bluuebunny/crossref_metadata_2025 huggingface dataset:
Sensitivity of C‐reactive protein for the identification of patients with laboratory‐confirmed bacterial infections in northern Tanzania
Authors: Althaus Thomas , Lubell Yoel , Maro Venance P. , Mmbaga Blandina T. , Lwezaula Bingileki , Halleux Christine , Biggs Holly M. , Galloway Renee L. , Stoddard Robyn A. , Perniciaro Jamie L. , Nicholson William L. , Doyle Kelly , Olliaro Piero , Crump John A. , Rubach Matthew P.
Published: December 2019

Objective

Identifying febrile patients requiring antibacterial treatment is challenging, particularly in low‐resource settings. In South‐East Asia, C‐reactive protein (CRP) has been demonstrated to be highly sensitive and moderately specific in detecting bacterial infections and to safely reduce unnecessary antibacterial prescriptions in primary care. As evidence is scant in sub‐Saharan Africa, we assessed the sensitivity of CRP in identifying serious bacterial infections in Tanzania.

Methods

Samples were obtained from inpatients and outpatients in a prospective febrile illness study at two hospitals in Moshi, Tanzania, 2011–2014. Bacterial bloodstream infections (BSI) were established by blood culture, and bacterial zoonotic infections were defined by ≥4 fold rise in antibody titre between acute and convalescent sera. The sensitivity of CRP in identifying bacterial infections was estimated using thresholds of 10, 20 and 40 mg/l. Specificity was not assessed because determining false‐positive CRP results was limited by the lack of diagnostic testing to confirm non‐bacterial aetiologies and because ascertaining true‐negative cases was limited by the imperfect sensitivity of the diagnostic tests used to identify bacterial infections.

Results

Among 235 febrile outpatients and 569 febrile inpatients evaluated, 31 (3.9%) had a bacterial BSI and 61 (7.6%) had a bacterial zoonosis. Median (interquartile range) CRP values were 173 (80–315) mg/l in bacterial BSI, and 108 (31–208) mg/l in bacterial zoonoses. The sensitivity (95% confidence intervals) of CRP was 97% (83%–99%), 94% (79%–98%) and 90% (74%–97%) for identifying bacterial BSI, and 87% (76%–93%), 82% (71%–90%) and 72% (60%–82%) for bacterial zoonoses, using thresholds of 10, 20 and 40 mg/l, respectively.

Conclusion

C‐reactive protein was moderately sensitive for bacterial zoonoses and highly sensitive for identifying BSIs. Based on these results, operational studies are warranted to assess the safety and clinical utility of CRP for the management of non‐malaria febrile illness at first‐level health facilities in sub‐Saharan Africa.
Clinical outcomes and transfusion management following intracranial hemorrhage in patients with acute leukemia
Authors: Nixon Shannon , Lieberman Lani , Atenafu Eshetu G. , Doherty Mary , Murray Cindy , Wolfe Amanda , Brandys Danielle , Rowland Suzanne , Kwan Benjamin YM , Yu Eugene , Lechner Breanne , Maze Dawn
Published: December 2019

BACKGROUND

There is little evidence to guide management of patients with acute leukemia and intracranial hemorrhage (ICH). Predictors of long‐term outcome following ICH are unknown.

STUDY DESIGN AND METHODS

This study included adult patients with acute leukemia and ICH over an 8‐year period. The primary outcome was data regarding 90‐day mortality. Secondary outcomes included data related to the proportion of patients receiving post‐remission therapy and predictors of 90‐day mortality.

RESULTS

ICH occurred in 101 patients; 12 patients died within 72 hours. For the 89 others, 90‐day mortality was 40%. Of 43 patients who received induction, 30 achieved remission and 26 received post‐remission therapy. Older age (p = 0.03) and higher white count (p = 0.02) at the time of ICH were predictive of inferior survival. During 90‐day follow‐up, median platelet count was 37 x 109/L (0‐1526 x 109/L). Lower platelet count during follow‐up was predictive of 90‐day mortality (p = <0.01). Twenty‐one percent of platelet transfusions were provided when the platelet count was less than 10 x 109/L, 54% between 10 and 29 x 109/L, and 25% greater than 30 x 109/L. New or progressive ICH occurred in 23 patients. There was no difference in the median platelet transfusion trigger between patients who had new or progressive ICH and those who did not.

CONCLUSION

In patients with acute leukemia, survival following ICH is poor. Older age and higher white count is associated with increased mortality, perhaps reflecting higher risk disease. Following ICH in acute leukemia platelet transfusions do not appear to alter the risk of progressive bleeding or mortality.
Reviewer Acknowledgements
Authors: Brown Bennett
Published: December 2019

