bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of tracheostomy to support critically ill children receiving orthotopic liver transplantation: a single‐center experience
Authors: Mian Muhammad Umair M. , Kennedy Curtis , Fogarty Thomas , Naeem Buria , Lam Fong , Coss‐Bu Jorge , Arikan Ayse A. , Nguyen Trung , Bashir Dalia , Virk Manpreet , Harpavat Sanjiv , Raynor Tiffany , Rana Abbas A. , Goss John , Leung Daniel , Desai Moreshwar S.
Published: September 2021

Background

Children with end‐stage liver disease and multi‐organ failure, previously considered as poor surgical candidates, can now benefit from liver transplantation (LT). They often need prolonged mechanical ventilation (MV) post‐LT and may need tracheostomy to advance care. Data on tracheostomy after pediatric LT are lacking.

Method

Retrospective chart review of children who required tracheostomy in the peri‐LT period in a large, freestanding quaternary children's hospital from 2014 to 2019.

Results

Out of 205 total orthotopic LTs performed in 200 children, 18 (9%) required tracheostomy in the peri‐transplant period: 4 (2%) pre‐LT and 14 (7%) post‐LT. Among those 14 needing tracheostomy post‐LT, median age was 9 months [IQR = 7, 14] at LT and 10 months [9, 17] at tracheostomy. Nine (64%) were infants and 12 (85%) were cirrhotic at the time of LT. Seven (50%) were intubated before LT. Median MV days prior to LT was 23 [7, 36]. Eight (57%) patients received perioperative continuous renal replacement therapy (CRRT). The median MV days from LT to tracheostomy was 46 [33, 56]; total MV days from initial intubation to tracheostomy was 57 [37, 66]. Four (28%) children died, of which 3 (21%) died within 1 year of transplant. Total ICU and hospital length of stay were 92 days [I72, 126] and 177 days [115, 212] respectively. Among survivors, 3/10 (30%) required MV at home and 8/10 (80%) were successfully decannulated at 400 median days [283, 584].

Conclusion

Tracheostomy though rare after LT remains a feasible option to support and rehabilitate critically ill children who need prolonged MV in the peri‐LT period.
Narrow vessels cavitate first during a simulated drought in Eucalyptus camaldulensis
Authors: Barigah Têtè Sévérien , Gyenge Javier Enrique , Barreto Florencia , Rozenberg Philippe , Fernández María Elena
Published: September 2021

Establishing drying‐limits for mortality of different tree species and understanding the anatomical and physiological traits involved is crucial to predict forests' responses to climate change. The xylem of Eucalyptus camaldulensis presents a complex of solitary vessels surrounded by different imperforate tracheary elements and parenchyma that influence, in a poorly known way, its hydraulic functioning. We aimed at describing the dynamics of embolism propagation in this type of xylem, seeking any vessel‐size pattern, and unraveling the threshold of xylem embolism leading to nonrecovery after drought in E. camaldulensis. We assigned potted saplings to a protracted water‐stress for 70 days. We relied on colorimetric and hydraulic methods to test for links between xylem anatomy and embolism propagation in the main stem. On average, the occurrence of embolism was randomly distributed in the stem xylem, but the probability of embolized vessels was higher than predicted by chance in the narrowest vessels of individuals that experienced low to moderate water‐stress. The saplings could recover from severe water‐stress if their percentage loss of conductance (PLC) was <77%, but not when the PLC was ˃ 85%. We concluded that, contrary to results reported for most species, the narrowest vessels are the most vulnerable to cavitation in E. camaldulensis, suggesting a lack of tradeoff between xylem efficiency and safety (in response to drought) at the tissue level. These results challenge the well‐established paradigm of the effect of vessel size on cavitation, which states that the widest conduits are the most vulnerable to both freeze–thaw and drought‐induced cavitation.
Initiating home non‐invasive ventilation: How well are we doing?
Authors: Piper Amanda J.
Published: September 2021

See related article
The inhibition of CD4+ T cell proinflammatory response by lactic acid is independent of monocarboxylate transporter 1
Authors: Yang Peng , Sun Ying , Zhang Min , Hu Linhan , Wang Xinwei , Luo Longlong , Qiao Chunxia , Wang Jing , Xiao He , Li Xinying , Feng Jiannan , Chen Yu , Zheng Yuanqiang , Shi Yanchun , Chen Guojiang
Published: September 2021

Lactic acid was originally a by‐product of glucose metabolism, but many studies have shown that lactic acid plays a vital role in regulating immune cell polarization, differentiation and effector functions. In this study, we provide evidence that lactic acid and low pH impaired the effector function of CD4+ T cells in response to TCR and non‐TCR stimulation. Specifically, lactic acid or hydrochloric acid treatment significantly decreased IL‐2 and IFN‐γ production as well as CD25/CD69 expression. Furthermore, although MCT1 was required for the suppression of CD25 and CD69 expression by lactic acid, using pharmacological inhibition and genetic deletion, we demonstrated that it was dispensable for lactic acid‐mediated inhibition of IL‐2 and IFN‐γ production.
Voter experience and ballot language framing effects: Evidence from a survey experiment
Authors: Rossier Ted D.
Published: September 2021

Objective

Discover the extent to which habitual voting may alter the effects of framing in the language of ballot measures.

Methods

Online survey was conducted using Amazon Mechanical Turk crowd labor service. Participants were presented with two ballot questions with two separate sets of language, randomized so that each participant had an equal chance of seeing either version. Logistic regression was used to analyze responses.

