bluuebunny/crossref_metadata_2025 huggingface dataset:
Postdivorce Parent–Child Contact and Child Well‐being: The Importance of Predivorce Parental Involvement
Authors: Poortman Anne‐Rigt
Published: April 2018

Frequent parent–child contact after divorce is generally assumed to be in children's best interests, but findings are mixed. This study extends the small body of research about the conditions under which parent–child contact is more beneficial or less beneficial by examining the role of predivorce parental involvement. It is argued that the more a parent was involved in child rearing in the past, the more important postdivorce parent–child contact is for child well‐being. Data from the Netherlands (N = 3,694) show that when children live with the parent who was not the primary caretaker, child well‐being is lower. Similarly, the more the father used to be involved in child rearing, the more beneficial nonresident father–child contact is for children. These findings suggest that it is not so much the frequency of contact per se that matters for child well‐being but, rather, the extent to which postdivorce residence arrangements reflect predivorce parenting arrangements.
Visitation Orders, Family Courts, and Fragile Families
Authors: Waller Maureen R. , Dwyer Emory Allison
Published: April 2018

Despite proposals to make parenting time a part of all new child support orders, limited research has examined why some unmarried are more likely than others to establish legal visitation agreements. This mixed‐methods study draws on qualitative data collected from unmarried mothers and fathers living in New York (N = 70) to develop hypotheses about the contexts in which parents set up visitation orders, which are then tested in a large sample of unmarried parents living apart (N = 1,392). Both qualitative and quantitative findings show that disengagement, cooperation, and conflict in the coparenting relationship postseparation influence unmarried parents' decisions about whether to establish a legal visitation agreement. The qualitative data further illustrate how parents' distrust of the court system, preference for informal agreements, and uncertainty about the custody of nonmarital children inform their decisions. The article concludes by considering approaches for helping low‐conflict coparents set up visitation agreements outside of family court.
A neural correlate for common trait dissociation: Decreased EEG connectivity is related to dissociative absorption
Authors: Soffer‐Dudek Nirit , Todder Doron , Shelef Leah , Deutsch Inbal , Gordon Shirley
Published: April 2018

Objective

Dissociation refers to a disintegration between psychological elements; common manifestations are embodied in “absorption and imaginative involvement,” a propensity for being immersed in a stimulus while oblivious to the environment, and acting without awareness. Trait dissociation was hypothesized to relate to lower EEG signal connectivity, but studies on healthy populations are scarce. The present study set out to examine whether dissociative absorption in a nonclinical sample would be associated with decreased intrahemispheric coherence.

Method

In 84 healthy Israeli soldiers (49% females;Mage = 22.24,SD = 2.64), resting‐state electroencephalography (rsEEG) was recorded for a period of 3 min with eyes closed and 3 min with eyes open.

Results

Decreased coherence was related to high dissociative absorption in the long (frontal‐occipital) range, and in one of the pairs of the short range (central‐parietal). The effects emerged mostly in the left hemisphere, in both eyes‐open and eyes‐closed conditions, and for a range of spectral bands, although long‐range effects were more pronounced in slow‐wave bands (theta and delta).

Conclusions

Dissociative absorption is manifested in segregated cortical activity, supporting the notion that it may represent less integrated mental functioning. The findings contribute to our understanding of the neural correlates of consciousness and personality.
Parent–child genetic testing for familial hypercholesterolaemia in an Australian context
Authors: Pang Jing , Martin Andrew C , Bates Timothy R , Hooper Amanda J , Bell Damon A , Burnett John R , Norman Richard , Watts Gerald F
Published: April 2018

Aim

The aim of this study was to evaluate the clinical outcome of parent–child testing for familial hypercholesterolaemia (FH) employing genetic testing and the likely additional cost of treating each child.

Methods

Parent–child testing for gene variants causative of FH was carried out according to Australian guidelines. The number of new cases detected, the low‐density lipoprotein (LDL)‐cholesterol that best predicted a mutation and the proportional reduction in LDL‐cholesterol following statin treatment was evaluated. Treatment costs were calculated as the cost per mmol/L reduction in LDL‐cholesterol.

Results

A total of 126 adult patients, known to have a pathogenic mutation causative of FH, and their children were studied. From 244 children identified, 148 (60.7%) were genetically screened; 84 children were identified as mutative positive (M+) and 64 as mutative negative. Six of the M+ children were already on statin treatment; 40 were subsequently treated with low‐dose statins, with LDL‐cholesterol falling significantly by 38% (P < 0.001). The estimated cost per mmol/L reduction of LDL‐cholesterol of a child receiving statins from ages 10 to 18 years is AU$1361, which can potentially be cost‐effective. An LDL‐cholesterol threshold of 3.5 mmol/L had a sensitivity of 92.8% and specificity of 96.6% for the detection of a mutation.

