bluuebunny/crossref_metadata_2025 huggingface dataset:
Non‐specific phospholipases C, NPC2 and NPC6, are required for root growth in Arabidopsis
Authors: Ngo Anh H. , Kanehara Kazue , Nakamura Yuki
Published: August 2019

Mutants in lipid metabolism often show a lethal phenotype during reproduction that prevents investigating a specific role of the lipid during different developmental processes. We focused on two non‐specific phospholipases C, NPC2 and NPC6, whose double knock‐out causes a gametophyte‐lethal phenotype. To investigate the role of NPC2 and NPC6 during vegetative growth, we produced transgenic knock‐down mutant lines that circumvent the lethal effect during gametogenesis. Despite no defect observed in leaves, root growth was significantly retarded, with abnormal cellular architecture in root columella cells. Furthermore, the short root phenotype was rescued by exogenous supplementation of phosphocholine, a product of non‐specific phospholipase C (NPC) ‐catalyzed phosphatidylcholine hydrolysis. The expression of phospho‐base N‐methyltransferase 1 (PMT1), which produces phosphocholine and is required for root growth, was induced in the knock‐down mutant lines and was attenuated after phosphocholine supplementation. These results suggest that NPC2 and NPC6 may be involved in root growth by producing phosphocholine via metabolic interaction with a PMT‐catalyzed pathway, which highlights a tissue‐specific role of NPC enzymes in vegetative growth beyond the gametophyte‐lethal phenotype.
Evaluation of a routine hematology analyzer for quality control of leukoreduced plasma
Authors: Petersson Annika , Ekblom Kim
Published: August 2019

BACKGROUND

Quality control of residual white blood cells (WBCs) and red blood cells (RBCs) in leukoreduced plasma is mandatory. Although technological advances have been made, analysis of quality controls using routine hematology analyzers has not generally been introduced. The aim of this study was to evaluate if the routine hematology analyzer Sysmex XN‐10, (Sysmex Nordic ApS) could be used for quality control of residual WBCs and RBCs in leukoreduced plasma.

STUDY DESIGN AND METHODS

Linearity, accuracy, and precision were established for two Sysmex XN‐10 analyzers using spiked donor plasma. ADAM rWBC (NanoEnTek) and manual counting in the Bürker chamber (NanoEnTek) were reference methods for WBCs and RBCs, respectively. Twenty‐five consecutive leukoreduced donor plasma samples were also tested.

RESULTS

For WBCs, the linearity criteria were met for the ADAM rWBC, but not for the Sysmex XN‐10 instruments. Precision on both Sysmex XN‐10 instruments was accurate only at 6 cells/μL, and accuracy was consistently acceptable only at 5 to 6 cells/μL. The precision and accuracy of the ADAM rWBC were acceptable at 2 to 6 cells/μL.

For RBCs, both Sysmex XN‐10 instruments and manual counting in the Bürker chamber were linear and fulfilled the precision criteria. Accuracy was acceptable for both Sysmex instruments at 6 to 12 × 109 WBCs/L but fluctuated within the study's measuring range for the Bürker chamber.

No false‐positive results were seen in the 25 consecutive donor plasma samples tested.

CONCLUSION

For quality control purposes of leukoreduced plasma, the Sysmex XN‐10 analyzer is suitable for the enumeration of residual RBCs but not of residual WBCs.
Acute Zika virus infection in an asymptomatic blood donor at the onset of the Puerto Rico epidemic
Authors: Saa Paula , Chiu Charles , Grimm Kacie , Yu Guixia , Benjamin Richard J. , Corash Laurence , Stramer Susan L.
Published: August 2019

BACKGROUND

Zika virus (ZIKV) spread to Puerto Rico likely originated from southeastern Brazil approximately 8.5 months earlier than blood donation screening for ZIKV was initiated, but the time of ZIKV introduction in the blood donor population remains unknown.

METHODS

To better understand when arboviral infections first appeared in the blood donor pool in Puerto Rico, we retrospectively screened for ZIKV RNA (as well as chikungunya [CHIKV] and dengue [DENV] viral RNA) a repository of 1186 linked blood donor and recipient samples collected from February 2015 to May 2016 as an endpoint efficacy measure following the introduction of platelet pathogen reduction (PR). Phylogenetic analysis identified relatedness of donor strain to other circulating strains, and molecular clock analysis identified the estimated time of introduction.

RESULTS

An asymptomatic donor collected in December 2015 was ZIKV RNA confirmed positive, 4 months BEFORE investigational nucleic acid testing (NAT) implementation in April 2016, coincident and related to the first reported autochthonous cases. No CHIKV RNA or DENV RNA reactives were identified in donors or recipients, and no adverse events were reported from PR use in recipients. Phylogenetic analysis confirmed the molecular relatedness of the donor ZIKV strain to the Puerto Rico lineage likely introduced approximately 4.5 months earlier.