Results

Support for one measure was drastically reduced with the change in question framing; for the other, the results were inconclusive. None of the models exhibited any evidence that habitual voting mitigated framing effects.

Conclusion

Experienced voters are no more immune to framing effects than inexperienced voters.
The new older adult participant in American politics
Authors: Burge Ryan P. , Bramlett Brittany H.
Published: September 2021

This article analyzes the politics of older Americans in the 21st century. Older Americans have been significantly involved in American politics, relative to younger generations. Political participation typically increases with age, even ramping up during the early period of older adulthood. However, past work has indicated that political participation drops off due to frailty and loss of cognition in the latest years of the life span. And, yet, people are living longer than in previous decades when much of the past research on this relationship was conducted. We want to know whether these relationships remain consistent and want to especially analyze the old–old, a growing age group that has been difficult to study in the past due to their low numbers in traditional surveys. With tens of thousands of respondents, survey data from the Cooperative Election Studies from 2008 to 2020 allow us to analyze these older groups in recent years, across types of participation and party affiliation. We find that there is not much of a dip in political activity among the old–old. They are still quite active, particularly when it comes to donating money to campaigns and voting. Additionally, through analyzing birth cohorts, we find that political activity gradually increases as people age through their 60s and 70s and does not notably decline when they move into the old–old age group.
The new donor vigilance system in Denmark reveals regional differences in adverse reactions supposedly caused by variation in the registration
Authors: Mikkelsen Christina , Paarup Helene Martina , Bruun Mie Topholm , Pedersen Louise Ørnskov , Hasslund Sys , Larsen Rune , Aagaard Bitten , Sørensen Betina Samuelsen
Published: September 2021

Background and Objectives

In recent years, there has been an increased focus among blood bank professionals on the health and safety of blood donors. In 2019, the Danish Haemovigilance Committee designed a national donor vigilance system to improve the registration of adverse reactions (AR) in blood donors. The new donor vigilance system was implemented on 1 January 2020 and we here present the results from the first year of registration.

Materials and Methods

AR categories, severity level and imputability score were defined based on the definitions from the International Society of Blood Transfusion, AABB and the European Commission directive 2005/61/EC, respectively.

Results

Across all severity levels, AR in Danish blood donors were found to be rare (1498 per 100,000 donations). Only 0.2% of the registered reactions were classified as serious (2.7 per 100,000 donations). Large regional differences were seen in the registration of citrate reactions and haematomas.

Conclusion

Significant differences across regions in what to categorize as an AR were persistent even when including a severity score in the reporting. The Danish Haemovigilance Committee will commence a national work to align the definitions but suggests that this matter is raised to an international level as part of the current work to agree upon definitions for assessment of donor AR.
Selective dry etching of UV-nanoimprinted resin passivation masks for area selective atomic layer deposition of aluminum oxide
Authors: Miyajima Chiaki , Ito Shunya , Nakagawa Masaru
Published: September 2021

To demonstrate area selective atomic layer deposition (ALD) using UV-nanoimprinted resin patterns as physical passivation masks, we investigated the removal of UV-cured resin films subjected to sequential mutual doses of trimethylaluminum (TMA) and H2O by using dry etching procedures. On the basis of the removal of a residual layer characteristic from imprint resin patterns by anisotropic oxygen reactive ion etching (O2 RIE), oxidatively etched UV-cured films were modified with TMA and H2O in an ALD-like cyclic manner. Atomic force microscopy and time-of-flight secondary ion mass spectrometry [time-of-flight secondary ion mass spectrometry (TOF-SIMS)] analysis suggested that the combination of physical Ar ion milling and subsequent chemical O2 RIE enabled the elimination of oxidized UV-cured resin masks modified with 5-cycle TMA doses. By contrast, Ar ion milling or O2 RIE left organic or inorganic residues on silicon surfaces, respectively. A TMA-modified hybridized resin layer was etched by physical Ar ion milling; subsequently, the organic residual resin layer was removed by chemical O2 RIE in the case of 5-cycle modification with TMA. The mapping image of Al+ visualized by TOF-SIMS suggested that line patterns of aluminum oxide were left selectively on unmasked silicon substrate surfaces by site-selective dry etching of TMA-modified imprint resin passivation masks with 500 nm linewidth.
Roller Massage Prior to Running Does Not Affect Gait Mechanics in Well-Trained Runners
Authors: Hunter Jessica G. , Garcia Gina L. , Ranadive Sushant M. , Shim Jae Kun , Miller Ross H.
Published: September 2021