Conclusion

Genetic testing of children of affected parents with FH is an effective means of detecting new cases of FH. Cascade testing can enable early statin therapy with significant reductions in LDL‐cholesterol concentration.
Smartphone addiction risk and daytime sleepiness in Korean adolescents
Authors: Chung Jee Eun , Choi Soo An , Kim Ki Tai , Yee Jeong , Kim Joo Hee , Seong Jin Won , Seong Jong Mi , Kim Ju Young , Lee Kyung Eun , Gwak Hye Sun
Published: April 2018

Aim

Smartphone overuse can cause not only mobility problems in the wrists, fingers and neck but also interference with sleep habits. However, research on smartphone addiction and sleep disturbances is scarce. Therefore, we aimed to investigate daytime sleepiness in association with smartphone addiction risk in Korean adolescents.

Methods

A cross‐sectional survey method was used in this study. The Pediatric Daytime Sleepiness Scale was used to assess daytime sleepiness, and the Korean Smartphone Addiction Proneness Scale index was used to evaluate the degree of risk for smartphone addiction.

Results

The analyses were performed in 1796 adolescents using smartphones, including 820 boys and 976 girls. The at‐risk smartphone users made up 15.1% of boys and 23.9% of girls. Our multivariate analyses demonstrated that students who were female, consumed alcohol, had lower academic performance, did not feel refreshed in the morning and initiated sleep after 12 am were at a significantly higher risk of smartphone addiction. The at‐risk smartphone user group was independently associated with the upper quartile Pediatric Daytime Sleepiness Scale score in students with the following factors: Female gender, alcohol consumption, poor self‐perceived health level, initiating sleep after 12 am, longer time taken to fall asleep and duration of night sleep less than 6 h.

Conclusions

The quality of sleep in adolescence affects growth, emotional stability and learning skills. Therefore, the management of smartphone addiction seems to be essential for proper sleeping habits. There is a critical need to develop a means of preventing smartphone addiction on a social level.
Pilot study of acupuncture to treat anxiety in children and adolescents
Authors: Leung Brenda , Takeda Wendy , Holec Victoria
Published: April 2018

Aim

This pilot study investigated the use of acupuncture in the treatment of paediatric anxiety.

Methods

Children with anxiety, aged 8–16, were randomised to either the acupuncture or waitlist control groups. Anxiety was measured using the Hamilton Anxiety Rating Scale (HAM‐A) for children and adolescents with generalised anxiety disorder and Multidimensional Anxiety Scale for Children 2nd Edition (MASC‐2) self‐rated and parent‐rated forms.

Results

Twenty participants were enrolled in the study and 19 completed all the questionnaires to be included in the analysis. There were no differences in socio‐demographic characteristics at baseline between the two groups. At the second assessment, the mean MASC‐parent score for the acupuncture group was significantly lower than the waitlist group (65.6 (SD 15.0) compared to 81.0 (SD 11.9), P = 0.025) with an effect size = 1.13. The pre‐ and post‐treatment comparisons were also significantly lower for both groups in the anxiety measures. In the acupuncture group, MASC‐parent (P = 0.008, effect size 0.75) and the HAM‐A (P < 0.001, effect size 1.4). In the waitlist group, MASC‐self (P = 0.022; effect size 0.4), MASC‐parent (P = 0.048; effect size 0.75) and HAM‐A (P = 0.007; effect size 1.21).

Conclusions

This study provided promising results on the potential use of acupuncture to treat children and adolescents with general anxiety. Future research using a randomised control trial with a sufficient sample size to control for confounders and sham (placebo) comparators is warranted.
Propofol for implantable cardioverter defibrillator implantation in patients with Brugada syndrome
Authors: Kwon Hye‐Mee , Kim Sung‐Hoon , Park Se‐Ung , Rhim Jin‐Ho , Park Hee‐Sun , Kim Wook‐Jong , Nam Gi‐Byoung
Published: April 2018

Aims

Avoiding propofol in patients with Brugada syndrome has been suggested because of the theoretical risk of provoking ventricular arrhythmias, although propofol may be selected for conscious sedation during electrophysiological procedures in catheterization laboratories. This study aimed to document periprocedural electrocardiographic changes and adverse events in patients with Brugada syndrome undergoing implantable cardioverter defibrillator (ICD) implantation using propofol sedation.

Methods

We reviewed the clinical data of 53 consecutive patients who underwent ICD implantation during 1998–2011. Sedation was achieved by combining propofol with either midazolam or fentanyl, and a bolus propofol dose (0.5–1 mg/kg) was administered to induce deep sedation. Periprocedural events, including arrhythmias, defibrillations, and hyperthermia episodes, were evaluated, and electrocardiogram (ECG) variables were measured. The need for emergency anesthetic support/intubation and incidence of perioperative complications or mortality were analyzed.

Results

Procedure time and cumulative propofol dose for each patient was 125.2 (42.8) min and 204.6 (212.7) mg, respectively. During deep sedation, blood pressure, heart rate, and oxygen saturation were significantly decreased (P < 0.001) such that eight (15.1%) patients required manual ventilation and one (1.9%) needed atropine injection. No significant ECG changes were observed. Only two (3.7%) patients showed newly developed ST elevation in the anterior precordial lead, whereas three (5.6%) had isolated premature ventricular contractions.

