bluuebunny/crossref_metadata_2025 huggingface dataset:
Propagation and attenuation of mechanical signals in ultrasoft 2D solids
Authors: van Doorn Jan Maarten , Higler Ruben , Wegh Ronald , Fokkink Remco , Zaccone Alessio , Sprakel Joris , van der Gucht Jasper
Published: September 2020

We analyze wave propagation and attenuation in extremely soft, strongly overdamped solids both experimentally and theoretically.
Highly energy-tunable quantum light from moiré-trapped excitons
Authors: Baek H. , Brotons-Gisbert M. , Koong Z. X. , Campbell A. , Rambach M. , Watanabe K. , Taniguchi T. , Gerardot B. D.
Published: September 2020

Photon antibunching, a hallmark of quantum light, is observed from moiré-trapped interlayer excitons in a 2D heterobilayer.
Real-time nanodiamond thermometry probing in vivo thermogenic responses
Authors: Fujiwara Masazumi , Sun Simo , Dohms Alexander , Nishimura Yushi , Suto Ken , Takezawa Yuka , Oshimi Keisuke , Zhao Li , Sadzak Nikola , Umehara Yumi , Teki Yoshio , Komatsu Naoki , Benson Oliver , Shikano Yutaka , Kage-Nakadai Eriko
Published: September 2020

Nanoparticle quantum temperature sensors detect subcellular heat generation in a multicellular model organism.
Dimorphism in cryptophytes—The case of
Teleaulax amphioxeia
/
Plagioselmis prolonga
and its ecological implications
Authors: Altenburger A. , Blossom H. E. , Garcia-Cuetos L. , Jakobsen H. H. , Carstensen J. , Lundholm N. , Hansen P. J. , Moestrup Ø. , Haraguchi L.
Published: September 2020

Microscopic algae have sex too, and it is an important aspect of their ecological success.
Deciphering the effect of traps on electronic charge transport properties of methylammonium lead tribromide perovskite
Authors: Musiienko Artem , Pipek Jindřich , Praus Petr , Brynza Mykola , Belas Eduard , Dryzhakov Bogdan , Du Mao-Hua , Ahmadi Mahshid , Grill Roman
Published: September 2020

Unique detrapping activity in perovskites prevents free carrier recombination leading to more efficient optoelectronic devices.
Political storms: Emergent partisan skepticism of hurricane risks
Authors: Long Elisa F. , Chen M. Keith , Rohla Ryne
Published: September 2020

Following conservative media skepticism of hurricane warnings in 2017, a partisan wedge in evacuation behavior rapidly emerged.
Intrinsic reconstruction of ice-I surfaces
Authors: Kawakami N. , Iwata K. , Shiotari A. , Sugimoto Y.
Published: September 2020

Atomic force microscopy showed that the reconstruction of ice-I surfaces occurs with a short-range (2 × 2) H-atom order.
Distinct phosphorylation sites in a prototypical GPCR differently orchestrate β-arrestin interaction, trafficking, and signaling
Authors: Dwivedi-Agnihotri Hemlata , Chaturvedi Madhu , Baidya Mithu , Stepniewski Tomasz Maciej , Pandey Shubhi , Maharana Jagannath , Srivastava Ashish , Caengprasath Natarin , Hanyaloglu Aylin C. , Selent Jana , Shukla Arun K.
Published: September 2020

GPCR–β-arrestin interaction and signaling are differentially regulated by distinct phosphorylation sites on the receptor.
Immobilized
13
C-labeled polyether chain ends confined to the crystallite surface detected by advanced NMR
Authors: Yuan Shichen , Schmidt-Rohr Klaus
Published: September 2020

Polymer chain ends mostly confined to crystallite surfaces have been detected by versatile isotope labeling and advanced NMR.
Gadofullerene inhibits the degradation of apolipoprotein B100 and boosts triglyceride transport for reversing hepatic steatosis
Authors: Zhou Chen , Zhen Mingming , Yu Meilan , Li Xue , Yu Tong , Liu Jingchao , Jia Wang , Liu Shuai , Li Lei , Li Jie , Sun Zihao , Zhao Zhongpu , Wang Xinyao , Zhang Xiaoyan , Wang Chunru , Bai Chunli
Published: September 2020

Fullerene nanomaterials protect the liver from lipid accumulation by promoting the transport of lipids out of liver.
Thermoregulation of
Pseudomonas aeruginosa
Biofilm Formation
Authors: Kim Suran , Li Xi-Hui , Hwang Hyeon-Ji , Lee Joon-Hee
Published: September 2020

Biofilm formation is an important protection mechanism used by most microorganisms and provides cells with many advantages, like high infectivity, antibiotic resistance, and strong survivability. Since most persistent bacterial infections are believed to be associated with biofilms, biofilm control is an important issue in medicine, environmental engineering, and industry. Biofilm formation is influenced by various environmental factors. Temperature is the most direct environmental cue encountered by microorganisms. Here, we investigated the effect of temperature on the biofilm formation of
P. aeruginosa
, a notorious pathogen, and found that temperature is an important factor determining the amount and structure of biofilms. Low temperatures greatly increase biofilm formation and give biofilms a highly conspicuous structure. Although thermoregulation of biofilm formation is mainly mediated by c-di-GMP, some c-di-GMP-independent regulations were also observed. This study shows how biofilms are formed at various temperatures and provides new insights to control biofilms using temperature.
An Ixodes scapularis Protein Disulfide Isomerase Contributes to Borrelia burgdorferi Colonization of the Vector
Authors: Cao Yongguo , Rosen Connor , Arora Gunjan , Gupta Akash , Booth Carmen J. , Murfin Kristen E. , Cerny Jiri , Marin Lopez Alejandro , Chuang Yu-Min , Tang Xiaotian , Pal Utpal , Ring Aaron , Narasimhan Sukanya , Fikrig Erol
Published: September 2020

