bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowing what’s growing: Why ductal and intraductal prostate cancer matter
Authors: Lawrence Mitchell G. , Porter Laura H. , Clouston David , Murphy Declan G. , Frydenberg Mark , Taylor Renea A. , Risbridger Gail P.
Published: March 2020

IDC-P and ductal adenocarcinoma are two pathologies that can indicate aggressive primary prostate cancer.
TAMing efferocytosis to fight tumors
Authors: Rodell Christopher B.
Published: March 2020

Preventing clearance of dying tumor cells elicits an inflammatory response by macrophages, supporting development of antitumor immunity in mice.
Improved Molecular Diagnosis of COVID-19 by the Novel, Highly Sensitive and Specific COVID-19-RdRp/Hel Real-Time Reverse Transcription-PCR Assay Validated
In Vitro
and with Clinical Specimens
Authors: Chan Jasper Fuk-Woo , Yip Cyril Chik-Yan , To Kelvin Kai-Wang , Tang Tommy Hing-Cheung , Wong Sally Cheuk-Ying , Leung Kit-Hang , Fung Agnes Yim-Fong , Ng Anthony Chin-Ki , Zou Zijiao , Tsoi Hoi-Wah , Choi Garnet Kwan-Yue , Tam Anthony Raymond , Cheng Vincent Chi-Chung , Chan Kwok-Hung , Tsang Owen Tak-Yin , Yuen Kwok-Yung
Published: March 2020

On 31 December 2019, the World Health Organization was informed of a cluster of cases of pneumonia of unknown etiology in Wuhan, China. Subsequent investigations identified a novel coronavirus, now named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), from the affected patients. Highly sensitive and specific laboratory diagnostics are important for controlling the rapidly evolving SARS-CoV-2-associated coronavirus disease 2019 (COVID-19) epidemic. In this study, we developed and compared the performance of three novel real-time reverse transcription-PCR (RT-PCR) assays targeting the RNA-dependent RNA polymerase (RdRp)/helicase (Hel), spike (S), and nucleocapsid (N) genes of SARS-CoV-2 with that of the reported RdRp-P2 assay, which is used in >30 European laboratories.
Multicenter Evaluation of the BD Phoenix CPO Detect Test for Detection and Classification of Carbapenemase-Producing Organisms in Clinical Isolates
Authors: Whitley Vicki , Kircher Susan , Gill Tracey , Hindler Janet A. , O’Rourke Susan , Cooper Charles , Tulpule Anagha , Denys Gerald A.
Published: March 2020

Limited treatment options contribute to high morbidity/mortality rates with carbapenem-resistant, Gram-negative bacterial infections. New approaches for carbapenemase-producing organism (CPO) detection may help inform clinician decision-making on patient treatment and infection control. BD Phoenix CPO detect (CPO detect) detects and classifies carbapenemases in
Enterobacterales
,
Acinetobacter baumannii
, and
Pseudomonas aeruginosa
during susceptibility testing.
Pooling Pharyngeal, Anorectal, and Urogenital Samples for Screening Asymptomatic Men Who Have Sex with Men for Chlamydia trachomatis and Neisseria gonorrhoeae
Authors: Durukan Duygu , Read Tim R. H. , Bradshaw Catriona S. , Fairley Christopher K. , Williamson Deborah A. , De Petra Vesna , Maddaford Kate , Wigan Rebecca , Chen Marcus Y. , Tran Anne , Chow Eric P. F.
Published: March 2020

Screening for
Chlamydia trachomatis
and
Neisseria gonorrhoeae
at the pharyngeal, urogenital, and anorectal sites is recommended for men who have sex with men (MSM). Combining the three individual-site samples into a single pooled sample could result in significant cost savings, provided there is no significant sensitivity reduction. The aim of this study was to examine the sensitivity of pooled samples for detecting chlamydia and gonorrhea in asymptomatic MSM using a nucleic acid amplification test.
An EBNA3A-Mutated Epstein-Barr Virus Retains the Capacity for Lymphomagenesis in a Cord Blood-Humanized Mouse Model
Authors: Romero-Masters James C. , Ohashi Makoto , Djavadian Reza , Eichelberg Mark R. , Hayes Mitchell , Zumwalde Nicholas A. , Bristol Jillian A. , Nelson Scott E. , Ma Shidong , Ranheim Erik A. , Gumperz Jenny E. , Johannsen Eric C. , Kenney Shannon C.
Published: March 2020

The EBV protein EBNA3A is expressed in latently infected B cells and is important for efficient EBV-induced transformation of B cells
in vitro
. In this study, we used a cord blood-humanized mouse model to compare the phenotypes of an EBNA3A hypomorph mutant virus (Δ3A) and wild-type EBV. The Δ3A virus caused lymphomas with delayed onset compared to the onset of those caused by WT EBV, although the tumors occurred at a similar rate. The WT EBV and EBNA3A mutant tumors expressed similar levels of the EBV protein EBNA2 and cellular protein p16, but in some cases, Δ3A tumors had less LMP1. Our analysis suggested that Δ3A-infected tumors have elevated T cell infiltrates and decreased expression of the CLEC2D receptor, which may point to potential novel roles of EBNA3A in T cell and NK cell responses to EBV-infected tumors.
One size doesn’t fit all: contouring and addressing social vitals in reversing tobacco epidemic in Punjab, India
Authors: Bhatt Garima , Goel Sonu , Shergill Gagandeep
Published: March 2020