Conclusion

ICD implantation without significant ECG changes or adverse outcomes is feasible under propofol sedation in patients with Brugada syndrome. However, because of significant hemodynamic changes and respiratory compromise, close monitoring and meticulous propofol dose titration is warranted.
A dicistronic precursor encoding miR398 and the legume‐specific miR2119 coregulates CSD1 and ADH1 mRNAs in response to water deficit
Authors: De la Rosa Carlos , Covarrubias Alejandra Alicia , Reyes José Luis
Published: April 2018

Plant microRNAs are commonly encoded in transcripts containing a single microRNA precursor. Processing by DICER‐LIKE 1 and associated factors results in the production of a small RNA, followed by its incorporation into an AGO‐containing protein complex to guide silencing of an mRNA possessing a complementary target sequence. Certain microRNA loci contain more than one precursor stem‐loop structure, thus encoding more than one microRNA in the same transcript. Here, we describe a unique case where the evolutionary conserved miR398a is encoded in the same transcript as the legume‐specific miR2119. The dicistronic arrangement found in common bean was also observed in other legumes. In Phaseolus vulgaris, mature miR398 and miR2119 are repressed in response to water deficit, and we demonstrate that both are functional as they target the mRNAs for CSD1 and ADH1, respectively. Our results indicate that the repression of miR398 and miR2119 leads to coordinated up‐regulation of CSD1 and ADH1 mRNAs in response to water deficit in common bean and possibly in other legumes. Furthermore, we show that miRNA directed CSD1 and ADH1 mRNAs up‐regulation also occurs when common bean plants are exposed to flooding, suggesting that plant redox status and fermentation metabolism must be closely coordinated under different adverse conditions.
Understanding Local Service Delivery Arrangements: Are the ICMA ASD Data Reliable?
Authors: Lamothe Meeyoung , Lamothe Scott , Bell Elizabeth
Published: April 2018

The authors utilize the two latest ICMA Profile of Local Government Service Delivery Choices surveys to investigate whether the service provision and delivery arrangement information reported in the surveys accurately represents reality and, if not, what factors contribute to generating incorrect or unreliable survey responses. Interviews with practitioners are used to better understand both the accuracy of the survey responses and improvements that could be made to the survey instrument. Results suggest that the ICMA ASD survey data are highly erratic, with more than 70 percent of the cases (N = 70) investigated containing some inaccuracies. A qualitative analysis shows that the majority of the errors appear to be caused by the lack of a clear definition of service provision or by the service titles being too vague or too broad, both of which likely lead to discretion in interpreting survey questions and thus inconsistent answers by individual respondents over time.
Clinical outcome of dental procedures among renal transplant recipients
Authors: Caliento Rubens , Sarmento Dmitry José de Santana , Kobayashi‐Velasco Solange , de Sá Stella Núbia Coelho , Shibutani Patrícia Pinheiro , Gallotini Marina
Published: April 2018

Aims

To compare outcomes of dental procedures among a group of renal transplant recipients who had received antibiotic prophylaxis (AP) before the procedure and another group that had not received AP.

Methods and Results

The records of all renal transplant patients treated at the Special Care Dentistry Center (SCDC) were assessed. Dental procedures documented in the records were classified as invasive or noninvasive. All dental procedures performed were compiled, and the prescription or nonprescription of prophylactic antibiotics, and the incidence and description of postoperative complications after invasive procedures were recorded. Eighty‐seven records were evaluated. Out of 190 invasive procedures all were simple dental extractions, 107 (56.3%) were preceded by AP; out of 242 noninvasive procedures, 14 (5.7%) were preceded by AP. A lack of uniformity on the type and dose of the antibiotic prescribed was observed. Four postoperative complications after invasive procedures (dental extraction) were noted and in 2 cases the procedures were preceded by AP.

Conclusion

This retrospective study showed no difference in postextraction outcomes between renal transplant recipients who received and who did not receive AP before dental extractions.
Clinical outcomes after colopexy through left ventral paramedian incision in 156 thoroughbred broodmares with large colon disorders (1999‐2015)
Authors: Broyles Alecsya H. , Hopper Scott A. , Woodie J. Brett , Ruggles Alan J.
Published: April 2018

Objective

To describe a technique for colopexy via a left ventral paramedian incision and report postoperative clinical outcomes.

Study Design

Retrospective case series.

Animals

One hundred fifty‐six thoroughbred broodmares treated with a colopexy through a left ventral paramedian incision between 1999 and 2015.

Methods

Medical records were reviewed for postoperative complications and survival to discharge. The survival rate at 1 year after surgery was based on the medical record, progeny record, or client telephone conversation. Progeny records were reviewed to assess reproductive performance. T tests, χ2tests, logistic regression, and Kaplan–Meier survival curves were used to identify prognostic factors.

Results

The rates of postoperative recurrence of large colon volvulus and colon rupture were 1.2% and 3%, respectively. Ninety‐three percent of mares that were treated were discharged alive from the hospital, and 78% were alive 1 year after surgery. The diagnosis of 1 of the following complications increased the risk of death within 1 year: systemic inflammatory response syndrome (SIRS), diarrhea, and/or thrombophlebitis (odds ratio [OR] 4.76). Sixty‐six percent of mares that were pregnant at the time of colopexy and discharged alive from the hospital produced a live foal. The percentage of live foals produced each year that the mare was bred after colopexy was 67%.

