cost-effectiveness analysis
Authors: Huang Xiaoting , Weng Xiuhua , Lin Shen , Liu Yiwei , Luo Shaohong , Wang Hang , Ming Wai-kit , Huang Pinfang
Published: August 2020

Objective

The S0226 trial demonstrated that the combination of half-dose fulvestrant (FUL) and anastrozole (ANA) (F&A) caused a significant improvement in overall survival (OS) versus ANA monotherapy for first-line treatment of postmenopausal women with hormone receptor-positive metastatic breast cancer (PMW-MBC (HR+)). The objective of this study was to evaluate the cost-effectiveness of F&A in the first-line treatment for PMW-MBC (HR+) in China.

Design

We constructed a Markov model over a life-time horizon. The clinical outcomes and utility data were obtained from published literature. Cost data were obtained from official Chinese websites. Sensitivity analyses were performed to test result uncertainty.

Setting

Chinese healthcare system perspective.

Population

A hypothetical cohort of adult patients presenting with PMW-MBC (HR+).

Interventions

F&A compared with full-dose FUL and ANAmonotherapy.

Main outcome measures

The main outcome of this study was the incremental cost-effectiveness ratio (ICER) and quality-adjusted life-years (QALY).

Results

ANA was estimated to have the lowest cost and minimum life-years. The ICER of F&A versus ANA was US$15 665.891/QALY with incremental cost and QALY of US$12 401.120 and 0.792, respectively, which was less than the willingness-to-pay of US$29 383/QALY. Compared with F&A, FUL yielded a higher cost and a shorter lifetime; hence, it was identified as a dominated strategy. The univariate sensitivity analysis indicated the price of FUL was the most influential factor in our study. The probability that F&A was cost-effective at a threshold of US$29 383/QALY in China was 86.5%.

Conclusion

F&A is a cost-effective alternative to FUL and ANA monotherapy for the first-line treatment of PMW-MBC (HR+) in China. F&A is a promising first-line treatment for PMW-MBC (HR+), and more research is needed to evaluate the economy of using F&A in other countries.
Point-of-care viral load testing among adolescents and youth living with HIV in Haiti: a protocol for a randomised trial to evaluate implementation and effect
Authors: Reif Lindsey K , Belizaire Marie Elmase , Seo Grace , Rouzier Vanessa , Severe Patrice , Joseph Joseph Marie , Joseph Bernadette , Apollon Sandra , Abrams Elaine J , Arpadi Stephen M , Elul Batya , Pape Jean W , McNairy Margaret L , Fitzgerald Daniel W , Kuhn Louise
Published: August 2020

Introduction

Adolescents living with HIV have poor antiretroviral therapy (ART) adherence and viral suppression outcomes. Viral load (VL) monitoring could reinforce adherence but standard VL testing requires strong laboratory capacity often only available in large central laboratories. Thus, coordinated transport of samples and results between the clinic and laboratory is required, presenting opportunities for delayed or misplaced results. Newly available point-of-care (POC) VL testing systems return test results the same day and could simplify VL monitoring so that adolescents receive test results faster which could strengthen adherence counselling and improve ART adherence and viral suppression.

Methods and analysis

This non-blinded randomised clinical trial is designed to evaluate the implementation and effectiveness of POC VL testing compared with standard laboratory-based VL testing among adolescents and youth living with HIV in Haiti. A total of 150 participants ages 10–24 who have been on ART for >6 months are randomised 1:1 to intervention or standard arms. Intervention arm participants receive a POC VL test (Cepheid Xpert HIV-1 Viral Load system) with same-day result and immediate ART adherence counselling. Standard care participants receive a laboratory-based VL test (Abbott m2000sp/m2000rt) with the result available 1 month later, at which time they receive ART adherence counselling. VL testing is repeated 6 months later for both arms. The primary objective is to describe the implementation of POC VL testing compared with standard laboratory-based VL testing. The secondary objective is to evaluate the effect of POC VL testing on VL suppression at 6 months and participant comprehension of the correlation between VL and ART adherence.

Ethics and dissemination

This study is approved by GHESKIO, Weill Cornell Medicine and Columbia University ethics committees. This trial will provide critical data to understand if and how POC VL testing may impact adolescent ART adherence and viral suppression. If effective, POC VL testing could routinely supplement standard laboratory-based VL testing among high-risk populations living with HIV.

