bluuebunny/crossref_metadata_2025 huggingface dataset:
Glycogenic hepatopathy as a cause of severe deranged liver enzymes in a young patient with type 1 diabetes mellitus
Authors: Azariadis Kalliopi , Gatselis Nikolaos K , Koukoulis George K , Dalekos Georgios N
Published: March 2019

Glycogenic hepatopathy (GH) is a rare complication of poorly controlled type 1 diabetes mellitus (T1DM). We present a 19-year-old woman with T1DM and autoimmune thyroiditis who admitted to our department because of abrupt onset intermittent abdominal pain in the right upper quadrant accompanied by laboratory evidence of acute anicteric hepatitis. Physical examination revealed significant hepatomegaly but the common imagining studies were negative. Following exclusion of common causes of acute hepatitis and because of the presence of smooth muscle antibodies in a young female patient with already established two autoimmune diseases, a liver biopsy was performed in order to exclude the potential presence of autoimmune hepatitis. However, liver histology showed typical findings of GH. Intense treatment targeting strict glycemic control resulted in normalisation of liver biochemistry. This case underlines that GH should be considered as a rare cause of acute hepatitis in T1DM patients with poor glycemic control.
Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study
Authors: Magnus Maria C , Wilcox Allen J , Morken Nils-Halvdan , Weinberg Clarice R , Håberg Siri E
Published: March 2019

Objectives

To estimate the burden of miscarriage in the Norwegian population and to evaluate the associations with maternal age and pregnancy history.

Design

Prospective register based study.

Setting

Medical Birth Register of Norway, the Norwegian Patient Register, and the induced abortion register.

Participants

All Norwegian women that were pregnant between 2009-13.

Main outcome measure

Risk of miscarriage according to the woman’s age and pregnancy history estimated by logistic regression.

Results

There were 421 201 pregnancies during the study period. The risk of miscarriage was lowest in women aged 25-29 (10%), and rose rapidly after age 30, reaching 53% in women aged 45 and over. There was a strong recurrence risk of miscarriage, with age adjusted odds ratios of 1.54 (95% confidence interval 1.48 to 1.60) after one miscarriage, 2.21 (2.03 to 2.41) after two, and 3.97 (3.29 to 4.78) after three consecutive miscarriages. The risk of miscarriage was modestly increased if the previous birth ended in a preterm delivery (adjusted odds ratio 1.22, 95% confidence interval 1.12 to 1.29), stillbirth (1.30, 1.11 to 1.53), caesarean section (1.16, 1.12 to 1.21), or if the woman had gestational diabetes in the previous pregnancy (1.19, 1.05 to 1.36). The risk of miscarriage was slightly higher in women who themselves had been small for gestational age (1.08, 1.04 to 1.13).

Conclusions

The risk of miscarriage varies greatly with maternal age, shows a strong pattern of recurrence, and is also increased after some adverse pregnancy outcomes. Miscarriage and other pregnancy complications might share underlying causes, which could be biological conditions or unmeasured common risk factors.
Data sharing practices of medicines related apps and the mobile ecosystem: traffic, content, and network analysis
Authors: Grundy Quinn , Chiu Kellia , Held Fabian , Continella Andrea , Bero Lisa , Holz Ralph
Published: March 2019

Objectives

To investigate whether and how user data are shared by top rated medicines related mobile applications (apps) and to characterise privacy risks to app users, both clinicians and consumers.

Design

Traffic, content, and network analysis.

Setting

Top rated medicines related apps for the Android mobile platform available in the Medical store category of Google Play in the United Kingdom, United States, Canada, and Australia.

Participants

24 of 821 apps identified by an app store crawling program. Included apps pertained to medicines information, dispensing, administration, prescribing, or use, and were interactive.

Interventions

Laboratory based traffic analysis of each app downloaded onto a smartphone, simulating real world use with four dummy scripts. The app’s baseline traffic related to 28 different types of user data was observed. To identify privacy leaks, one source of user data was modified and deviations in the resulting traffic observed.

Main outcome measures

Identities and characterisation of entities directly receiving user data from sampled apps. Secondary content analysis of company websites and privacy policies identified data recipients’ main activities; network analysis characterised their data sharing relations.

Results

19/24 (79%) of sampled apps shared user data. 55 unique entities, owned by 46 parent companies, received or processed app user data, including developers and parent companies (first parties) and service providers (third parties). 18 (33%) provided infrastructure related services such as cloud services. 37 (67%) provided services related to the collection and analysis of user data, including analytics or advertising, suggesting heightened privacy risks. Network analysis revealed that first and third parties received a median of 3 (interquartile range 1-6, range 1-24) unique transmissions of user data. Third parties advertised the ability to share user data with 216 “fourth parties”; within this network (n=237), entities had access to a median of 3 (interquartile range 1-11, range 1-140) unique transmissions of user data. Several companies occupied central positions within the network with the ability to aggregate and re-identify user data.

