bluuebunny/crossref_metadata_2025 huggingface dataset:
Humidified versus nonhumidified low‐flow oxygen therapy in children with Pierre‐Robin syndrome: Study protocol for a randomised controlled trial
Authors: Wen Zunjia , Zhang Xin , Liu Yingfei , Li Yan , Li Xiaoyan , Wei Li
Published: June 2019

Aims and objectives

To evaluate the necessity of oxygen humidification for low‐flow oxygen therapy in children with Pierre–Robin syndrome.

Background

Whether to carry out humidification or not in the low‐flow oxygen delivery remains unclear, and currently, there is no published study on this issue in the population of children. Therefore, it is necessary to conduct more studies to elucidate this issue.

Design

A randomised controlled trial.

Methods

We attempt to report this randomised controlled trial to comply with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT). 188 children with Pierre–Robin syndrome will be expected to inclusion. The participants will be randomly divided into the humidified group (n = 94) and nonhumidified group (n = 94) at a ratio of 1:1. For humidified group, the oxygen will be routinely humidified with disposable bottle containing sterile water, whereas for nonhumidified group, the oxygen will not be humidified. Average arterial oxygen partial pressure (PaO2) and carbon dioxide partial pressure (PaCO2), incidence of ventilator‐associated pneumonia (VAP), nasal cavity dryness, nasal mucosal bleeding and bacterial contamination of the humidified bottle, the cost of nasal oxygen therapy and duration of ICU stay are collected and analysed.

Results

The study is planned to start in May 2019, and the results will be expected in July 2020.

Conclusions

This study is expected to provide a credible evidence on the necessity of routine oxygen humidification in low‐flow oxygen delivery.

Relevance to clinical practice

Understanding the role of oxygen humidification and no humidification for low‐flow oxygen therapy in the population of children is beneficial to the nursing care of healthcare providers in clinical setting.
Parents of preterm children narrate constructive aspects of their experiences
Authors: Widding Ulrika , Hägglöf Bruno , Farooqi Aijaz
Published: June 2019

Aims and objectives

To explore how parents of preterm infants express the constructive aspects of their experiences. Using the notion of post‐traumatic growth as a back‐drop, this study supplements the research on parents' difficulties by providing a more nuanced understanding of what it is like to have a preterm child.

Background

Researchers have reported that parents feel afraid, worried, helpless, powerless, guilty and stressed, as well as that preterm birth can be associated with physical and psychological ill health among parents; however, a few researchers have found indications of post‐traumatic growth among parents.

Design

This study includes qualitative interviews and relates to COREQ guidelines for reporting qualitative research.

Methods

A total of 13 mothers and 10 fathers of extremely preterm children, as well as 11 mothers and 7 fathers of moderately preterm children, were interviewed. The data analysis was based on thematic analysis.

Results

The analysis resulted in six themes that describe various constructive aspects of having a preterm child: acceptance of the fact that events do not always occur as planned; gratitude and reconsideration of the situation; reappraisal of close relationships; reliance on one's own ability to deal with events; thankfulness for what one has; and openness to being exposed to various kinds of people and their experiences.

Conclusions

The parents recounted constructive aspects of their experiences such as an altered understanding of themselves, others and life itself. These themes provide a more nuanced way of understanding how parents can relate to having preterm children.

Relevance to clinical practice

This knowledge can help professionals to enable parents to activate their social network and to acknowledge their care for each other, as well as to help parents see beyond cultural ideals regarding childbirth and family life and to find their own solutions to everyday life.
Inhibitory efficacy of different essential oils against storage carrot rot with antifungal and resistance‐inducing potential
Authors: Ojaghian Seyedmohammadreza , Wang Ling , Xie Guan‐Lin , Zhang Jing‐Ze
Published: June 2019