Trial registration number

NCT03288246.
Trends in cancer incidence and survival in the Augsburg study region—results from the Augsburg cancer registry
Authors: Grundmann Nina , Meisinger Christa , Trepel Martin , Müller-Nordhorn Jacqueline , Schenkirsch Gerhard , Linseisen Jakob
Published: August 2020

Objectives

Knowledge about time trends of cancer incidence and cancer survival in a defined region is an essential prerequisite for the planning of regional healthcare infrastructure. The aim of the study was to provide population-based analyses of all common tumour sites to assess the cancer burden in the Augsburg study region.

Setting

Total population of the study region of Augsburg (668 522 residents), Southern Germany.

Participants

The data obtained from the Cancer Registry Augsburg comprised 37 487 incident cases of malignant tumours (19 313 men and 18 174 women) diagnosed between 2005 and 2016 in the Augsburg region’s resident population.

Primary and secondary outcome measures

We calculated sex-specific, age-standardised incidence rates and annual percent change to assess time trends. In men and in women, 3-year and 5-year relative survival was calculated and results were compared with the latest German estimates. Survival trends were presented for the most common cancers only.

Results

Decreasing age-standardised incidence rates were observed for prostate cancer and for colorectal cancer in men. For oropharyngeal cancer, rates declined in men, but significantly increased in women. Incidence for female breast cancer remained stable. Five-year relative survival ranged between 6.4% (95% CI: 4.1% to 10.1%) for pancreatic cancer and 97.7% (95% CI: 96.0% to 99.4%) for prostate cancer in men and between 10.2% (95% CI: 7.1% to 14.6%) for pancreatic cancer and 96.6% (95% CI: 93.6% to 99.6%) for malignant melanoma in women. Trends in 3-year survival of the five most common tumour sites in men showed a significant increase for lung and oropharyngeal cancer. In women, continuously rising survival trends were observed for breast cancer.

Conclusions

Survival of cancer patients in the Augsburg study region was largely concordant with the situation in Germany as a whole, while incidence showed slight deviations in some cancer sites. Regional evaluations on cancer survival are a valuable instrument for identifying deficits and determining advances in oncological health management.
Determining the long-term health burden and risk of sequelae for 14 foodborne infections in British Columbia, Canada: protocol for a retrospective population-based cohort study
Authors: Majowicz Shannon E , Panagiotoglou Dimitra , Taylor Marsha , Gohari Mahmood R , Kaplan Gilaad G , Chaurasia Ashok , Leatherdale Scott T , Cook Richard J , Patrick David M , Ethelberg Steen , Galanis Eleni
Published: August 2020

Introduction

Over one in eight Canadians is affected by a foodborne infection annually; however, the long-term consequences, including the risks and costs of sequelae, are unclear. We aim to estimate the health burden and direct costs of 14 infections commonly transmitted by food, considering the acute illness and subsequent sequelae and mortality, for the population of British Columbia, Canada (~4.7 million).

Methods and analysis

We will conduct a population-based retrospective cohort study of the British Columbia provincial population, over a 10-year study period (1 January 2005 to 31 December 2014). Exposure is defined as a provincially reported illness caused byClostridium botulinum,Campylobacter,Cryptosporidium, Cyclospora, Giardia, hepatitis A virus,Listeria, non-typhoidalSalmonellaspp,SalmonellaTyphi,SalmonellaParatyphi, Shiga toxin-producingEscherichia coli,Shigella,Vibrio parahaemolyticusorYersinia(excludingpestis). We will link individual-level longitudinal data from eight province-wide administrative health and reportable disease databases that include physician visits, hospitalisations and day surgeries, deaths, stillbirths, prescription medications (except those to treat HIV) and reportable foodborne diseases. Using these linked databases, we will investigate the likelihood of various sequelae and death. Hazard models will be used to estimate the risk of outcomes and their association with the type of foodborne infection. Epidemiological analyses will be conducted to determine the progression of illness and the fraction of sequelae attributable to specific foodborne infections. Economic analyses will assess the consequent direct healthcare costs.