There are many tobacco users who wish to quit. In some cases, ostracism related to religious proscriptions serves as a barrier and prevents them from revealing their addiction status. Religion as an institution has an immense influence on human behaviour. It contributes to the cultural identity of individuals, moderating uniformity in their behaviour and social life. We describe a case from a province in Punjab in North India, where tobacco use is a ‘taboo’ due to the widely practised faith of Sikhism. The case illustrates how a doctoral thesis student, along with the healthcare providers at a non-communicable disease clinic, overcame the concealment of tobacco use of a patient with hypertension due to fear of social exclusion. The student assisted him in quitting tobacco use through a culturally specific, patient-centric, individualised, behavioural intervention using religion as a backdrop. This case study highlights the importance of recognising and appreciating the dynamics of sociocultural factors to develop a suitable and successful deaddiction strategy. This case elaborates how a simple ‘nudge’ of religious tenets-based counselling helps the tobacco addict transgress or tide over such barriers.
Steroids as rescue therapy for vitamin A-induced acute liver failure
Authors: Kulkarni Anand V , Kumar Pramod , Talukdar Rupjyoti , Rao Nagaraj P
Published: March 2020

Antioxidant drugs form one of the mainstay therapies for pain management in chronic pancreatitis. Heightened oxidative stress and free radical activity is the target for the use of antioxidant therapy in chronic pancreatitis pain relief. One of the chief components of these drugs is beta-carotene, and vitamin A. Vitamin A is a proven hepatotoxic agent which can lead to liver injury ranging from acute hepatitis to cirrhosis. Here, we present a case of chronic pancreatitis who continued antioxidant therapy unsupervised for 7 years and developed vitamin A-induced acute liver failure, which was treated with prednisolone.
Central corneal basal cell density and nerve parameters in ocular surface disease and limbal stem cell deficiency: a review and meta-analysis
Authors: Bhattacharya Pradipta , Edwards Katie , Harkin Damien , Schmid Katrina L
Published: March 2020

Objective

To conduct a review and meta-analysis for investigating the relative reduction of central corneal basal cell density (BCD) and nerve parameters in ocular surface disease (OSD) and limbal stem cell deficiency (LSCD).

Methods

A systematic literature search using the terms ((1) “ocular surface disease” or “ocular surface disorder”; (2) “in vivo confocal microscopy”; (3) “limbal stem cell deficiency”; (4) “basal cell density” or “corneal basal cell density” or “central corneal basal cell density”; (5) “corneal nerves” or “corneal nerve parameters” or “central corneal nerve parameters”) was performed. The results are presented as weighted mean difference (WMD) with corresponding 95% CI.

Results

16 studies that reported the central corneal BCD and 21 studies that reported the central corneal nerve parameters in OSD (including LSCD) were included. A significant reduction in central corneal BCD was observed in patients with various OSDs (WMD=−9.50, 95% CI −14.04 to −4.97, p<0.01) as well as in patients with LSCD (WMD=−22.14, 95% CI −37.91 to −6.37, p<0.01) compared with healthy controls, however, no significant difference in BCD was observed between the two groups (WMD=−11.61, 95% CI −15.96 to −7.26, p=0.13). There was no conclusive difference in various central corneal nerve parameters between OSDs and LSCD.

Conclusion

Central corneal BCD and nerve parameters are reduced in LSCD, there is a similar reduction in other OSDs.
Comparison of true-colour wide-field confocal scanner imaging with standard fundus photography for diabetic retinopathy screening
Authors: Olvera-Barrios Abraham , Heeren Tjebo FC , Balaskas Konstantinos , Chambers Ryan , Bolter Louis , Tufail Adnan , Egan Catherine , Anderson John
Published: March 2020

Background

Screening of diabetic retinopathy (DR) reduces blindness by early identification of retinopathy. This study compares DR grades derived from a two-field imaging protocol from two imaging platforms, one providing a single 60-degree horizontal field of view (FOV) and the other, a standard 45-degree FOV.

Methods

Cross-sectional study which included 1257 diabetic patients aged ≥18 years attending their DR screening visit in the English National Diabetic Eye Screening Programme (NDESP). Patients with maculopathy (M1), preproliferative (R2) or proliferative DR (R3) were referred to an ophthalmologist. Patients with ungradable images (U) are examined in a slit-lamp biomicroscopy clinic. Image acquisition under mydriasis of two images per eye was carried out with the EIDON and with standard fundus cameras. Evaluation was performed by masked graders.

Results

Agreement after consensus with kappa statistic was 0.89 (quadratic weights (95% CI 0.87 to 0.92)) for NDESP severity grade, 0.88 (quadratic weights (95% CI 0.82 to 0.94)) for referable disease and 0.92 (linear weights (95% CI 0.88 to 0.95)) for maculopathy. The EIDON detected clinically relevant DR features outside the 45-degree fields in two patients (0.16%): one with intraretinal microvascular abnormalities (IRMAs) and one with neovascularisation. In eight patients (0.64%), the EIDON allowed DR feature visualisation inside the 45-degree fields that were not identified in the NDESP images: three patients (0.24%) with IRMA and five patients (0.40%) with maculopathy. The rates of ungradable encounters were 12 (0.95%) and 13 (1.03%) with the EIDON and NDESP images, respectively.

Conclusion

The EIDON identifies a small number of additional patients with referable disease which are not detected with standard imaging. This is due to the EIDON finding disease outside the standard FOV and greater clarity finding disease within the standard FOV.
Acceptability, adherence and economic analyses of a new clinical pathway for the identification of non-responders to glaucoma eye drops: a prospective observational study
Authors: Waterman Heather , Read Simon , Morgan James Edwards , Gillespie David , Nollett Claire , Allen Davina , Weiss Marjorie , Anderson Pippa
Published: March 2020

Background/aims

Assess whether a new clinical pathway for glaucoma was acceptable to patients and healthcare professionals and whether it provided useful clinical information on non-responsiveness and non-adherence to the treatment of elevated intraocular pressure with latanoprost eye drops.