The inhibitory effects of essential oils (EOs) derived from coriander, lavender, geranium, thyme, savoury and eucalyptus were assessed against Sclerotinia sclerotiorum, the causal agent of carrot white mould. All EOs showed antifungal activity against the pathogen in vitro and in vivo. In addition, all EOs markedly increased 6‐methoxymellein in the treated carrots. The EOs of thyme and savoury were found to be more effective than other tested EOs. The enzymatic tests showed that thyme and savoury EOs were more able than lavender EO to significantly increase the level of chitinases, peroxidases, β‐1,3‐glucanases, polyphenol oxidase, peroxidase and phenylalanine ammonia‐lyase in the treated carrots, indicating that the EOs of thyme and savoury have potential to be considered as effective inducers of resistance against carrot white mould. In this study, all EOs inhibited myceliogenic and carpogenic germination of sclerotia at concentrations 1 and 10 µl/ml sterile distilled water, respectively. After gas chromatography/mass spectrometry, major component in the thyme EO was found to be thymol (39.15%) followed by p‐cymene (13.85%) and carvacrol (10.36%), while in savoury EO were carvacrol (41.9%), γ‐terpinene (17.38) and p‐cymene (11.25%).
Pharmacokinetics of chloramphenicol base in horses and comparison to compounded formulations
Authors: Patel Trishna , Magdesian K. Gary , Estell Krista E. , Edman Judy M. , Knych Heather K.
Published: June 2019

Chloramphenicol is commonly used in horses; however, there are no studies evaluating the pharmacokinetics of veterinary canine‐approved tablets. Studies using different formulations and earlier analytical techniques led to concerns over low bioavailability in horses. Safety concerns about human health have led many veterinarians to prescribe compounded formulations that are already in suspension or paste form. The objective of this study was to evaluate the pharmacokinetics of approved chloramphenicol tablets in horses, along with compounded preparations. The hypothesis was that chloramphenicol has low absorption and a short half‐life in horses leading to low serum concentrations and that compounded preparations have lower relative bioavailability. Seven horses were administered chloramphenicol tablets (50 mg/kg orally). In a crossover design, they were administered two compounded preparations to compare all three formulations at the same dose (50 mg/kg). Cmax was 5.25 ± 4.07 μg/ml at 4.89 hr, 4.96 ± 3.31 μg/ml at 4.14 hr, and 3.84 ± 2.96 μg/ml at 4.39 hr for the tablets, paste, and suspension, respectively. Elimination half‐life was 2.65 ± 0.75, 3.47 ± 1.47, and 4.36 ± 4.54 hr for tablets, paste, and suspension, respectively. The AUC0→∞ was 17.93 ± 7.69, 16.25 ± 1.85, and 14.00 ± 5.47 hr*μg/ml for the tablets, compounded paste, and compounded suspension, respectively. Relative bioavailability of compounded suspension and paste was 78.1% and 90.6%. Cmax after administration of all formulations did not reach the recommended MIC target of 8 μg/ml set by the Clinical Laboratory Standards Institute (CLSI) for most bacteria. Multidose studies are warranted, but the low serum concentrations suggest that bacteria with MIC values lower than CLSI recommendations should be targeted in adult horses.
Chronic pulmonary aspergillosis in a tertiary care centre in Spain: A retrospective, observational study
Authors: Aguilar‐Company Juan , Martín María Teresa , Goterris‐Bonet Lidia , Martinez‐Marti Alex , Sampol Júlia , Roldán Elisa , Almirante Benito , Ruiz‐Camps Isabel
Published: June 2019

The aim of this study was to describe the characteristics of patients with chronic pulmonary aspergillosis (CPA) in a tertiary care centre in Spain. Retrospective cohort study of all patients diagnosed with CPA between January 2010 and December 2015. The patients were identified through the Microbiology Registry. Demographic, clinical, laboratory, radiological, microbiological and clinical data were recorded. Patients were followed up for 12 months. Fifty‐three patients were included; median age was 61.5 years. Forty‐seven had a lung condition, 25 suffered from COPD, 19 an active malignancy, 10 had previous pulmonary tuberculosis and 9 lung interstitial disease. Twenty‐eight patients presented with chronic cavitary pulmonary form (CCPA) and 20 with subacute invasive aspergillosis (SAIA). Species identified were A fumigatus (34), A niger (5), A terreus (4) and A flavus (3). All‐cause 1‐year mortality was 56%. Predictors of mortality were cancer history (OR, 9.5; 95% CI, 2.54‐35.51; P < 0.01) and SAIA (OR, 5.49; 95% CI, 1.49‐19.82; P < 0.01). Previous pulmonary tuberculosis, surgery for the treatment of CPA and CCPA were found to be associated with lower mortality (OR, 0.05; 95% CI, <0.01‐0.47; P < 0.01; OR, 0.16; 95% CI, 0.03‐0.88; P = 0.035 and OR 0.2, 95% CI, 0.01‐0.67; P = 0.01, respectively). This is the first study providing an overview of the features of CPA in patients from Spain. CCPA was the most frequent form of CPA and A fumigatus the most frequently isolated species. Patients with cancer history and SAIA had a worse prognosis.
Particle-Vane Interaction Probability in Gas Turbine Engines
Authors: Bojdo Nicholas , Ellis Matthew , Filippone Antonio , Jones Merren , Pawley Alison
Published: June 2019