Conclusion

Thoroughbred mares treated with colopexy via a left paramedian incision had a good prognosis for survival and continued use as a broodmare. SIRS, diarrhea, or jugular thrombophlebitis affected long‐term survival in this population.

Clinical significance

Colopexy via a left paramedian incision is a suitable alternative to colopexies requiring a second incision or creating adhesions between the colon and the linea alba in thoroughbred mares.
Operator inequalities involving Khatri-Rao Sums and Moore-Penrose inverses
Authors: Ploymukda Arnon , Chansangiam Pattrawut
Published: April 2018

We establish relations between the Khatri-Rao sum of Hilbert space operators and ordinary products, powers, ordinary inverses, and Moore-Penrose inverses in terms of inequalities. In particular, such relations hold for the tensor sum of operators and the Khatri-Rao sum of complex matrices.
An overview of transboundary haze studies: The underlying causes and regional disputes on Southeast Asia Region
Authors: Ku Yusof Ku Mohd Kalkausar , Azid Azman , Samsudin Mohd Saiful , Jamalani Mohd. Asrul
Published: April 2018

Air pollution is now ranked as the ninth worst scenario globally and is expected to be the most serious global issue by the year 2050. The objective of this study is to get information regarding transboundary haze phenomenon blanketing the Southeast Asia that has been happened for decades ago. Various techniques such as qualitative and quantitative techniques have been applied to get the informative input detailed out by previous researchers. The finding shows that that the smoky haze occurred in the dry season, which at this point, the activities of cleaning and ground maintenance being carried out by Indonesian farmers. Indonesia is one of the countries drastically affected by deforestation process where their forest loss is 2% yr-1 which is equal to 1.9 million ha each year. The establishment of ASEAN in 2002 would be a turning point in addressing on more reliance on prevention and cooperation than establishing a liability regime or adopting legal instruments to protect the environment. However, the reflection of so-called ‘ASEAN Way', which preferred on non-interference in other states has inhibited the reliance on strong regional efforts in executing a more effective action in order to address and combat the transboundary haze pollution in Southeast Asia.
A preliminary study of marine water quality status using principal component analysis at three selected mangrove estuaries in East Coast Peninsular Malaysia
Authors: Khalit Saiful Iskandar , Samsudin Mohd Saiful , Azid Azman , Yunus Kamaruzzaman , Zaudi Muhammad Amar , Sharip Zati , Sharifuddin Syazrin Syima , Husin Tariq Mubarak
Published: April 2018

This research presents marine water quality status in three different mangrove estuaries. The objective of this study is to evaluate the surface water quality of three estuaries in east coast Peninsular Malaysia. The parameters measured were Dissolved Oxygen (DO), pH, Biochemical Oxygen Demand (BOD), total dissolved solid (TDS), ammonium (NH4-N), turbidity (TUR), total suspended solid (TSS) and coliform. Monthly sampling was performed during the dry season, from June 2016 until September 2016. Data were analysed using principal component analysis (PCA). PCA yielded two PCs where VF1 forms strong factor loadings for pH, NH4-N, SAL, and TDS signifying saltwater intrusion in mangrove area. VF2 designed strong factors of BOD, TUR and Coliform and strong negative loading of DO indicating anthropogenic pollutions in the area. This study output will be a baseline setting for future studies in mangrove estuary marine water quality. Mangrove marine water samples of future monitoring studies in mangrove estuary will benefit by enabling understanding of pollution loading and coastal water quality. It is essential to plan a workable water quality modelling as powerful tool to simulate marine water quality and forecast future consequences to facilitate mangrove biodiversity conservation.
Effect of H2O/SiO2 Molar Ratio on Direct Synthesis of ZSM-5 from Bangka’s Kaolin Without Pretreatment
Authors: Hartanto Djoko , Iqbal Rendy Muhamad , Shahbihi Wahyu Erizky , Santoso Eko , Fansuri Hamzah , Iryani Ani
Published: April 2018

The influence of the molar ratio H2O/SiO2 in the synthesis directly from Bangka Belitung’s Kaolin has been studied by performing synthesis of ZSM-5 with a variation of the molar ratio H2O/SiO2 is different at 15, 25, 30, and 35. Weighing 3.980 g Bangka’s kaolin are added other material so obtained molar composition 10Na2O: 120SiO2: 2Al2O3: 1800-4200H2O, and 1% of silicalite seed, subsequent hydrothermal process of 175°C for 24 hours. The result of solids was analyzed by X-ray diffraction (XRD) and Fourier Transform Infrared (FTIR) and SEM EDX to the analyzed morphology of ZSM-5 crystal. The synthesis of ZSM-5 was directly optimum with molar ratio H2O/SiO2 of 30 having the highest cristallinity and largest crystal size of 59.44% and 3.795 µm, respectively.
Whole-Genome Sequencing of Recent Listeria monocytogenes Isolates from Germany Reveals Population Structure and Disease Clusters
Authors: Halbedel Sven , Prager Rita , Fuchs Stephan , Trost Eva , Werner Guido , Flieger Antje
Published: April 2018