Borrelia burgdorferi
causes Lyme disease, the most common tick-transmitted illness in North America. When
Ixodes scapularis
feed on an infected vertebrate host, spirochetes enter the tick gut along with the bloodmeal and colonize the vector. Here, we show that a secreted tick protein,

I
.
s
capularis

p
rotein
d
isulfide
i
somerase
A3
(IsPDIA3), enhances
B. burgdorferi
colonization of the tick gut.
Cefiderocol Antimicrobial Susceptibility Testing against Multidrug-Resistant Gram-Negative Bacilli: a Comparison of Disk Diffusion to Broth Microdilution
Authors: Morris C. Paul , Bergman Yehudit , Tekle Tsigedera , Fissel John A. , Tamma Pranita D. , Simner Patricia J.
Published: September 2020

Antimicrobial susceptibility testing (AST) of cefiderocol poses challenges because of its unique mechanism of action (i.e., requiring an iron-depleted state) and due to differences in interpretative criteria established by the Clinical and Laboratory Standards Institute (CLSI), U.S. Food and Drug Administration (FDA), and European Committee on Antimicrobial Susceptibility Testing (EUCAST). Our objective was to compare cefiderocol disk diffusion methods (DD) to broth microdilution (BMD) for AST of Gram-negative bacilli (GNB).
Quaternary influx of proximal coarse-grained dust altered circum-Mediterranean soil productivity and impacted early human culture
Authors: Amit Rivka , Enzel Yehouda , Crouvi Onn
Published: September 2020

The carbonate mountainous landscape around most of the Mediterranean is karstic, is almost barren, and has thin soils. Erosion of preexisting thicker soils is a common hypothesis used to explain this bare terrain. An alternative hypothesis is that in the Mediterranean region, thin soils are attributed to long-distance transport of very fine, silty clay dust, resulting in low mass accumulation rates. Even if accreted over millennia, such dust cannot produce thick, highly productive soils. A pronounced anomaly in the Mediterranean is the thick, more productive soil of the semiarid southern Levant (SL). These soils contain order-of-magnitude coarser grains than the characteristic thin soils in the Mediterranean and a high proportion (>70%) of coarse silt quartz sourced from the nearby Sinai-Negev erg, the primary contributor of the Negev loess. This proximal intense dust supply produced greatly thicker soils. However, influx of coarse silt quartz loess is a geologically recent phenomenon in the SL. Pre-loess (i.e., older than 200 ka, pre-coarse-silt influx) SL soils are much finer and were generated by long-distance dust from the Sahara and Arabia like most other Mediterranean soils. Thus, we hypothesize that the geologically recent Negev Desert loess interval caused a drastic change in mountainous soil properties within the SL, enriching the Levant’s ecology and affecting early human development. The high amounts of coarse silt deposited on the landscape have contributed to the unique sustainable agriculture in the SL, which assisted in transforming the Levant into “the land of milk and honey” and a cradle of civilizations.
Supplemental Material: Reconciling along-strike disparity in slip displacement of the San Andreas fault, central California, USA
Authors: Gooley Jared T. , al. et
Published: September 2020

Appendix S1: Sample preparation and analytical methods; Table S1: Original sample names; Table S2: San Andreas fault offset estimates used in Figures 3 and 15; Tables S3 and S4: U-Th-Pb data; Table S5: Modern river and Eocene Th/U data sources; Table S6: Major structures with NW-SE deformation.
Locked 90°-double plating of scapular spine fracture after reverse shoulder arthroplasty with union and good outcome despite plate adjacent acromion fracture
Authors: Bauer Stefan , Traverso Aurélien , Walch Gilles
Published: September 2020

We report the case of a 74-year-old woman who sustained a scapular spine (SS) fracture after a fall 4 weeks after reverse shoulder arthroplasty (RSA). Open reduction and internal fixation (ORIF) with locked 90°-double plating resulted in union of the SS fracture with a good outcome (subjective shoulder value: 80%; Constant score 67; 1 year) despite of an adjacent lateral acromion fracture 3 weeks after ORIF. This is the second description in the literature of a successful double plate ORIF with union of an SS fracture after RSA. SS fractures are known to lead to poor RSA outcomes with a high mal-union rate and non-union rate. We describe the positioning of the plates and technical steps for successful ORIF to avoid complications, discuss the aftercare and report the outcome.
Case of prostate stromal tumour of uncertain malignant potential where positron emission tomography with 18F-fluorodeoxyglucose was useful for surgical planning
Authors: Suzuki Issei , Kijima Toshiki , Owada Atsuko , Kamai Takao
Published: September 2020