Engine durability tests are used by manufacturers to demonstrate engine life and minimum performance when subjected to doses of test dusts, often Arizona Road Dust. Grain size distributions are chosen to replicate what enters the engine; less attention is paid to other properties such as composition and shape. We demonstrate here the differences in the probability of interaction of a particle of a given particle Reynolds number on to a vane if particle shape, vane geometry, and flow Reynolds number are varied and discuss why the traditional definition of Stokes number is inadequate for predicting the likelihood of interaction in these flows. We develop a new generalized Stokes number for nozzle guide vanes and demonstrate its use through application to 2D sections of the General Electric E3 nozzle guide vane. The new Stokes number is used to develop a reduced-order probability curve to predict the interaction efficiency of spherical and nonspherical particles, independent of flow conditions and vane geometry. We show that assuming spherical particles instead of more realistic sphericity of 0.75 can lead to as much as 25% difference in the probability of interaction at Stokes numbers of around unity. Finally, we use a hypothetical size distribution to demonstrate the application of the model to predict the total mass fraction of dust interaction with a nozzle guide vane at design point conditions and highlight the potential difference in the accumulation factor between spherical and nonspherical particles.
Review Article: Crystal alignment for high performance organic electronics devices
Authors: He Zhengran , Chen Jihua , Li Dawen
Published: June 2019

Organic electronics devices based on high-performance small-molecule organic semiconductors have gained substantial attention because of their unique advantages such as excellent charge transport, solution processability, and environmental stability. However, the intrinsic crystallization of small-molecule organic semiconductors is anisotropic, resulting in significant device performance variations of organic electronics devices. In this article, the authors review the various approaches and techniques developed to control and align the crystallization of some benchmark solution-processable, high-performance, small-molecule organic semiconductors, such as 6,13-bis(triisopropylsilylethynyl) pentacene, N,N′-1H,1H-perfluorobutyl dicyanoperylenecarboxydiimide, and 5,11-bis(triethylgermylethynyl)anthradithiophene. These alignment approaches are studied in the context of capillary force-based techniques, patterning-based techniques, solution-shearing-based techniques, and other miscellaneous techniques, including zone-casting, vertical flowing, air flow navigation, temperature gradient alignment, etc. The organic semiconductors and crystal alignment techniques reviewed in this article shed light on important relationship among crystallization, charge transport, and device performance and can be applied to various high-performance organic electronics devices, such as organic thin film transistors and solar cells.
Transcriptional activation of elephant shark mineralocorticoid receptor by corticosteroids, progesterone, and spironolactone
Authors: Katsu Yoshinao , Kohno Satomi , Oka Kaori , Lin Xiaozhi , Otake Sumika , Pillai Nisha E. , Takagi Wataru , Hyodo Susumu , Venkatesh Byrappa , Baker Michael E.
Published: June 2019

Binding and activity assays suggest a role for progesterone in stimulating the elephant shark mineralocorticoid receptor.
Jet-Setting Koalas Spread Cryptococcus gattii VGII in Australia
Authors: Schmertmann Laura J. , Danesi Patrizia , Monroy-Nieto Juan , Bowers Jolene , Engelthaler David M. , Malik Richard , Meyer Wieland , Krockenberger Mark B.
Published: June 2019