Listeria monocytogenes
causes foodborne outbreaks with high mortality. For improvement of outbreak cluster detection, the German consiliary laboratory for listeriosis implemented whole-genome sequencing (WGS) in 2015. A total of 424 human
L. monocytogenes
isolates collected in 2007 to 2017 were subjected to WGS and core-genome multilocus sequence typing (cgMLST). cgMLST grouped the isolates into 38 complexes, reflecting 4 known and 34 unknown disease clusters. Most of these complexes were confirmed by single nucleotide polymorphism (SNP) calling, but some were further differentiated. Interestingly, several cgMLST cluster types were further subtyped by pulsed-field gel electrophoresis, partly due to phage insertions in the accessory genome. Our results highlight the usefulness of cgMLST for routine cluster detection but also show that cgMLST complexes require validation by methods providing higher typing resolution. Twelve cgMLST clusters included recent cases, suggesting activity of the source. Therefore, the cgMLST nomenclature data presented here may support future public health actions.
Convergent Metabolic Specialization through Distinct Evolutionary Paths in Pseudomonas aeruginosa
Authors: La Rosa Ruggero , Johansen Helle Krogh , Molin Søren
Published: April 2018

Evolution by natural selection under complex and dynamic environmental conditions occurs through intricate and often counterintuitive trajectories affecting many genes and metabolic solutions. To study short- and long-term evolution of bacteria
in vivo
, we used the natural model system of cystic fibrosis (CF) infection. In this work, we investigated how and through which trajectories evolution of
Pseudomonas aeruginosa
occurs when migrating from the environment to the airways of CF patients, and specifically, we determined reduction of growth rate and metabolic specialization as signatures of adaptive evolution. We show that central metabolic pathways of three distinct
Pseudomonas aeruginosa
lineages coevolving within the same environment become restructured at the cost of versatility during long-term colonization. Cell physiology changes from naive to adapted phenotypes resulted in (i) alteration of growth potential that particularly converged to a slow-growth phenotype, (ii) alteration of nutritional requirements due to auxotrophy, (iii) tailored preference for carbon source assimilation from CF sputum, (iv) reduced arginine and pyruvate fermentation processes, and (v) increased oxygen requirements. Interestingly, although convergence was evidenced at the phenotypic level of metabolic specialization, comparative genomics disclosed diverse mutational patterns underlying the different evolutionary trajectories. Therefore, distinct combinations of genetic and regulatory changes converge to common metabolic adaptive trajectories leading to within-host metabolic specialization. This study gives new insight into bacterial metabolic evolution during long-term colonization of a new environmental niche.

IMPORTANCE
Only a few examples of real-time evolutionary investigations in environments outside the laboratory are described in the scientific literature. Remembering that biological evolution, as it has progressed in nature, has not taken place in test tubes, it is not surprising that conclusions from our investigations of bacterial evolution in the CF model system are different from what has been concluded from laboratory experiments. The analysis presented here of the metabolic and regulatory driving forces leading to successful adaptation to a new environment provides an important insight into the role of metabolism and its regulatory mechanisms for successful adaptation of microorganisms in dynamic and complex environments. Understanding the trajectories of adaptation, as well as the mechanisms behind slow growth and rewiring of regulatory and metabolic networks, is a key element to understand the adaptive robustness and evolvability of bacteria in the process of increasing their
in vivo
fitness when conquering new territories.
Considering the Lives of Microbes in Microbial Communities
Authors: Shank Elizabeth A.
Published: April 2018

Over the last decades, sequencing technologies have transformed our ability to investigate the composition and functional capacity of microbial communities. Even so, critical questions remain about these complex systems that cannot be addressed by the bulk, community-averaged data typically provided by sequencing methods.
Scoliosis in association with the 22q11.2 deletion syndrome: an observational study
Authors: Homans Jelle F , Baldew Vyaas G M , Brink Rob C , Kruyt Moyo C , Schlösser Tom P C , Houben Michiel L , Deeney Vincent F X , Crowley Terrence B , Castelein René M , McDonald-McGinn Donna M
Published: April 2018

Objective

The 22q11.2 deletion syndrome (22q11.2DS) is the most common microdeletion syndrome in humans. It is characterised by wide phenotypic variability, including congenital heart disease (CHD), immunodeficiency and scoliosis. However, little is known regarding the prevalence and characteristics of scoliosis in patients with 22q11.2DS. The objective of this study is to assess the prevalence of scoliosis, its characteristics and the association with CHD in patients with 22q11.2DS.

Design

This prevalence study is based on physical examination and questionnaires of the world’s largest 22q11.2DS longitudinal collected database (n=1393, Children’s Hospital of Philadelphia) and was augmented with the scoliosis prevalence based on radiography in a smaller cohort (cross-sectional, University Medical Center Utrecht).

Patients

Patients with a laboratory-confirmed 22q11.2 deletion who visited the specialised outpatient clinics were considered for inclusion.

Main outcome measures

(1) The prevalence of scoliosis, (2) its association with CHD, and (3) the similarity between 22q11.2DS curve patterns and adolescent idiopathic scoliosis (AIS) curve patterns.