CONCLUSION

This study identified an asymptomatic ZIKV infection in a blood donor occurring before those previously recognized by blood donation screening. NAT and PR continue to be used as acceptable strategies to prevent transfusion‐transmitted arboviral infections worldwide; however, repeated arboviral outbreaks warrant consideration of PR as a more proactive approach.
Examination of the relationship between the exploitation of geothermal sources and regional economies: a Beijing case study
Authors: Jiang Yong , Lei Yalin , Liu Jing , Li Li
Published: August 2019

Rapid urbanization has resulted in severe demands on water, heat and energy resources, which threaten the sustainability of the urban economy and environment. Geothermal energy is one of the cleanest sources of energy, and it plays an important role in the sustainability of the regional economy and environment. This paper employs the vector autoregressive (VAR) model to assess the effects of water, heat and energy consumption on geothermal adoption and the interactions among these factors. Beijing is chosen as a case study to investigate the water–heat–energy nexus and examination of the relationship between geothermal adoption and the regional economy. The results reveal that water consumption has mainly affected geothermal adoption. Water consumption and energy consumption have negative effects on geothermal adoption, while the centralized heat supply has a positive effect on geothermal adoption. This paper also adopts a gear model and coupling coordination degrees to investigate the relationship between geothermal adoption and the regional economy. The rates of geothermal adoption and the regional economy vary, but they are in a good state of coupling coordination. In addition, the coupling coordination of geothermal adoption and the regional economy has the potential to improve.
Auxiliary xenotransplantation as an in vivo bioreactor—Development of a transplantable liver graft from a tiny partial liver
Authors: Masano Yuki , Yagi Shintaro , Miyachi Yosuke , Okumura Shinya , Kaido Toshimi , Haga Hironori , Kobayashi Eiji , Uemoto Shinji
Published: August 2019

Background

We established a completely novel method of auxiliary xenogeneic partial liver transplantation and examined whether liver grafts procured from Syrian hamsters regenerated in nude rats, which were used as in vivo bioreactors.

Methods

The hamsters and the rats were all males (n = 10). Partial liver grafts from hamsters were transplanted into nude rats in an auxiliary manner. We evaluated liver graft injury, rejection, and regeneration during 7 days after auxiliary xenogeneic partial liver transplantation.

Results

All rats survived until sacrifice on post‐operative day (POD) 1, 3, and 7. HE‐staining showed normal at POD1, mild periportal edema, and slight bile duct and venous endothelial inflammation at POD3, and moderate acute cellular rejection at POD7 without parenchymal necrosis. The liver regeneration rates at POD3 and 7 were 1.54 ± 0.23 and 2.54 ± 0.43, respectively. The Ki‐67 labeling index was also elevated at POD3 (27.5 ± 4.1%). Serum HGF and VEGF were elevated at POD1 and 3. ATP levels of liver grafts recovered at POD7.

Conclusions

These results revealed that with appropriate immunosuppressive therapy, partial liver graft regeneration occurred in a xenogeneic animal, which suggests liver grafts regenerated in xenogeneic environments, such as an in vivo bioreactor, have potential to be transplantable liver grafts for humans.
FokI‐dCas9 mediates high‐fidelity genome editing in pigs
Authors: Fisicaro Nella , Salvaris Evelyn J. , Philip Gayle K. , Wakefield Matthew J. , Nottle Mark B. , Hawthorne Wayne J. , Cowan Peter J.
Published: August 2019

Gene editing using clustered regularly interspaced short palindromic repeats/Cas9 has great potential for improving the compatibility of porcine organs with human recipients. However, the risk of detrimental off‐target mutations in gene‐edited pigs remains largely undefined. We have previously generated GGTA1 knock‐in pigs for xenotransplantation using FokI‐dCas9, a variant of Cas9 that is reported to reduce the frequency of off‐target mutagenesis. In this study, we used whole genome sequencing (WGS) and optimized bioinformatic analysis to assess the fidelity of FokI‐dCas9 editing in the generation of these pigs. Genomic DNA was isolated from porcine cells before and after gene editing and sequenced by WGS. The genomic sequences were analyzed using GRIDSS variant‐calling software to detect putative structural variations (SVs), which were validated by PCR of DNA from knock‐in and wild‐type pigs. Platypus variant‐calling software was used to detect single‐nucleotide variations (SNVs) and small insertions/deletions (indels). GRIDSS analysis confirmed the precise integration of one copy of the knock‐in construct in the gene‐edited cells. Three additional SVs were detected by GRIDSS: deletions in intergenic regions in chromosome 6 and the X chromosome and a duplication of part of the CALD1 gene on chromosome 18. These mutations were not associated with plausible off‐target sites, and were not detected in a second line of knock‐in pigs generated using the same pair of guide RNAs, suggesting that they were the result of background mutation rather than off‐target activity. Platypus identified 1375 SNVs/indels after quality filtering, but none of these were located in proximity to potential off‐target sites, indicating that they were probably also spontaneous mutations. This is the first WGS analysis of pigs generated from FokI‐dCas9‐edited cells. Our results demonstrate that FokI‐dCas9 is capable of high‐fidelity gene editing with negligible off‐target or undesired on‐target mutagenesis.
Effects of isomaltulose ingestion on postexercise hydration state and heat loss responses in young men
Authors: Amano Tatsuro , Sugiyama Yuki , Okumura Junya , Fujii Naoto , Kenny Glen P. , Nishiyasu Takeshi , Inoue Yoshimitsu , Kondo Narihiko , Sasagawa Katsumi , Enoki Yasuaki , Maejima Daisuke
Published: August 2019

New Findings

What is the central question of this study?