Stromal tumour of uncertain malignant potential of the prostate is a rare tumour with a variable clinical behaviour ranging from incidentally detected indolent tumours that never progress, to aggressive diseases almost identical to sarcomas that may invade surrounding organs or develop metastases. Surgical excision is generally recommended for local diseases; however, owing to its diverse clinical outcomes, optimal management may vary from surgery alone to wide excision combined with chemotherapy and/or radiotherapy. Therefore, preoperative evaluation of the malignant potential of the disease is essential to decide the treatment strategy. Herein, we report a case of stromal tumour of uncertain malignant potential successfully treated with minimally invasive robot-assisted radical prostatectomy alone under the diagnosis of the disease with low malignant potential based on the findings of positron emission tomography with 18F-fluorodeoxyglucose.
Diabetes mellitus is associated with elevated urinary pyrrole markers of γ-diketones known to cause axonal neuropathy
Authors: Chen Xiao , Liu Wei , Wang Lu , Lin Dafeng , Nie Lulin , He Kaiwu , Guo Zhiwei , Zhu Feiqi , Feng Wenting , Liu Weimin , Yuan Jing , Yang Xifei , Spencer Peter , Liu Jianjun
Published: September 2020

Introduction

Progressive distal symmetrical axonal neuropathy, a complication of diabetes mellitus (DM), has an unknown cause. Normal physiological metabolism and diabetic dysmetabolism are associated with the generation of γ-diketones. γ-Diketones form pyrroles with protein amines, notably with axonal proteins required for the maintenance of nerve fiber integrity, especially elongate, large-diameter peripheral nerve fibers innervating the extremities. We tested the hypothesis that neuropathy-associated γ-diketone pyrroles are elevated in DM.

Research design and methods

We measured the urinary concentration of γ-diketone pyrroles in age-matched and gender-matched elderly (60–84 years) persons with (n=267) or without (n=267) indicators of DM based in a community population (9411 community older adults aged ≥60 years) in Shenzhen city, Guangdong, China. We used statistical methods, including a generalized linear model, multivariate logistic regression analysis and restricted cubic splines, to assess linear and nonlinear relationships between urinary γ-diketone pyrroles and indicators of DM.

Results

Compared with healthy controls, those with DM had significantly higher levels of fasting blood glucose, glycated hemoglobin A1c, urinary ketone bodies and urinary γ-diketone pyrroles. The median concentration of urinary γ-diketone pyrrole adducts was significantly higher (p<0.0001) in individuals with DM (7.5 (5.4) μM) compared with healthy controls (5.9 (4.3) μM). Both linear and non-linear relations were found between urinary γ-diketone pyrroles and indicators of DM.

Conclusions

Diabetic dysmetabolism includes increased generation and excretion of neuropathy-associated γ-diketone pyrroles. These findings form the foundation for studies to test whether γ-diketone pyrrole concentration correlates with quantitative sensory (vibration and temperature) and electrodiagnostic testing.
Case of nivolumab-induced sclerosing cholangitis: lessons from long-term follow-up
Authors: McClure Tess , Cui Wanyuan , Asadi Khashayar , John Thomas , Testro Adam
Published: September 2020

Nivolumab is an immune checkpoint inhibitor used to treat multiple solid-organ malignancies. While many of its immune-related adverse events are well established, nivolumab-induced sclerosing cholangitis remains poorly characterised, with no defined diagnostic criteria. Moreover, data regarding long-term outcomes are particularly lacking. We present a biopsy-proven case of nivolumab-induced sclerosing cholangitis, which uniquely captures 18 months of follow-up post-treatment. Our case highlights key features of intrahepatic subtype sclerosing cholangitis and suggests durable response to corticosteroid therapy.
Prevalence, risk factors and associated ocular diseases of cerebral stroke: the population-based Beijing Eye Study
Authors: Wang Ya Xing , Wei Wen Bin , Xu Liang , Jonas Jost B
Published: September 2020

Objective

To assess the prevalence of cerebral stroke in the general population of Beijing and its association with systemic risk factors and ocular diseases.

Setting

The population-based Beijing Eye Study was conducted in a rural and urban region of Beijing.

Participants

With eligibility criteria of age 50+ years and living in the study regions, 3468 subjects (78.8%) out of 4403 eligible individuals participated.

Primary and secondary outcome measures

The study participants underwent a detailed systemic and ophthalmological examination and an interview in which the occurrence of a previous stroke was assessed.

Results

A previous stroke was reported by 235 individuals (7.33%; 95% CI 6.43% to 8.24%). The prevalence of previous stroke increased from 2.0% (95% CI 0.9% to 3.1%) in the age group of 50 to <55 years to 21.9% (95% CI 16.4% to 27.4%) in the age group of 80+ years. In multivariable regression analysis, a higher prevalence of previous stroke was correlated (Nagelkerke R2=0.20) with the systemic parameters of older age (p<0.001; OR 1.06; 95% CI 1.04 to 1.08), male gender (p<0.001; OR 0.54; 95% CI 0.40 to 0.74), lower quality of life score (p<0.001; OR 1.39; 95% CI 1.25 to 1.55), higher prevalence of arterial hypertension (p<0.001; OR 2.86; 95% CI 2.05 to 3.98), and cardiovascular disease (p<0.001; OR 1.8554; 95% CI 1.34 to 2.56), and with the ocular parameter of higher prevalence of diabetic retinopathy (p<0.001; OR 4.41; 95% CI 2.38 to 8.18) or alternatively, with higher stage of diabetic retinopathy (p<0.001; OR 1.64; 95% CI 1.26 to 2.14).