Methods

A single arm non-randomised prospective observational study incorporating new glaucoma/ocular hypertension patients. To assess issues of acceptability, qualitative observation and interviews were conducted with patients and healthcare professionals. To determine clinical responsiveness, intraocular pressures were measured before and 4 hours after a clinician-instilled eye drop over two distinct appointments. Adherence data were collected using a Medicine Event Monitoring System. Economic analyses compared the costs between novel and standard care pathways.

Results

Of 72 patients approached, 53 entered the study (74.3%) and 50 completed all procedures (94.3%). Intraocular pressure was reduced more than 15% in 83 out of 92 study eyes by final visit (90.2%). The non-response rate was 5.1% once the effect of low adherence was minimised. For the 1376 drop instillation days under observation, eye drops were instilled as prescribed on 1004 days (73.0%), over-instilled on 137 days (9.9%) and not instilled on 235 days (17.1%). The Cardiff Model of Glaucoma Care involved negligible cost, although acceptance for healthcare professionals showed variation.

Conclusions

The Cardiff Model of Glaucoma Care offers novel clinical and adherence insights at marginal costs while acceptable to patients. Healthcare professionals felt that 4 hour and 4 week follow-up appointments could cause administrative problems. A streamlined version of the pathway has therefore been developed to facilitate clinical adoption.

Trial registration number

ISRCTNID:ISRCTN75888393
Incidence and associates of diabetic ketoacidosis in a community-based cohort: the Fremantle Diabetes Study Phase II
Authors: Davis Timothy M E , Davis Wendy
Published: March 2020

Objective

To assess the incidence and associates of diabetic ketoacidosis (DKA) in a representative community-based cohort.

Methods

All hospitalizations of 1724 participants in the Fremantle Diabetes Study Phase II for/with DKA (plasma glucose >13.8 mmol/L, urinary/serum ketones, serum bicarbonate <18 mmol/L and/or arterial/venous pH <7.30) were identified between study entry from 2008 to 2011 and end-2013. Details of each episode were categorized by chart review as confirmed/probable DKA, possible DKA or not DKA. Incidence rates by diabetes type were calculated. Cox proportional hazards modeling determined predictors of first episode, and negative binomial regression identified predictors of frequency.

Results

There were 53 coded DKA episodes (41 first episodes, 12 recurrences), of which 19 (35.8%) were incorrectly coded, 9 (17.0%) had possible DKA and 25 (47.2%) had confirmed/probable DKA. Of this latter group, 44% had type 1 diabetes, 32% had type 2 diabetes, 12% had latent autoimmune diabetes of adults (LADA) and 12% had secondary diabetes. The overall incidence of confirmed/probable DKA (95% CI) was 35.6 (23.0 to 52.6)/10 000 person-years (178.6 (85.7 to 328.5)/10 000 person-years for type 1 diabetes, 13.3 (5.7 to 26.1)/10 000 person-years for type 2 diabetes, 121.5 (33.1 to 311.0)/10 000 person-years for LADA and 446.5 (92.1 to 1304.9)/10 000 person-years for secondary diabetes). Baseline ln(fasting serum C-peptide) (inversely), glycated hemoglobin and secondary diabetes predicted both incident first confirmed/probable DKA episode and the frequency of DKA (p<0.001).

Conclusions

These data highlight the contribution of poor glycemic control and limited pancreatic beta cell function to incident DKA, and show that people with types of diabetes other than type 1, especially secondary diabetes, are at risk.
Prevalence and major risk factors of type 2 diabetes mellitus among adult psychiatric inpatients from 2005 to 2018 in Beijing, China: a longitudinal observational study
Authors: Yang Fude , Ma Qiuyue , Liu Jue , Ma Botao , Guo Moning , Liu Fangchao , Li Juan , Wang Zhiren , Liu Min
Published: March 2020

Objective

We aim to investigate the prevalence, trends, and major risk factors of type 2 diabetes mellitus (T2DM) among adult psychiatric inpatients in Beijing, China.

Research design and methods

We did a longitudinal observational study using data from the Beijing Municipal Commission of Health and Family Planning Information Center, including 157 570 adult psychiatric inpatients in 19 specialized psychiatric hospitals from 2005 to 2018 in Beijing. Data on demographic characteristics and antipsychotic medication use were obtained from electronic health records. Schizophrenia, T2DM, and comorbidities were defined according to the International Classification of Diseases, 10th revision codes of discharge diagnosis. The overall prevalence of T2DM in adult psychiatric inpatients was calculated, and the annual prevalence of T2DM was calculated and adjusted to the overall participant population. Univariate and multivariate logistic regression analyses were performed to obtain crude ORs and adjusted ORs (aORs) on the risk of T2DM in patients with different demographic characteristics, schizophrenia, antipsychotic medication use, and different comorbidities. Age-specific prevalence of T2DM under a stratification of schizophrenia or other psychiatric disorders was calculated in the subgroup analysis.

Results

Out of 157 570 adult inpatients, 16 939 had T2DM, with a prevalence of 10.75% (95% CI 10.60% to 10.90%). The prevalence was 11.63% (95% CI 11.37% to 11.88%) among patients with schizophrenia and 10.17% (95% CI 9.98% to 10.37%) among patients with other psychiatric disorders. During 2005–2018, the prevalence of T2DM in adult patients increased over the years, from an adjusted prevalence of 5.20% in 2005, to 10.98% in 2010, 12.50% in 2015, and 12.71% in 2018. Results from the multivariate analysis showed that increasing age, diagnosis of schizophrenia (aOR=1.23, 95% CI 1.18 to 1.29), and comorbidities of hypertension (aOR=3.09, 95% CI 2.97 to 3.22), lipid disorders (aOR=1.95, 95% CI 1.88 to 2.04), and fatty liver (aOR=1.93, 95% CI 1.84 to 2.03) were major risk factors of T2DM in adult psychiatric inpatients.