What are the effects of isomaltulose, an ingredient in carbohydrate–electrolyte beverages to maintain glycaemia and attenuate the risk of dehydration during exercise heat stress, on postexercise rehydration and physiological heat loss responses?

What is the main finding and its importance?

Consumption of a 6.5% isomaltulose–electrolyte beverage following exercise heat stress restored hydration following a 2 h recovery as compared to a 2% solution or water only. While the 6.5% isomaltulose–electrolytes increased plasma volume and plasma osmolality, which are known to modulate postexercise heat loss, sweating and cutaneous vascular responses did not differ between conditions. Consequently, ingestion beverages containing 6.5% isomaltulose–electrolytes enhanced postexercise rehydration without affecting heat loss responses.

Isomaltulose is a disaccharide carbohydrate widely used during exercise to maintain glycaemia and hydration. We investigated the effects of ingesting a beverage containing isomaltulose and electrolytes on postexercise hydration state and physiological heat loss responses. In a randomized, single‐blind cross‐over design, 10 young healthy men were hypohydrated by performing up to three 30 min successive moderate‐intensity (50% heart rate reserve) bouts of cycling, each separated by 10 min, while wearing a water‐perfusion suit heated to 45°C. The protocol continued until a 2% reduction in body mass was achieved. Thereafter, participants performed a final 15 min moderate‐intensity exercise bout followed by a 2 h recovery. Following cessation of exercise, participants ingested a beverage consisting of (i) water only (Water), (ii) 2% isomaltulose (CHO‐2%), or (iii) 6.5% isomaltulose (CHO‐6.5%) equal to the volume of 2% body mass loss within the first 30 min of the recovery. Changes in plasma volume (ΔPV) after fluid ingestion were greater for CHO‐6.5% compared with CHO‐2% (120 min postexercise) and Water (90 and 120 min) (all P ≤ 0.040). Plasma osmolality remained elevated with CHO‐6.5% compared with consumption of the other beverages at 30 and 90 min postexercise (all P ≤ 0.050). Urine output tended to be reduced with CHO‐6.5% compared to other fluid conditions (main effect, P = 0.069). Rectal and mean skin temperatures, chest sweat rate and cutaneous perfusion did not differ between conditions (all P > 0.05). In conclusion, compared with CHO‐2% and Water, consuming a beverage consisting of CHO‐6.5% and electrolytes during recovery under heat stress enhances PV recovery without modulating physiological heat loss responses.
The passive leg movement technique for assessing vascular function: defining the distribution of blood flow and the impact of occluding the lower leg
Authors: Shields Katherine L. , Broxterman Ryan M. , Jarrett Catherine L. , Bisconti Angela V. , Park Soung Hun , Richardson Russell S.
Published: August 2019

New Findings

What is the central question of this study?

What is the distribution of the hyperaemic response to passive leg movement (PLM) in the common (CFA), deep (DFA) and superficial (SFA) femoral arteries? What is the impact of lower leg cuff‐induced blood flow occlusion on this response?

What is the main finding and its importance?

Of the total blood that passed through the CFA, the majority was directed to the DFA and this was unaffected by cuffing. As a small fraction does pass through the SFA to the lower leg, cuffing during PLM should be considered to emphasize the thigh‐specific hyperaemia.

It has yet to be quantified how passive leg movement (PLM)‐induced hyperaemia, an index of vascular function, is distributed beyond the common femoral artery (CFA), into the deep femoral (DFA) and the superficial femoral (SFA) arteries, which supply blood to the thigh and lower leg, respectively. Furthermore, the impact of cuffing the lower leg, a common practice, especially with drug infusions during PLM, on the hyperaemic response is, also, unknown. Therefore, PLM was performed with and without cuff‐induced blood flow (BF) occlusion to the lower leg in 10 healthy subjects, with BF assessed by Doppler ultrasound. In terms of BF distribution during PLM, of the 380 ± 191 ml of blood that passed through the CFA, 69 ± 8% was directed to the DFA, while only 31 ± 8% passed through the SFA. Cuff occlusion of the lower leg significantly attenuated the PLM‐induced hyperaemia through the SFA (∼30%), which was reflected by a fall in BF through the CFA (∼20%), but not through the DFA. Additionally, cuff occlusion significantly attenuated the PLM‐induced peak change in BF (BFΔpeak) in the SFA (324 ± 159 to 214 ± 114 ml min−1), which was, again, reflected in the CFA (1019 ± 438 to 833 ± 476 ml min−1), but not in the DFA. Thus, the PLM‐induced hyperaemia predominantly passes through the DFA and this was unaltered by cuffing. However, as a small fraction of the PLM‐induced hyperaemia does pass through the SFA to the lower leg, cuffing the lower leg during PLM should be considered to emphasize thigh‐specific hyperaemia in the PLM assessment of vascular function.
Evidence of adaptation of maternofetal transport of glutamine relative to placental size in normal mice, and in those with fetal growth restriction
Authors: McIntyre Kirsty R. , Hayward Christina E. , Sibley Colin P. , Greenwood Susan L. , Dilworth Mark R.
Published: August 2019

Key points

Fetal growth restriction (FGR) is a major risk factor for stillbirth and has significant impact upon lifelong health.