Conclusions

In this North Chinese population aged 50+ years, the prevalence of a previous stroke was 7.33% (95% CI 6.43% to 8.24%). After adjusting for systemic risk factors of older age, male gender and higher prevalence of arterial hypertension and cardiovascular disease, a higher prevalence of a previous stroke was significantly correlated with a higher prevalence and stage of diabetic retinopathy. The prevalence of a previous stroke increased for each step of an increase in the stage of diabetic retinopathy with an OR of 1.64 (95% CI 1.26 to 2.14), and it increased by the presence of diabetic retinopathy with an OR of 4.41 (95% CI 2.38 to 8.18).
Randomised controlled trial to investigate the effectiveness of local oestrogen treatment in postmenopausal women undergoing pelvic organ prolapse surgery (LOTUS): a pilot study to assess feasibility of a large multicentre trial
Authors: Verghese Tina Sara , Middleton Lee , Cheed Versha , Leighton Lisa , Daniels Jane , Latthe Pallavi Manish
Published: September 2020

Objective

To evaluate the feasibility of a multicentre randomised controlled trial (RCT) comparing oestrogen treatment with no oestrogen supplementation in women undergoing pelvic organ prolapse (POP) surgery.

Design and setting

A randomised, parallel, open, external pilot trial involving six UK urogynaecology centres (July 2015–August 2016).

Participants

Postmenopausal women with POP opting for surgery, unless involving mesh or for recurrent POP in same compartment.

Intervention

Women were randomised (1:1) to preoperative and postoperative oestrogen or no treatment. Oestrogen treatment (oestradiol hemihydrate 10 μg vaginal pessaries) commenced 6 weeks prior to surgery (once daily for 2 weeks, twice weekly for 4 weeks) and twice weekly for 26 weeks from 6 weeks postsurgery.

Outcome measures

The main outcomes were assessment of eligibility and recruitment rates along with compliance and data completion. To obtain estimates for important aspects of the protocol to allow development of a definitive trial.

Results

325 women seeking POP surgery were screened over 13 months and 157 (48%) were eligible. Of these, 100 (64%) were randomised, 50 to oestrogen and 50 to no oestrogen treatment, with 89 (44/45 respectively) ultimately having surgery. Of these, 89% (79/89) returned complete questionnaires at 6 months and 78% (32/41) reported good compliance with oestrogen. No serious adverse events were attributable to oestrogen use.

Conclusions

A large multicentre RCT of oestrogen versus no treatment is feasible, as it is possible to randomise and follow up participants with high fidelity. Four predefined feasibility criteria were met. Compliance with treatment regimens is not a barrier. A larger trial is required to definitively address the role of perioperative oestrogen supplementation.

Trial registration number

ISRCTN46661996.
Prognostic value of red cell distribution width in patients undergoing percutaneous coronary intervention: a meta-analysis
Authors: Bao Donglai , Luo Gaojiang , Kan Fuqiang , Wang Xiaoyan , Luo Jinwei , Jiang Changhao
Published: September 2020

Objective

To evaluate the prognostic value of baseline red cell distribution width (RDW) in patients with coronary artery diseases (CADs) undergoing percutaneous coronary intervention (PCI) by conducting a meta-analysis.

Design

Systematic review and meta-analysis.

Data source

PubMed, Embase, Wanfang, CNKI and VIP databases were searched from their inceptions to 19 June 2019.

Eligible criteria

Studies investigating the value of baseline RDW for predicting all-cause mortality, cardiovascular mortality and major adverse cardiac events (MACEs) in patients with CAD undergoing PCI were included.

Data extraction and synthesis

Two authors independently extracted the data and evaluated the methodological quality using the Newcastle–Ottawa Scale. STATA V.12.0 software was applied to produce the forest plots using a random-effect model.

Results

Twelve studies (13 articles) involving 17 113 patients were included and analysed. Comparison between the highest and lowest RDW category indicated that the pooled risk ratio (RR) was 1.77 (95% CI 1.32 to 2.37) for all-cause mortality, 1.70 (95% CI 1.25 to 2.32) for cardiovascular mortality and 1.62 (95% CI 1.21 to 2.18) for MACEs. The predictive effect of elevated RDW for all-cause mortality was stronger in the subgroup of patients without anaemia (RR 4.59; 95% CI 3.07 to 6.86) than with anaemia.

Conclusions

This meta-analysis indicated that elevated RDW was associated with higher risk of mortality and adverse cardiac events in patients with CAD undergoing PCI. The value of elevated RDW for predicting all-cause mortality appears to be stronger in patients without anaemia. RDW may be served as a promising prognostic biomarker in patients undergoing PCI.
Protocol for the economic evaluation of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression
Authors: Shields Gemma E , Wells Adrian , Doherty Patrick , Reeves David , Capobianco Lora , Heagerty Anthony , Buck Deborah , Davies Linda M
Published: September 2020

Introduction

Cardiac rehabilitation (CR) is offered to reduce the risk of further cardiac events and to improve patients’ health and quality of life following a cardiac event. Psychological care is a common component of CR as symptoms of depression and/or anxiety are more prevalent in this population, however evidence for the cost-effectiveness of current interventions is limited. Metacognitive therapy (MCT), is a recent treatment development that is effective in treating anxiety and depression in mental health settings and is being evaluated in CR patients. This protocol describes the planned approach to the economic evaluation of MCT for CR patients.