Context:Understanding if roller massage prior to a run can mitigate fatigue-related decrements in muscle force production during prolonged running is important because of the association between fatigue and running-related injury.Objective:The authors investigated whether a bout of roller massage prior to running would (1) mitigate fatigue-related increases in vertical average load rate and free moment of the ground reaction force of running and (2) mitigate decreases in maximal countermovement jump height.Design:Repeated-measures study.Setting:Laboratory.Participants:A total of 14 recreational endurance athletes (11 men and 3 women) volunteered for the study.Interventions:A 12.5-minute foam roller protocol for the lower extremities and a fatiguing 30-minute treadmill run.Main Outcome Measures:Vertical average load rate, free moment, and maximal jump height before (PRE) and after (POST) the fatiguing treadmill run on separate experimental days: once where participants sat quietly prior to the fatiguing run (REST) and another where the foam roller protocol was performed prior to the run (ROLL).Results:A 2-way multiple analysis of variance found no significant differences in vertical average load rate, free moment, and jump height between PRE/POST times in both REST/ROLL conditions.Conclusions:The authors concluded that recreational endurance athletes maintain running mechanics and jump performance after a fatiguing run regardless of prerun roller massage and may not rely on prerun roller massage as a form of injury prevention.
Correlated oxide Dirac semimetal in the extreme quantum limit
Authors: Ok Jong Mok , Mohanta Narayan , Zhang Jie , Yoon Sangmoon , Okamoto Satoshi , Choi Eun Sang , Zhou Hua , Briggeman Megan , Irvin Patrick , Lupini Andrew R. , Pai Yun-Yi , Skoropata Elizabeth , Sohn Changhee , Li Haoxiang , Miao Hu , Lawrie Benjamin , Choi Woo Seok , Eres Gyula , Levy Jeremy , Lee Ho Nyung
Published: September 2021

Signatures of strong correlation of Dirac electrons are discovered in an oxide-based correlated topological quantum material.
MYO10 drives genomic instability and inflammation in cancer
Authors: Mayca Pozo Franklin , Geng Xinran , Tamagno Ilaria , Jackson Mark W. , Heimsath Ernest G. , Hammer John A. , Cheney Richard E. , Zhang Youwei
Published: September 2021

This study reveals insights into cancer development and may result in the discovery of a biomarker for cancer immunotherapy.
Parallel characterization of cis-regulatory elements for multiple genes using CRISPRpath
Authors: Ren Xingjie , Wang Mengchi , Li Bingkun , Jamieson Kirsty , Zheng Lina , Jones Ian R. , Li Bin , Takagi Maya Asami , Lee Jerry , Maliskova Lenka , Tam Tsz Wai , Yu Miao , Hu Rong , Lee Lindsay , Abnousi Armen , Li Gang , Li Yun , Hu Ming , Ren Bing , Wang Wei , Shen Yin
Published: September 2021

A new CRISPR screening strategy allows characterizing enhancers for multiple genes associated with converging phenotypes.
TIPE2 is a checkpoint of natural killer cell maturation and antitumor immunity
Authors: Bi Jiacheng , Cheng Chen , Zheng Chaoyue , Huang Chen , Zheng Xiaohu , Wan Xiaochun , Chen Youhai H. , Tian Zhigang , Sun Haoyu
Published: September 2021

TIPE2 suppresses NK cells to reach an optimal functional status and NK cell antitumor immunity.
Overcoming the quantum limit of optical amplification in monolithic waveguides
Authors: Ye Zhichao , Zhao Ping , Twayana Krishna , Karlsson Magnus , Torres-Company Victor , Andrekson Peter A.
Published: September 2021

A compact, integrated, and ultralow-noise amplifier based on low-loss monolithic silicon nitride waveguides is demonstrated.
NF-κB responds to absolute differences in cytokine concentrations
Authors: Son Minjun , Wang Andrew G. , Tu Hsiung-Lin , Metzig Marie Oliver , Patel Parthiv , Husain Kabir , Lin Jing , Murugan Arvind , Hoffmann Alexander , Tay Savaş
Published: September 2021

The behavior of the NF-κB pathway as a differentiator circuit enables the pathway to track changes in cytokine dose.
Efficient Conversion of Glycerol to Ethanol by an Engineered Saccharomyces cerevisiae Strain
Authors: Khattab Sadat Mohamed Rezk , Watanabe Takashi
Published: September 2021

With the development of efficient lignocellulosic biorefineries, glycerol has attracted attention as an eco-friendly biomass-derived solvent that can enhance the dissociation of lignin and cell wall polysaccharides during the pretreatment process. Coconversion of glycerol with the sugars released from biomass after glycerolysis increases the resources for ethanol production and lowers the burden of component separation.
Biosynthesis of Ditropolonyl Sulfide, an Antibacterial Compound Produced by Burkholderia cepacia Complex Strain R-12632
Authors: Depoorter Eliza , Coenye Tom , Vandamme Peter
Published: September 2021

Burkholderia
bacteria are historically known for their biocontrol properties and have been proposed as a promising and underexplored source of bioactive specialized metabolites.
Burkholderia cepacia
complex strain R-12632 inhibits various Gram-positive and Gram-negative resistant pathogens and produces numerous specialized metabolites, among which is ditropolonyl sulfide. This unusual antimicrobial has been poorly studied and its biosynthetic pathway remains unknown.
Dynamics of the Two Stator Systems in the Flagellar Motor of Pseudomonas aeruginosa Studied by a Bead Assay
Authors: Wu Zhengyu , Tian Maojin , Zhang Rongjing , Yuan Junhua
Published: September 2021

Cells of
Pseudomonas aeruginosa
possess a single polar flagellum, driven by a rotatory motor powered by two sets of torque-generating units (stators). We developed a robust bead assay for studying the behavior of the flagellar motor in
P. aeruginosa
, by attaching a microsphere to shortened flagellar filament and using it as an indicator of motor rotation.
APOBEC3B Potently Restricts HIV-2 but Not HIV-1 in a Vif-Dependent Manner
Authors: Bandarra Susana , Miyagi Eri , Ribeiro Ana Clara , Gonçalves João , Strebel Klaus , Barahona Isabel
Published: September 2021