A small, poorly functioning placenta, as evidenced by reduced transport of nutrients to the baby, underpins FGR. It remains unclear how a small but normal placenta differs from the small FGR placenta in terms of ability to transfer nutrients to the fetus.

Placental transport of glutamine and glutamate, key amino acids for fetal growth, was assessed in normal mice and those with FGR.

Glutamine and glutamate transport was greater in the lightest versus heaviest placenta in a litter of normally grown mice. Placentas of mice with FGR had increased transport capacity in mid‐pregnancy, but this adaptation was insufficient in late pregnancy.

Placental adaptations, in terms of increased nutrient transport (per gram) to compensate for small size, appear to achieve appropriate fetal growth in normal pregnancy. Failure of this adaptation might contribute to FGR.

Fetal growth restriction (FGR), a major risk factor for stillbirth, and neonatal and adulthood morbidity, is associated with reduced placental size and decreased placental nutrient transport. In mice, a small, normal placenta increases its nutrient transport, thus compensating for its reduced size and maintaining normal fetal growth. Whether this adaptation occurs for glutamine and glutamate, two key amino acids for placental metabolism and fetal growth, is unknown. Additionally, an assessment of placental transport of glutamine and glutamate between FGR and normal pregnancy is currently lacking. We thus tested the hypothesis that the transport of glutamine and glutamate would be increased (per gram of tissue) in a small normal placenta [C57BL6/J (wild‐type, WT) mice], but that this adaptation fails in the small dysfunctional placenta in FGR [insulin‐like growth factor 2 knockout (P0) mouse model of FGR]. In WT mice, comparing the lightest versus heaviest placenta in a litter, unidirectional maternofetal clearance (Kmf) of 14C‐glutamine and 14C‐glutamate (glutamineKmf and glutamateKmf) was significantly higher at embryonic day (E) 18.5, in line with increased expression of LAT1, a glutamine transporter protein. In P0 mice, glutamineKmf and glutamateKmf were higher (P0 versus wild‐type littermates, WTL) at E15.5. At E18.5, glutamineKmf remained elevated whereas glutamateKmf was similar between groups. In summary, we provide evidence that glutamineKmf and glutamateKmf adapt according to placental size in WT mice. The placenta of the growth‐restricted P0 fetus also elevates transport capacity to compensate for size at E15.5, but this adaptation is insufficient at E18.5; this may contribute to decreased fetal growth.
College Coaching and Salary Restrictions: Using Law to Teach Current Events in the Classroom
Authors: Oregon Evie , McCoy Lauren , Carmon-Johnson Lacee’ , Brown-Reveles Angel
Published: August 2019

Each year, the college football season ends with hiring and firing moves. These transitions raise questions about the million-dollar salaries prevalent in college sports. Current events like this tend to dominate classroom conversations. Navigating these issues and their relation to class content can be challenging. Although the amount of money spent on coaches is not surprising, any discussion to provide new strategies may not be legally viable. For example, when students propose ideas about limiting coaching salaries, they may not realize the legal implication of that action. This case study uses the legal case-study model to address questions related to intercollegiate athletic coaching salaries and the possibility of a salary cap. Providing legal application in other courses will address these questions for both students and for faculty members who might not have the legal background to answer these questions.
How Well Do Routine Molecular Diagnostics Detect Rifampin Heteroresistance in Mycobacterium tuberculosis?
Authors: Ng Kamela C. S. , Supply Philip , Cobelens Frank G. J. , Gaudin Cyril , Gonzalez-Martin Julian , de Jong Bouke C. , Rigouts Leen
Published: August 2019

Rifampin heteroresistance—where rifampin-resistant and -susceptible tuberculosis (TB) bacilli coexist—may result in failed standard TB treatment and potential spread of rifampin-resistant strains. The detection of rifampin heteroresistance in routine rapid diagnostic tests (RDTs) allows for patients to receive prompt and effective multidrug-resistant-TB treatment and may improve rifampin-resistant TB control.
LYAR Suppresses Beta Interferon Induction by Targeting Phosphorylated Interferon Regulatory Factor 3
Authors: Yang Cha , Liu Xiaokun , Cheng Tailang , Xiao Rong , Gao Qingxia , Ming Fan , Jin Meilin , Chen Huanchun , Zhou Hongbo
Published: August 2019

Type I interferon (IFN-I) plays a critical role in the antiviral innate immune responses that protect the host against virus infection. The negative regulators of IFN-I are important not only for fine-tuning the antiviral responses to pathogens but also for preventing excessive inflammation. Identification of negative regulators and study of their modulation in innate immune responses will lead to new strategies for the control of both viral and inflammatory diseases. Here, we report for the first time that the cell growth-regulating nucleolar protein LYAR behaves as a repressor of host innate immune responses. We demonstrate that LYAR negatively regulates IFN-β-mediated immune responses by inhibiting the DNA binding ability of IFN regulatory factor 3 (IRF3). Our study reveals a common mechanism of LYAR in promoting different virus replication events and improves our knowledge of host negative regulation of innate immune responses.
Appendicitis within the contents of an incarcerated paraumbilical hernia
Authors: Zormpa Artemis , Alfa-Wali Maryam , Chung Alex
Published: August 2019