Conclusions

The prevalence of T2DM was high among adult psychiatric inpatients in Beijing, China. Elderly patients, those with schizophrenia, and those with hypertension, lipid disorders, and fatty liver had higher prevalence of T2DM. Prevention and treatment of T2DM are of utmost relevance in hospitalized psychiatric patients.
Glucagon receptor antagonist upregulates circulating GLP-1 level by promoting intestinal L-cell proliferation and GLP-1 production in type 2 diabetes
Authors: Lang Shan , Yang Jin , Yang Kun , Gu Liangbiao , Cui Xiaona , Wei Tianjiao , Liu Junling , Le Yunyi , Wang Haining , Wei Rui , Hong Tianpei
Published: March 2020

Objective

Glucagon receptor (GCGR) blockage improves glycemic control and increases circulating glucagon-like peptide-1 (GLP-1) level in diabetic animals and humans. The elevated GLP-1 has been reported to be involved in the hypoglycemic effect of GCGR blockage. However, the source of this elevation remains to be clarified.

Research design and methods

REMD 2.59, a human GCGR monoclonal antibody (mAb), was administrated for 12 weeks indb/dbmice and high-fat diet+streptozotocin (HFD/STZ)-induced type 2 diabetic (T2D) mice. Blood glucose, glucose tolerance and plasma GLP-1 were evaluated during the treatment. The gut length, epithelial area, and L-cell number and proliferation were detected after the mice were sacrificed. Cell proliferation and GLP-1 production were measured in mouse L-cell line GLUTag cells, and primary mouse and human enterocytes. Moreover, GLP-1 receptor (GLP-1R) antagonist or protein kinase A (PKA) inhibitor was used in GLUTag cells to determine the involved signaling pathways.

Results

Treatment with the GCGR mAb lowered blood glucose level, improved glucose tolerance and elevated plasma GLP-1 level in bothdb/dband HFD/STZ-induced T2D mice. Besides, the treatment promoted L-cell proliferation and LK-cell expansion, and increased the gut length, epithelial area and L-cell number in these two T2D mice. Similarly, our in vitro study showed that the GCGR mAb promoted L-cell proliferation and increased GLP-1 production in GLUTag cells, and primary mouse and human enterocytes. Furthermore, either GLP-1R antagonist or PKA inhibitor diminished the effects of GCGR mAb on L-cell proliferation and GLP-1 production.

Conclusions

The elevated circulating GLP-1 level by GCGR mAb is mainly due to intestinal L-cell proliferation and GLP-1 production, which may be mediated via GLP-1R/PKA signaling pathways. Therefore, GCGR mAb represents a promising strategy to improve glycemic control and restore the impaired GLP-1 production in T2D.
Prevalence and severity of periodontal disease among Spanish military personnel
Authors: Bárcena García Millán , Cobo Plana J M , Arcos González P I
Published: March 2020

Introduction

Periodontal disease ranges from simple gums inflammation to major damage to the periodontal tissues, even losing teeth. Severe periodontitis has a world overall prevalence of 11.2%. These are evaluated with periodontal probes and oral epidemiological indices. Our aim is to estimate the prevalence and severity of periodontal disease of a Spanish military population according to the 2013 WHO criteria.

Methods

Observational study of prevalence carried out in a representative random sample of 221 military staff from the Spanish Army base ‘Conde de Gazola’. Prevalence was estimated by calculating the Community Periodontal Index modified, loss of attachment, Plaque Index and Gingival Bleeding Index measured with a third-generation electronic ‘Pa-on’ periodontal probe.

Results

Averages of probing depth, recession and clinical attachment level were 2.17, 0.19 and 2.36 mm. Plaque and gingival bleeding indices were 71% and 40.3%. All subjects bled in some tooth after probing. 3.6% of subjects had no periodontal pockets, 58.8% mild periodontal pockets and 37.1% severe periodontal pockets. All had some loss of attachment, 52% mild loss of attachment and 47.5% severe loss of attachment. Teeth present with and without bleeding were 24.4 (86.5%) and 3.6 (13.1%). 28% of teeth had periodontal pockets and 40.4% loss of attachment. Sextant averages with periodontal pockets and loss of attachment were 2.79 and 3.56.

Conclusions

Our plaque and gingival bleeding indices were high and we found a higher prevalence and severity of periodontal disease than other Spanish and foreign military populations. This could be related to differences in context, life habits and insufficient dental hygiene.
Vitamin D status in an Australian patient population: a large retrospective case series focusing on factors associated with variations in serum 25(OH)D
Authors: Voo Veronica Tsin Fong , Stankovich Jim , O’Brien Terence J , Butzkueven Helmut , Monif Mastura
Published: March 2020

Objectives

To investigate whether sex, age, medical specialty and seasonal variations in serum concentration of 25-hydroxy vitamin D (25(OH)D) are evident among an Australian patient population.

Design

Retrospective study analysing the results of serum 25(OH)D lab tests and vitamin D supplementation from Royal Melbourne Hospital (RMH) between 2014 and 2017.

Setting

Tertiary healthcare centre in Victoria, Australia.

Participants

30 023 patients (inpatient and outpatient) who had their serum 25(OH)D levels measured at RMH between 2014 and 2017.