Primate lentiviruses encode a series of accessory genes that facilitate virus adaptation to its host. Among those, the
vif
-encoded protein functions primarily by targeting the APOBEC3 (A3) family of cytidine deaminases.
Gut Microbiota Serves a Predictable Outcome of Short-Term Low-Carbohydrate Diet (LCD) Intervention for Patients with Obesity
Authors: Zhang Susu , Wu Peili , Tian Ye , Liu Bingdong , Huang Liujing , Liu Zhihong , Lin Nie , Xu Ningning , Ruan Yuting , Zhang Zhen , Wang Ming , Cui Zongbing , Zhou HongWei , Xie Liwei , Chen Hong , Sun Jia
Published: September 2021

Obesity and its related complications pose a serious threat to human health. Short-term low-carbohydrate diet (LCD) intervention without calorie restriction has a significant weight loss effect for overweight/obese people.
Genetic Determinants of Intrinsic Antibiotic Tolerance in Mycobacterium avium
Authors: Matern William M. , Parker Harley , Danchik Carina , Hoover Leah , Bader Joel S. , Karakousis Petros C.
Published: September 2021

The prolonged treatment required to eradicate
Mycobacterium avium
complex (MAC) infection is likely due to the presence of subpopulations of antibiotic-tolerant bacteria with reduced susceptibility to currently available drugs. However, little is known about the genes and pathways responsible for antibiotic tolerance in MAC.
Clinically Relevant Influenza Virus Evolution Reconstituted in a Human Lung Airway-on-a-Chip
Authors: Si Longlong , Bai Haiqing , Oh Crystal Yuri , Jin Lei , Prantil-Baun Rachelle , Ingber Donald E.
Published: September 2021

The rapid evolution of viruses, such as influenza viruses and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is challenging the use and development of antivirals and vaccines. Studies of within-host viral evolution can contribute to our understanding of the evolutionary and epidemiological factors that shape viral global evolution as well as development of better antivirals and vaccines.
Temporal Transcriptomics of Gut Escherichia coli in Caenorhabditis elegans Models of Aging
Authors: Brycki Joshua D. , Chen See Jeremy R. , Letson Gillian R. , Emlet Cade S. , Unverdorben Lavinia V. , Heibeck Nathan S. , Brislawn Colin J. , Buonaccorsi Vincent P. , Chan Jason P. , Lamendella Regina
Published: September 2021

Previous research has reported effects of the microbiome on health span and life span of
Caenorhabditis elegans
, including interactions with evolutionarily conserved pathways in humans. We build on this literature by reporting the gene expression of
Escherichia coli
OP50 in wild-type (N2) and three long-lived mutants of
C. elegans
.
Comparative Phylogenomic Analysis Reveals Evolutionary Genomic Changes and Novel Toxin Families in Endophytic
Liberibacter
Pathogens
Authors: Tan Yongjun , Wang Cindy , Schneider Theresa , Li Huan , de Souza Robson Francisco , Tang Xueming , Swisher Grimm Kylie D. , Hsieh Tzung-Fu , Wang Xu , Li Xu , Zhang Dapeng
Published: September 2021

Liberibacter
pathogens are associated with several severe crop diseases, including citrus Huanglongbing, the most destructive disease to the citrus industry. Currently, no effective cure or treatments are available, and no resistant citrus variety has been found.
Supplemental Material: Hypogenic karst of the Great Basin
Authors: Hose Louise
Published: September 2021

Slide PDFs of trip stops
Supplemental Material: Lateral variation in slab window viscosity inferred from global navigation satellite system (GNSS)–observed uplift due to recent mass loss at Patagonia ice fields
Authors: Russo Raymond M. , Mocanu Victor , al. et
Published: September 2021

Modeling method, Table S1 (newly obtained uplift rates for the ten continuous GNSS sites shown in Figure1A),Table S2 (slab window viscosity values and RMS data), supplemental figures, and the weekly solutions for GNSS data used in the study.
Using institutional entrepreneurship to understand the role of innovation teams in healthcare: a longitudinal qualitative study
Authors: Melder Angela , Mcloughlin Ian , Robinson Tracy , Iedema Rick , Teede Helena J
Published: September 2021

Objectives

We draw on institutional theory to explore the roles and actions of innovation teams and how this influences their behaviour and capabilities as ‘institutional entrepreneurs (IEs)’, in particular the extent to which they are both ‘willing’ and ‘able’ to facilitate transformational change in healthcare through service redesign.

Design

A longitudinal qualitative study that applied a ‘researcher in residence’ as an ethnographic approach.

Setting

The development and implementation of two innovation projects within a single public hospital setting in an Australian state jurisdiction.

Participants

Two innovation teams, with members including senior research fellows, PhD scholars and front-line clinicians (19 participants and 47 interviews).

Results

Despite being from the same hospital, the two innovation teams occupied contrasting subject positions with one facilitating transformational improvements in service delivery, while the other sought more conservative improvements. Cast as ‘IEs’ we show how one team took steps to build legitimacy for their interventions enabling spread and scale in improvements and how, in the other case, failure to build legitimacy resulted in unintended consequences which undermined the sustainability of the improvements achieved.