International Journal of Law and Public Administration (IJLPA) would like to acknowledge the following reviewers for their assistance with peer review of manuscripts for this Volume. Many authors, regardless of whether IJLPA publishes their work, appreciate the helpful feedback provided by the reviewers. Their comments and suggestions were of great help to the authors in improving the quality of their papers. Each of the reviewers listed below returned at least one review for this Volume.Reviewers for Volume 2, Number 2Adrian Cristian Moise, Spiru Haret University of Bucharest, RomaniaAllison Jean Ballard, University of Canberra, AustraliaCarmen Garcimartin, University of A Coruña, SpainDragoljub Popović, Union University School of Law, SerbiaElena Atienza-Macias, University of the Basque Country UPV/EHU, SpainEncarnación Abad Arenas, National University of Distance Education (UNED), SpainGeorge Ndi, University of Huddersfield, UKIvan Kosnica, University of Zagreb, CroatiaJaber Seyvanizad, Shahid Beheshti University, IranJuanita Goicovici, University Babeș-Bolyai of Cluj-Napoca, RomaniaMarcin Czubala Czubala Ostapiuk, Universidad Complutense de Madrid, SpainRose Casimiro, Nueva Ecija University of Science and Technology, PhilippinesSabina Hilaiel, Hastings College, USATatiana Bachvarova, Special Tribunal for Lebanon, BulgariaTaylisi de Souza Corrêa Leite, Anhanguera University, BrazilYusra, University Utara Malaysia, Malaysia Best Regards, Bennett BrownEditorial AssistantInternational Journal of Law and Public Administration--------------------------------------------------------------------Redfame Publishing9450 SW Gemini Dr. #99416Beaverton, OR 97008, USATel: 1-503-828-0536 ext. 511Fax: 1-503-828-0537E-mail: ijlpa@redfame.comURL: http://ijlpa.redfame.com
The Shape of a Photo-Actuated Pyramidal Cone
Authors: He L. H. , Xia S.
Published: December 2019

Polydomain nematic sheets can be designed for desired shape transition, and a typical example is a disc composed of congruent wedges with rank-1 connected director field. Recent theoretical study indicated that such a disc, if infinitesimally thin, tends to become a perfect pyramid upon illumination. Nonetheless, what is the influence of the finite thickness remains unexplored. In the present work, we reexamine this problem by treating the disc as an elastic plate with finite thickness. Analytical solution to the photo-actuated shape is obtained in small deformations, and the influences of the number of domains and the attenuation of photo intensity are discussed in detail. The results are expected helpful to the design of related photo-responsive devices.
Dynamic Modeling of Aerostatic Spindle With Shaft Tilt Deformation
Authors: Shi Jianghai , Cao Hongrui , Maroju Naresh Kumar , Jin Xiaoliang
Published: December 2019

This paper presents a new dynamic model of aerostatic spindle including the journal and thrust bearings. Reynolds equations are used to model the dynamics of a 4-degree-of-freedom (DOF) aerostatic journal bearing and a 3-DOF aerostatic thrust bearing. Finite element model of the spindle shaft is developed based on the Timoshenko beam theory considering the centrifugal and gyroscopic effects and is coupled with the bearing to construct the dynamic model of the whole aerostatic spindle. The effect of shaft tilt motion due to elastic deformation on the dynamic characteristics of the aerostatic bearing is considered for the first time. The finite difference method is used to determine the load capacity and moments provided by the bearings with changing air film thickness due to shaft vibration, and Newmark-β method is used to obtain the dynamic response of the spindle shaft. The simulated natural frequencies of the aerostatic spindle are verified through impact experiments under static and rotating conditions. Based on the developed model, the effects of tool overhang length, rotating speed, air film thickness, and supply air pressure on the frequency response function of the spindle are investigated comprehensively. The proposed dynamic model of the aerostatic spindle is able to provide useful guidance for structure design and process planning for micro-machining.
Numerical Study on Effect of Dimples on Tribo-Characteristics in Non-Newtonian Thermal Elastohydrodynamic Lubrication Point Contacts With Different Mechanical and Thermal Properties
Authors: Kaneta Motohiro , Matsuda Kenji , Wang Jing , Yang Peiran
Published: December 2019

The transient behavior of tribo-characteristics caused by micro-dimples on point contact surfaces with different mechanical and thermal properties was investigated based on non-Newtonian thermal elastohydrodynamic lubrication (EHL) analysis. The dimples were assumed to exist on both contact surfaces and the surface shapes of the contact bodies were evaluated separately. It is pointed out that surface texturing due to the micro-dimples is not necessarily beneficial in EHL contacts under fully flooded conditions since the micro-dimples provide a high pressure and a thin minimum film thickness as compared with the case of contacts with smooth surfaces, although the friction coefficient of surfaces with micro-dimples is always lower than that of the smooth surfaces. In order to obtain relatively good tribo-characteristics, the velocity of the surface with low thermal conductivity should be faster than that with high thermal conductivity, and the wavelengths of micro-dimples in the direction of motion on both surfaces should be different.
The effect of infection of hard ticks Ixodes ricinus (L.) and Ixodes persulcatus Sch. (Acari: Ixodinae) with the causative agent of Lyme borreliosis (Borrelia burgdorferi s.l.) on their host search activity (using attractants)

Authors: GRIGORYEVA L. A. , MITEVA O. A. , MYASNIKOV V. A. , GOGOLEVSKY A. S. , SHITOVA L. F.
Published: December 2019