Cryptococcus gattii
molecular type VGII is one of the causes of cryptococcosis, a severe fungal disease that is acquired from the environment and affects many host species (including humans and koalas). In Australia, disease caused by
C. gattii
VGII is largely confined to western and central northern parts of the country, with sporadic cases reported in eastern Australia. We investigated an unusual case cluster of cryptococcosis, caused predominantly by
C. gattii
VGII, in a group of captive koalas in eastern Australia. This research identified that the movements of koalas between wildlife parks, including an initial transfer of a koala from Western Australia, introduced and subsequently spread
C. gattii
VGII in this captive environment. The spread of this pathogen by koalas could also impact other species, and these findings are significant in the implications they have for the management of koala transfers and captive environments.
Bridging the two fossil records: Paleontology’s “big data” future resides in museum collections
Authors: Allmon Warren D. , Dietl Gregory P. , Hendricks Jonathan R. , Ross Robert M.
Published: June 2019

There are two fossil records: the physical fossil record, which consists of specimens, and the abstracted fossil record, which is made up of data derived from those specimens. Mseum collections are the conduit between these two fossil records. Over the past several decades, the abstracted fossil record has provided many important insights about the major features of life’s history, but it has relied mostly on limited types of data (primarily taxonomic occurrence data) derived from ultimately finite literature sources. In contrast, specimen collections and modern tools for digitizing information about them present an opportunity to transform paleobiology into a “big data” science. Digitally capturing non-traditional (e.g., paleoecological, taphonomic, geochemical, and morphological) data from millions of specimens in museum collections and then integrating them with other unique big data resources has the potential to lead to the most important paleontological discoveries of the twenty-first century.

What we know about the past record relied heavily on museum collections—the cumulation of centuries of investigation of the fossil record. The sample of past biodiversity will accumulate only with continued exploration of the fossil record … and restudy of existing collections….

—J. Sepkoski (1992, p. 80)
Museum Wormianum: Collecting and learning in seventeenth-century Denmark
Authors: Tarp Lisbet
Published: June 2019

During the first half of the seventeenth century, the Danish polyhistor, Ole Worm (1588–1654), established a collection in Copenhagen, the Museum Wormianum, consisting of minerals, plants, animals, and man-made objects. The collection attracted visitors and was renowned throughout Europe; however, Worm also used it as a site for teaching his university students. Even though Worm did not contribute significantly to the history of science with new discoveries, this article argues that he played a role in shaping an intellectual environment founded on international exchange in which discussions took place, methods were enhanced, and talents were supported. In this context, his museum had an important function as a site of attraction and exchange, anticipating social interaction and learning, even when Worm himself could not participate.
Different functions of learning and knowledge—Geology takes form: Museums in the Habsburg Empire, 1815–1848
Authors: Klemun Marianne
Published: June 2019

Few institutions are as multifaceted and successful as museums. The three main objectives of the museum—collecting, researching, and teaching—always existed next to each other, but they were not necessarily equally weighted. They changed in the course of the history of the museum depending on location and concept. How different was the character of these institutions at the beginning of their existence, when many of them were newly established in the Habsburg Empire. In contrast to modern museums, which focus apart from preservation on exhibitions for a broader public, the concept of the museum of the Vormärz period (1815–1848) was based on different forms of teaching. In 1811, Archduke Johann founded the Joanneum, a universal museum (a museum that included objects from nature and culture as well as crafts) in the province of Styria as a state museum (Landesmuseum) for the region, which became the model for other institutions in the Habsburg provinces. It has been largely overlooked that this outstanding early museum, first and foremost, provided regular instructional lectures in botany and mineralogy and, in so doing, made natural history and earth sciences known to interested people. At a time when mineralogy was not taught at secondary schools and was rarely part of the university curriculum, scholars such as Friedrich Mohs, Matthias Anker, and Karl Haidinger filled this gap and gave lectures in these subjects at museums. This contribution examines the shift from mineralogy as a science of specimens to geognosy (geology) as a science of stratigraphy during the Vormärz period, and I will argue that museums played a pivotal role in this transition process.
The Rutgers Geology Museum: America’s first geology museum and the past 200 years of geoscience education
Authors: Neitzke-Adamo Lauren , Blandford A.J. , Criscione Julia , Olsson Richard K. , Gorder Erika
Published: June 2019