Conclusions

Adopting an institutional approach provided insight into the ‘willingness’ and ‘ability’ to facilitate transformational change in healthcare through service redesign. The manner in which innovation teams operate from different subject positions influences the structural and normative legitimacy afforded to their activities. Specifically, we observed that those with the most power (organisational or professional) to bring about transformational change can be the least willing to do so in ways which challenge current practice. Those most willing to challenge the status quo (more peripheral organisation members or professionals) can be least able to deliver transformation. Better understanding of these insights can inform healthcare leaders in supporting innovation team efforts, considering their subject position.
Prevalence of and risk factors for diabetes mellitus in the school-attending adolescent population of the United Arab Emirates: a large cross-sectional study
Authors: Barakat Caroline , Yousufzai Susan Jamuria , Booth Alison , Benova Lenka
Published: September 2021

Objectives

The prevalence of diabetes has reportedly increased among adolescents in low-income and middle-income countries of the Middle East and may be linked to social, demographic and economic contextual factors. This study aimed: (1) to estimate the prevalence of self-reported diagnosis of diabetes in the adolescent population of the United Arab Emirates (UAE); (2) to assess differences in the prevalence based on gender and (3) to identify other characteristics of those with diabetes including parental marital status, smoking/illegal drug use, quality of life and nationality.

Design

A secondary data analysis was performed on data from the National Study of Population Health in the UAE, conducted between 2007 and 2009.

Setting

Large cross-sectional population-based survey study.

Participants

Survey was administered to a stratified random sample of 151 public and private schools from the UAE, across 7 emirates. 6365 school-attending adolescents (12–22 years; mean=16 years) participated.

Outcomes

Multivariable logistic regression analysis was used to examine the relationships between diabetes diagnosis and characteristics of participants after adjusting for confounding from other predictors.

Results

The overall prevalence of self-reported diabetes was 0.9% (95% CI 0.7% to 1.2%) and was higher in males 1.5% (95% CI 1.0% to 2.1%) than females 0.5% (95% CI 0.3% to 0.8%), (p<0.001). Children of parents who were not currently married had more than twice the odds of self-reporting diabetes (p=0.031) compared with those with married parents. Adolescents who reported ever smoking/using illegal drugs had more than three times the odds of diabetes (p<0.001).

Conclusion

We found a positive association between certain characteristics of adolescents and their diabetes status, including male gender, parental marital status and smoking/illegal drug use. The high prevalence of smoking/illegal drug use among those reporting a diagnosis of diabetes suggests the need for behavioural and mental health interventions for adolescents with diabetes, as well as strong parental support and involvement.
Assessing health-related quality of life and health utilities in patients with chronic hepatitis B-related diseases in China: a cross-sectional study
Authors: Zhang Meng , Li Yaoguang , Fan Zihao , Shen Dongqi , Huang Xueying , Yu Qi , Liu Mei , Ren Feng , Wang Xiao , Dai Liping , Wang Peng , Ye Hua , Shi Jianxiang , Yang Xiaoang , Zhang Shunxiang , Zhang Jianying
Published: September 2021

Objectives

The health-related quality of life (HRQoL) and utilities of patients with chronic hepatitis B (CHB) virus infection, including compensated cirrhosis (CC), decompensated cirrhosis (DC) and different stages of hepatocellular carcinoma (HCC), have not been well described in China. This study aimed to evaluate HRQoL and utilities and provide parameters for the economic evaluation of CHB-related diseases.

Methods

We conducted a multicentre cross-sectional and study to measure the HRQoL of patients with CHB, CC, DC and HCC using the Chinese short form (SF) 36 health survey V.2. The utilities were extracted based on the SF-six dimension scoring model. Multivariable regression analyses identified the effects on HRQoL.

Results

A total of 1071 patients (639 with CHB, 125 with CC, 85 with DC and 222 with HCC) were invited to complete the questionnaire. Physical HRQoL was not impaired in the CHB stage, while mental HRQoL was significantly impaired. Physical composite summary scores have a more significant decrease than mental composite summary scores at the advanced stages (CC, DC and HCC). The utility scores of CHB only, CC, DC and HCC were 0.773, 0.750, 0.683 and 0.640, respectively. The utility scores in the early, middle and terminal stages of HCC were 0.656, 0.635 and 0.615, respectively.

Conclusion

Slowing the progress of CHB-related diseases and providing psychological support early are the key points to improving the quality of life with the diseases. The utility values estimated in this study can provide a vital instrument for cost-effectiveness studies on CHB-related diseases.
Clinical evaluation of enhanced recovery after surgery protocol for anterior cervical decompression and fusion (ACDF): study protocol for a multicentre randomised controlled trial
Authors: Zhong Gui Qin , Lin Bi Hua , Lin Ren Qin , Liang Ze Yan , Lin Yan Juan , Chen Chun Mei
Published: September 2021

Introduction

To improve the efficacy of anterior cervical decompression and fusion (ACDF) and reduce postoperative complications in degenerative cervical myelopathy, our team established a set of perioperative care of enhanced recovery guidelines of ACDF based on the concept of enhanced recovery after surgery. In addition, a prospective, multicentre, randomised clinical trial was designed.

Methods and analysis

A total of 260 patients aged 18–65 years will be included. Preoperative MRI and CT will be used to confirm the typical manifestations of cervical spondylosis, such as cervical disc herniation and spinal cord compression. The patient presents with neck and shoulder pain, numbness of upper limbs, weakened grip strength and cotton sense of foot tread. Patients received normal conservative treatment for 3 months with no obvious relief or even aggravation of symptoms. Patients will be assigned to the group in strict accordance with the random allocation table. Patients in groups A and B will receive conventional perioperative care and perioperative care for enhanced recovery, respectively. The main outcome indicators are the Karnofsky Performance Scale score and the Japanese Orthopaedic Association scale. Secondary outcome indicators are pain assessment by Numeric Rating Scale, Neck Disability Index, quality of life index (QL-Index) and postoperative complications. Follow-up will be conducted at 3, 6 and 12 months postoperatively.