A series of lab experiments with ticks (collected by flagging in the natural biotopes in North-Western Russia) was carried out in order to study tick reaction to attractants imitating the smell of a potential host. All the ticks that showed either positive or negative reactions to attractants in the experiment were individually PCR-tested for B. burgdorferi s.l DNA.The percent of Borrelia - positive specimen among hungry active adult I. ricinus and I. persulcatus ticks was higher than that among hungry passive ones. The discovered infection of I. persulcatus females by B. burgdorferi s. l. was 56% from which 67% were active and 36% were passive ticks. Total infection of adult ticks was 45% (61% active, 24% passive ticks). Infection of I. ricinus females was 60%, 69% in active individuals and 48% in passive, total infection of adult ticks was 56% (70% in active, 43% in passive). Synthetic kyromonas (attractant) composed of 1-octen-3-ol and a mixture of ethyl myristate-methyl salicylate (1:1), simulated the odour of the host in the experiment, attracted up to 70% of adults of I. ricinus and up to 80% of I. persulcatus. It can be assumed that this percent of adult ticks reflect an overall number of individuals searching for a hosts during the season of activity in natural biotopes.
Europe to lead in monitoring carbon from space
Authors: Clery Daniel
Published: December 2019

Budget hike for ESA's Copernicus program advances satellites to monitor Paris accord cuts.
Institute that aims to reshape health care seeks renewal
Authors: Kaiser Jocelyn
Published: December 2019

Mixed reviews for effort to compare medical treatments.
Direct determination of mode-projected electron-phonon coupling in the time domain
Authors: Na M. X. , Mills A. K. , Boschini F. , Michiardi M. , Nosarzewski B. , Day R. P. , Razzoli E. , Sheyerman A. , Schneider M. , Levy G. , Zhdanovich S. , Devereaux T. P. , Kemper A. F. , Jones D. J. , Damascelli A.
Published: December 2019

A timely look into electron-phonon coupling

The coupling between electrons and phonons—lattice vibrations in solids—is responsible for macroscopic quantum phenomena such as superconductivity. Yet, experimentally measuring this coupling as a function of momentum and for a particular phonon mode is tricky. Na
et al.
used time- and angle-resolved photoemission spectroscopy to excite electrons in graphite and monitor their decay, which was accompanied by the release of phonons. The time constants of these decay processes provided direct information on electron-phonon couplings in this system.

Science
, this issue p.
1231
Massively multiplex chemical transcriptomics at single-cell resolution
Authors: Srivatsan Sanjay R. , McFaline-Figueroa José L. , Ramani Vijay , Saunders Lauren , Cao Junyue , Packer Jonathan , Pliner Hannah A. , Jackson Dana L. , Daza Riza M. , Christiansen Lena , Zhang Fan , Steemers Frank , Shendure Jay , Trapnell Cole
Published: December 2019

Single-cell chemical transcriptomics

Single-cell transcriptomic technologies have emerged as powerful tools to explore cellular heterogeneity at the resolution of individual cells. Srivatsan
et al.
now add another layer of information and complexity by combining single-cell transcriptomics with oligo hashing and small molecule screening in a method called sci-Plex. Because screening many chemical compounds requires the ability to profile many cells, and because screens perturb cells in many different ways, the authors demonstrate the effects of 188 compounds in three cancer lines. The sci-Plex method can capture gene expression profiles from thousands of experimental conditions in a single experiment.

Science
, this issue p.
45
Ultrafast stimulated emission microscopy of single nanocrystals
Authors: Piatkowski Lukasz , Accanto Nicolò , Calbris Gaëtan , Christodoulou Sotirios , Moreels Iwan , van Hulst Niek F.
Published: December 2019

Tracking excitations

Illumination can be used to excite a sample from its ground state to a number of excited states. Typically, however, the details of the excitation dynamics are hidden from view because they decay so fast. Piatkowski
et al.
combined pump-probe transient absorption and two-pulse photoluminescence correlation spectroscopy, allowing them to assess stimulated emission and ground-state bleaching contributions to the transient absorption signal. This approach provides a window on the excitation dynamics within single nanocrystals and should also be useful for ultrafast nanocharacterization of complex samples.

Science
, this issue p.
1240
Folding unpredicted
Authors: Schwenk Jochen , Fakler Bernd
Published: December 2019

Unexpected topology is the key to glutamate receptor gating in neurotransmission
Identification of Drug Resistance Determinants in a Clinical Isolate of Pseudomonas aeruginosa by High-Density Transposon Mutagenesis
Authors: Sonnabend Michael S. , Klein Kristina , Beier Sina , Angelov Angel , Kluj Robert , Mayer Christoph , Groß Caspar , Hofmeister Kathrin , Beuttner Antonia , Willmann Matthias , Peter Silke , Oberhettinger Philipp , Schmidt Annika , Autenrieth Ingo B. , Schütz Monika , Bohn Erwin
Published: December 2019

With the aim to identify potential new targets to restore antimicrobial susceptibility of multidrug-resistant (MDR)Pseudomonas aeruginosaisolates, we generated a high-density transposon (Tn) insertion mutant library in an MDRP. aeruginosabloodstream isolate (isolate ID40). The depletion of Tn insertion mutants upon exposure to cefepime or meropenem was measured in order to determine the common resistome for these clinically important antipseudomonal β-lactam antibiotics.
The Impact of pH on Clostridioides difficile Sporulation and Physiology
Authors: Wetzel Daniela , McBride Shonna M.
Published: December 2019