Conclusions

Sharing of user data is routine, yet far from transparent. Clinicians should be conscious of privacy risks in their own use of apps and, when recommending apps, explain the potential for loss of privacy as part of informed consent. Privacy regulation should emphasise the accountabilities of those who control and process user data. Developers should disclose all data sharing practices and allow users to choose precisely what data are shared and with whom.
Are trajectories of neck–shoulder pain associated with sick leave and work ability in workers? A 1-year prospective study
Authors: Hallman David Michael , Holtermann Andreas , Dencker-Larsen Sofie , Birk Jørgensen Marie , Nørregaard Rasmussen Charlotte Diana
Published: March 2019

Objectives

The study aimed to determine the extent to which latent trajectories of neck–shoulder pain (NSP) are associated with self-reported sick leave and work ability based on frequent repeated measures over 1 year in an occupational population.

Methods

This longitudinal study included 748 Danish workers (blue-collar, n=620; white collar, n=128). A questionnaire was administered to collect data on personal and occupational factors at baseline. Text messages were used for repeated measurements of NSP intensity (scale 0–10) over 1 year (14 waves in total). Simultaneously, self-reported sick leave (days/month) due to pain was assessed at 4-week intervals, while work ability (scale 0–10) was assessed using a single item (work ability index) at 12-week intervals over the year. Trajectories of NSP, distinguished by latent class growth analysis, were used as predictors of sick leave and work ability in generalised estimation equations with multiple adjustments.

Results

Sick leave increased and work ability decreased across all NSP trajectory classes (low, moderate, strong fluctuating and severe persistent pain intensity). In the adjusted model, the estimated number of days on sick leave was 1.5 days/month for severe persistent NSP compared with 0.1 days/month for low NSP (relative risk=13.8, 95% CI 6.7 to 28.5). Similarly, work ability decreased markedly for severe persistent NSP (OR=12.9, 95% CI 8.5 to 19.7; median 7.1) compared with low NSP (median 9.5).

Conclusion

Severe persistent NSP was associated with sick leave and poor work ability over 1 year among workers. Preventive strategies aiming at reducing severe persistent NSP among working populations are needed.
Association between periductal fibrosis and bile duct dilatation among a population at high risk of cholangiocarcinoma: a cross-sectional study of cholangiocarcinoma screening in Northeast Thailand
Authors: Chamadol Nittaya , Khuntikeo Narong , Thinkhamrop Bandit , Thinkhamrop Kavin , Suwannatrai Apiporn T , Kelly Matthew , Promthet Supannee
Published: March 2019

Objectives

To assess associations between periductal fibrosis (PDF) and bile duct dilatation (BDD) in ultrasonography (US) screening of population at risk of cholangiocarcinoma (CCA) due to residence in an endemic area forOpisthorchis viverrini.CCA survival rates are low, and early identification of risk factors is essential. BDD is one symptom that can identify patients at risk of CCA. Detection of PDF by US can also identify at-risk patients, at an earlier stage of CCA development. Identification of association between PDF and BDD will inform screening practices for CCA risk, by increasing the viability of PDF screening for CCA risk.

Setting

Nine tertiary care hospitals in Northeast Thailand.

Design

Cross-sectional study.

Participants

Study subjects in the Cholangiocarcinoma Screening and Care Program (CASCAP) in Northeast Thailand. CASCAP inclusion criteria are all residents of Northeast Thailand aged ≥40 years. Participants are recruited through CCA screening centres and through primary healthcare units. So far, 394 026 have been enrolled.

Methods

PDF and BDD were identified through US. PDF was categorised into three groups, PDF1, 2 and 3, depending on their high echo locality in the peripheral, segmental and main bile duct, respectively. Associations between PDF and BDD were determined by adjusted OR and 95% CI using multiple logistic regression.

Results

BDD was found in 6.6% of PDF3, 1.7% of PDF2 and 1.4% of PDF1 cases. Among PDF cases, especially in PDF3, BDD was found in men more than in women (8.9% and 4.6%, respectively). Compared with non-PDF, the association between PDF3 and BDD was highly significant (adjusted OR=5.74, 95% CI 4.57 to 7.21, p<0.001).

Conclusions

Our findings reveal that there is a relationship between PDF and BDD, which is associated with CCA. Therefore, PDF can also be an indicator for suspected CCA diagnosis through US.
Experiences of community-dwelling older adults living with multiple chronic conditions: a qualitative study
Authors: Ploeg Jenny , Canesi Marta , D Fraser Kimberly , McAiney Carrie , Kaasalainen Sharon , Markle-Reid Maureen , Dufour Sinead , Garland Baird Lisa , Chambers Tracey
Published: March 2019

Objectives

The aim of the study was to understand the experiences of living with multiple chronic conditions (MCC) from the perspective of community-living older adults with MCC.

Design

A qualitative study using an interpretive description approach.

Setting

Participants were recruited from southern Ontario, Canada.

Participants

21 community-living, older adults (≥65 years) with an average of 7.4 chronic conditions including one of diabetes, dementia or stroke.

Methods

Data were collected through digitally-recorded, in-depth, semi-structured in-person interviews. Interview transcripts were analysed and coded using Thorne’s interpretive description approach.

Results

Five themes were identified representing older adults' experiences of living with MCC: (a) trying to stay healthy while living with MCC, (b) depending on family caregivers for support with just about everything, (c) paying the high costs of living with MCC, (d) making healthcare decisions by proxy and (e) receiving healthcare services that do not address the complex needs of persons living with MCC.