Ethics and dissemination

Ethical approval has been granted by the Ethics Committee of Fujian Medical University Union Hospital, Fuzhou, China (2020YF034-01). Results of the research will be published in an international peer-reviewed scientific journal and disseminated through presentation at scientific conferences.

Trial registration number

ChiCTR2000040508.
Level of adherence to vitamin D supplementation guidelines in an antenatal centre in Birmingham, UK, and its effect on biochemical and obstetrical outcomes: a single-centre cross-sectional study
Authors: Yamanouchi Liana , Srinivasan Maheshwari , Barlow Nicola , Basu Ansu
Published: September 2021

Objectives

A third of pregnant women in the UK are vitamin D deficient, which may confer deleterious consequences, including an increased risk of pre-eclampsia, gestational diabetes mellitus and intrauterine growth restriction. This study aims to determine the proportion of women that met National Institute for Health and Care Excellence (NICE) standards for vitamin D supplementation in pregnancy and compare biochemical and obstetrical outcomes according to supplementation status.

Design and setting

This is a single-centre cross-sectional study in an antenatal centre in Birmingham, UK. Participants received a questionnaire regarding their experiences with vitamin D supplementation during their pregnancy with their general practitioner. Serum 25-hydroxyvitamin D and bone profile results were obtained during the same appointment and obstetrical outcomes were collected retrospectively once participants had delivered.

Results

41.8% of participants (n=61) received written and/or verbal advice about supplementation, (NICE standards=100%). 72.6% (n=106) had one or more risk factors for vitamin D deficiency, of which 38.7% (n=41, NICE standards=100%) were asked about supplementation. Among those asked, 85.4% (n=41, NICE standards=100%) received the correct dosage. Compared with the supplementation group, the non-supplementation group had offspring that were 1.40 cm (95% CI 0.01 to 2.80, p=0.04) longer at birth; which was significant after adjusting for confounding factors. No significant differences in any biochemical parameters were observed between supplementation categories (p>0.05).

Conclusions

Adherence to NICE standards was suboptimal. This may be attributed to insufficient training for general practitioners on the importance of supplementation, causing them to underestimate the consequences of gestational vitamin D deficiency. Recommendations include implementing a mandatory screening tool to identify ‘at-risk’ women and providing more clinician training to ensure that supplementation during pregnancy is standard of care.
Prognostic significance of dipstick proteinuria in heart failure with preserved ejection fraction: insight from the PURSUIT-HFpEF registry
Authors: Oeun Bolrathanak , Hikoso Shungo , Nakatani Daisaku , Mizuno Hiroya , Suna Shinichiro , Kitamura Tetsuhisa , Okada Katsuki , Dohi Tomoharu , Sotomi Yohei , Kida Hirota , Sunaga Akihiro , Sato Taiki , Nakagawa Akito , Nakagawa Yusuke , Hayashi Takaharu , Yano Masamichi , Tamaki Shunsuke , Yasumura Yoshio , Yamada Takahisa , Sakata Yasushi
Published: September 2021

Objective

The semiquantitative urine dipstick test is a simple and convenient method that is available in the smallest community-based healthcare clinics. We sought to clarify the prognostic significance of dipstick proteinuria in patients with heart failure (HF) with preserved ejection fraction (HFpEF).

Design

AProspective mUlticenteRobServational stUdy of patIenTs withHeartFailure withpreservedEjectionFraction (PURSUIT-HFpEF) registry.

Participants and setting

We assessed 851 discharged-alive patients in the PURSUIT-HFpEF registry who were initially hospitalised due to an acute decompensated HFpEF (EF≥50%) and elevated N-terminal-pro-brain natriuretic peptide (≥400 ng/L) at Osaka University Hospital and other 30 affiliated hospitals in the Kansai region of Japan. Patients received a urine dipstick test, and were divided into two groups according to the absence or presence of proteinuria. A trace or more of dipstick proteinuria was defined as the presence of proteinuria.

Main outcome measures

A composite of cardiac death or HF rehospitalisation.

Results

Median age was 83 years and 473 patients (55.6%) were female. Five hundred and two patients (59%) were proteinuria (−) and 349 patients (41%) were proteinuria (+). The composite endpoint and HF rehospitalisation occurred more often in proteinuria (+) individuals than proteinuria (−) individuals (log-rank p=0.006 and p=0.007, respectively); but cardiac death did not (log-rank p=0.139). Multivariable Cox regression analysis showed that the presence of proteinuria was associated with the composite endpoint (HR: 1.47, 95% CI 1.07 to 2.01, p=0.016), and HF rehospitalisation (HR: 1.48, 95% CI 1.07 to 2.05, p=0.020), but not with cardiac death (HR: 1.52, 95% CI 0.83 to 2.76, p=0.172).

Conclusions

Dipstick proteinuria may be a prognostic marker in patients with HFpEF. Evaluation of proteinuria by a urine dipstick test may be a simple but useful method for risk stratification in HFpEF.