Main outcome measures

Serum 25(OH)D levels stratified according to patients’ sex, age and medical specialty admitted to, as well as the season and year (2014 to 2017) 25(OH)D level was measured.

Results

Mean serum 25(OH)D level of study population was 69.9 nmol/L (95% CI 69.5 to 70.2). Only 40.2% patients in this cohort were sufficient in vitamin D (>75 nmol/L). On average, 25(OH)D levels in male patients were 6.1 units (95% CI 5.4 to 6.9) lower than in females. Linear regression analysis found that 25(OH)D levels increased by 0.16 unit (95% CI 0.14 to 0.18) for every year increase in age. One-way analysis of variance showed patients from neurology had the highest average 25(OH)D level, 76.8 nmol/L (95% CI 74.2 to 79.3) compared with other medical specialties. Mean 25(OH)D level during winter, 64.9 nmol/L (95% CI 64.2 to 65.6) was significantly lower compared with other seasons despite supplementation. Average 25(OH)D level measured in 2014, 71.5 nmol/L (95 CI% 70.8 to 72.2) was significantly higher than levels measured in 2016–2017.

Conclusions

There is a sex, age, medical specialty, seasonal and yearly variation in vitamin D status in an Australian patient population. The association between low vitamin D status and winter despite supplementation suggests other interventions are required to boost serum 25(OH)D levels.
Influence of trust on two different risk perceptions as an affective and cognitive dimension during Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in South Korea: serial cross-sectional surveys
Authors: Jang Won Mo , Kim Un-Na , Jang Deok Hyun , Jung Hyemin , Cho Sanghyun , Eun Sang Jun , Lee Jin Yong
Published: March 2020

Objectives

This study aimed to assess the affective and cognitive risk perceptions in the general population of Middle East respiratory syndrome (MERS) during the 2015 MERS coronavirus (MERS-CoV) outbreak in South Korea and the influencing factors.

Design

Serial cross-sectional design with four consecutive surveys.

Setting

Nationwide general population in South Korea.

Participants

Overall 4010 respondents (aged 19 years and over) from the general population during the MERS-CoV epidemic were included.

Primary and secondary outcome measures

The main outcome measures were (1) affective risk perception, (2) cognitive risk perception, and (3) trust in the government. Multivariate logistic regression models were used to identify factors (demographic, socioeconomic, area and political orientation) associated with risk perceptions.

Results

Both affective and cognitive risk perceptions decreased as the MERS-CoV epidemic progressed. Proportions of affective risk perception were higher in all surveys and slowly decreased compared with cognitive risk perception over time. Females (adjusted OR (aOR) 1.72–2.00; 95% CI 1.14 to 2.86) and lower self-reported household economic status respondents were more likely to perceive the affective risk. The older the adults, the higher the affective risk perception, but the lower the cognitive risk perception compared with younger adults. The respondents who had low trust in the government had higher affective (aOR 2.19–3.11; 95 CI 1.44 to 4.67) and cognitive (aOR 3.55–5.41; 95 CI 1.44 to 9.01) risk perceptions.

Conclusions

This study suggests that even if cognitive risk perception is dissolved, affective risk perception can continue during MERS-CoV epidemic. Risk perception associating factors (ie, gender, age and self-reported household economic status) appear to be noticeably different between affective and cognitive dimensions. It also indicates that trust in the government influences affective risk perception and cognitive risk perception. There is a need for further efforts to understand the mechanism regarding the general public’s risk perception for eﬀective risk communication.
Cluster randomised controlled trial evaluating the clinical and humanistic impact of a pharmacist-led minor ailment service
Authors: Dineen-Griffin Sarah , Benrimoj Shalom I , Rogers Kris , Williams Kylie A , Garcia-Cardenas Victoria
Published: March 2020

Background

Community pharmacists are well positioned to support patients’ minor ailments. The objective was to evaluate the clinical and humanistic impact of a minor ailment service (MAS) in community pharmacy compared with usual pharmacist care (UC).

Methods

A cluster randomised controlled trial was conducted. Intervention patients received MAS, which included a consultation with the pharmacist. MAS pharmacists were trained in clinical pathways and communication systems mutually agreed with general practitioners and received monthly support. Control patients received UC. All patients were followed up by telephone at 14 days. Clinical and humanistic impact were defined by primary (appropriate referral rate and appropriate non-prescription medicine rate) and secondary outcomes (clinical product-based intervention rate, referral adherence, symptom resolution, reconsultation and EuroQol EQ-5D visual analogue scale (VAS)).

Results

Patients (n=894) were recruited from 30 pharmacies and 82% (n=732) responded to follow-up. Patients receiving MAS were 1.5 times more likely to receive an appropriate referral (relative rate (RR)=1.51; 95% CI 1.07 to 2.11; p=0.018) and were five times more likely to adhere to referral, compared with UC (RR=5.08; 95%CI 2.02 to 12.79; p=0.001). MAS patients (94%) achieved symptom resolution or relief at follow-up, while this was 88% with UC (RR=1.06; 95% CI 1 to 1.13; p=0.035). MAS pharmacists were 1.2 times more likely to recommend an appropriate medicine (RR 1.20, 95% CI 1.1 to 1.3; p=0.000) and were 2.6 times more likely to perform a clinical product-based intervention (RR=2.62, 95% CI 1.28 to 5.38; p=0.009), compared with UC. MAS patients had a greater mean difference in VAS at follow-up (4.08; 95% CI 1.23 to 6.87; p=0.004). No difference in reconsultation was observed (RR=0.98; 95% CI 0.75 to 1.28; p=0.89).