Conclusions

The experience of living with MCC in the community was complex and multi-faceted. The need for a person-centred and family-centred approach to care in the community, which includes the coordination of health and social services that are tailored to the needs of older adults and their informal caregivers, was underscored. Such an approach would facilitate improved information-sharing and discussion of care management options between health professionals and their patients, enable older adults with MCC to actively engage in priority-setting and decision-making and may result in improved health and quality of life for older adults with MCC.
Familial aggregation of myocardial infarction and coaggregation of myocardial infarction and autoimmune disease: a nationwide population-based cross-sectional study in Taiwan
Authors: Wang Chun-Li , Kuo Chang-Fu , Yeh Yung-Hsin , Hsieh Mei-Yun , Kuo Chi-Tai , Chang Shang-Hung
Published: March 2019

Objective

This study examined how a history of myocardial infarction (MI) in a person’s first-degree relatives affects that person’s risk of developing MI and autoimmune diseases.

Design

Nationwide population-based cross-sectional study

Setting

All healthcare facilities in Taiwan.

Participants

A total of 24 361 345 individuals were enrolled.

Methods

Using data from the National Health Insurance Research Database in Taiwan, we conducted a nationwide cross-sectional study of data collected from all beneficiaries in the Taiwan National Health Insurance system in 2015, of whom 259 360 subjects had at least one first-degree relative affected by MI in 2015. We estimated the absolute risks and relative risks (RRs) of MI and autoimmune disease in those subjects, and the relative contribution of genetic and environmental factors to their MI susceptibility.

Results

The absolute risks of MI for subjects with at least one affected first-degree relative and the general population were 0.87% and 0.56%, respectively, in 2015. Patients with affected first-degree relatives were significantly associated with a higher RR of MI (1.76, 95% CI: 1.68 to 1.85) compared with the general population. There was no association with a higher RR of autoimmune disease. The sibling, offspring and parental MI history conferred RRs (95% CI) for MI of 2.35 (1.96 to 2.83), 2.21 (2.05 to 2.39) and 1.60 (1.52 to 1.68), respectively. The contributions of heritability, shared environmental factors and non-shared environmental factors to MI susceptibility were 19.6%, 3.4% and 77.0%, respectively.

Conclusions

Individuals who have first-degree relatives with a history of MI have a higher risk of developing MI than the general population. Non-shared environmental factors contributed more significantly to MI susceptibility than did heritability and shared environmental factors. A family history of MI was not associated with an increased risk of autoimmune disease.
Trends, patterns and predictive factors of infant and child mortality in well-performing and underperforming states of India: a secondary analysis using National Family Health Surveys
Authors: Bhatia Mrigesh , Dwivedi Laxmi Kant , Ranjan Mukesh , Dixit Priyanka , Putcha Venkata
Published: March 2019

Objectives

This paper analyses the patterns and trends in the mortality rates of infants and children under the age of 5 in India (1992–2016) and quantifies the variation in performance between different geographical states through three rounds of nationally representative household surveys.

Design

Three rounds of cross-sectional survey data.

Setting

The study is conducted at the national level: India and its selected good-performing states, namely Haryana, Kerala, Maharashtra, Punjab and Tamil Nadu, and selected poor-performing states, namely Bihar, Chhattisgarh, Madhya Pradesh and Uttar Pradesh.

Participants

Adopting a multistage, stratified random sampling, 601 509 households with 699 686 women aged 15–49 years in 2015–2016, 109 041 households with 124 385 women aged 15–49 years in 2005–2006, and 88 562 households with 89 777 ever married women in the age group 13–49 years in 1992–1993 were selected.

Results

Through the use of maps, this paper clearly shows that the overall trend in infant and child mortality is on a decline in India. Computation of relative change shows that majority of the states have witnessed over 50% reduction in both infant and under-5 mortality rates from National Family Health Survey (NFHS)-I to NFHS-4. However, the improvements are not evenly distributed, and there is huge variation in performance between states over time. Funnel plots show that the most populous states like Uttar Pradesh Bihar and Madhya Pradesh have underperformed consistently across the survey period from 1992 to 2016. Regression analysis comparing high-performing and low-performing states revealed that female infants and women with shorter birth intervals had greater risk of infant deaths in poor-performing states.

Conclusion

Attempts to reduce infant and child mortality rates in India are heading in the right direction. Even so, there is huge variation in performance between states. This paper recommends a mix of strategies that reduce child and infant mortality among the high-impact states where the biggest improvements can be expected, including the need to address neonatal mortality.
Physicians’ patient base composition and mortality among people living with HIV who initiated antiretroviral therapy in a universal care setting
Authors: Allan Beverly , Closson Kalysha , Collins Alexandra B , Kibel Mia , Pan Shenyi , Cui Zishan , McLinden Taylor , Parashar Surita , Lima Viviane Dias , Chia Jason , Yip Benita , Barrios Rolando , Montaner Julio S G , Hogg Robert S
Published: March 2019

Objectives

To assess the impact of physicians’ patient base composition on all-cause mortality among people living with HIV (PLHIV) who initiated highly active antiretroviral therapy (HAART) in British Columbia (BC), Canada.

Design

Observational cohort study from 1 January 2000 to 31 December 2013.

Setting

BC Centre for Excellence in HIV/AIDS’ (BC-CfE) Drug Treatment Program, where HAART is available at no cost.

Participants

PLHIV aged ≥ 19 who initiated HAART in BC in the HAART Observational Medical Evaluation and Research (HOMER) Study.