A 30-year-old woman known to have a paraumbilical hernia presented with central abdominal pain and vomiting. On examination, she was tender around the umbilical area, and a lump was felt on the umbilicus with associated skin changes. A CT scan was performed which showed an inflamed appendix within an incarcerated paraumblical hernia.
Methodical history taking may help in timely diagnosis of spontaneous intracranial hypotension
Authors: Irie Jin , Shiga Kensuke
Published: August 2019

Orthostatic headache (OH) is a key symptom of spontaneous intracranial hypotension (SIH). However, there is no optimal history taking for OH. A 35-year-old man complained of headache that prevented him from performing routine physical activities, which was relieved on lying down. We initially considered migraine as the most likely diagnosis. However, detailed history taking revealed that his headache worsened on standing, and he was finally diagnosed with SIH. Headache relief on lying down is not a specific indicator of OH associated with SIH. Thus, with regard to headache history taking, we suggest it important to confirm headache aggravation on standing.
Expansion of pulmonary arteriovenous malformations after grand mal seizures and other circumstances of PAVM growth
Authors: Schattner Ami , Dubin Ina
Published: August 2019

A woman with asymptomatic pulmonary arteriovenous malformation (PAVM) discovered incidentally on admission developed recurrent generalised seizures. Immediately after, the PAVM demonstrated marked expansion, and was safely resected. Congenital PAVMs (associated with hereditary haemorrhagic telangiectasia or sporadic) are considered stable lesions that exhibit very slow growth if at all. A review of the literature reveals all circumstances of accelerated growth of PAVM (puberty, pregnancy, postpartum, pulmonary hypertension) and suggests a novel mechanism of seizure-associated expansion. This is important because the size and rapid growth of PAVMs correlate with the potential for rupture and other ominous complications such as right to left shunt and paradoxical emboli. The new seizures–PAVM progression association mandates recognition since the risk of seizures in patients with PAVM is substantial. Our observations strongly suggest the need to monitor PAVM in patients with or without haemorrhagic telangiectasis by repeated imaging after generalised seizures to evaluate potential expansion and risk.
Secondary pneumatic retinopexy for failed scleral buckle
Authors: Balakrishnan Divya , Oli Avadhesh
Published: August 2019

Scleral buckle (SB) is a well-established modality to treat retinal detachment (RD). The surgery can fail because of various reasons. This case highlights the role of secondary pneumatic retinopexy (PR) for dealing with recurrent RD after SB surgery. This modality of treatment could be explored before taking up patients for vitrectomy, especially in cases of retinal break without proliferative vitreoretinopathy. In the case presented, secondary PR could save another major surgery and good outcome was achieved with less invasive option.
Pigmented paravenous retinochoroidal atrophy associated with unilateral cystoid macular oedema
Authors: Figueiredo Ricardo , Morais Sarmento Tiago , Garrido João , Ramalho António
Published: August 2019

A 65-year-old man was referred to our department with complaints of blurred vision in the left eye. Funduscopic examination revealed areas of retinochoroidal atrophy along the retinal veins bilaterally and bone spicule pigmentation along the nasal and superior temporal venous branches, as well as macular oedema in the left eye. Fluorescein angiography, visual field test, optical coherence tomography and electrophysiological examination were performed, and results were compatible with the diagnosis of pigmented paravenous retinochoroidal atrophy (PPRCA). Treatment with topical dorzolamide and intravitreal bevacizumab in the left eye resulted in poor anatomical and visual response. There is scarce documentation of macular involvement with non-inflammatory unilateral cystoid macular oedema in PPRCA in the literature. Further investigation is required to elucidate the pathogenesis of PPRCA and to properly manage these patients.
Using an Impella device to reverse refractory cardiac arrest and enable efficient coronary revascularisation
Authors: Persico Nicolas , Guervilly Christophe , Verhamme Baptiste , Bonello Laurent
Published: August 2019

We report the case of a 54-year-old man who suffered from refractory cardiac arrest secondary to acute myocardial infarction. As veno-arterial extracorporeal membrane oxygenation was unavailable, mechanical chest compression was performed and an Impella device was used that immediately delivered at 3.2 l/min flow to reach the optimal mean arterial pressure. Within 1 min, return of spontaneous circulation was achieved and a 40% left ventricular ejection fraction was measured on echography. Then, the right coronary artery could be revascularised. Despite 62 min low flow, the patient was discharged home on day 19 without neurological sequelae. During refractory cardiac arrest, the European Resuscitation Guidelines indicate that veno-arterial extracorporeal membrane oxygenation should be considered as rescue therapy. Other mechanical circulatory supports such as an Impella device (left ventricular assist device propelling blood in the ascending aorta) can be a promising treatment in select patients; however, insufficient data in humans are available.
Longitudinal changes in the ganglion cell-inner plexiform layer thickness in high myopia: a prospective observational study
Authors: Lee Min Woo , Nam Ki Yup , Park Hye Jin , Lim Hyung-Bin , Kim Jung-Yeul
Published: August 2019

Aim

To determine longitudinal changes of the ganglion cell-inner plexiform layer (GC-IPL) thickness in patients with high myopia.

Methods

The subjects were divided into two groups: a high myopia group (axial length ≥26.0 mm) and a normal control group. Both groups were divided into subgroups based on age (decade): 20s, 30s, 40s and 50s. Twenty eyes were included in each subgroup. After the initial visit, GC-IPL thicknesses were measured three more times with at least a 1-year interval between examinations using spectral domain optical coherence tomography. The average GC-IPL thickness was fitted with linear mixed models.