Clostridioides difficile
is an anaerobic bacterium that causes gastrointestinal disease.
C. difficile
forms dormant spores which can survive harsh environmental conditions, allowing their spread to new hosts. In this study, we determine how intestinally relevant pH conditions impact
C. difficile
physiology in the two divergent strains, 630Δ
erm
and R20291. Our data demonstrate that low pH conditions reduce
C. difficile
growth, sporulation, and motility. However, toxin production and spore morphology were differentially impacted in the two strains at low pH. In addition, we observed that alkaline environments reduce
C. difficile
growth, but increase cell motility. When pH was adjusted rapidly during growth, we observed similar impacts on both strains. This study provides new insights into the phenotypic diversity of
C. difficile
grown under diverse pH conditions present in the intestinal tract, and demonstrates similarities and differences in the pH responses of different
C. difficile
isolates.
Acute oxalate nephropathy associated withClostridiumdifficileinfection
Authors: Pandey Deepali , Verma Ashish , Ding Yanli , Singh Priyamvada , Magoo Hemant
Published: December 2019

Acute oxalate nephropathy has been associated with chronic diarrheal illness and only one case has been reported due to acute diarrhea secondary toClostridium difficilecolitis. To the best of our knowledge, this is the second case report of acute oxalate nephropathy due toC.difficilecolitis. A 75-year-old man with a medical history of hypertension, type 2 diabetes mellitus, chronic kidney disease stage IV, recentC.difficilecolitis was admitted for acute kidney injury with a creatinine (Cr) of 8.54 mg/dL (baseline Cr, 2.3–2.6 mg/dL). His urinalysis did not show any eosinophils, casts or crystals. Antinuclear antibody, antineutrophil cytoplasmic antibody, complement levels (C3 and C4) and hepatitis screen were negative; a renal ultrasound visualized no hydronephrosis. A kidney biopsy showed widespread tubular oxalate crystal deposition suggestive of hyperoxaluria as the cause of acute kidney injury. In conclusion, an acute diarrheal illness likeC.difficilecolitis can cause acute oxalate nephropathy.
Is whole genome sequencing the answer for identifyingShigellabacteraemia?
Authors: Amos Dora , Khanna Priya , Aali Sayeed Adnan , Rao Guduru Gopal
Published: December 2019

We present a rare case ofShigella flexneribacteraemia and the challenges of differentiatingEscherichia coliandShigellaspp using conventional and newer laboratory techniques in diagnostic laboratories. The organism was identified only after whole genomic sequencing .
Diet patterns and the incidence of age-related macular degeneration in the Atherosclerosis Risk in Communities (ARIC) study
Authors: Dighe Shruti , Zhao Jiwei , Steffen Lyn , Mares J A , Meuer Stacy M , Klein Barbara E K , Klein Ronald , Millen Amy E
Published: December 2019

Background

Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss among the elderly.

Objective

This study aimed to determine the association between dietary patterns and food groups (used to make them) with the 18-year incidence of AMD.

Methods

ARIC (Atherosclerosis Risk in Communities) participants who showed change in AMD lesions between retinal photographs taken at visit 3 and visit 5 were graded side by side to determine incident AMD (any=144; early=117; late=27). A 66-line item food frequency questionnaire, administered at visit 1 and visit 3, was used to identify 29 food groups. Principal component analysis was used to derive dietary patterns from average food group servings. Logistic regression was used to estimate ORs and 95% CIs for incident AMD (any, early and late) by tertiles of dietary pattern scores, adjusted for age, race, education, total calories and smoking status. P-trend was estimated using continuous scores.

Results

Western (unhealthy) and Prudent (healthy) dietary patterns were identified. No significant associations were observed between either dietary pattern and incident any or incident early AMD. However, a threefold higher incidence of late AMD was observed among participants with a Western pattern score above, as compared with below, the median (OR=3.44 (95% CI 1.33 to 8.87), p-trend=0.014). The risk of developing late AMD was decreased, but not statistically significant, among participants with a Prudent pattern score above, as compared with below, the median (OR=0.51 (95% CI 0.22 to 1.18), p-trend=0.054).

Conclusions

Diet patterns were not significantly associated with incident any or incident early AMD. However, consumption of a Western pattern diet may be a risk factor for development of late AMD.
Effectiveness and cost-utility of a multifaceted eHealth strategy to improve back pain beliefs of patients with non-specific low back pain: a cluster randomised trial
Authors: Suman Arnela , Schaafsma Frederieke G. , van Dongen Johanna M. , Elders Petra J.M. , Buchbinder Rachelle , van Tulder Maurits W. , Anema Johannes R.
Published: December 2019

Objectives

To assess the effectiveness and cost-utility of a multifaceted eHealth strategy compared to usual care in improving patients’ back pain beliefs, and in decreasing disability and absenteeism.

Design

Stepped-wedge cluster randomised trial with parallel economic evaluation.

Setting

Dutch primary healthcare.

Participants

Patients diagnosed with non-specific low back pain by their general practitioner or physiotherapist. Patients with serious comorbidities or confirmed pregnancy were excluded. 779 patients were randomised into intervention group (n=331, 59% female; 60.4% completed study) or control group (n=448, 57% female; 77.5% completed study).

Interventions

The intervention consisted of a multifaceted eHealth strategy that included a (mobile) website, digital monthly newsletters, and social media platforms. The website provided information about back pain, practical advice (eg, on self-management), working and returning to work with back pain, exercise tips, and short video messages from healthcare providers and patients providing information and tips. The control consisted of a digital patient information letter. Patients and outcome assessors were blinded to group allocation.

Primary and secondary outcome measures

The primary outcome was back pain beliefs. Secondary outcome measures were disability and absenteeism, and for the preplanned economic evaluation quality of life and societal costs were measured.