Outcome measures

All-cause mortality as determined through monthly linkages to the BC Vital Statistics Agency.

Statistical analysis

We examined the relationships between patient characteristics, physicians’ patient base composition, the location of the practice, and physicians’ experience with PLHIV and all-cause mortality using unadjusted and adjusted Cox proportional hazards models.

Results

A total of 4 445 PLHIV (median age = 42, Q1, Q3 = 34–49; 80% male) were eligible for our study. Patients were seen by 683 prescribing physicians with a median experience of 77 previously treated PLHIV in the past 2 years (Q1, Q3 = 23–170). A multivariable Cox model indicated that the following factors were associated with all-cause mortality: age (aHR = 1.05 per 1-year increase, 95% CI = 1.04 to 1.06), year of HAART initiation (2004–2007: aHR = 0.65, 95% CI = 0.53 to 0.81, 2008-2011: aHR = 0.46, 95% CI = 0.35 to 0.61, Ref: 2000–2003), CD4 cell count at baseline (aHR = 0.88 per 100-unit increase in cells/mm3, 95% CI = 0.82 to 0.94), and < 95% adherence in first year on HAART (aHR = 2.28, 95% CI = 1.88 to 2.76). In addition, physicians’ patient base composition, specifically, the proportion of patients who have a history of injection drug use (aHR = 1.11 per 10% increase in the proportion of patients, 95% CI = 1.07 to 1.15) or Indigenous ancestry (aHR = 1.07 per 10% increase , 95% CI = 1.03–1.11) and being a patient of a physician who primarily serves individuals outside of the Vancouver Coastal Health Authority region (aHR = 1.22, 95% CI = 1.01 to 1.47) were associated with mortality.

Conclusions

Our findings suggest that physicians with a higher proportion of individuals who face potential barriers to care may need additional supports to decrease mortality among their patients. Future research is required to examine these relationships in other settings and to determine strategies that may mitigate the associations between the composition of physicians’ patient bases and survival.
Obesity and recovery from acute kidney injury (Ob AKI): a prospective cohort feasibility study
Authors: MacLaughlin Helen L , Blacklock Rochelle M , Wright Kelly , Pot Gerda , Jayawardene Satish , McIntyre Christopher W , Macdougall Iain C , Selby Nicholas M
Published: March 2019

Objectives

To test the methodology of recruitment, retention and data completeness in a prospective cohort recruited after a hospitalised episode of acute kidney injury (AKI), to inform a future prospective cohort study examining the effect of obesity on AKI outcomes.

Design

Feasibility study.

Setting

Single centre, multi-site UK tertiary hospital.

Participants

101 participants (67M; 34F) with a median age of 64 (IQR 53–73) years, with and without obesity, recruited within 3 months of a hospitalised episode of AKI.

Outcome measures

Feasibility outcomes were recruitment (>15% meeting inclusion criteria recruited), participant retention at 6 and 12 months (≥80%) and completeness of data collection. Exploratory measures included recovery from AKI (regaining >75% of pre-AKI estimated glomerular filtration rate [eGFR]) at 6 months, development or progression of chronic kidney disease (CKD) (kidney function decrease of ≥25% +  rise in CKD category) at 12 months, and associations with poorer kidney outcomes.

Results

41% of eligible patients consented to take part, exceeding the target recruitment uptake rate of 15%. Retention was 86% at 6 months and 78% at 12 months; 10 patients died and three commenced dialysis during the study. Data were 90%–100% complete. Median BMI was 27.9 kg/m2(range 18.1 kg/m2–54.3 kg/m2). 50% of the cohort had stage 3 AKI and 49% had pre-existing CKD. 46% of the cohort met the AKI recovery definition at 6 months. At 12 months, 20/51 patients developed CKD (39%) and CKD progression occurred in 11/49 patients (22%). Post-AKI interleukin-6 and cystatin-C were associated with 12 months decline in eGFR.

Conclusions

Feasibility to conduct a long-term observational study addressing AKI outcomes associated with obesity was demonstrated. A fully powered prospective cohort study to examine the relationships between obesity and outcomes of AKI is warranted.
Impact of first and second eye cataract surgery on physical activity: a prospective study
Authors: Meuleners Lynn B , Feng Ying Ru , Fraser Michelle , Brameld Kate , Chow Kyle
Published: March 2019

Objectives

To investigate the impact of first eye and second eye cataract surgery on the level of physical activity undertaken by older adults with bilateral cataract.

Design

Prospective cohort study.

Setting

Three public ophthalmology clinics in Western Australia.

Participants

Fifty-five older adults with bilateral cataract aged 55+ years, awaiting first eye cataract surgery.

Outcome measures

The primary outcome measure was participation in moderate leisure-time physical activity. The secondary outcomes were participation in walking, gardening and vigorous leisure-time physical activity. Participants completed a researcher-administered questionnaire, containing the Active Australia Survey and visual tests before first eye cataract surgery, after first eye surgery and after second eye surgery. A Generalised Estimating Equation linear regression model was undertaken to analyse the change in moderate leisure-time physical activity participation before first eye surgery, after first eye surgery and after second eye surgery, after accounting for relevant confounders.