Ethics and dissemination

This study has been approved by a University of Waterloo Research Ethics Committee (no 30645), the University of British Columbia Behavioral Research Ethics Board (no H16-00021) and McGill University’s Institutional Review Board (no A03-M12-19A). Results will be disseminated via presentations to academics, public health practitioners and knowledge users, and publication in peer-reviewed journals. Where such publications are not open access, manuscripts will also be available via the University of Waterloo’s Institutional Repository (https://uwspace.uwaterloo.ca).
Eye health and quality of life: an umbrella review protocol
Authors: Assi Lama , Rosman Lori , Chamseddine Fatimah , Ibrahim Perla , Sabbagh Hadi , Congdon Nathan , Evans Jennifer , Ramke Jacqueline , Kuper Hannah , Burton Matthew J , Ehrlich Joshua R , Swenor Bonnielin K
Published: August 2020

Introduction

Vision impairment and eye disease are major global health concerns and have been associated with increased morbidity and mortality, and lower quality of life. Quality of life, whether generic, vision-specific or disease-specific, is an important measure of the impact of eye health on people’s daily activities, well-being and visual function, and is increasingly used to evaluate the impact of ophthalmic interventions and new devices. While many studies and reviews have examined the relationship between vision or eye health and quality of life across different contexts, there has yet to be a synthesis of the impact of vision impairment, eye disease and ophthalmic interventions on quality of life globally and across the lifespan.

Methods and analysis

An umbrella review of systematic reviews will be conducted to address these two questions: (1) What is the association of vision impairment and eye disease with quality of life? (2) What is the impact of ophthalmic interventions on quality of life? A search of related literature will be performed on the 11 February 2020 in Medline Ovid, Embase.com, Cochrane Database of Systematic Reviews, Proquest Dissertations and Theses Global, and the grey literature, and repeated at the synthesis stage. Title/abstract and full-text screening, methodological quality assessment and data extraction will be conducted by reviewers working independently and in duplicate. Assessment of methodological quality and data extraction will be performed using Joanna Briggs Institute standard forms. Findings from the systematic reviews and their methodological quality will be summarised qualitatively in the text and using tables.

Ethics and dissemination

No ethical approval is required. Results of this umbrella review will be published in a peer-reviewed journal and summarised in theLancet Global HealthCommission on Global Eye Health.

Trial registration number

This protocol was registered in the Open Science Framework Registries (https://osf.io/qhv9g/).
Mortality and hospitalisation in the Danish Helicopter Emergency Medical Service (HEMS) population from 2014 to 2018: a national population-based study of HEMS triage
Authors: Alstrup Karen , Petersen Jens Aage Kølsen , Sollid Stephen , Johnsen Søren Paaske , Rognås Leif
Published: August 2020

Objective

To describe characteristics and outcomes for patients where the Danish Helicopter Emergency Medical Service (HEMS) either transported the patient to hospital, treated the patient on scene but did not transport the patient or was dispatched but cancelled en route to the patient (aborted mission), and to assess the field triage by comparing these outcomes.

Design

National population-based study.

Setting and participants

HEMS dispatches are undertaken from the five Danish emergency dispatch medical centres according to national guidelines. The study analysed all primary missions with helicopter take off where the patient was admitted to hospital between 1st October 2014 and 30th April 2018.

Main outcome measures

Mortality rates, admittance to an intensive care unit (ICU), need of mechanical ventilation and length of hospital stay (LOS).

Results

6931 patients were admitted to hospital; 3311 patients were air lifted, 164 patients were ground escorted by a HEMS physician, 1421 were assisted on scene by HEMS, but escorted by the ground units and 2035 missions were aborted. The mortality was highest among the airlifted and ground escorted patients, and lowest among the patients in the aborted mission group. Mortality for the airlifted patients increased from 8.2% (95% CI; 7.3 to 9.2) at day 1 to 19.5% (95% CI; 18.2 to 20.9) after 1 year. The airlifted and ground escorted patients were frequently admitted to ICU and subsequently mechanically ventilated and they also had an increased LOS compared with the patients only assisted on scene by HEMS and the patients in the aborted mission group.

Conclusion

Patients to whom HEMS are dispatched are often critically ill or injured and have a relatively high mortality. The patients airlifted or ground escorted to hospital by HEMS appear more critically ill or injured compared with the assisted patients and the patients in the aborted mission group. The on-scene triage seems appropriate.
New types of diaphragms and cervical caps versus older types of diaphragms and different gels for contraception: a systematic review
Authors: Lindh Ingela , Othman Jwan , Hansson Mariann , Ekelund Ann-Catrin , Svanberg Therese , Strandell Annika
Published: August 2020

Introduction

Our primary objective was to evaluate whether new types of single-size diaphragms or cervical caps differ in prevention of pregnancy compared with older types of diaphragms, and whether different types of gels differ in their ability to prevent pregnancy. A secondary aim was to evaluate method discontinuation and complications.