UMIN-CTR ID

UMIN000021831.
Falls: a marker of preclinical Alzheimer disease: a cohort study protocol
Authors: Bollinger Rebecca M , Keleman Audrey , Thompson Regina , Westerhaus Elizabeth , Fagan Anne M , Benzinger Tammie LS , Schindler Suzanne E , Xiong Chengjie , Balota David , Morris John C , Ances Beau M , Stark Susan L
Published: September 2021

Introduction

Progression to symptomatic Alzheimer disease (AD) occurs slowly over a series of preclinical stages. Declining functional mobility may be an early indicator of loss of brain network integration and may lead to an increased risk of experiencing falls. It is unknown whether measures of functional mobility and falls are preclinical markers of AD. The purpose of this study is to examine (1) the relationship between falls and functional mobility with AD biomarkers to determine when falls occur within the temporal progression to symptomatic Alzheimer disease, and (2) the attentional compared with perceptual/motor systems that underlie falls and functional mobility changes seen with AD.

Methods and analysis

This longitudinal cohort study will be conducted at the Knight Alzheimer Disease Research Center. Approximately 350 cognitively normal participants (with and without preclinical AD) will complete an in-home visit every year for 4 years. During each yearly assessment, functional mobility will be assessed using the Performance Oriented Mobility Assessment, Timed Up and Go, and Timed Up and Go dual task. Data regarding falls (including number and severity) will be collected monthly by self-report and confirmed through interviews. This study will leverage ongoing neuropsychological assessments and neuroimaging (including molecular imaging using positron emission tomography and MRI) performed by the Knight Alzheimer Disease Research Center. Relationships between falls and biomarkers of amyloid, tau and neurodegeneration will be evaluated.

Ethics and dissemination

This study was approved by the Washington University in St. Louis Institutional Review Board (reference number 201807135). Written informed consent will be obtained in the home prior to the collection of any study data. Results will be published in peer-reviewed publications and presented at national and international conferences.

Trial registration number

NCT04949529; Pre-results.
Shared decision making interventions in mental healthcare: a protocol for an umbrella review
Authors: Chmielowska Marta , Zisman-Ilani Yaara , Saunders Rob , Pilling Stephen
Published: September 2021

Introduction

Shared decision making (SDM) has been advocated as a key component of person-centred care and recovery from mental illness. Although the principles of SDM have been well documented, there is a lack of guidance about how to accomplish SDM in mental healthcare. The objective of the present protocol is to describe the methods for an umbrella review to determine the effectiveness elements of SDM interventions for persons diagnosed with a mental illness. An umbrella review’s key characteristic is that it only considers for inclusion the highest level of evidence, namely other systematic reviews and meta-analyses.

Methods and Analysis

Electronic searches will be performed in CINAHL, PubMed, Scopus, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Library, Web of Science, Scopus and Ovid PsycINFO. Based on Joanna Briggs Institute recommended guidelines, review articles will be included if they were published between 2010 and 2021. This approach will help identify current and emerging evidence-based treatment options in mental illness. Included articles will be assessed for quality using Assessment of Multiple Systematic Reviews 2 tool and ratings of the quality of evidence in each review. Presentation of results will align with guidelines in the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Findings will be stratified by mode of intervention and implementation characteristics and will inform development of SDM taxonomy in mental healthcare.

Ethics and dissemination

This umbrella review will focus on the analysis of secondary data and does not require ethics approval. Findings will be disseminated widely to clinicians, researchers and services users via journal publication, conference presentations and social media. The results will contribute to the conceptualisation and understanding of effective SDM interventions in mental healthcare and to improving the quality of SDM for individuals with a mental illness.

PROSPERO registration number

CRD42020190700.
Searching for a technology-driven acute rheumatic fever test: the START study protocol
Authors: Ralph Anna P , Webb Rachel , Moreland Nicole J , McGregor Reuben , Bosco Anthony , Broadhurst David , Lassmann Timo , Barnett Timothy C , Benothman Rym , Yan Jennifer , Remenyi Bo , Bennett Julie , Wilson Nigel , Mayo Mark , Pearson Glenn , Kollmann Tobias , Carapetis Jonathan R
Published: September 2021

Introduction

The absence of a diagnostic test for acute rheumatic fever (ARF) is a major impediment in managing this serious childhood condition. ARF is an autoimmune condition triggered by infection with group AStreptococcus. It is the precursor to rheumatic heart disease (RHD), a leading cause of health inequity and premature mortality for Indigenous peoples of Australia, New Zealand and internationally.

Methods and analysis

‘Searching for a Technology-Driven Acute Rheumatic Fever Test’ (START) is a biomarker discovery study that aims to detect and test a biomarker signature that distinguishes ARF cases from non-ARF, and use systems biology and serology to better understand ARF pathogenesis. Eligible participants with ARF diagnosed by an expert clinical panel according to the 2015 Revised Jones Criteria, aged 5–30 years, will be recruited from three hospitals in Australia and New Zealand. Age, sex and ethnicity-matched individuals who are healthy or have non-ARF acute diagnoses or RHD, will be recruited as controls. In the discovery cohort, blood samples collected at baseline, and during convalescence in a subset, will be interrogated by comprehensive profiling to generate possible diagnostic biomarker signatures. A biomarker validation cohort will subsequently be used to test promising combinations of biomarkers. By defining the first biomarker signatures able to discriminate between ARF and other clinical conditions, the START study has the potential to transform the approach to ARF diagnosis and RHD prevention.