Results

There were no between-group differences in back pain beliefs, disability, or absenteeism. Mean intervention costs were €70— and the societal cost difference was €535—in favour of the intervention group, but no significant cost savings were found. The incremental cost-effectiveness ratio indicated that the intervention dominated usual care and the probability of cost-effectiveness was 0.85 on a willingness-to-pay of €10.000/quality adjusted life year (QALY).

Conclusions

A multifaceted eHealth strategy was not effective in improving patients’ back pain beliefs or in decreasing disability and absenteeism, but showed promising cost-utility results based on QALYs.

Trial registration number

NTR4329.
COveRs to impRove AesthetiC ouTcome after Surgery for Chronic subdural haemAtoma by buRr hole trepanation (CORRECT-SCAR): protocol of a Swiss single-blinded, randomised controlled trial
Authors: Stienen Martin N , Akeret Kevin , Vasella Flavio , Velz Julia , Jehli Elisabeth , Scheffler Pierre , Voglis Stefanos , Bichsel Oliver , Smoll Nicolas Roydon , Bozinov Oliver , Regli Luca , Germans Menno R
Published: December 2019

Introduction

Outcomes rated on impairment scales are satisfactory after burr hole trepanation for chronic subdural haematoma (cSDH). However, the surgery leads to bony defects in the skull with skin depressions above that are frequently considered aesthetically unsatisfactory by the patients. Those defects could be covered by the approved medical devices (burr hole covers), but this is rarely done today. We wish to assess, whether the application of burr hole covers after trepanation for the evacuation of cSDH leads to higher patient satisfaction with the aesthetical result at 90 days postoperative, without worsening disability outcomes or increasing the complication rate.

Methods and analysis

This is a prospective, single-blinded, randomised, controlled, investigator-initiated clinical trial enrolling 80 adult patients with first-time unilateral or bilateral cSDH in Switzerland. The primary outcome is the difference in satisfaction with the aesthetic result of the scar, comparing patients allocated to the intervention (burr hole cover) and control (no burr hole cover) group, measured on the Aesthetic Numeric Analogue scale at 90 days postoperative. Secondary outcomes include differences in the rates of skin depression, complications, as well as neurological, disability and health-related quality of life outcomes until 12 months postoperative.

Ethics and dissemination

The institutional review board (Kantonale Ethikkommission Zürich) approved this study on 29 January 2019 under case number BASEC 2018–01180. This study determines, whether a relatively minor modification of a standard surgical procedure can improve patient satisfaction, without worsening functional outcomes or increasing the complication rate. The outcome corresponds to the value-based medicine approach of modern patient-centred medicine. Results will be published in peer-reviewed journals and electronic patient data will be safely stored for 15 years.

Trial registration number

NCT03755349.
Improving data sharing between acute hospitals in England: an overview of health record system distribution and retrospective observational analysis of inter-hospital transitions of care
Authors: Warren Leigh R , Clarke Jonathan , Arora Sonal , Darzi Ara
Published: December 2019

Objectives

To determine the frequency of use and spatial distribution of health record systems in the English National Health Service (NHS). To quantify transitions of care between acute hospital trusts and health record systems to guide improvements to data sharing and interoperability.

Design

Retrospective observational study using Hospital Episode Statistics.

Setting

Acute hospital trusts in the NHS in England.

Participants

All adult patients resident in England that had one or more inpatient, outpatient or accident and emergency encounters at acute NHS hospital trusts between April 2017 and April 2018.

Primary and secondary outcome measures

Frequency of use and spatial distribution of health record systems. Frequency and spatial distribution of transitions of care between hospital trusts and health record systems.

Results

21 286 873 patients were involved in 121 351 837 encounters at 152 included trusts. 117 (77.0%) hospital trusts were using electronic health records (EHR). There was limited regional alignment of EHR systems. On 11 017 767 (9.1%) occasions, patients attended a hospital using a different health record system to their previous hospital attendance. 15 736 863 (73.9%) patients had two or more encounters with the included trusts and 3 931 255 (25.0%) of those attended two or more trusts. Over half (53.6%) of these patients had encounters shared between just 20 pairs of hospitals. Only two of these pairs of trusts used the same EHR system.

Conclusions

Each year, millions of patients in England attend two or more different hospital trusts. Most of the pairs of trusts that commonly share patients do not use the same record systems. This research highlights significant barriers to inter-hospital data sharing and interoperability. Findings from this study can be used to improve electronic health record system coordination and develop targeted approaches to improve interoperability. The methods used in this study could be used in other healthcare systems that face the same interoperability challenges.
Sexually transmitted infections among high-risk populations that use treatment as prevention or pre-exposure prophylaxis: a protocol for a systematic review
Authors: Coudray Makella , Kiplagat Sandra , Saumell Franklin , Madhivanan Purnima
Published: December 2019

Background

Among men who have sex with men, pre-exposure prophylaxis (PrEP) reduces the risk of HIV by 95%. Based on the documented benefits, the Centre for Disease Control and Prevention has recommended PrEP as a prevention method for high-risk groups. Moreover, for those HIV-infected individuals, antiretroviral therapy has been shown to serve as both as a treatment and prevention method for HIV.