Methods and analysis

The economic evaluation work will consist of a within-trial analysis and an economic model. The PATHWAY Group MCT study has been prospectively designed to collect comprehensive self-reported resource use and health outcome data, including the EQ-5D, within a randomised controlled trial study design (UK Clinical Trials Gateway). A within-trial economic evaluation and economic model will compare the cost-effectiveness of MCT plus usual care (UC) to UC, from a health and social care perspective in the UK. The within-trial analysis will use intention-to-treat and estimate total costs and quality-adjusted life-years (QALYs) for the trial follow-up. Single imputation will be used to impute missing baseline variables. Multiple imputation will be used to impute values missing at follow-up. Items of resource use will be multiplied by published national healthcare costs. Regression analysis will be used to estimate net costs and net QALYs and these estimates will be bootstrapped to generate 10 000 net pairs of costs and QALYs to inform the probability of cost-effectiveness. A decision analytical economic model will be developed to synthesise trial data with the published literature over a longer time frame. Sensitivity analysis will explore uncertainty. Guidance of the methods for economic models will be followed and dissemination will adhere to reporting guidelines.

Ethics and dissemination

The economic evaluation includes a within-trial analysis. The trial which included the collection of this data was reviewed and approved by Ethics. Ethics approval was obtained by the Preston Research Ethics Committee (project ID 156862). The modelling analysis is not applicable for Ethics as it will use data from the trial (secondary analysis) and the published literature. Results of the main trial and economic evaluation will be published in the peer-reviewed National Institute for Health Research (NIHR) journals library (Programme Grants for Applied Research), submitted to a peer-reviewed journal and presented at appropriate conferences.

Trial registration number

ISRCTN74643496; Pre-results.
Using nutritional survey data to inform the design of sugar-sweetened beverage taxes in low-resource contexts: a cross-sectional analysis based on data from an adult Caribbean population
Authors: Alvarado Miriam , Harris Rachel , Rose Angela , Unwin Nigel , Hambleton Ian , Imamura Fumiaki , Adams Jean
Published: September 2020

Objective

Sugar-sweetened beverage (SSB) taxes have been implemented widely. We aimed to use a pre-existing nutritional survey data to inform SSB tax design by assessing: (1) baseline consumption of SSBs and SSB-derived free sugars, (2) the percentage of SSB-derived free sugars that would be covered by a tax and (3) the extent to which a tax would differentiate between high-sugar SSBs and low-sugar SSBs. We evaluated these three considerations using pre-existing nutritional survey data in a developing economy setting.

Methods

We used data from a nationally representative cross-sectional survey in Barbados (2012–2013, prior to SSB tax implementation). Data were available on 334 adults (25–64 years) who completed two non-consecutive 24-hour dietary recalls. We estimated the prevalence of SSB consumption and its contribution to total energy intake, overall and stratified by taxable status. We assessed the percentage of SSB-derived free sugars subject to the tax and identified the consumption-weighted sugar concentration of SSBs, stratified by taxable status.

Findings

Accounting for sampling probability, 88.8% of adults (95% CI 85.1 to 92.5) reported SSB consumption, with a geometric mean of 2.4 servings/day (±2 SD, 0.6, 9.2) among SSB consumers. Sixty percent (95% CI 54.6 to 65.4) of SSB-derived free sugars would be subject to the tax. The tax did not clearly differentiate between high-sugar beverages and low-sugar beverages.

Conclusion

Given high SSB consumption, targeting SSBs was a sensible strategy in this setting. A substantial percentage of free sugars from SSBs were not covered by the tax, reducing possible health benefits. The considerations proposed here may help policymakers to design more effective SSB taxes.
Study protocol for a randomised-controlled study on emotion regulation training for adolescents with major depression: the KONNI study
Authors: Greimel Ellen , Feldmann Lisa , Piechaczek Charlotte , Oort Frans , Bartling Jürgen , Schulte-Rüther Martin , Schulte-Körne Gerd
Published: September 2020

Introduction

Major depression (MD) often has its onset during adolescence and is associated with significant morbidity and mortality. One important factor for the development and maintenance of adolescent MD are disturbances in emotion regulation and the underlying neural processes. Cognitive reappraisal (CR) is a particular adaptive emotion regulation strategy. Previously, it has been shown in healthy adults that a task-based training in CR is efficient to reduce negative affect, and that these effects translate into everyday life.

This randomised controlled trial examines for the first time whether a task-based training in CR proves effective in MD adolescents. Specifically, we will investigate whether the CR training improves the ability to downregulate negative affect in MD individuals as assessed by behavioural and neurobiological indices, and whether training effects generalise outside the laboratory.

Methods and analysis

Adolescents with MD will be randomly allocated to a group that either receives a task-based training in CR or a control training. Both involve four training sessions over a time period of 2 weeks. In the CR training, participants will be instructed to downregulate negative affective responses to negative pictures via CR, while the control training involves picture viewing. During the training sessions, the Late Positive Potential, gaze fixations on negative picture aspects and affective responses to pictures will be collected. Before and after the training programmes, and at a 2-week follow-up, overall negative and positive affect, rumination and perceived stress will be assessed as primary outcomes. Analyses of variance will be conducted to test the effectiveness of the CR training with regard to both primary outcomes and task-based behavioural and neurobiological parameters.

Ethics and dissemination

The study was approved by the Ethics Committee of the Medical Faculty of the LMU Munich, Germany. The results will be published in peer-reviewed journals and disseminated through conferences, social media and public events.

Trial registration details

ClinicalTrials.gov NCT03957850, registered 21st May 2019; URL: https://clinicaltrials.gov/ct2/show/NCT03957850.
Risperidone versus placebo for aggression following traumatic brain injury: a feasibility randomised controlled trial
Authors: Deb Shoumitro , Aimola Lina , Leeson Verity , Bodani Mayur , Li Lucia , Weaver Tim , Sharp David , Bassett Paul , Crawford Mike
Published: September 2020

Objectives

To conduct a feasibility randomised controlled trial of risperidone for the treatment of aggression in adults with traumatic brain injury (TBI).