Results

The average GC-IPL thickness at the first visit was 78.50
±
8.79 µm and 84.29
±
6.12 µm in the high myopia and control groups, respectively. In both groups, the average GC-IPL thickness showed a significant change over time. The rate of GC-IPL reduction in individuals aged in their 50s, 40s, 30s and 20s with high myopia were −0.81 µm/year,–0.51 µm/year, −0.28 µm/year and −0.12 µm/year, respectively, and in controls in their 50s, 40s, 30s and 20s, they were −0.31 µm/year,–0.25 µm/year, −0.12 µm/year and −0.02 µm/year, respectively. Additionally, individuals aged in their 50s showed a statistically significant interaction between group and duration (p<0.001).

Conclusions

Highly myopic eyes had thinner GC-IPL and a significantly greater reduction in GC-IPL over 3 years when compared with normal eyes. Additionally, the reduction rate of the GC-IPL thickness was greater in older patients in both groups, which was more prominent in the high myopia group.
Institutionalising participatory health governance: lessons from nine years of the National Health Assembly model in Thailand
Authors: Rajan Dheepa , Mathurapote Nanoot , Putthasri Weerasak , Posayanonda Tipicha , Pinprateep Poldej , de Courcelles Sana , Bichon Rozenn , Ros Emma , Delobre Aurore , Schmets Gerard
Published: August 2019

Improving health governance is increasingly recognised as a key pillar for achieving universal health coverage (UHC). One good practice example of a participatory health governance platform is the National Health Assembly (NHA) in Thailand. This review of 9 years of the Thai NHA process attempted to understand how it works, given the paucity of such mechanisms worldwide. In addition, an in-depth look at its strengths and weaknesses allowed for reflection on whether the lessons learnt from this participatory governance model can be relevant for other settings.

Overall, the power of stakeholder groups coming together has been impressively harnessed in the NHA process. The NHA has helped foster dialogue through understanding and respect for very differing takes on the same issue. The way in which different stakeholders discuss with each other in a real attempt at consensus thus represents a qualitatively improved policy dialogue.

Nevertheless, the biggest challenge facing the NHA is ensuring a sustainable link to decision-making and the highest political circles. Modalities are needed to make NHA resolutions high priorities for the health sector.

The NHA embodies many core features of a well-prepared deliberative process as defined in the literature (information provision, diverse views, opportunity to discuss freely) as well as key ingredients to enable the public to effectively participate (credibility, legitimacy and power). This offers important lessons for other countries for conducting similar processes. However, more research is necessary to understand how improvements in the deliberative process lead to concrete policy outcomes.
Quasi-experimental study on the effectiveness of a house officer preparatory course for medical graduates on self-perceived confidence and readiness: a study protocol
Authors: Rashid Aneesa Abdul , Shariff Ghazali Sazlina , Mohamad Iliana , Mawardi Maliza , Roslan Dalila , Musa Husna
Published: August 2019

Introduction

Being a house officer (HO) is said to be associated with high levels of stress, leading to mental health problems and sometimes to quitting the medical profession altogether. In Malaysia, the number of HOs completing training on time is slowly declining, with increasing annual dropout rates. Feeling incompetent is one of the contributors towards this growing problem. This study aimed to evaluate the effectiveness of a 3-day pre-HO intervention module in addressing participants’ confidence, readiness and psychological well-being in preparation for their HO training.

Methods and analysis

The pre-HO intervention is the ‘Medicorp’ module that includes clerkship, experience sharing, hands-on skills training, common clinical cases and introduction of the local healthcare system. This is a pre-post quasi-experimental study lasting 1 year, with three assessment time points—at pretraining, immediately after training and 1 month into the participants’ HO-ship. The study is currently ongoing and involves 208 participants who attended the course in Malaysia. Participants with known psychiatric illness, working HOs and medical students are excluded. A pretested, self-administered questionnaire that includes baseline sociodemography, adaptation of the International Medical University (IMU) Student Competency Survey and the Depression Anxiety Stress Scale has been adopted, and 1 month follow-up will be conducted by telephone. Data will be analysed using SPSS V.24. The primary outcome is change in confidence level, while the secondary outcomes are changes in the readiness and psychological well-being of the participants.

Ethics and dissemination

This study protocol has received ethics approval from Ethics Committee for Research Involving Human Subjects Universiti Putra Malaysia and the National Medical Research Registry Malaysia. Written informed consent has been obtained from each participant. Results will be disseminated through journals and conferences, especially those involved in medical education specifically looking into the training of medical doctors.

Trial registration number

NCT03510195.
Attitudes of Korean smokers towards smoke-free public places: findings from the longitudinal ITC Korea Survey, 2005–2010
Authors: Park Eunja , Cho Sung-il , Seo Hong Gwan , Kim Yeol , Jung Hyun-Suk , Driezen Pete , Ouimet Janine , Quah Anne C K , Fong Geoffrey T.
Published: August 2019

Objective

Prior to December 2012, restaurants in South Korea were required to implement only partial smoking bans. This study documents the changes in Korean smokers’ attitudes towards smoking bans between 2005 and 2010 and explores the effects of anti-smoking advertising as a correlate of support for total smoking bans in public places.