Results

Within the Philadelphia cohort, the prevalence of scoliosis in patients older than 16 years (n=317) was 48% (n=152). A similar prevalence (49%) was shown for the younger Utrecht cohort (n=97). The occurrence of scoliosis was not associated with the presence of CHD. Sixty-three per cent of patients with scoliosis had a scoliotic curve pattern that resembled AIS.

Conclusions

Clinicians should be aware that scoliosis is highly prevalent (48%–49%) in association with 22q11.2DS, irrespective of other clinical features (eg, the presence of CHD). Furthermore, 22q11.2DS may provide insights into the causes of AIS.
Acute lower limb ischaemia secondary to intestinal occlusion
Authors: Malo Francois-Charles , Acar Philippe , Lapie Véronique , Bédard Valérie
Published: April 2018

In general, acute lower limb ischaemia is caused by embolic, thrombotic or traumatic phenomena. Here, we describe the case of a 67-year-old woman in an emergency room setting who was initially assessed for paralysis and numbness of her lower left limb. On physical examination, the abdomen was distended and non-compressible. An abdominal AngioScan showed complete occlusion of the left iliac artery by extrinsic compression of the dilated small intestine. After a review of the literature, no case was found describing a lower limb ischaemia by extrinsic vascular compression secondary to a compartment syndrome caused by small bowel obstruction. The treatment of this case required surgical decompression of the abdomen which led to an instantaneous reperfusion of the left leg. Unfortunately, the patient deceased a few hours after the surgery due to haemodynamic deterioration.
Distribution and determinants of pneumonia diagnosis using Integrated Management of Childhood Illness guidelines: a nationally representative study in Malawi
Authors: Uwemedimo Omolara T , Lewis Todd P , Essien Elsie A , Chan Grace J , Nsona Humphreys , Kruk Margaret E , Leslie Hannah H
Published: April 2018

Background

Pneumonia remains the leading cause of child mortality in sub-Saharan Africa. The Integrated Management of Childhood Illness (IMCI) strategy was developed to standardise care in low-income and middle-income countries for major childhood illnesses and can effectively improve healthcare worker performance. Suboptimal clinical evaluation can result in missed diagnoses and excess morbidity and mortality. We estimate the sensitivity of pneumonia diagnosis and investigate its determinants among children in Malawi.

Methods

Data were obtained from the 2013–2014 Service Provision Assessment survey, a census of health facilities in Malawi that included direct observation of care and re-examination of children by trained observers. We calculated sensitivity of pneumonia diagnosis and used multilevel log-binomial regression to assess factors associated with diagnostic sensitivity.

Results

3136 clinical visits for children 2–59 months old were observed at 742 health facilities. Healthcare workers completed an average of 30% (SD 13%) of IMCI guidelines in each encounter. 573 children met the IMCI criteria for pneumonia; 118 (21%) were correctly diagnosed. Advanced practice clinicians were more likely than other providers to diagnose pneumonia correctly (adjusted relative risk 2.00, 95% CI 1.21 to 3.29). Clinical quality was strongly associated with correct diagnosis: sensitivity was 23% in providers at the 75th percentile for guideline adherence compared with 14% for those at the 25th percentile. Contextual factors, facility structural readiness, and training or supervision were not associated with sensitivity.

Conclusions

Care quality for Malawian children is poor, with low guideline adherence and missed diagnosis for four of five children with pneumonia. Better sensitivity is associated with provider type and higher adherence to IMCI. Existing interventions such as training and supportive supervision are associated with higher guideline adherence, but are insufficient to meaningfully improve sensitivity. Innovative and scalable quality improvement interventions are needed to strengthen health systems and reduce avoidable child mortality.
Supporting the development of a health benefits package in Malawi
Authors: Ochalek Jessica , Revill Paul , Manthalu Gerald , McGuire Finn , Nkhoma Dominic , Rollinger Alexandra , Sculpher Mark , Claxton Karl
Published: April 2018

Malawi, like many low-income and middle-income countries, has used health benefits packages (HBPs) to allocate scarce resources to key healthcare interventions. With no widely accepted method for their development, HBPs often promise more than can be delivered, given available resources. An analytical framework is developed to guide the design of HBPs that can identify the potential value of including and implementing different interventions. It provides a basis for informing meaningful discussions between governments, donors and other stakeholders around the trade-offs implicit in package design. Metrics of value, founded on an understanding of the health opportunity costs of the choices faced, are used to quantify the scale of the potential net health impact (net disability adjusted life years averted) or the amount of additional healthcare resources that would be required to deliver similar net health impacts with existing interventions (the financial value to the healthcare system). The framework can be applied to answer key questions around, for example: the appropriate scale of the HBP; which interventions represent ‘best buys’ and should be prioritised; where investments in scaling up interventions and health system strengthening should be made; whether the package should be expanded; costs of the conditionalities of donor funding and how objectives beyond improving population health can be considered. This is illustrated using data from Malawi. The framework was successfully applied to inform the HBP in Malawi, as a core component of the country’s Health Sector Strategic Plan II 2017–2022.
Should total calcium be adjusted for albumin? A retrospective observational study of laboratory data from central Norway
Authors: Lian Ingrid Alsos , Åsberg Arne
Published: April 2018

Objectives

Albumin-adjusted total calcium is often used as a surrogate marker for free calcium to evaluate hypocalcaemia or hypercalcaemia. Many adjustment formulas based on simple linear regression models have been published, and continue to be used in spite of questionable diagnostic accuracy. In the hope of finding a more pure albumin effect on total calcium, we used multiple linear regression models to adjust for other relevant variables. The regression coefficients of albumin were used to construct local adjustment formulas, and we tested whether the diagnostic accuracy was improved compared with previously published formulas and unadjusted calcium.