Methods and analysis

This systematic review protocol was reported according to the Preferred Reporting Items for Systematic reviews and Analyses (PRISMA) P framework. Medline (1980–present), Embase (1980–present), CINAHL (1980–present), Cochrane Central Register of Controlled Trials and clinicaltrials.gov will be used to identify relevant articles based on a piloted search strategy. Peer-reviewed observational and experimental studies will be included. A narrative style will be used to describe descriptive data. A meta-analysis will be conducted if heterogeneity is not significant.

Ethics and dissemination

Recent evidence suggests that there is an increased risk of sexually transmitted infections (STIs) among high-risk persons that use PrEP. Furthermore, there is a paucity of data on the relationship of treatment as prevention and incidence of STIs. The findings of this review will assess this emerging public health phenomenon and serve to inform future public health policy. No formal ethical review is required for this protocol. All findings will be published in a peer reviewed journal.

PROTOCOL registration number

CRD42019128720.
Role of patient preferences in clinical practice guidelines: a multiple methods study using guidelines from oncology as a case
Authors: Gärtner Fania R , Portielje Johanneke E , Langendam Miranda , Hairwassers Desiree , Agoritsas Thomas , Gijsen Brigitte , Liefers Gerrit-Jan , Pieterse Arwen H , Stiggelbout Anne M
Published: December 2019

Objective

Many treatment decisions are preference-sensitive and call for shared decision-making, notably when benefits are limited or uncertain, and harms impact quality of life. We explored if clinical practice guidelines (CPGs) acknowledge preference-sensitive decisions in how they motivate and phrase their recommendations.

Design

We performed a qualitative analysis of the content of CPGs and verified the results in semistructured interviews with CPG panel members.

Setting

Dutch oncology CPGs issued in 2010 or later, concerning primary treatment with curative intent.

Participants

14 CPG panel members.

Main outcomes

For treatment recommendations from six CPG modules, two researchers extracted the following: strength of recommendation in terms of the Grading of Recommendations Assessment, Development and Evaluation and its consistency with the CPG text; completeness of presentation of benefits and harms; incorporation of patient preferences; statements on the panel’s benefits–harm trade-off underlying recommendation; and advice on patient involvement in decision-making.

Results

We identified 32 recommendations, 18 were acknowledged preference-sensitive decisions. Three of 14 strong recommendations should have been weak based on the module text. The reporting of benefits and harms, and their probabilities, was sufficiently complete and clear to inform the strength of the recommendation in one of the six modules only. Numerical probabilities were seldom presented. None of the modules presented information on patient preferences. CPG panel’s preferences were not made explicit, but appeared to have impacted 15 of 32 recommendations. Advice to involve patients and their preferences in decision-making was given for 20 recommendations (14 weak). Interviewees confirmed these findings. Explanations for lack of information were, for example, that clinicians know the information and that CPGs must be short. Explanations for trade-offs made were cultural-historical preferences, compliance with daily care, presumed role of CPGs and lack of time.

Conclusions

The motivation and phrasing of CPG recommendations do not stimulate choice awareness and a neutral presentation of options, thus hindering shared decision-making.
New warfarin anticoagulation management model after heart valve surgery: rationale and design of a prospective, multicentre, randomised trial to compare an internet-based warfarin anticoagulation management model with the traditional warfarin management model
Authors: Zhu Zhihui , Li Yuehuan , Meng Xu , Han Jie , Li Yan , Liu Kun , Shen Jinglun , Qin Ying , Zhang Haibo
Published: December 2019

Introduction

Warfarin is an effective anticoagulant and the only oral anticoagulant available for patients with mechanical heart valves. The prothrombin time and the associated international normalised ratio (INR) are routinely tested to monitor the response to anticoagulation therapy in patients. Patients who undergo mechanical heart valve replacement need lifelong anticoagulation therapy, and their INR is regularly measured to adjust the anticoagulation strength and the dose of anticoagulation drugs. Appropriate warfarin anticoagulation management can reduce patient complications, such as bleeding and thrombosis, and improve the long-term survival rate. We propose modern internet technology as a platform to build a warfarin anticoagulation follow-up system after valve replacement surgery. This system will provide doctors and patients with more standardised and safer follow-up methods as well as a method to further reduce the risk of warfarin anticoagulation-related complications and improve its therapeutic effects.

Methods and analysis

A prospective, multicentre, randomised, controlled trial will be conducted. A total of 700 patients who require long-term warfarin anticoagulation monitoring after heart valve replacement will be enrolled and randomly divided at a 1:1 ratio into a traditional outpatient anticoagulation management group and a group undergoing a new method of management based on the internet technology with follow-up for 1 year. Differences in the percentage of time in the therapeutic range (TTR), drug dose adjustments, bleeding/thrombosis and other related complications will be observed. The primary endpoint is the difference in the TTR between the two groups. The purpose of this study is to explore a safer and more effective mode of doctor–patient interaction and communication in the internet era. As of 13 July 2019, 534 patients had been enrolled.

Ethics and dissemination

This study protocol was approved by the Ethics Committee of Beijing Anzhen Hospital, Capital Medical University. The results will be published in a peer-reviewed medical journal.

Trial registration number

ChiCTR1800016204.
Association between prescription of hypnotics/anxiolytics and mortality in multimorbid and non-multimorbid patients: a longitudinal cohort study in primary care
Authors: Linnet Kristjan , Sigurdsson Johann Agust , Tomasdottir Margret Olafia , Sigurdsson Emil Larus , Gudmundsson Larus Steinthor
Published: December 2019

Objectives

To assess the risk of mortality in primary care patients, multimorbid (≥2 chronic conditions) or not, prescribed hypnotics/anxiolytics.