Methods

A comprehensive search was conducted in PubMed, Embase and the Cochrane Library. The certainty of evidence was assessed according to the GRADE system.

Results

Four randomised controlled studies were included in the assessment. When comparing the new and old types of female barrier contraceptives the 6-month pregnancy rate varied between 11%–15% and 8%–12%, respectively. More women reported inability to insert or remove the FemCap device (1.1%) compared with the Ortho All-Flex diaphragm (0%) (p<0.0306). Urinary tract infections were lower when using the single-size Caya, a difference of −6.4% (95% CI −8.9 to −4.09) compared with the Ortho All-Flex diaphragm. The 6-month pregnancy rate for acid-buffering gel and spermicidal nonoxynol-9 gel varied between 10% and 12%. The discontinuation rate was lower in women who used acid-buffering gel compared with nonoxynol-9 gel (risk ratio (RR) 0.77, 95% CI 0.68 to 0.97).

Conclusions

Pregnancy rates were generally high in women using female barrier contraceptives. There was no difference in the efficacy for pregnancy prevention between the new types of diaphragms and cervical caps and the older diaphragms. The new types of diaphragms and cervical caps resulted in fewer urinary tract infections. Acid-buffering gels did not differ from spermicidal nonoxynol-9 gels regarding pregnancies but seemed to be better tolerated.
Anakinra for constrictive pericarditis associated with incessant or recurrent pericarditis
Authors: Andreis Alessandro , Imazio Massimo , Giustetto Carla , Brucato Antonio , Adler Yehuda , De Ferrari Gaetano Maria
Published: August 2020

Objective

Frequent flares of pericardial inflammation in recurrent or incessant pericarditis with corticosteroid dependence and colchicine resistance may represent a risk factor for constrictive pericarditis (CP). This study was aimed at the identification of CP in these patients, evaluating the efficacy and safety of anakinra, a third-line treatment based on interleukin-1 inhibition, to treat CP and prevent the need for pericardiectomy.

Methods

Consecutive patients with recurrent or incessant pericarditis with corticosteroid dependence and colchicine resistance were included in a prospective cohort study from 2015 to 2018. Enrolled patients received anakinra 100 mg once daily subcutaneously. The primary end point was the occurrence of CP. A clinical and echocardiographic follow-up was performed at 1, 3, 6 months and then every 6 months.

Results

Thirty-nine patients (mean age 42 years, 67% females) were assessed, with a baseline recurrence rate of 2.76 flares/patient-year and a median disease duration of 12 months (IQR 9–20). During follow-up, CP was diagnosed in 8/39 (20%) patients. After anakinra dose of 100 mg/day, 5 patients (63%) had a complete resolution of pericardial constriction within a median of 1.2 months (IQR 1–4). In other three patients (37%), CP became chronic, requiring pericardiectomy within a median of 2.8 months (IQR 2–5). CP occurred in 11 patients (28%) with incessant course, which was associated with an increased risk of CP over time (HR for CP 30.6, 95% CI 3.69 to 253.09).

Conclusions

In patients with recurrent or incessant pericarditis, anakinra may have a role in CP reversal. The risk of CP is associated with incessant rather than recurrent course.
Impact of COVID-19 on percutaneous coronary intervention for ST-elevation myocardial infarction
Authors: Kwok Chun Shing , Gale Chris P , Kinnaird Tim , Curzen Nick , Ludman Peter , Kontopantelis Evan , Wu Jianhua , Denwood Tom , Fazal Nadeem , Deanfield John , de Belder Mark A , Mamas Mamas
Published: August 2020

Background

The objective of the study was to identify any changes in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in England by analysing procedural numbers, clinical characteristics and patient outcomes during the COVID-19 pandemic.

Methods

We conducted a retrospective cohort study of patients who underwent PCI in England between January 2017 and April 2020 in the British Cardiovascular Intervention Society-National Institute of Cardiovascular Outcomes Research database. Analysis was restricted to 44 hospitals that reported contemporaneous activity on PCI. Only patients with primary PCI for STEMI were included in the analysis.

Results

A total of 34 127 patients with STEMI (primary PCI 33 938, facilitated PCI 108, rescue PCI 81) were included in the study. There was a decline in the number of procedures by 43% (n=497) in April 2020 compared with the average monthly procedures between 2017 and 2019 (n=865). For all patients, the median time from symptom to hospital showed increased after the lockdown (150 (99–270) vs 135 (89–250) min, p=0.004) and a longer door-to-balloon time after the lockdown (48 (21–112) vs 37 (16–94) min, p<0.001). The in-hospital mortality rate was 4.8% before the lockdown and 3.5% after the lockdown (p=0.12). Following adjustment for baseline characteristics, no differences were observed for in-hospital death (OR 0.87, 95% CI 0.45 to 1.68, p=0.67) and major adverse cardiovascular events (OR 0.71, 95% CI 0.39 to 1.32, p=0.28).