Design

A retrospective hospital laboratory data study.

Data sources

The local hospital laboratory data system.

Setting

Norway, 2006–2015.

Participants

6549 patients above 2 years of age, where free calcium standardised at pH 7.40, total calcium, creatinine, albumin and phosphate had been analysed in a single blood draw, including hospitalised patients and patients from outpatient clinics and general practice.

Main outcome measures

Diagnostic accuracy by Harrell’s c and receiver operating characteristic curve analysis, using free calcium standardised at pH 7.40 as a gold standard, in subgroups with estimated glomerular filtration rate (eGFR) ≥60 or <60 mL/min/1.73 m2.

Results

In the subgroup with eGFR <60 mL/min/1.73 m2, the Harrell’s c of unadjusted total calcium (0.801) was significantly larger than those of the local formulas (0.790, p=0.002) and the best formula taken from literature (0.791, p=0.004). In the subgroup with eGFR ≥60 mL/min/1.73 m2, no significant differences were found between these three formulas.

Conclusions

Our study shows that the diagnostic accuracy ofunadjustedtotal calcium is superior to several commonly used adjustment formulas, and we suggest that the use of such formulas should be abandoned in clinical practice. If the clinician does not trust total calcium to reflect the calcium status of the patient, free calcium should be measured.
Long-term benzodiazepine use in patients taking antidepressants in a public health setting in Brazil: a cross-sectional study
Authors: Fulone Izabela , Silva Marcus Tolentino , Lopes Luciane Cruz
Published: April 2018

Objective

The aims of the study were to investigate the prevalence of long-term use of benzodiazepines in patients taking antidepressants and to identify the risk factors associated with the prolonged use of benzodiazepines.

Design

Cross-sectional study.

Setting

Public health system in Brazil.

Participants

Outpatients using antidepressants from January 2008 to December 2009 were included. The data were obtained from pharmacy databases and medical records. All individuals in the database were included in the study and were classified into two categories: (1) patients who had not used benzodiazepines combined with antidepressants or had combined the use of antidepressants with benzodiazepines for a short period (up to 4 weeks), and (2) those who used antidepressants plus benzodiazepines for a longer period (more than 4 weeks).

Main outcome measure

The outcome measure is prolonged use of benzodiazepines (more than 4 weeks). We conducted a multivariate analysis to identify the factors associated with prolonged use of benzodiazepines.

Results

Forty per cent of the 870 patients evaluated had prolonged use of benzodiazepines (more than 4 weeks). The risk factors associated with prolonged use were age above 35 years (prevalence ratio (PR): 2.18, 95% CI 1.55 to 3.06, P<0.001), female sex (PR: 1.47, 95% CI 1.07 to 2.02, P=0.019), diagnosis at least 3 years prior (PR: 2.1, 95% CI 1.6 to 2.8, P<0.001), use of selective serotonin reuptake inhibitor antidepressants (PR: 1.7, 95% CI 1.3 to 2.2, P<0.001) and having a prescription from a psychiatrist (PR: 6.5, 95% CI 3.2 to 13.2, P<0.001).

Conclusions

Prolonged use of benzodiazepines occurs more frequently in women, adults diagnosed several years earlier, users of selective serotonin reuptake inhibitor antidepressants and those who received a prescription from a psychiatrist. Education of clinicians, especially with regard to these populations, may decrease the overuse and misuse of benzodiazepines.
Risk of perinatal mortality in the first year of midwifery practice in New Zealand: analysis of a retrospective national cohort
Authors: Sadler Lynn C , McAra-Couper Judith , Pittam Deborah , Wise Michelle R , Thompson John M D
Published: April 2018

Objectives

To determine whether there was an increased risk of perinatal mortality among mothers booked for care with community lead maternity carer (LMC) midwives in their first compared with later years of practice.

Design

Retrospective cohort study using linked national maternity, mortality and workforce data; adjusted analysis using logistic regression.

Setting

New Zealand.

Participants

Women under community LMC midwifery care birthing 2008–2014.

Main outcome measures

Perinatal mortality (stillbirths and neonatal deaths of babies born from 20 weeks’ gestation to the 27th day of postnatal life), excluding terminations and deaths associated with congenital abnormalities.

Results

There were 2045 deaths among 344 910 births booked with midwives.

First year of practice midwives cared for women with higher risk of perinatal mortality, including Māori, Pacific, Indian, <20-year-old mothers, nullipara, smokers, women living in socioeconomic deprivation and with high body mass index, than midwives beyond first year of practice.

There was a significant reduction in unadjusted odds of perinatal mortality among women under the care of midwives beyond the first year compared with those within the first year (OR 0.79, 95% CI 0.67 to 0.93) but no significant reduction in risk remained after adjusting for known risk factors, (OR 0.89, 95% CI 0.74 to 1.07).