Design

Longitudinal cohort study of Korean adult smokers.

Setting

The data were derived from three waves (2005, 2008 and 2010) of the International Tobacco Control (ITC) Korea Survey.

Participants

The ITC Korea Survey respondents were a probability-based, nationally representative sample of Korean smokers aged 19 and older. The current analysis includes 995 smokers who participated in Wave 1 (2005), 1737 smokers who participated in Wave 2 (2008) and 1560 smokers who participated in Wave 3 (2010).

Primary and secondary outcome measures

Changes in respondents’ awareness of secondhand smoke (SHS) harm, attitudes towards smoking bans and personal rules for smoking in private homes and/or vehicles were analysed. Correlates of support for smoking bans in public places were examined using generalised estimating equation regression models.

Results

More than 80% of Korean smokers are aware of the harms of SHS. The proportion of smokers who support smoke-free restaurants or smoke-free bars increased twofold between 2005 and 2010. Smokers who were aware of the dangers of SHS were more likely to support a total smoking ban in workplaces. Noticing anti-smoking advertising or information was not significantly associated with support for a total smoking ban in public places.

Conclusions

Korean smokers became more supportive of smoking bans in public places between 2005 and 2008. These results show that smokers’ attitudes towards smoking bans can change with the implementation of smoke-free policies, even in a country that has a high prevalence of smokers.
Implementing professional behaviour change in teams under pressure: results from phase one of a prospective process evaluation (theImplementing Nutrition Screening in Community Care for Older People(INSCCOPe) project)
Authors: Bracher Mike , Steward Katherine , Wallis Kathy , May Carl R , Aburrow Annemarie , Murphy Jane
Published: August 2019

Objectives

To evaluate the implementation of a new procedure for screening and treatment of malnutrition for older people in community settings and to identify factors promoting or inhibiting its implementation as a routine aspect of care.

Design

Prospective process evaluation using mixed methods with pre/post-implementation measures.

Setting and participants

Community teams (nursing and allied health professionals) within a UK National Health Service Community Trust. 73 participants were recruited, of which 32 completed both pre-implemetation and post-implementation surveys.

Main outcome measures

NoMAD survey for pre–post-intervention measures; telephone interviews exploring participant experiences and wider organisational/contextual processes.

Methods

Data prior to implementation of training, baseline (T0—survey and telephone interview) and 2 months following training (T1—follow-up survey). Quantitative data described using frequency tables reporting team type, healthcare provider role group and total study sample; analysis using Wilcoxon rank-sum (subgroup comparison) and Wilcoxon signed-rank (within-group observation point comparison) tests. Qualitative interview data (audio and transcription) analysed through directed content analysis using normalisation process theory.

Results

High support for nutrition screening and treatment indicated by participants. Concerns expressed around logistical, organisational and specialist dietetic support. Pre–post-training measures indicated a positive impact of training on knowledge of the new procedure; however, most implementation measures saw no significant changes between time points or between subgroups (training participants vs non-participants). Implementation barriers included the following: high levels of training non-completion; vulnerability to attrition of trained staff; lack of monitoring of post-intervention compliance and lack of access to dietetic support.

Conclusion

Greater support necessary to support implementation in relation to monitoring of training completion, and organisational support for nutrition screening and treatment activity. Recommended changes to implementation design are as follows: appointment of a key person to support and monitor procedure compliance; adoption of training as an e-learning module within the existing organisational platform to increase participation in changeable working conditions.
Multicentre, prospective observational study of the correlation between the Glasgow Admission Prediction Score and adverse outcomes
Authors: Jones Dominic , Cameron Allan , Lowe David J , Mason Suzanne M , O'Keeffe Colin A , Logan Eilidh
Published: August 2019

Objectives

To assess whether the Glasgow Admission Prediction Score (GAPS) is correlated with hospital length of stay, 6-month hospital readmission and 6-month all-cause mortality. This study represents a 6-month follow-up of patients who were included in an external validation of the GAPS’ ability to predict admission at the point of triage.

Setting

Sampling was conducted between February and May 2016 at two separate emergency departments (EDs) in Sheffield and Glasgow.

Participants

Data were collected prospectively at triage for consecutive adult patients who presented to the ED within sampling times. Any patients who avoided formal triage were excluded from the study. In total, 1420 patients were recruited.

Primary outcomes

GAPS was calculated following triage and did not influence patient management. Length of hospital stay, hospital readmission and mortality against GAPS were modelled using survival analysis at 6 months.

Results

Of the 1420 patients recruited, 39.6% of these patients were initially admitted to hospital. At 6 months, 30.6% of patients had been readmitted and 5.6% of patients had died. For those admitted at first presentation, the chance of being discharged fell by 4.3% (95% CI 3.2% to 5.3%) per GAPS point increase. Cox regression indicated a 9.2% (95% CI 7.3% to 11.1%) increase in the chance of 6-month hospital readmission per point increase in GAPS. An association between GAPS and 6-month mortality was demonstrated, with a hazard increase of 9.0% (95% CI 6.9% to 11.2%) for every point increase in GAPS.