Design

A longitudinal cohort study

Setting

Primary healthcare in the Reykjavik area.

Participants

114 084 individuals (aged 10–79 years, average 38.5, SD 18.4) contacting general practitioners during 2009–2012 (mortality follow-up to 31 December 2016). Of those, the reference group comprised 58 560 persons who were neither multimorbid nor had redeemed prescriptions for hypnotics/anxiolytics. Participants (16 108) redeeming prescriptions for hypnotics/anxiolytics on a regular basis for 3 consecutive years were considered as consistent, long-term users. They were subdivided into low-dose (1–300 defined daily doses (DDD)/3 years), medium-dose (301–1095 DDDs/3 years) and high-dose users (>1095 DDDs/3 years). All six groups taking these drugs were compared with the reference group.

Main outcome measures

All-cause mortality.

Results

HRs were calculated with the no multimorbidity—no drug group as a reference, using Cox proportional hazards regression model adjusting for age, sex and the number of chronic conditions (n=111 767), patients with cancer excluded. During follow-up, 516 358 person-years in total, 1926 persons died. Mean follow-up was 1685 days (4.6 years), range 1–1826 days (5.0 years). For all multimorbid patients who took no drugs the HR was 1.14 (95% CI 1.00 to 1.30) compared with those without multimorbidity. HRs in the non-multimorbid participants varied from 1.49 to 3.35 (95% CI ranging from 1.03 to 4.11) with increasing doses of hypnotics/anxiolytics, and correspondingly from 1.55 to 3.52 (1.18 to 4.29) in multimorbid patients.

Conclusions

Mortality increased in a dose-dependent manner among both multimorbid and non-multimorbid patients taking hypnotics/anxiolytics. This increase was clearly associated with prescribing of these drugs. Their use should be limited to the recommended period of 2–4 up to 6 weeks; long-term use may incur increased risk and should be re-examined.
Impact of structured interdisciplinary bedside rounding on patient outcomes at a large academic health centre
Authors: Sunkara Padageshwar R , Islam Tareq , Bose Abhishek , Rosenthal Gary E , Chevli Parag , Jogu Hanumantha , TK Luqman Arafath , Huang Chi-Cheng , Chaudhary Dipendra , Beekman Daniel , Dutta Abhishek , Menon Suma , Speiser Jaime L
Published: December 2019

Background

Effective communication between healthcare providers and patients and their family members is an integral part of daily care and discharge planning for hospitalised patients. Several studies suggest that team-based care is associated with improved length of stay (LOS), but the data on readmissions are conflicting. Our study evaluated the impact of structured interdisciplinary bedside rounding (SIBR) on outcomes related to readmissions and LOS.

Methods

The SIBR team consisted of a physician and/or advanced practice provider, bedside nurse, pharmacist, social worker and bridge nurse navigator. Outcomes were compared in patients admitted to a hospital medicine unit using SIBR (n=1451) and a similar control unit (n=770) during the period of October 2016 to September 2017. Multivariable negative binomial regression analysis was used to compare LOS and logistic regression analysis was used to calculate 30-day and 7-day readmission in patients admitted to SIBR and control units, adjusting for covariates.

Results

Patients admitted to SIBR and control units were generally similar (p≥0.05) with respect to demographic and clinical characteristics. Unadjusted readmission rates in SIBR patients were lower than in control patients at both 30 days (16.6% vs 20.3%, p=0.03) and 7 days (6.3% vs 9.0%, p=0.02) after discharge, while LOS was similar. After adjusting for covariates, SIBR was not significantly related to the odds of 30-day readmission (OR 0.81, p=0.07) but was lower for 7-day readmission (OR 0.70, p=0.03); LOS was similar in both groups (p=0.58).

Conclusion

SIBR did not reduce LOS and 30-day readmissions but had a significant impact on 7-day readmissions.
Firearm ownership and acquisition in California: findings from the 2018 California Safety and Well-being Survey
Authors: Kravitz-Wirtz Nicole , Pallin Rocco , Miller Matthew , Azrael Deborah , Wintemute Garen J
Published: December 2019

Objective

To describe the prevalence of and factors associated with firearm ownership; the types, subtypes and quantity of firearms owned; and when, where and why firearms were acquired in California.

Methods

A cross-sectional analysis of a state-representative, probability-based, internet survey of California adults was conducted in September–October 2018 (n=2558; completion rate 49%). Household firearm ownership was ascertained for all respondents; personal firearm ownership was ascertained only among respondents who reported living in a home with firearms; and information on the types and quantity of firearms owned and details about recently acquired firearms came from firearm owners only.

Findings

Roughly one in four (25%, 95% CI 22% to 28%) California adults live in a home with a firearm, including 4.2 million adults—14% (95% CI 13% to 16%) of the adult population—who personally own a firearm. These owners collectively own an estimated 19.9 million firearms (8.9 million handguns). Approximately half (48%, 95% CI 34% to 61%) of the firearm stock in California is owned by the 10% (95% CI 6% to 14%) of owners who own 10 or more firearms, though more than half (54%, 95% CI 47% to 62%) of owners in the state own only one or two firearms. Most (69%, 95% CI 63% to 75%) owners purchased their last firearm from a firearm retailer, usually a handgun purchased primarily for protection against people.