There was a significant increase in the adjusted odds of perinatal mortality among midwives booking a caseload of 15 or fewer mothers per year (1.34, 1.01 to 1.78) and 16 to 30 (1.25, 1.04 to 1.50) compared with midwives booking 51 to 80.

Conclusions

Findings suggest that the first year of midwifery practice is not associated with an increased risk of perinatal mortality but there is evidence that early career midwives are caring for higher-risk women. These findings suggest inequity of access for higher-risk women to experienced midwives and highlight an opportunity to improve support for vulnerable women and new midwives.
Antithrombotic therapy in patients receiving saphenous vein coronary artery bypass grafts: a protocol for a systematic review and network meta-analysis
Authors: Solo Karla , Martin Janet , Lavi Shahar , Kabali Conrad , John-Baptiste Ava , Nevis Immaculate F , Choudhury Tawfiq , Mamas Mamas A , Bagur Rodrigo
Published: April 2018

Introduction

The current evidence for the prevention of saphenous vein graft failure (SVGF) after coronary artery bypass graft (CABG) surgery consists of direct head-to-head comparison of treatments (including placebo) in randomised-controlled trials (RCTs) and observational studies. However, summarising the evidence using traditional pairwise meta-analyses does not allow the inclusion of data from treatments that have not been compared head to head. Exclusion of such comparisons could impact the precision of pooled estimates in a meta-analysis. Hence, to address the challenge of whether aspirin alone or in addition to another antithrombotic agent is a more effective regimen to improve SVG patency, a network meta-analysis (NMA) is necessary. The objectives of this study are to synthesise the available evidence on antithrombotic agents (or their combination) and estimate the treatment effects among direct and indirect treatment comparisons on SVGF and major adverse cardiovascular events, and to generate a treatment ranking according to their efficacy and safety outcomes.

Methods

We will perform a systematic review of RCTs evaluating antithrombotic agents in patients undergoing CABG. A comprehensive English literature search will be conducted using electronic databases and grey literature resources to identify published and unpublished articles. Two individuals will independently and in duplicate screen potential studies, assess the eligibility of potential studies and extract data. Risk of bias and quality of evidence will also be evaluated independently and in duplicate. We will investigate the data to ensure its suitability for NMA, including adequacy of the outcome data and transitivity of treatment effects. We plan to estimate the pooled direct, indirect and the mixed effects for all antithrombotic agents using a NMA.

Ethics and dissemination

Due to the nature of the study, there are no ethical concerns nor informed consent required. We anticipate that this NMA will be the first to simultaneously assess the relative effects of multiple antithrombotic agents in patients undergoing CABG. The results of this NMA will inform clinicians, patients and guideline developers the best available evidence on comparative effects benefits of antithrombotic agents after CABG while considering the side effect profile to support future clinical decision-making. We will disseminate the results of our systematic review and NMA through a peer-reviewed journal.

PROSPERO registration number

CRD42017065678.
Pathways of association between maternal haemoglobin and stillbirth: path-analysis of maternity data from two hospitals in England
Authors: Nair Manisha , Knight Marian , Robinson Susan , Nelson-Piercy Catherine , Stanworth Simon J , Churchill David
Published: April 2018

Objective

To investigate the mechanisms that link maternal haemoglobin concentration with stillbirth.

Design

A retrospective cohort analysis using anonymised maternity data from two hospitals in England.

Setting

The Royal Wolverhampton NHS Trust and Guy’s and St Thomas’ NHS Foundation Trust.

Study population

12 636 women with singleton pregnancies ≥24 weeks of gestation giving birth in the two hospitals during 2013–2015.

Method

A conceptual framework of hypothesised pathways through birth weight-for-gestational age and maternal infection including potential confounders and other risk factors was developed and examined using path-analysis. Path-analysis was performed by fitting a set of regression equations using weighted least squares adjusted for mean and variance. Goodness-of-fit indices were estimated.

Main outcome measures

Coefficient of association (β) for relationship between each parameter, and direct, indirect and total effects via the postulated pathways.

Results

The path-model showed a significant adjusted indirect negative effect of maternal haemoglobin on stillbirth mediated via birth weight-for-gestational age (standardised estimate (SE)=−0.01; 95% CI=−0.01 to −0.001; P=0.028). The effect through maternal infection was not significant at P<0.05 (SE=0.001; 95% CI=−0.004 to 0.01; P=0.610). There was a residual direct negative effect of maternal haemoglobin on stillbirth (SE=−0.12; 95% CI −0.23 to −0.02; P=0.020) after accounting for the two pathways. Total indirect SE=−0.004; 95% CI −0.01 to 0.003; P=0.267; total direct and indirect SE=−0.13; 95% CI −0.23 to −0.02; P=0.016. The goodness-of-fit indices showed a good fit between the model and the data.

Conclusion

While some of the influence on risk of stillbirth acts through low birth weight-for-gestational age, the majority does not. Several new mechanisms have been suggested for how haemoglobin may be exerting its influence on the risk of stillbirth possibly involving genetic, epigenetic and/or alternative obstetric and nutritional pathologies, but much more research is needed.