Ethics and dissemination

The study has approval from the Northern Territory Department of Health and Menzies School of Health Research ethics committee and the New Zealand Health and Disability Ethics Committee. It will be conducted according to ethical standards for research involving Indigenous Australians and New Zealand Māori and Pacific Peoples. Indigenous investigators and governance groups will provide oversight of study processes and advise on cultural matters.
Increasing the uptake of cervical screening at cornerstone medical practice
Authors: Oyegbite Adeola , Roberts Jessica , Bircher Joanna
Published: September 2021

Background

Nationally, cervical screening uptake is suboptimal, even though research shows that the programme is highly effective at preventing cervical cancer.

Local problem

Cornerstone is a small practice located in Salford in the North West of England. Historically, screening uptake here has been lower than average. There were 656 eligible women on our practice list and 177 of them were unscreened at the start of the project. The largest group of non-white British or Irish people on our list (13) spoke Polish as their first language.

Methods

We used quality improvement methods: the model for improvement, a driver diagram and Plan, Do, Study, Act cycles. Specifically, we targeted 177 women who were previously non-responders, as well as keeping up the regular screening service. We managed to contact 120 women during the project.

Interventions

We tested different methods of inviting women to attend cervical screening: telephone calls, text messages and letters. Later, a video link was also included in the text invitation. Information leaflets about the tests were added to letters. The letter was also translated into Polish.

Results

Uptake improved and the aim was reached. Telephone calls from the nurse increased uptake but took time away from other work, so was not a sustainable change for our practice. A letter stating evidence basis for the test, and a letter translated into Polish showed limited improvement. Sending letters with information leaflets and text messages with video links achieved similar response rates with no statistical significance when we analysed the data. Offering extended hours and flexible appointment times showed very positive results.

Conclusions

The text message with a video attached was adopted as an effective method for targeting persistent non-responders.

The project in its second year is being scaled up across the Primary Care Network.
Cohort study of impact on length of stay of individual enhanced recovery after surgery protocol components
Authors: Sisodia Rachel C. , Ellis Dan , Hidrue Michael , Linov Pamela , Cavallo Elena , Bryant Allison S. , Wakamatsu May , del Carmen Marcela G.
Published: September 2021

Objective

The goal of this study was to explore which enhanced recovery after surgery (ERAS) bundle items were most associated with decreased length of stay after surgery, most likely associated with decreased length of stay after surgery.

Design

A cohort study.

Setting

Large tertiary academic medical centre.

Participants

The study included 1318 women undergoing hysterectomy as part of our ERAS pathway between 1 February 2018 and 30 January 2020 and a matched historical cohort of all hysterectomies performed at our institution between 3 October 2016 and 30 January 2018 (n=1063).

Intervention

The addition of ERAS to perioperative care.

This is a cohort study of all patients undergoing hysterectomy at an academic medical centre after ERAS implementation on 1 February 2018. Compliance and outcomes after ERAS roll out were monitored and managed by a centralised team. Descriptive statistics, multivariate regression, interrupted time series analysis were used as indicated.

Main outcome measures

Impact of ERAS process measure adherence on length of stay.

Results

After initiation of ERAS pathway, 1318 women underwent hysterectomy. There were more open surgeries after ERAS implementation, but cohorts were otherwise balanced. The impact of process measure adherence on length of stay varied based on surgical approach (minimally invasive vs open). For open surgery, compliance with intraoperative antiemetics (−30%, 95% CI −18% to 40%) and decreased postoperative fluid administration (−12%, 95% CI −1% to 21%) were significantly associated with reduced length of stay. For minimally invasive surgery, ambulation within 8 hours of surgery was associated with reduced length of stay (−53%, 95% CI −55% to 52%).

Conclusions

While adherence to overall ERAS protocols decreases length of stay, the specific components of the bundle most significantly impacting this outcome remain elusive. Our data identify early ambulation, use of antiemetics and decreasing postoperative fluid administration to be associated with decreased length of stay.
A sex-related mediating effect of uric acid in the association between body composition and blood pressure in children and adolescents
Authors: Dutra Deyse M. , Zaniqueli Divanei , Alvim Rafael O. , Baldo Marcelo P. , Morra Elis A. , Faria Eliane R. , Mill José G. , Faria Carolina P.
Published: September 2021

The increase in blood pressure (BP) during somatic growth might have direct determinants but also mediating factors. We investigated whether uric acid (UA) and other metabolic factors would mediate the association between body composition components and BP. A cross-sectional study was conducted in 928 children and adolescents (aged 6–18 years), in which body composition and blood biochemistry were evaluated. Structural equation modeling was performed to test the direct and indirect pathways between systolic blood pressure (SBP) and body composition parameters. Muscle mass (MM) showed a strong direct effect on BP, regardless of sex. In girls, a mediating pathway through UA was not significant, but the association between fat mass (FM) and MM with SBP was mediated by the cluster of metabolic factors. In boys, both MM and FM were associated with SBP through a mediating pathway via UA, but not via the cluster of metabolic factors. The association between body composition and BP in children and adolescents has a complex design and also has a sex-specific mediating component. The increase in the UA levels may affect BP levels early in boys. Also, metabolic changes elicited by FM contribute to the increase in BP at an early age in girls.

Novelty: MM showed a strong direct effect on BP, regardless of sex. In girls, the association between FM and MM with SBP was mediated by the cluster of metabolic factors. In boys, both MM and FM were associated with SBP through a mediating pathway via UA.