Design

Multicentre, parallel design, placebo controlled (1:1 ratio) double-blind feasibility trial with an embedded process evaluation. No statistical comparison was performed between the two study groups.

Setting

Four neuropsychiatric and neurology outpatient clinics in London and Kent, UK.

Participants

Our aim was to recruit 50 patients with TBI over 18 months. Follow-up participants at 12 weeks using a battery of assessment scales to measure changes in aggressive behaviour and irritability (Modified Overt Aggression Scale (MOAS)-primary outcome, Irritability Questionnaire) as well as global functioning (Glasgow Outcome Scale-Extended, Clinical Global impression) and quality of life (EQ-5D-5L, SF-12), mental health (Hospital Anxiety and Depression Scale) and medication adverse effects (Udvalg for Kliniske Undersøgelser).

Results

Six participants were randomised to the active arm of the trial and eight to the placebo arm over a 10-month period (28% of our target). Two participants withdrew because of adverse events. Twelve out of 14 (85.7%) patients completed a follow-up assessment at 12 weeks. At follow-up, the scores of all outcome measures improved in both groups. Placebo group showed numerically better score change according to the primary outcome MOAS. No severe adverse events were reported. The overall rate of adverse events remained low. Data from the process evaluation suggest that existence of specialised TBI follow-up clinics, availability of a dedicated database of TBI patients’ clinical details, simple study procedures and regular support to participants would enhance recruitment and retention in the trial. Feedback from participants showed that once in the study, they did not find the trial procedure onerous.

Conclusions

It was not feasible to conduct a successful randomised trial of risperidone versus placebo for post-TBI aggression using the methods we deployed in this study. It is not possible to draw any definitive conclusion about risperidone’s efficacy from such a small trial.

Trial registration number

ISRCTN30191436
Automatic deep learning-based colorectal adenoma detection system and its similarities with pathologists
Authors: Song Zhigang , Yu Chunkai , Zou Shuangmei , Wang Wenmiao , Huang Yong , Ding Xiaohui , Liu Jinhong , Shao Liwei , Yuan Jing , Gou Xiangnan , Jin Wei , Wang Zhanbo , Chen Xin , Chen Huang , Liu Cancheng , Xu Gang , Sun Zhuo , Ku Calvin , Zhang Yongqiang , Dong Xianghui , Wang Shuhao , Xu Wei , Lv Ning , Shi Huaiyin
Published: September 2020

Objectives

The microscopic evaluation of slides has been gradually moving towards all digital in recent years, leading to the possibility for computer-aided diagnosis. It is worthwhile to know the similarities between deep learning models and pathologists before we put them into practical scenarios. The simple criteria of colorectal adenoma diagnosis make it to be a perfect testbed for this study.

Design

The deep learning model was trained by 177 accurately labelled training slides (156 with adenoma). The detailed labelling was performed on a self-developed annotation system based on iPad. We built the model based on DeepLab v2 with ResNet-34. The model performance was tested on 194 test slides and compared with five pathologists. Furthermore, the generalisation ability of the learning model was tested by extra 168 slides (111 with adenoma) collected from two other hospitals.

Results

The deep learning model achieved an area under the curve of 0.92 and obtained a slide-level accuracy of over 90% on slides from two other hospitals. The performance was on par with the performance of experienced pathologists, exceeding the average pathologist. By investigating the feature maps and cases misdiagnosed by the model, we found the concordance of thinking process in diagnosis between the deep learning model and pathologists.

Conclusions

The deep learning model for colorectal adenoma diagnosis is quite similar to pathologists. It is on-par with pathologists’ performance, makes similar mistakes and learns rational reasoning logics. Meanwhile, it obtains high accuracy on slides collected from different hospitals with significant staining configuration variations.
Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study
Authors: Henderson Angela , Mcskimming Paula , Kinnear Deborah , McCowan Colin , McIntosh Alasdair , Allan Linda , Cooper Sally-Ann
Published: September 2020

Objectives

To investigate psychotropic prescribing in the intellectual disabilities population over 10 years, and associated mental ill health diagnoses.

Design

Comparison of cross-sectional data in 2002–2004 (T1) and 2014 (T2). Longitudinal cohort study with detailed health assessments at T1 and record linkage to T2 prescribing data.

Setting

General community.

Participants

1190 adults with intellectual disabilities in T1 compared with 3906 adults with intellectual disabilities in T2. 545/1190 adults with intellectual disabilities in T1 were alive and their records linked to T2 prescribing data.

Main outcome measures

Encashed regular and as-required psychotropic prescriptions.

Results

50.7% (603/1190) of adults in T1 and 48.2% (1881/3906) in T2 were prescribed at least one psychotropic; antipsychotics: 24.5% (292/1190) in T1 and 16.7% (653/3906) in T2; antidepressants: 11.2% (133/1190) in T1 and 19.1% (746/3906) in T2. 21.2% (62/292) prescribed antipsychotics in T1 had psychosis or bipolar disorder, 33.2% (97/292) had no mental ill health or problem behaviours, 20.6% (60/292) had problem behaviours but no psychosis or bipolar disorder. Psychotropics increased from 47.0% (256/545) in T1 to 57.8% (315/545) in T2 (p<0.001): antipsychotics did not change (OR 1.18; 95% CI 0.87 to 1.60; p=0.280), there was an increase for antidepressants (OR 2.80; 95% CI 1.96 to 4.00; p<0.001), hypnotics/anxiolytics (OR 2.19; 95% CI 1.34 to 3.61; p=0.002), and antiepileptics (OR 1.40; 95% CI 1.06 to 1.84; p=0.017). Antipsychotic prescribing increased for people with problem behaviours in T1 (OR 6.45; 95% CI 4.41 to 9.45; p<0.001), more so than for people with other mental ill health in T1 (OR 4.11; 95% CI 2.76 to 6.11; p<0.001).