Results

Participants spent significantly less time per week (20 min) on moderate leisure-time physical activity before first eye cataract surgery compared with after first eye surgery (p=0.04) after accounting for confounders. After second eye cataract surgery, participants spent significantly more time per week (32 min) on moderate physical activity compared with after first eye surgery (p=0.02). There were no significant changes in walking, gardening and vigorous physical activity throughout the cataract surgery process.

Conclusion

First and second eye cataract surgery each independently increased participation in moderate leisure-time physical activity. This provides a rationale for timely first and second eye cataract surgery for bilateral cataract patients, even when they have relatively good vision.
Frequency of television viewing and association with overweight and obesity among women of the reproductive age group in Myanmar: results from a nationwide cross-sectional survey
Authors: Das Gupta Rajat , Sajal Ibrahim Hossain , Hasan Mehedi , Sutradhar Ipsita , Haider Mohammad Rifat , Sarker Malabika
Published: March 2019

Objectives

This study aimed to discern the association between the frequency of television viewing and overweight and obesity among reproductive age women of Myanmar.

Design

This was a cross-sectional study.

Setting

This study used Myanmar Demographic and Health Survey (2015–2016) data.

Participants

Total of 12 021 women both aged 15–49 years and also not pregnant or did not deliver a child within the 2 months prior to the survey were included.

Primary and secondary outcome measures

The primary outcome was overweight (23.0 kg/m2to <27.5 kg/m2) and obesity (≥27.5 kg/m2), which was measured using the Asian body mass index cut-off. Ordered logistic regression analysis was conducted to find the association between the explanatory and outcome variables. The potential confounders controlled in the multivariable analyses were age, place of residence, region of residence, highest educational status, current employment status, wealth index, parity and number of household members.

Results

The prevalence of overweight was 26.5% and obesity was 12.2% among the study participants. The odds of being overweight and obese were 20% higher (adjusted OR (AOR) 1.16, 95% CI 1.02 to 1.32; p=0.023) among those who watched television at least once a week compared with those who did not watch television at all. Rural women who watched television at least once a week were 1.2 times more likely to be obese (AOR 1.16, 95% CI 1.01 to 1.34; p=0.040) compared with those who did not watch television at all.

Conclusions

Frequent television watching was associated with obesity among rural women of reproductive age in Myanmar.
App to support Recovery in Early Intervention Services (ARIES) study: protocol of a feasibility randomised controlled trial of a self-management Smartphone application for psychosis
Authors: Steare Thomas , O’Hanlon Puffin , Eskinazi Michelle , Osborn David , Lloyd-Evans Brynmor , Jones Rebecca , Rostill Helen , Amani Sarah , Johnson Sonia
Published: March 2019

Introduction

Mental health interventions delivered through digital technology have potential applications in promoting recovery and improving outcomes among people in the early stages of psychosis. Self-management approaches are recommended for the treatment of psychosis and could be delivered via applications (apps) installed on Smartphones to provide low-cost accessible support. We describe the protocol for a feasibility trial investigating a self-management Smartphone app intervention for adults using Early Intervention in Psychosis (EIP) services.

Methods and analysis

In this feasibility randomised controlled trial, 40 participants will be recruited from EIP services in London and Surrey. Twenty participants will be randomised to receive a supported self-management Smartphone app (My Journey 3) plus Treatment As Usual (TAU), while the other 20 participants will receive TAU only. The primary objective of this study is to evaluate the feasibility of conducting a full-scale trial of this intervention in EIP services. Participant data will be collected at baseline and at two follow-up assessments conducted 4 months and 12 months post-baseline. Analysed outcome measures will include relapse of psychosis (operationalised as admission to a hospital or community acute alternative), mental health and well-being, recovery, quality of life and psychopathology. Semi-structured interviews with participants and EIP service clinicians will additionally explore experiences of using My Journey 3 and participating in the trial and suggestions for improving the intervention.

Ethics and dissemination

The App to support Recovery in Early Intervention Services study has been reviewed and approved by the National Research Ethics Service Committee London—Brent (Research Ethics Committee reference: 15/LO/1453). The findings of this study will be disseminated through peer-reviewed scientific journals and conferences, magazines and web publications.

Trial registration number

ISRCTN10004994.
Shared decision-making about cardiovascular disease medication in older people: a qualitative study of patient experiences in general practice
Authors: Jansen Jesse , McKinn Shannon , Bonner Carissa , Muscat Danielle Marie , Doust Jenny , McCaffery Kirsten
Published: March 2019

Objectives

To explore older people’s perspectives and experiences with shared decision-making (SDM) about medication for cardiovascular disease (CVD) prevention.

Design, setting and participants

Semi-structured interviews with 30 general practice patients aged 75 years and older in New South Wales, Australia, who had elevated CVD risk factors (blood pressure, cholesterol)orhad received CVD-related lifestyle advice. Data were analysed by multiple researchers using Framework analysis.

Results

Twenty eight participants out of 30 were on CVD prevention medication, half with established CVD. We outlined patient experiences using the four steps of the SDM process, identifying key barriers and challenges: Step 1. Choice awareness: taking medication for CVD prevention was generally not recognised as a decision requiring patient input; Step 2. Discuss benefits/harms options: CVD prevention poorly understood with emphasis on benefits; Step 3. Explore preferences: goals, values and preferences (eg, length of life vs quality of life, reducing disease burden vs risk reduction) varied widely but generally not discussed with the general practitioner; Step 4. Making the decision: overall preference for directive approach, but some patients wanted more active involvement. Themes were similar across primary and secondary CVD prevention, different levels of self-reported health and people on and off medication.