Conclusion

A higher GAPS is associated with increased hospital length of stay, 6-month hospital readmission and 6-month all-cause mortality. While GAPS’s primary application may be to predict admission and support clinical decision making, GAPS may provide valuable insight into inpatient resource allocation and bed planning.
Psychosocial singing interventions for the mental health and well-being of family carers of patients with cancer: results from a longitudinal controlled study
Authors: Fancourt Daisy , Warran Katey , Finn Saoirse , Wiseman Theresa
Published: August 2019

Objective

The mental health challenges facing people who care for somebody with cancer are well documented. While many support interventions focus on provision of information or cognitive behavioural therapy, the literature suggests that psychosocial interventions could also be of value, especially given the low social support frequently reported by carers. Singing is a psychosocial activity shown to improve social support, increase positive emotions, and reduce fatigue and stress. This study explored whether weekly group singing can reduce anxiety, depression and well-being in cancer carers over a 6-month period.

Design

A multisite non-randomised longitudinal controlled study.

Setting

The Royal Marsden National Health Service Trust in Greater London.

Participants

62 adults who currently care for a spouse, relative or close friend with cancer who had not recently started any psychological therapy or medication.

Interventions

On enrolment, participants selected to join a weekly community choir for 12 weeks (n=33) or continue with life as usual (n=29).

Outcome measures

The primary outcome was mental health using the Hospital Anxiety and Depression Scale. The secondary outcome was well-being using the Warwick Edinburgh Mental Wellbeing Scale. Using linear mixed effects models, we compared the change in mental health and well-being over time between the two groups while adjusting for confounding variables including demographics, health-related variables, musical engagement and length of time caring.

Results

Participants in the choir group showed a significantly greater decrease in anxiety over time than participants in the control group (B=−0.94, SE=0.38, p=0.013) and a significantly greater increase in well-being (B=1.25, SE=0.49, p=0.011). No changes were found for depression. Sub-group analyses showed carers with anxiety or below-average well-being were most likely to benefit.

Conclusions

This study builds on previous research showing the mental health benefits of singing for people with cancer by showing that weekly singing can also support anxiety and well-being in cancer carers.
Training machine learning models to predict 30-day mortality in patients discharged from the emergency department: a retrospective, population-based registry study
Authors: Blom Mathias Carl , Ashfaq Awais , Sant'Anna Anita , Anderson Philip D , Lingman Markus
Published: August 2019

Objectives

The aim of this work was to train machine learning models to identify patients at end of life with clinically meaningful diagnostic accuracy, using 30-day mortality in patients discharged from the emergency department (ED) as a proxy.

Design

Retrospective, population-based registry study.

Setting

Swedish health services.

Primary and secondary outcome measures

All cause 30-day mortality.

Methods

Electronic health records (EHRs) and administrative data were used to train six supervised machine learning models to predict all-cause mortality within 30 days in patients discharged from EDs in southern Sweden, Europe.

Participants

The models were trained using 65 776 ED visits and validated on 55 164 visits from a separate ED to which the models were not exposed during training.

Results

The outcome occurred in 136 visits (0.21%) in the development set and in 83 visits (0.15%) in the validation set. The model with highest discrimination attained ROC–AUC 0.95 (95% CI 0.93 to 0.96), with sensitivity 0.87 (95% CI 0.80 to 0.93) and specificity 0.86 (0.86 to 0.86) on the validation set.

Conclusions

Multiple models displayed excellent discrimination on the validation set and outperformed available indexes for short-term mortality prediction interms of ROC–AUC (by indirect comparison). The practical utility of the models increases as the data they were trained on did not require costly de novo collection but were real-world data generated as a by-product of routine care delivery.
Interventional radiology versus operative management for splenic injuries: a study protocol for a systematic review and meta-analysis
Authors: Kashiura Masahiro , Yada Noritaka , Yamakawa Kazuma
Published: August 2019

Introduction

Over the past decades, the treatment for blunt splenic injuries has shifted from operative to non-operative management. Interventional radiology such as splenic arterial embolisation generally increases the success rate of non-operative management. However, the type of intervention, such as the first definitive treatment for haemostasis (interventional radiology or surgery) in blunt splenic injuries is unclear. Therefore, we aim to clarify whether interventional radiology improves mortality in patients with blunt splenic trauma compared with operative management by conducting a systematic review and meta-analysis.

Methods and analysis

We will search the following electronic bibliographic databases to retrieve relevant articles for the literature review: Medline, Embase and the Cochrane Central Register of Controlled Trials. We will include controlled trials and observational studies published until September 2018. We will screen search results, assess the study population, extract data and assess the risk of bias. Two review authors will extract data independently, and discrepancies will be identified and resolved through a discussion with a third author where necessary. Data from eligible studies will be pooled using a random-effects meta-analysis. Statistical heterogeneity will be assessed by using the Mantel-Haenszel χ² test and the I² statistic, and any observed heterogeneity will be quantified using the I² statistic. We will conduct sensitivity analyses according to several factors relevant for the heterogeneity.

Ethics and dissemination

Our study does not require ethical approval as it is based on the findings of previously published articles. This systematic review will provide guidance on selecting a method for haemostasis of splenic injuries and may also identify knowledge gaps that could direct further research in the field. Results will be disseminated through publication in a peer-reviewed journal and presentations at relevant conferences.

PROSPERO registration number

CRD42018108304.