Conclusions

Following the lockdown in England, we observed a decline in primary PCI procedures for STEMI and increases in overall symptom-to-hospital and door-to-balloon time for patients with STEMI. Restructuring health services during COVID-19 has not adversely influenced in-hospital outcomes.
Chronic inflammatory demyelinating polyneuropathy associated with diabetes: a European multicentre comparative reappraisal
Authors: Rajabally Yusuf A , Peric Stojan , Cobeljic Mina , Afzal Saadia , Bozovic Ivo , Palibrk Aleksa , Basta Ivana
Published: August 2020

Introduction

The association between chronic inflammatory demyelinating polyneuropathy (CIDP) and diabetes is uncertain despite important diagnostic and management implications.

Methods

We retrospectively analysed two European cohorts, totaling 257 patients with ‘definite’ or ‘probable’ CIDP, from Serbia and Birmingham, UK.

Results

Diabetes was present at CIDP diagnosis in 25/139 (18%) subjects in the Serbian cohort and in 23/118 (19.5%) in the UK cohort. In both cohorts, diabetes prevalence was higher than local general population prevalence rates (RR: 2.09; 95% CI 1.39 to 2.95 and RR: 2.22; 95% CI 1.46 to 3.17, respectively). Considering typical CIDP only, diabetes prevalence was greater than expected in both cohorts (RR: 2.58; 95% CI 1.60 to 3.82 and RR: 2.68; 95% CI 1.71 to 3.87, respectively). CIDP with diabetes occurred later in life than CIDP without diabetes (58.96 years, SD: 11.09 vs 51.71 years, SD: 16.02; p=0.003) and presented more frequently in the typical form than in patients without diabetes (79.2% vs 61.2%; p=0.02). Baseline Inflammatory Neuropathy Cause and Treatment disability scores were similar in patients with and without diabetes (p=0.90). Proportions of treatment responders were similar in both groups (70% vs 74.9%; p=0.65), as were response amplitudes (p=0.87).

Discussion

Our results, both for all CIDP and typical CIDP presentations, support a twofold increased relative risk of diabetes compared with the general population. CIDP with diabetes appears to present older and more frequently in the typical form, as compared with CIDP without diabetes. CIDP with diabetes appears similar to CIDP without diabetes in disability levels at diagnosis and probability, as well as amplitude of treatment response.
The frequency of uveitis in patients with adult versus childhood spondyloarthritis
Authors: Turk Matthew , Hayworth Jacqueline , Nevskaya Tatiana , Pope Janet
Published: August 2020

Objectives

This meta-analysis investigated the frequency of ocular involvement in childhood and adult spondyloarthritis (SpA).

Methods

A systematic review of the literature was conducted. Medline, Web of Science and Cochrane databases were searched upto October 2018 identifying publications related to SpA, including ankylosing spondylitis (AS) with ocular conditions (OC) (uveitis, iritis, retinitis, chorioretinitis and other ocular involvement). The rates of OC were extracted and random effects models estimated their frequency. Heterogeneity was evaluated using I2. Inclusion criteria were studies in SpA of either children or adults who included a frequency of OC.

Results

3164 studies were identified, and 41 analysed which included frequencies of uveitis/iritis. Other OC were too infrequent to analyse. A pooled random effects model showed that the prevalence of uveitis was 24% in adult AS (23 studies, 11 943 patients), 10% in adult psoriatic arthritis (PsA) (9 studies, 1817) and 17% in undifferentiated adult SpA (9 studies, 6568 patients). In juveniles with AS, the prevalence of uveitis was 27% (8 studies, 927 patients), in juvenile PsA it was 16% (5 studies, N=498) and in juvenile undifferentiated SpA, uveitis occurred in 7% (2 studies, 1531 patients). In all evaluated SpA subgroups, there were no statistical differences in the frequency of uveitis between juveniles and adults.

Conclusions

Uveitis in adult versus child-onset SpA is similar in AS but more common in adult-onset undifferentiated SpA, and less frequent in adult-onset PsA compared to child-onset PsA, but the differences were not significant.