Conclusions

Results demonstrate how older participants vary widely in their health goals and preferences for treatment outcomes, suggesting that CVD prevention decisions are preference sensitive. Combined with the fact that the vast majority of participants were taking medications, and few understood the aims and potential benefits and harms of CVD prevention, it seems that older patients are not always making an informed decision. Our findings highlight potentially modifiable barriers to greater participation of older people in SDM about CVD prevention medication and prevention in general.
Radiation protection effect of mobile shield barrier for the medical personnel during endoscopic retrograde cholangiopancreatography: a quasi-experimental prospective study
Authors: Chung Kwang Hyun , Park Young Sook , Ahn Sang Bong , Son Byoung Kwan
Published: March 2019

Objective

To investigate the effectiveness of radiation protection offered by a newly designed mobile shield barrier for medical personnel during endoscopic retrograde cholangiopancreatography (ERCP).

Design

Quasi-experimental prospective study.

Setting

ERCP procedures conducted between October 2016 and June 2017 at a single secondary referral hospital that performs approximately 250 therapeutic ERCP procedures annually.

Interventions

The mobile shield barrier was a custom-made 2 mm Pb shielding plate (width: 120 cm, height: 190 cm) with a 0.5 mm Pb window (width: 115 cm, height: 60 cm) on its upper part was used. Four wheels were attached to the bottom to allow easy moving.

Primary and secondary outcome measures

The radiation doses were measured during ERCP using personal thermoluminescence dosimetry (TLD) badges on both sides of the mobile shield barrier (patient’s side: TLD1 and medical staff’s side: TLD2). The radiation doses were also measured on the outer surface of the thyroid shield of the endoscopist (TLD3), and on the chest area inside the protective apron of the endoscopist (TLD4) and the main assistant (TLD5). The TLD was changed and reported once every 3 months. The radiation dose measured by TLD badges were compared.

Results

During the study period, a total of 128 ERCP procedures were performed. The mean fluoroscopy time per procedure was 244.9±257.0 s and the mean number of digital radiographs per procedure was 3.7±1.0. TLD1 (outside the barrier) had a mean radiation dose of 26.85±3.47 mSv and all the other TLDs (inside the barrier) had less than 1 mSv (p<0.001). In the post hoc analysis, the difference between TLD1 and others showed a statistical significance; however, there were no significant differences between the TLDs inside the barrier.

Conclusion

Our mobile shield barrier was useful to reduce the radiation exposure of medical personnel during ERCP.
External continuous ECG versus loop recording for atrial fibrillation detection in patients who had a stroke
Authors: Sejr Michala Herskind , May Ole , Damgaard Dorte , Sandal Birgitte Forsom , Nielsen Jens Cosedis
Published: March 2019

Background

Detection of atrial fibrillation (AF) in patients who had ischaemic stroke and transient ischaemic attack (IS/TIA) is recommended. We aimed to compare external loop recording (ELR) against simultaneous continuous ECG recording for AF detection in patients who had acute IS/TIA and determine sensitivity, specificity and positive predictive value of AF detection using ELR. We hypothesised ELR to detect 15% fewer patients with AF than continuous ECG recording.

Methods

In this prospective cohort study, we included 1412 patients who had acute IS/TIA without prior AF. Monitoring was 48 hours. Primary outcome was AF >30 s. Cardiologist verified AF in continuous ECG was gold standard.

Results

In continuous ECG, 38 (2.7%) patients had AF. ELR automatically categorised 219/1412 patients (15.5%) with AF, including 32/38 (85%) patients with AF in continuous ECG. After cardiologist adjudication of ELR recordings, AF was diagnosed in 57/219 patients, of which 32 (56%) had AF in continuous ECG. For adjudicated AF detection by ELR, sensitivity was 84%, 95% CI (69% to 94%), specificity was 98%, 95% CI (97% to 99%) and positive predictive value was 56%, 95% CI (42% to 69%).

Conclusion

Automatic AF detection with ELR results in an AF diagnosis in more than five patients without AF for each patient with AF as verified in continuous ECG. For adjudicated AF detection by ELR, sensitivity was confirmed to 84% and specificity 98%. Automatic ELR as investigated in this study may be considered to rule out AF, but it is not suitable as a single monitoring device for AF screening in patients early after stroke.

Trial registration number

NCT02155907.
OTOR in breast carcinoma as a potent prognostic predictor correlates with cell proliferation, migration, and invasiveness
Authors: Wang Yu-Fei , Han Jie
Published: March 2019