The Rutgers Geology Museum is America’s first geology museum. Rocks, fossils, and minerals had been collected into “cabinets of curiosities” since first contact between Europeans and Native Americans, and beginning in the late eighteenth century, many of these small personal cabinets were expanded, organized, and made available to the public at natural history and philosophical societies in Philadelphia and Boston. In the first decades of the nineteenth century, geology was widely recognized as an important new science that influenced the organization of collections on display at the growing number of colleges, academies, societies, lyceums, and museums that began popping up all over the United States, but it was not until 1872 that the first museum dedicated specifically to geology was built at Rutgers College. Rutgers University, known as Rutgers College until 1924, is itself one of the oldest colleges in America. Originally chartered as Queens College in the British colony of New Jersey in 1766, Rutgers, along with Harvard (1636), William and Mary (1693), Yale (1701), University of Pennsylvania (1740), Columbia (1754), Princeton (1755), Brown (1764), and Dartmouth College (1769), was among the nine colonial colleges founded before the American Revolution.

Since its inception, the Rutgers Geology Museum’s primary mission has been to educate the public on natural history–related topics. How this was accomplished has varied greatly through the years and originated with the “cabinet” of minerals that was displayed to students, alumni, and professors in the days of Dr. Lewis Beck, the first geology professor at Rutgers College. Through the efforts of Dr. George Cook, professor and vice president of Rutgers College, Geology Hall was erected in 1872 as the permanent home for the collections, and the museum and its collections became the focal point of the natural history courses taught at the time. The many professors and curators who tended to the museum and its collections over the next half century helped shape and dictate the future of science and geology education at the university, and with the creation of the Department of Geology in 1931, the museum became a center of leading geologic research and the outlet to present the results to the community. Today, the museum strives to connect with the local K–12 and university communities to inspire the next generation of geoscientists to continue building upon the legacy that the many Rutgers University geologists worked so hard to build.
The Children’s Museum of Indianapolis: A history of leveraging field expeditions and lab work to enhance public engagement
Authors: Evans Dallas C.
Published: June 2019

Any child that has been to a museum, gone stomping through a creek, or gazed at the stars knows that science learning isn’t confined to a classroom.

Children are eager to explore the wonders of the natural world, and parents and teachers value the importance of science education—thus, The Children’s Museum of Indianapolis (TCMI) has collected science objects and conducted fieldwork since it was first established.

During the 1930s, museum staff members drove equipment-laden Model T cars on expeditions known as Prairie Treks. Indianapolis schoolchildren were given the chance to venture to the western United States and investigate the plants and wildlife of the region. Campers learned to identify birds and animals, pan for gold, make plaster casts of dinosaur footprints, and collect fossils and rocks to add to the museum’s collection.

The natural science collection at TCMI is composed of more than 10,000 unique objects that help foster both curiosity and enthusiasm for the sciences. Science is an intensely hands-on and investigative endeavor, and this is reflected in the scope and the use of the objects in the collection. Items related to zoology, botany, and geology provide core materials that are utilized throughout the museum in exhibits, programs, and interpretation.

TCMI is closing in on its 100-year history. Its unique mission, as the world’s largest children’s museum, helps it to provide public engagement with the geosciences. Today each year more than 1.2 million visitors can experience programs ranging from self-guided discovery to active participation with scientists and their current research. Thousands have joined dinosaur excavations in the rocks of the Hell Creek Formation of South Dakota, prepped fossil materials in the Paleo Prep Lab, and even assisted in collection-based research.
Can real-time feedback improve the simulated infant cardiopulmonary resuscitation performance of basic life support and lay rescuers?
Authors: Kandasamy Jeyapal , Theobald Peter S , Maconochie Ian K , Jones Michael D
Published: June 2019

Background

Performing high-quality chest compressions during cardiopulmonary resuscitation (CPR) requires achieving of a target depth, release force, rate and duty cycle.

Objective

This study evaluates whether ‘real time’ feedback could improve infant CPR performance in basic life support-trained (BLS) and lay rescuers. It also investigates whether delivering rescue breaths hinders performing high-quality chest compressions. Also, this study reports raw data from the two methods used to calculate duty cycle performance.