Conclusions

Despite concerns about antipsychotic prescribing and guidelines recommending their withdrawal, it appears that while fewer antipsychotic prescriptions were initiated by T2 than in T1, people were not withdrawn from them once commenced. People with problem behaviours had increased prescribing. There was also a striking increase in antidepressant prescriptions. Adults with intellectual disabilities need frequent and careful medication reviews.
Bariatric surgery and LDL cholesterol (BASALTO) trial study protocol: randomised controlled study evaluating the effect of gastric bypass versus sleeve gastrectomy on high LDL cholesterol
Authors: Benaiges David , Goday Albert , Flores-Le Roux Juana A , Fitó Montserrat , Pozo Oscar , Rodríguez-Morató Jose , Serra Carme , Pera Manuel , Llauradó Gemma , Climent Elisenda , Castañer Olga , Ramon Jose M , Pedro-Botet Juan
Published: September 2020

Introduction

Observational studies have shown gastric bypass to be superior to sleeve gastrectomy in terms of low-density lipoprotein (LDL) cholesterol improvement. If these results are confirmed in randomised controlled trials, presurgical LDL cholesterol status could be a relevant factor in surgical procedure election. Furthermore, it is also necessary to establish the mechanisms by which LDL cholesterol improves after surgery and whether qualitative and quantitative changes occur in the different lipoprotein subclasses. The first objective is to ascertain whether high LDL cholesterol levels before surgery can be considered an additional factor when selecting the most appropriate surgical procedure for each patient (gastric bypass or sleeve gastrectomy). Hence, the 1-year remission rates of high LDL cholesterol after gastric bypass and sleeve gastrectomy in patients with morbid obesity will be compared. Secondary objectives were (1) to compare changes in other lipoproteins and LDL composition and (2) to study the pathophysiologic mechanisms related to LDL cholesterol remission.

Methods and analysis

A randomised clinical trial, with intention-to-treat analysis, will be conducted to compare LDL cholesterol remission between gastric bypass and sleeve gastrectomy, with a 12-month follow-up. Inclusion criteria will be patients between 18 and 60 years of age with body mass index ≥40 kg/m2or ≥35 kg/m2with significant obesity-related comorbidity and high LDL cholesterol levels. Patients will be evaluated preoperatively and at 3, 6 and 12 months after bariatric surgery. Examinations will include routine blood chemistry, anthropometric measurements, food intake recall, physical activity questionnaires and serum samples for lipidomic and lipoprotein characterisation.

Ethics and dissemination

Ethics approval has been granted by the Parc de Salut Mar Ethics Committee (2019/8471/I). The study and its conclusions regarding the primary and secondary objectives will be presented as manuscripts submitted for peer-reviewed journal publication.

Trial registration number

NCT03975478.
Media content analysis of general practitioners’ reactions to care.data expressed in the media: what lessons can be learned for future NHS data-sharing initiatives?
Authors: Ford Elizabeth , Kazempour Yalda , Cooper Maxwell J F , Katikireddi Srinivasa Vittal , Boyd Andy
Published: September 2020

Objectives

Care.data was a 2013 UK government initiative to extract patient data from general practices in England to form a centralised whole-population database for service planning and health research. After a public outcry, the scheme was postponed and cancelled. Public views of care.data have previously been analysed; this study aimed to understand contemporary general practitioners’ (GPs) views of the scheme, which may have been influential in its downfall.

Design

Systematic search of media articles, followed by media content analysis.

Setting

UK-based mainstream and GP-facing media in 2013 and 2014.

Participants

Articles were eligible if they focused on care.data, and GPs were quoted, authored the article, or if articles were written for a majority GP audience.

Interventions

N/A.

Primary and secondary outcome measures

Themes which explained GPs' reactions to care.data and which could explain support for or opposition to the scheme.

Results

162 media articles met inclusion criteria and were drawn from newspapers, news websites and GP-facing websites. GPs recognised care.data’s potential value for research and improving care, but had grave concerns about the scheme’s implementation. These centred the lack of safeguards and purpose around the scheme which meant patients were not able to make informed decisions about opt-out. GPs perceived they were poorly resourced to meet competing demands to both share patients’ data and protect confidentiality. They distrusted the government’s likely uses of the data and perceived a risk of patient reidentification if the data were sold onto commercial entities.