Otoraplin (OTOR), recognized as an important cochlear gene, has a predicted secretory signal peptide sequence and harbors a high degree of cross-species conservation. However, its role in tumor progression is relatively unclear, especially in breast carcinoma (BC). This study investigated the clinicopathological significance of OTOR in breast infiltrating ductal carcinoma (IDC) with high metastasis to uncover its biological function in BC. OTOR was highly overexpressed in BC tissues and cells compared with normal samples. OTOR overexpression was associated with certain clinicopathological characteristics and poorer prognosis (overall survival; OS) of patients with breast IDC. As determined using CCK-8, colony formation, wound-healing, and Transwell assays, silencing OTOR using siRNA impeded BC-cell proliferation, migration, and invasiveness, which may have resulted from inactivating the mitogen-activated protein kinase – extracellular-signal-regulated kinase pathway. These results indicate that OTOR plays a crucial role in the progression of and prognosis for BC, which could help to identify future therapeutic targets for treating BC patients.
Extracellular and intracellular tumor necrosis factor alpha modulates cytosolic and nuclear calcium in human cardiovascular cells
Authors: Chamoun Marc , Jacques Danielle , Bkaily Ghassan
Published: March 2019

Tumor necrosis factor alpha (TNFα) and its type 1 receptor (TNFR1) are implicated in several autoimmune diseases, including rheumatoid arthritis, and are associated with complications at the cardiovascular level. Using human cardiomyocytes, vascular smooth muscle, vascular endothelial, and endocardial endothelial cells coupled to indirect immunofluorescence, our results showed the presence of TNFR1 at the levels of the plasma membrane (including the cytosol) and mostly at the level of the nuclear membranes (including the nucleoplasm). The distribution of the receptor is different between cell types; however, the density is significantly higher at the nuclear level in all 4 cell types. The density of the receptor was the highest in contractile cells including the cardiomyocytes and vascular smooth muscle cells, compared with endothelial cells including endocardial endothelial and vascular endothelial cells. Using the Ca2+probe Fluo-3 coupled to quantitative confocal microscopy, our results showed that the cytokine induced a sustained Ca2+increase in both the cytosol and nucleoplasm of all 4 cell types. This increase was more significant at the nuclear level, mainly in endothelial cells. Our results demonstrated the presence of TNFR1 at both the cell and nuclear membranes of cardiovascular cells, and that its activation modulated both cytosolic and nuclear Ca2+.
Overexpression of anAPETALA1-like gene from cucumber (Cucumis sativusL.) induces earlier flowering and abnormal leaf development in transgenicArabidopsis
Authors: Zhou Yong , Hu Lifang , Ye Shuifeng , Jiang Lunwei , Liu Shiqiang
Published: March 2019

MADS-box proteins are important transcription factors that play essential roles in various aspects of plant development, particularly in flower development. In this study, we performed the identification and functional characterization of CsMADS09 isolated from cucumber (Cucumis sativus L.). CsMADS09 contains a 648-bp open reading frame encoding 215 amino acid residues, and shares high sequence identities with the members of the AP1/FUL family of MADS-box proteins, especially the euAPETALA1 (euAP1) subclade. Many cis-elements related to plant development, stress response, and hormones were identified in the promoter region of CsMADS09. Quantitative real-time polymerase chain reaction results showed that CsMADS09 was mainly expressed in reproductive tissues such as male flowers and unexpanded ovaries, while its expression was low in roots and only traceable in fertilized ovaries. Moreover, the results revealed that CsMADS09 expression tended to decline during male flower development and stayed nearly constant during female flower development. Ectopic expression of CsMADS09 resulted in earlier flowering and abnormal leaf development in transgenic Arabidopsis. This study is the first functional analysis of an AP1-like gene from cucumber and provides some clues for revealing the molecular mechanisms of flower development in cucumber.
Relatedness within and among northern long-eared bat (Myotis septentrionalis) colonies at a local scale
Authors: Olivera-Hyde Miluska , Silvis Alexander , Hallerman Eric M. , Ford W. Mark , Britzke Eric R.
Published: March 2019

We assessed parentage within and among maternity colonies of northern long-eared bats (Myotis septentrionalis (Trouessart, 1897)) in north-central Kentucky, USA, from 2011 to 2013 to examine colony social structure, formation, and membership dynamics. We intensively sampled colonies in close and remote (>10 km) proximity before and after targeted day-roost removal. Colonies were not necessarily composed of closely related individuals, although natal philopatry was common. Adjacent colonies often contained maternally related individuals, indicating that some pups did disperse, albeit not far from their natal home range. Whereas some young had been sired by males also collected on site, most had not, as would be expected since the species mates in fall near hibernacula across a wider landscape. The number of parentages that we inferred among colonies, however, suggests that outside the maternity season, social groups may be relatively flexible and open. Analysis of microsatellite DNA data showed a low FST(0.011) and best fit to a model of one multilocus genotypic cluster across the study area. We observed high turnover in colony membership between years in all colonies, regardless of roost-removal treatment. Our results suggest that female northern long-eared bats exhibit fidelity to a general geographic area and complex, dynamic social–genetic structure.
Influence of surface roughness in turning process — an analysis using artificial neural network
Authors: Radha Krishnan B. , Vijayan V. , Parameshwaran Pillai T. , Sathish T.
Published: March 2019

This paper presents methodology to identify the surface roughness value in CNC machining process using a soft computing approach. The aim of this paper is to achieve a roughness accuracy value above 95% and reduce the error rate to below 5% by using an artificial neural network. An artificial neural network method was selected to improve the time of inspection. Fourier transformation method will be used to extract the turning workpiece image, which is the squared value of the major frequency and principal component magnitude. Primary machining parameters such as feed rate, depth of cut, speed, frequency range, gray scale value, and conventional measurement value feed are used as the training input in the artificial neural network. Based on the training sample, the artificial neural network generates the vision measurement value for the testing samples that is compared to the stylus probe measurement value to predict the error rate and accuracy. The novelty of this work is to create an effective methodology using artificial neural network techniques to detect surface roughness errors of materials used in manufacturing industries.
Isochronous cosmological solutions of the Friedmann–Robertson–Walker model
Authors: Chen Aiyong , He Xiaokai , Tian Caixing
Published: March 2019