Conclusion

The study demonstrates improved clinical and humanistic outcomes with MAS. National implementation is a means to manage minor ailments more effectively in the Australian health system.

Trial registration number

ACTRN12618000286246.
Using emergency physicians’ abilities to predict patient admission to decrease admission delay time
Authors: Lee Erica E M , Kwok Edmund S H , Vaillancourt Christian
Published: March 2020

Background

In many EDs, emergency physicians (EPs) do not have admitting privileges and must wait for consultants to further assess and admit patients. This delays bed requests and increases ED crowding. We measured EPs’ abilities to predict patient admission prior to consultation and estimated the potential ED stretcher time saved if EPs requested a bed with consultation.

Methods

We conducted a prospective cohort study in an academic centre in Canada between October 2017 and February 2018 using a convenience sample of ED patient encounters requiring consultation. We excluded patients under 18 years or those clearly likely to be admitted (traumas, strokes, S-T elevation myocardial infarctions and Canadian Triage and Acuity Scale of 1). EPs predicted patient admission just before consultation. Potential ED stretcher time saved was estimated for correctly predicted admissions assuming bed requests were initiated with consultation and a constant time to inpatient bed.

Results

Characteristics of 454 patients were: mean age 60.1 years, 48.5% male, 46.9% evening presentation, 69.4% admitted and median time to bed request of 3.5 hours (IQR 2.0–5.3 hours). Overall, EPs prediction sensitivity, specificity, positive predictive value and negative predictive value were 90.5% (95% CI 86.7% to 93.5%), 84.2% (95% CI 77.0% to 89.8%), 92.8% (95% CI 89.8% to 95.0%) and 79.6% (95% CI 73.4% to 84.7%). Approximately 922.1 hours of ED stretcher time could have been saved during the 5-month study period if EPs initiated a bed request with consultation.

Conclusion

Crowding is a reality for EDs worldwide, and many systems could benefit from EP-initiated hospital admissions to decrease the amount of time admitted patients wait in the ED.
Cirrhosis as new indication for statins
Authors: Bosch Jaime , Gracia-Sancho Jordi , Abraldes Juan G
Published: March 2020

In the recent years, there have been an increasing number of reports on favourable effects of statins in patients with advanced chronic liver disease. These include reduction in portal pressure, improved liver sinusoidal endothelial and hepatic microvascular dysfunction, decreased fibrogenesis, protection against ischaemia/reperfusion injury, safe prolongation of ex vivo liver graft preservation, reduced sensitivity to endotoxin-mediated liver damage, protection from acute-on-chronic liver failure, prevention of liver injury following hypovolaemic shock and preventing/delaying progression of cirrhosis of any aetiology. Moreover, statins have been shown to have potential beneficial effects in the progression of other liver diseases, such as chronic sclerosing cholangitis and in preventing hepatocellular carcinoma. Because of these many theoretically favourable effects, statins have evolved from being considered a risk to kind of wonder drugs for patients with chronic liver diseases. The present article reviews the current knowledge on the potential applications of statins in chronic liver diseases, from its mechanistic background to objective evidence from clinical studies.
Clinical digital neuropathology: experience and observations from a departmental digital pathology training programme, validation and deployment
Authors: Williams Bethany Jill , Ismail Azzam , Chakrabarty Arundhati , Treanor Darren
Published: March 2020

Aim

To train and individually validate the neuropathologists in digital primary diagnosis and frozen section reporting using a novel protocol endorsed by the Royal College of Pathologists. The protocol allows early exposure to live digital reporting in a risk mitigated environment.

Methods

Two specialist neuropathologists completed training in the use of a digital microscopy system for primary neuropathological diagnosis and frozen section assessment. Participants were exposed to training sets of 20 histology cases and 10 frozen sections designed to help them identify their personal digital diagnostic pitfalls. Following this, the pathologists viewed 340 live, complete neuropathology cases. All primary diagnoses were made on digital slides with immediate glass slide reconciliation before final case sign-out.

Results

There was 100% clinical concordance between the digital slide and glass slide assessment of frozen section cases for each pathologist, and these assessments corresponded with the ground truth diagnoses obtained from examination of definitive histology. For primary diagnosis, there was complete clinical concordance between digital slide and glass slide diagnosis in 98.1% of cases. The majority of discordances were related to grading differences attributable to mitotic count differences.

Conclusion

Neuropathologists can develop the ability to make primary digital diagnosis competently and confidently following a course of individual training and validation.
Medical and neurobehavioural phenotypes in carriers of X-linked ichthyosis-associated genetic deletions in the UK Biobank
Authors: Brcic Lucija , Underwood Jack FG , Kendall Kimberley M , Caseras Xavier , Kirov George , Davies William
Published: March 2020

Background

X-linked ichthyosis (XLI) is an uncommon dermatological condition resulting from a deficiency of the enzyme steroid sulfatase (STS), often caused by X-linked deletions spanning STS. Some medical comorbidities have been identified in XLI cases, but small samples of relatively young patients has limited this. STS is highly expressed in subcortical brain structures, and males with XLI and female deletion carriers appear at increased risk of developmental/mood disorders and associated traits; the neurocognitive basis of these findings has not been examined.

Methods

Using the UK Biobank resource, comprising participants aged 40–69 years recruited from the general UK population, we compared multiple medical/neurobehavioural phenotypes in males (n=86) and females (n=312) carrying genetic deletions spanning STS (0.8–2.5 Mb) (cases) to male (n=190 577) and female (n=227 862) non-carrier controls.