Conclusion

This study provides the most detailed and up-to-date information available on firearm ownership and acquisition in California. Results can inform firearm violence prevention efforts and public health, safety and policy development in California and nationally.
The case against meta-consent: not only do Ploug and Holm notanswerit, they make iteven stronger
Authors: Manson Neil C
Published: December 2019

In a recent article, I argued that Ploug and Holm’s ‘meta-consent’ proposal should be rejected for biobank governance. This was because, although meta-consent is permissible, it is both burdensome and ethically omissible. There is no ethical reason why funders should undertake the additional costs. Ploug and Holm have sought to respond to these arguments. Here, it is noted that not only do they fail to adequately refuse the case against meta-consent, they fail to even engage with the arguments, either misunderstanding them or ignoring them. In their response, Ploug and Holm unwittingly provide the basis of an even stronger case against meta-consent. They argue that broad consent has a built in tendency to expire, while also holding that broad consent should be one of the options available in meta-consent. Meta-consent thus ends up being more like dynamic consent, but, arguably, even more burdensome and costly.
Do we need 30 min cortisol measurement in the short synacthen test: a retrospective study
Authors: Kumar Rajeev , Carr Peter , Moore Kimberley , Rajput Zeeshan , Ward Louise , Wassif W S
Published: December 2019

Objective

The short synacthen test (SST) is widely used across the UK to assess adrenal reserve but there remains no consensus on the timing of cortisol sampling to help diagnose adrenal insufficiency. The main objective of our study was to see if both 30 and 60 min sample are required following administration of synacthen to investigate suspected adrenal insufficiency (AI).

Design

This was a single-centre retrospective study of 393 SSTs measuring 0, 30 and 60 min cortisol levels after administration of 250 µg of synacthen.

Patients and methods

All the SSTs for patients suspected of primary or secondary AI between April 2016 and October 2018 were included in this study. The tests were performed as per our hospital protocol. A post-adrenocorticotropic hormone (ACTH) cortisol response of 420 nmol/L at any time point was considered adequate to rule out AI. The data were analysed to ascertain the proportion of patients who achieved this level at 30 and/or 60 min.

Results

A total of 393 SST results were included in this study. Patients were divided into two groups depending on whether (group A) or not (group B) they were on steroids. Overall, a total of 313 (79.6%) subjects achieved cortisol level of ≥420 nmol/L at 30 and 60 min while 19 (4.8%) had late response (ie, insufficient 30 min cortisol levels, rising to ≥420 nmol/L at 60 min). Another 61 subjects (15.5%) showed insufficient response at both 30 and 60 min (ie, failed to achieved level of ≥420 nmol/L). Importantly, there was no patient in either group who had adequate response at 30 min and then failed at 60 min. Patients in group A were more likely to have inadequate response at both 30 and 60 min while patients in group B were more likely to have normal response at both time points.

Conclusions

Our results suggest that about 5% of people undergoing SST may be inappropriately diagnosed as having AI (and subjected to long-term unnecessary steroid treatment) if the 60 min sample is not maintained. We suggest that 30 min sample does not add any additional diagnostic utility and can be omitted thus simplifying SST even further and saving on cost and resources. We propose that single measurement after 60 min of administration of synthetic ACTH is a sufficient screening test for AI.
Novel bacterial vaginosis-associated organisms mediate the relationship between vaginal douching and pelvic inflammatory disease
Authors: Gondwe Tamala , Ness Roberta , Totten Patricia A , Astete Sabina , Tang Gong , Gold Melanie A , Martin David , Haggerty Catherine L
Published: December 2019

Objectives

We sought to determine whether the relationship between a history of vaginal douching and pelvic inflammatory disease (PID) is mediated by endometrial infection with one or more novel bacterial vaginosis (BV)-associated organisms among
Atopobium vaginae
, the BV-associated bacterium 1 (BVAB1),
neathia
(
Leptotrichia
)
amnionii
and
Sneathia sanguinegens
.

Methods

We first conducted log-binomial regression analyses to identify risk factors for endometrial infection in 535 adolescent and adult women with clinically suspected PID in the PID Evaluation and Clinical Health (PEACH) study. We then examined whether endometrial infection by the BV-associated organisms mediated the association between a history of vaginal douching and histologically confirmed PID using inverse probability weighted marginal structural models.

Results

Vaginal douching was significantly associated with endometrial infection with one or more of the targeted BV-associated organisms (relative risk (RR) 1.21, 95% CI: 1.08 to 1.35). The total effect estimate suggested that vaginal douching increased the risk of endometritis by 24% (RR 1.24, 95% CI: 1.03 to 1.49). The controlled direct effect of this association was attenuated with endometrial infection by one or more BV-associated organisms (adjusted RR (aRR) 1.00, 95% CI: 0.57 to 1.74) and endometrial infection by all four BV-associated organisms (aRR 0.95, 95% CI: 0.53 to 1.70) as intermediate variables.

Conclusions

Endometrial infection with one or more of the novel BV-associated organisms partially mediated the relationship between vaginal douching and histologically confirmed endometritis in the PEACH study. Frequent vaginal douching may confer risk for endometritis through increasing the risk of endometrial infection by novel-BV-associated organisms. Other potential pathways should be explored.