Methodology

BLS (n=28) and lay (n=38) rescuers were randomly allocated to respective ‘feedback’ or ‘no-feedback’ groups, to perform two-thumb chest compressions on an instrumented infant manikin. Chest compression performance was then investigated across three compression algorithms (compression only; five rescue breaths then compression only; five rescue breaths then 15:2 compressions). Two different routes to calculate duty cycle were also investigated, due to conflicting instruction in the literature.

Results

No-feedback BLS and lay groups demonstrated <3% compliance against each performance target. The feedback rescuers produced 20-fold and 10-fold increases in BLS and lay cohorts, respectively, achieving all targets concurrently in >60% and >25% of all chest compressions, across all three algorithms. Performing rescue breaths did not impede chest compression quality.

Conclusions

A feedback system has great potential to improve infant CPR performance, especially in cohorts that have an underlying understanding of the technique. The addition of rescue breaths—a potential distraction—did not negatively influence chest compression quality. Duty cycle performance depended on the calculation method, meaning there is an urgent requirement to agree a single measure.
Panophthalmitis in a patient with dengue fever
Authors: Kumar Vimal , Deorari Vaibhav , Swaroop Shekhar , Biswas Ashutosh
Published: June 2019

Dengue fever is known for its life-threatening complications of bleeding and capillary leak syndrome. We report an unusual complication of dengue fever causing panophthalmitis, leading to rapidly progressive painful visual loss within days. Later on, the patient developed secondary bacterial infection of the eyeball and developed multiple brain abscesses due to spread of infection from the eyeball. Culture from pus swab of the right eye grewStaphylococcus epidermidis.The patient was promptly treated with broad spectrum antibiotics and after stabilisation, evisceration of the affected eye was done. Supportive therapy in the form of mechanical ventilation in view of poor sensorium, platelet transfusions for thrombocytopenia and guided fluid therapy was also provided. After multiple challenges in the management of the patient, fortunately, the patient survived but we failed to save his right eye. Therefore, it is necessary to carefully examine all vital organs at an early stage to prevent unfortunate outcome.
Intensive care use and mortality among patients with ST elevation myocardial infarction: retrospective cohort study
Authors: Valley Thomas S , Iwashyna Theodore J , Cooke Colin R , Sinha Shashank S , Ryan Andrew M , Yeh Robert W , Nallamothu Brahmajee K
Published: June 2019

Objective

To evaluate the effect of intensive care unit (ICU) admission on mortality among patients with ST elevation myocardial infarction (STEMI).

Design

Retrospective cohort study.

Setting

1727 acute care hospitals in the United States.

Participants

Medicare beneficiaries (aged 65 years or older) admitted with STEMI to either an ICU or a non-ICU unit (general/telemetry ward or intermediate care) between January 2014 and October 2015.

Main outcome measure

30 day mortality. An instrumental variable analysis was done to account for confounding, using as an instrument the additional distance that a patient with STEMI would need to travel beyond the closest hospital to arrive at a hospital in the top quarter of ICU admission rates for STEMI.

Results

The analysis included 109 375 patients admitted to hospital with STEMI. Hospitals in the top quarter of ICU admission rates admitted 85% or more of STEMI patients to an ICU. Among patients who received ICU care dependent on their proximity to a hospital in the top quarter of ICU admission rates, ICU admission was associated with lower 30 day mortality than non-ICU admission (absolute decrease 6.1 (95% confidence interval −11.9 to −0.3) percentage points). In a separate analysis among patients with non-STEMI, a group for whom evidence suggests that routine ICU care does not improve outcomes, ICU admission was not associated with differences in mortality (absolute increase 1.3 (−0.9 to 3.4) percentage points).