Results

We identified an elevated rate of atrial fibrillation/flutter in male deletion carriers (10.5% vs 2.7% in male controls, Benjamini-Hochberg corrected p=0.009), and increased rates of mental distress (p=0.003), irritability (p<0.001) and depressive-anxiety traits (p<0.05) in male deletion carriers relative to male controls completing the Mental Health Questionnaire. While academic attainment was unaffected, male and female deletion carriers exhibited impaired performance on the Fluid Intelligence Test (Cohen’s d≤0.05, corrected p<0.1). Neuroanatomical analysis in female deletion carriers indicated reduced right putamen and left nucleus accumbens volumes (Cohen’s d≤0.26, corrected p<0.1).

Conclusion

Adult males with XLI disease-causing deletions are apparently at increased risk of cardiac arrhythmias and self-reported mood problems; altered basal ganglia structure may underlie altered function and XLI-associated psychiatric/behavioural phenotypes. These results provide information for genetic counselling of deletion-carrying individuals and reinforce the need for multidisciplinary medical care.
Differentiating tic electrophysiology from voluntary movement in the human thalamocortical circuit
Authors: Cagle Jackson N , Okun Michael S , Opri Enrico , Cernera Stephanie , Molina Rene , Foote Kelly D , Gunduz Aysegul
Published: March 2020

Objectives

Tourette syndrome is a neurodevelopmental disorder commonly associated with involuntary movements, or tics. We currently lack an ideal animal model for Tourette syndrome. In humans, clinical manifestation of tics cannot be captured via functional imaging due to motion artefacts and limited temporal resolution, and electrophysiological studies have been limited to the intraoperative environment. The goal of this study was to identify electrophysiological signals in the centromedian (CM) thalamic nucleus and primary motor (M1) cortex that differentiate tics from voluntary movements.

Methods

The data were collected as part of a larger National Institutes of Health-sponsored clinical trial. Four participants (two males, two females) underwent monthly clinical visits for collection of physiology for a total of 6 months. Participants were implanted with bilateral CM thalamic macroelectrodes and M1 subdural electrodes that were connected to two neurostimulators, both with sensing capabilities. MRI scans were performed preoperatively and CT scans postoperatively for localisation of electrodes. Electrophysiological recordings were collected at each visit from both the cortical and subcortical implants.

Results

Recordings collected from the CM thalamic nucleus revealed a low-frequency power (3–10 Hz) increase that was time-locked to the onset of involuntary tics but was not present during voluntary movements. Cortical recordings revealed beta power decrease in M1 that was present during tics and voluntary movements.

Conclusion

We conclude that a human physiological signal was detected from the CM thalamus that differentiated tic from voluntary movement, and this physiological feature could potentially guide the development of neuromodulation therapies for Tourette syndrome that could use a closed-loop-based approach.
Incidence and prevalence of amyotrophic lateral sclerosis in urban China: a national population-based study
Authors: Xu Lu , Chen Lu , Wang Shengfeng , Feng Jingnan , Liu Lili , Liu Guozhen , Wang Jinxi , Zhan Siyan , Gao Pei , Fan Dongsheng
Published: March 2020

Objective

Amyotrophic lateral sclerosis (ALS) is a severe neurodegenerative disease and information on disease burden of ALS in mainland China was limited. We aimed to estimate the prevalence and incidence of ALS in China.

Methods

We used 2012–2016 data from China’s Urban Employee Basic Medical Insurance and Urban Residence Basic Medical Insurance, covering approximately 0.43 billion individuals. ALS cases were identified by the primary diagnosis (International Classification of Diseases code or text of diagnosis) in the insurance database.

Results

The crude prevalence and incidence in 2016 were 2.91 per 100 000 person-years (95% CI 2.31 to 3.58) and 1.65 (95% CI 1.33 to 2.01), respectively. The standardised prevalence and incidence based on 2010 Chinese census data were 2.97 (95% CI 2.91 to 3.03) and 1.62 (95% CI 1.58 to 1.67), respectively. The annual prevalence between 2013 and 2016 remained relatively constant, ranging from 2.91 (95% CI 2.31 to 3.58) in 2016 to 3.29 (95% CI 2.51 to 4.17) in 2014 (linear regression: β=−0.129, p=0.104). Both rates peaked in the group aged 75–79 years.

Conclusions

The prevalence and incidence of ALS in mainland China were lower than those in developed countries, and maintained a relatively stable trend. The age at onset and age at diagnosis for ALS patients were younger than those in developed countries. Further research is expected to clarify the potential pathophysiological mechanism of ALS.
Musculoskeletal injury outcomes: 2-year retrospective service evaluation of a UK defence primary care rehabilitation facility (PCRF)
Authors: Scott Peter James
Published: March 2020

Introduction

Musculoskeletal injury represents the leading cause of medical discharge from the UK Armed Forces. This study evaluates effectiveness of care provision within a large primary care rehabilitation facility (PCRF) against directed defence best practice guidelines (BPGs)

Methods

All new patient electronic records from January to July 16 were interrogated to identify demographics, causation, injury pathology, timelines and outcomes.