Conclusions

Findings show specific concerns which GPs had about care.data which led to the withdrawal of support. Future NHS patient data-sharing schemes should engage with GPs and other clinicians as key stakeholders from the earliest moments of planning, so that their views and needs are incorporated into the design of such schemes.
PropAngio study protocol: a neoadjuvant trial on the efficacy of propranolol monotherapy in cutaneous angiosarcoma—a proof of principle study
Authors: Heinhuis Kimberley M , IJzerman Nikki S , Koenen Anne Miek , van der Graaf Winette T A , Haas Rick L , Beijnen Jos H , Huitema Alwin D R , van Houdt Winan J , Steeghs Neeltje
Published: September 2020

Introduction

Angiosarcoma is a rare and aggressive malignancy with a high metastatic potential and recurrence rate. Despite optimal treatment with surgery, with or without radiation, the prognosis remains poor and, therefore, new treatment strategies are warranted. Recently, propranolol has effectively been repurposed for the treatment of infantile haemangioma. Propranolol is a β3-sparing antagonist of the β-adrenergic receptor. In infantile haemangioma, the β1, β2 and β3 receptors are highly expressed. Angiosarcoma has several similarities with haemangioma, including its high β-adrenergic receptor expression and the supposedly important role of vascular endothelial growth factor in malignant growth. As a result, propranolol has been administered small scale in individual angiosarcoma cases with promising results. The precise effect of propranolol, however, is not yet established.

Methods and analysis

The goal of this neoadjuvant window of opportunity study is to prospectively evaluate the activity of propranolol monotherapy in patients with cutaneous angiosarcoma. The neoadjuvant setting provides a good opportunity to rapidly evaluate both the clinical response and histological response, without a significant delay in standard anticancer treatment. Fourteen patients with primary, recurrent or metastatic cutaneous angiosarcoma will be included. Propranolol will be administered orally in an escalating dose during 3–6 weeks, before the initiation of standard treatment. The primary endpoint is clinical response according to Response Evaluation Criteria in Solid Tumours, as measured on consecutive coloured photographs or CT/MRI. The histological response will be determined as secondary endpoint, comparing the difference in proliferation index before and after propranolol by measuring the change in immunohistochemistry staining of Ki-67. The study will be considered positive when at least three patients have a response to propranolol.

Ethics and dissemination

Ethical approval was obtained from the Medical Ethical Committee of the Netherlands Cancer Institute. Independent of the outcome, results of this study will be shared and submitted for publication in an international peer-reviewed journal.

Trial registration number

NL8118; registry through the Netherlands Trial Register.
COVID-19 prevention and treatment information on the internet: a systematic analysis and quality assessment
Authors: Fan Ka Siu , Ghani Shahi Abdul , Machairas Nikolaos , Lenti Lorenzo , Fan Ka Hay , Richardson Daniel , Scott Aneya , Raptis Dimitri Aristotle
Published: September 2020

Objective

To evaluate the quality of information regarding the prevention and treatment of COVID-19 available to the general public from all countries.

Design

Systematic analysis using the ‘Ensuring Quality Information for Patients’ (EQIP) Tool (score 0–36), Journal of American Medical Association (JAMA) benchmark (score 0–4) and the DISCERN Tool (score 16–80) to analyse websites containing information targeted at the general public.

Data sources

Twelve popular search terms, including ‘Coronavirus’, ‘COVID-19 19’, ‘Wuhan virus’, ‘How to treat coronavirus’ and ‘COVID-19 19 Prevention’ were identified by ‘Google AdWords’ and ‘Google Trends’. Unique links from the first 10 pages for each search term were identified and evaluated on its quality of information.

Eligibility criteria for selecting studies

All websites written in the English language, and provides information on prevention or treatment of COVID-19 intended for the general public were considered eligible. Any websites intended for professionals, or specific isolated populations, such as students from one particular school, were excluded, as well as websites with only video content, marketing content, daily caseload update or news dashboard pages with no health information.

Results

Of the 1275 identified websites, 321 (25%) were eligible for analysis. The overall EQIP, JAMA and DISCERN scores were 17.8, 2.7 and 38.0, respectively. Websites originated from 34 countries, with the majority from the USA (55%). News Services (50%) and Government/Health Departments (27%) were the most common sources of information and their information quality varied significantly. Majority of websites discuss prevention alone despite popular search trends of COVID-19 treatment. Websites discussing both prevention and treatment (n=73, 23%) score significantly higher across all tools (p<0.001).

Conclusion

This comprehensive assessment of online COVID-19 information using EQIP, JAMA and DISCERN Tools indicate that most websites were inadequate. This necessitates improvements in online resources to facilitate public health measures during the pandemic.
Specialist palliative cancer care in acute hospitals and place of death: a population study
Authors: Kelly Maria , O'Brien Katie M , Hannigan Ailish
Published: September 2020

Objective

This study compares the characteristics and place of death of patients with cancer receiving specialist palliative care in acute hospitals with those who do not.

Methods

All patients with incident invasive cancer in Ireland (1994–2016 inclusive), excluding non-melanoma skin cancer, who attended a cancer centre and died in 2016 were identified from cancer registry data. Patients were categorised based on a diagnosis code ‘Encounter for palliative care’ from linked hospital episode data. Place of death was categorised from death certificate data. Data were analysed using descriptive statistics, χ2tests and logistic regression.

Results

Of n=4103 decedents identified, 62% had a hospital-based palliative care encounter in the year preceding death. Age (p<0.001), marital status (p=0.017), deprivation index (p<0.001) and health board region (p=0.008) were independent predictors of having a palliative care encounter. Place of death differed by palliative care encounter group: 45% of those with an encounter died in hospital versus 50% without an encounter, 33% vs 16% died in a hospice and 18% vs 28% died at home (p<0.001).

Conclusion

Almost two-thirds of patients with cancer who attended a cancer centre and died in 2016 had a palliative care encounter. They were younger, less likely to be married and more likely to be from deprived areas. Having accounted for sociodemographic factors, there was evidence of regional variation in receiving care. Demographic and clinical factors and the provision of health services in a region need to be considered together when assessing end-of-life care.