Conclusions

ICU care for STEMI is associated with improved mortality among patients who could be treated in an ICU or non-ICU unit. An urgent need exists to identify which patients with STEMI benefit from ICU admission and what about ICU care is beneficial.
Evaluating the implementation and effectiveness of a multi-component intervention to reduce post-surgical opioid prescribing: study protocol of a mixed-methods design
Authors: Stulberg Jonah J , Schäfer Willemijn L A , Shallcross Meagan L , Lambert Bruce L , Huang Reiping , Holl Jane L , Bilimoria Karl Y , Johnson Julie K
Published: June 2019

Introduction

Opioids prescribed after surgery accounted for 5% of the 191 million opioid prescriptions filled in 2017. Approximately 80% of the opioid pills prescribed by surgical care providers remain unused, leaving a substantial number of opioids available for non-medical use. We developed a multi-component intervention to address surgical providers’ role in the overprescribing of opioids. Our study will determine effective strategies for reducing post-surgical prescribing while ensuring adequate post-surgery patient-reported pain-related outcomes, and will assess implementation of the strategies.

Methods and analysis

The Minimising Opioid Prescribing in Surgery study will implement a multi-component intervention, in an Illinois network of six hospitals (one academical, two large community and three small community hospitals), to decrease opioid analgesics prescribed after surgery. The multi-component intervention involves four domains: (1) patient expectation setting, (2) baseline assessment of opioid use, (3) perioperative pain control optimisation and (4) post-surgical opioid minimisation. Four surgical specialities (general, orthopaedics, urology and gynaecology) at the six hospitals will implement the intervention. A mixed-methods approach will be used to assess the implementation and effectiveness of the intervention. Data from the network’s enterprise data warehouse will be used to evaluate the intervention’s effect on post-surgical prescriptions and a survey will collect pain-related patient-reported outcomes. Intervention effectiveness will be determined using a triangulation design, mixed-methods approach with staggered speciality-specific implementation for contemporaneous control of opioid prescribing changes over time. The Consolidated Framework for Implementation Research will be used to evaluate the site-specific contextual factors and adaptations to achieve implementation at each site.

Ethics and dissemination

The study aims to identify the most effective hospital-type and speciality-specific intervention bundles for rapid dissemination into our 56-hospital learning collaborative and in hospitals throughout the USA. All study activities have been approved by the Northwestern University Institutional Review Board (ID STU00205053).
Monitoring work well-being, job confidence and care provided by care home staff using a self-report survey
Authors: Benson Tim , Sladen Joe , Done Jessamy , Bowman Clive
Published: June 2019

Background and method

In care homes, staff well-being, job confidence and opinion of the care provided to residents are central to morale and care quality. In this study, care home staff in the East Midlands region of England completed self-reported outcome and experience surveys in two rounds. Mean scores for each home are shown using a scale from 0 (all chose lowest option) to 100 (all chose highest option). High scores are good.

Results

In round 1, 332 staff in 15 homes submitted responses; in round 2, 207 staff in 9 homes. Mean scores in round 1 and round 2 were similar, although those of some homes scores differed significantly, cancelling each other out. Overall, Work Wellbeing mean score was 83 (care home range 48–97), with worthwhileness (92) the highest ranked item and anxiety at work (78) the lowest. Job Confidence mean score was 84 (range 59–94), with able to manage the work (86) highest and involvement in decisions that affect staff (79) lowest. Care Provided mean score was 86 (range 59–97), with treat people kindly (91) highest and well organised (80) lowest. Homes rated as outstanding by the Care Quality Commission had higher scores on average than those rated good, which were higher than those rated as needing improvement.

Conclusions

This study has demonstrated the practicality of measuring staff views of their Work Wellbeing, Job Confidence and Care Provided in care homes. Rather than wait for adverse quality outcomes to be detected, this approach offers a way to track staff morale and declared capability over time.
Emerging patterns in clonal haematopoiesis
Authors: Capo-Chichi Jose-Mario , Michaels Phillip , Tremblay-Le May Rosemarie , Abelson Sagi , Hasserjian Robert Paul , Xia Daniel
Published: June 2019