Results

393 eligible records (81.9% male) were identified. 17.6% were officers, 32.8% were seniors and 49.6% were juniors. The average age was 35.1 years (mode 30). The average wait to treatment was 8.3 days with 75.6% key performance indicator compliance. 47.3% were repeat injuries. The average care timeline was 117.1 days with 8.7 average treatment sessions needed. 30 remained under care at 2 years. 17.8% accessed hydrotherapy and 44% underwent exercise remedial instructors care. 14.2% of individuals required concurrent DCMH care (15.9% male and 26.8% female). 28.5% required multidisciplinary injury assessment clinic intervention with 74.1% compliance against BPGs. 2.9% used the Defence Medical Rehabilitation Centre. Common pathologies were low back pain (LBP) (n=67), upper limb (UL) soft tissue (n=40) and knee trauma (n=38). LBP had the highest recurrence rates (71.6%). Anterior knee pain took the longest (173.1 days) but had the best outcome on discharge. Ankles and lower limb muscle injuries had the best outcomes. Patella tendinopathy and knee trauma had the poorest outcome on discharge. LBP and patellar tendinopathy had the lowest fully fit rates at 2 years (56.7% and 53.8%, respectively). At 2 years, 58.2% of individuals achieved full fitness (60.7% men and 46.4% women), rising to 64% and 55%, respectively, when including those retained with limitations.

Conclusions

The PCRF was generally compliant with BPGs, achieving good functional outcomes on discharge. Women were disproportionally represented, had higher concurrent DCMH attendance and poorer overall long-term outcomes. Repeat injury rates were significantly high.
Association of left anterior descending artery involvement on clinical outcomes among patients with STEMI presenting with and without out-of-hospital cardiac arrest
Authors: Bertic Mia , Fordyce Christopher B , Moghaddam Nima , Cairns John , Mackay Martha , Singer Joel , Lee Terry , Perry-Arnesen Michele , Tocher Wendy , Wong Graham
Published: March 2020

Background

ST-segment elevation myocardial infarction (STEMI) outcomes are influenced by the location of the culprit vessel with worse outcomes portended with a left anterior descending (LAD) culprit lesion. However, relatively little is known about the independent association of LAD involvement with clinical outcomes of patients with STEMI with and without out-of-hospital cardiac arrest (OHCA).

Methods

We identified 91 patients with and 929 without a preceding OHCA within the Vancouver Coastal Health Authority who presented with an acute STEMI and underwent primary percutaneous coronary intervention between 26 June 2007 and 31 March 2016.

Results

Patients with STEMI with OHCA had higher rates of in-hospital cardiac arrest (43.3% vs 8.3%, p<0.001), heart failure (50.5% vs 11.3%, p<0.001), cardiogenic shock (49.5% vs 5.7%, p<0.001), mortality (35.2% vs 3.3%, p<0.001) and reduced left ventricular ejection fraction (LVEF; 42.9% vs 47.3%, p<0.001) compared with those without OHCA. Among patients without OHCA, LAD involvement was associated with increased heart failure (18.1% vs 5.2%, p<0.001), in-hospital cardiac arrest (10.7% vs 6.2%, p<0.014), cardiogenic shock (8.4% vs 3.3%, p<0.001), reduced LVEF (43.0% vs 51.2%, p<0.001) and mortality (5.2% vs 1.3%, p=0.003) compared with patients without LAD involvement. With the exception of LVEF, these associations were not seen among patients with STEMI with OHCA and an LAD culprit. The presence of an LAD culprit was not independently associated with increased hospital mortality among patients with OHCA after adjusting for potential confounding factors.

Conclusion

Our study has demonstrated a differential impact of LAD involvement on clinical outcomes among patients with STEMI who present with and without OHCA. Our data highlight the complexity surrounding the prognostication following OHCA complicating STEMI and demonstrate that other mechanisms other than LAD involvement contribute to the high mortality associated with OHCA as a result of STEMI.
Measuring the illicit cigarette market in Mexico: a cross validation of two methodologies
Authors: Saenz de Miera Juarez Belen , Reynales-Shigematsu Luz Myriam , Stoklosa Michal , Welding Kevin , Drope Jeffrey
Published: March 2020

Objective

To compare two methods to estimate the magnitude of the illicit cigarette trade in Mexico and to contrast these results with tobacco industry figures.

Methods

We used two survey methods: a smoker survey and a discarded pack survey. Data were collected in eight major cities in Mexico between November and December 2017. A total of 2396 face-to-face interviews to adult smokers were conducted and 8204 discarded packs were collected. To determine whether cigarette packs were intended for the Mexican market, we analysed pack features required by Mexican regulations and self-reported brands of the last purchase. Standard statistical tests to compare proportions were employed. Correlates of illicit cigarette use were also analysed.

Results

The share of cigarettes not intended for the Mexican market was 8.8% based on the analysis of discarded packs and 7.6% based on the survey of smokers, that is, the difference was small and only borderline significant overall (p=0.055). Also, both results were lower than those presented by the tobacco industry (16.6%). However, differences across methods were statistically significant for various cities.

Conclusion

Our results suggest that the optimal practice for the study of illicit trade is to cross validate estimates using both the smoker survey and the littered pack survey. If resources are limited, however, our findings indicate that either method could be used because both yield similar overall results, as longs as the potential biases are considered. Also, consistent with findings from other studies, our results suggest that the tobacco industry exaggerates the scope of illicit cigarette trade.
Modelling a cost profile for road projects
Authors: Akinradewo Opeoluwa , Aigbavboa Clinton , Oke Ayodeji , Coffie Harrison
Published: March 2020

One of the vital success elements of a construction project is the accuracy of the estimation of construction cost. This study is aimed at developing a cost profile for road projects in Ghana. Pro forma was designed to retrieve historical cost data of completed road projects in Ghana. The pro forma retrieved data such as the initial budgeted cost and final construction cost of road projects, location of road projects, features of road projects, the scope of road projects (new project, renovation work, upgrade work or replacement work), type of road projects, and classification of road projects. Cost data were analyzed using descriptive analysis and probability distributions such as cumulative density functions and probability density functions. From the findings, estimates prepared for road projects in Ghana can be expected to be below the final construction cost by approximately 20% as most of the completed road projects in Ghana experience cost overrun.