In this paper, the periodic solutions of the equation of Friedmann–Robertson–Walker cosmology with a cosmological constant are investigated. Using variable transformation, the original second-order ordinary differential equation is converted to a planar dynamical system with cosmic time t. Numerical simulations indicate that period function T(h) of this dynamical system is monotonically increasing. However, a new planar dynamical system could be deduced by using conformal time variable [Formula: see text]. We prove that the new planar dynamical system has two isochronous centers under certain parameter conditions by using Picard–Fuchs equation. Explicitly, we find that there exist two families of periodic solutions with equal period for the new planar dynamical system which is derived from the Friedmann–Robertson–Walker model.
A note on some perfect fluid Kantowski–Sachs and Bianchi type III spacetimes and their conformal vector fields in f(R) theory of gravity
Authors: Shabbir Ghulam , Hussain Fiaz , Kara A. H. , Ramzan Muhammad
Published: March 2019

The purpose of this paper is to find conformal vector fields of some perfect fluid Kantowski–Sachs and Bianchi type III spacetimes in the [Formula: see text] theory of gravity using direct integration technique. In this study, there exist only eight cases. Studying each case in detail, we found that in two cases proper conformal vector fields exist while in the rest of the cases, conformal vector fields become Killing vector fields. The dimension of conformal vector fields is either 4 or 6.
On the κ-deformed Dirac oscillator in (2 + 1)-dimensions
Authors: Chargui Yassine
Published: March 2019

We show that the (2 + 1)-dimensional [Formula: see text]-Dirac oscillator is equivalent, to the first-order of the deformation parameter, to a couple of simultaneous Jaynes–Cummings (JC) and Anti-Jaynes–Cummings (AJC) models with opposite chiralities, where the former is entirely due to the deformation. The energy eigenvalues and the corresponding eigenfunctions of system are obtained in a simple manner from the solutions of the non-deformed Dirac oscillator by mapping the complete system to a single AJC model through a similarity transformation. The pseudo-supersymmetry and other interesting features of the system are also discussed.
Thermodynamic properties of a multiferroic antiferromagnetic spin system: The influence of Dzyaloshinskii Moriya interaction
Authors: Tchoffo Martin , Gueagni William Degaulle Waladi , Fouokeng Georges Collince , Kenfack Lionel Tenemeza , Fai Lukong Cornelius
Published: March 2019

In this paper, we address the influence of Dzyaloshinskii Moriya (DM) interaction on the thermodynamic properties of a multiferroic antiferromagnetic spin system using the spin wave theory (SWT) as a diagonalization method which, associated to the statistical physics, helps to evaluate the statistical sum. The basic factors in thermodynamics, such as the Boltzmann entropy and the specific heat capacity at thermal equilibrium, are obtained. Analyzing the numerical results, it follows that the DM interaction is the best candidate that can help to maintain in long time the system in its coherent state. Furthermore, we find that the influence of the DM interaction is more accentuated at low-temperature and that it enables the system to release heat energy. On the other hand, the fact that the specific heat capacity tends to the constant clearly shows that the system obeys the Dulong–Petit law. In addition, our results also show that for high magnetic field (greater than B[Formula: see text]=[Formula: see text]30 Tesla), the magnetic field dependence of both entropy and specific heat shows a peak-like behavior and that the DM interaction raises the corresponding critical magnetic field but lowers the peak amplitude. It follows that the spin-flop transition occurs in the system and that the strong magnetic field withdraw the antiferromagnetic phase. Overall, we find that the DM interaction is a promising candidate for the control of our system.
Artificial neural network assisted by first-principles calculations for predicting transformation temperatures in shape memory alloys
Authors: Minami Daichi , Uesugi Tokuteru , Takigawa Yorinobu , Higashi Kenji
Published: March 2019

A key property for the design of new shape memory alloys is their working temperature range that depends on their transformation temperature T0. In previous works, T0 was predicted using a simple linear regression with respect to the energy difference between the parent and the martensitic phases, [Formula: see text]E[Formula: see text]. In this paper, we developed an accurate method to predict T0 based on machine learning assisted by the first-principles calculations. First-principles calculations were performed on 15 shape memory alloys; then, we proposed an artificial neural network method that used not only computed [Formula: see text]E[Formula: see text] but also bulk moduli as input variables to predict T0. The prediction error of T0 was improved to 49 K for the proposed artificial neural network compared with 188 K for simple linear regression.
Darboux transformation of the second-type nonlocal derivative nonlinear Schrödinger equation
Authors: Meng De-Xin , Li Kuang-Zhong
Published: March 2019

The second-type nonlocal derivative nonlinear Schrödinger (NDNLSII) equation is studied in this paper. By constructing its [Formula: see text]-order Darboux transformations (DT) from the first-order DT, Vandermonde-type determinant solutions of the NDNLSII equation are obtained from zero seed solutions, which would be singular unless the square of eigenvalues are purely imaginary.