Clonal haematopoiesis (CH) is defined by the presence of acquired mutations and/or cytogenetic abnormalities in haematopoietic cells. By definition, these premalignant clones do not meet criteria for haematopoietic neoplasms listed in the Revised Fourth Edition of the WHO classification. CH is fairly common in elderly individuals and is associated with higher risks for haematological cancers, in particular myelodysplastic syndrome and acute myeloid leukaemia (AML), as well as cardiovascular events. Similar small clones have also been detected during follow-up in patients with AML in morphological remission, in individuals with aplastic anaemia, and in pre-chemotherapy blood samples from patients with other types of cancers. In each of these contexts, the presence of mutations carries different clinical implications, and sometimes demonstrates unique genetic profiles. Emerging research suggests that the number and identity of mutations, the size of the mutant clones and various other factors, including age, immune status and history of exogenous drugs/toxins, are important for disease biology and progression. This review focuses specifically on the subset of CH with gene mutations detected by sequencing, and includes discussions of nomenclature and molecular technologies that detect and quantify gene mutations.
Interplay of regional economic development, income, gender and type 2 diabetes: evidence from half a million Chinese
Authors: Tang Kun , Wang Hanyu , Liu Yuning , Tan Shi Hui
Published: June 2019

Background

Following the rapid economic growth, there has been a strong disparity of regional development and personal income in China. Type 2 diabetes mellitus (T2DM) may be influenced by socioeconomic status at both the societal and individual levels. This study examines the associations of regional economic development, household income and gender on T2DM.

Method

Data from the baseline of a Chinese population-based study of approximately 500 000 adults from 10 areas were analysed. Clinically identified and screen-detected T2DM were examined. Regional economic development was indicated by gross domestic product (GDP) per capita. A logistic regression-based method was used to calculate the adjusted prevalence.

Result

The prevalence of T2DM was significantly higher in medium GDP per capita areas for both males (7.04%, 95% CI 6.82% to 7.26%) and females (6.04%, 95% CI 5.86% to 6.22%) compared with areas of other levels of economic development. The different shapes of associations between household income and T2DM prevalence were observed in different GDP per capita areas. There were strong gender differences in terms of both the trend and strength of association between household income and T2DM prevalence.

Conclusions

Findings from this study underscore the importance of economic conditions and gender difference on T2DM. It suggests that strategies for diabetes prevention should address social–economic differences besides a person-centred approach.
Non-vitamin K antagonist oral anticoagulants in adults with a Fontan circulation: are they safe
Authors: Yang Hayang , Veldtman Gruschen R , Bouma Berto J , Budts Werner , Niwa Koichiro , Meijboom Folkert , Scognamiglio Giancarlo , Egbe Alexander Chima , Schwerzmann Markus , Broberg Craig , Morissens Marielle , Buber Jonathan , Tsai Shane , Polyzois Ioannis , Post Martijn C , Greutmann Matthias , Van Dijk Arie , Mulder Barbara JM , Aboulhosn Jamil
Published: June 2019

Background

In Fontan patients with atrial arrhythmias (AA), non-vitamin K antagonist oral anticoagulants(NOACs) have a class III recommendation according to the Pediatric & Congenital Electrophysiology Society (PACES)/Heart Rhythm Society (HRS) guideline in 2014, due to lack of data on outcomes as opposed to evidence of harm. To address this gap in data, we investigated the safety and efficacy of NOACs in adults with a Fontan circulation in a worldwide study.

Methods

This is an international multicentre prospective cohort study, using data from the NOTE (non-vitamin K antagonistoral anticoagulants forthromboembolic prevention in patients with congenital heart disease) registry. The study population comprised consecutive adults with a Fontan circulation using NOACs. Follow-up took place at 6 months and yearly thereafter. The primary endpoints were thromboembolism and major bleeding. Secondary endpoint was minor bleeding.

Results

From April 2014 onward, 74 patients (mean age 32±10 years (range 18–68), 54% male) with a Fontan circulation using NOACs were included. During a median follow-up of 1.2 (IQR 0.8–2.0) years, three thromboembolic events (2.9 per 100 patient-years (95% CI 0.7 to 7.6)) and three major bleedings (2.9 per 100 patient-years (95% CI 0.7 to 7.6)) occurred in five atriopulmonary Fontan and one total cavopulmonary connection Fontan patients with AA. Fifteen patients experienced minor bleeding episodes (15.8 per 100 patient-years (95% CI 9.1 to 25.2)). In patients (n=37) using vitamin K antagonists (VKAs) prior to the initiation of NOAC, annual incidence of historical thromboembolic events and major bleeding were 2.4% (95% CI 0.4% to 7.4%) (n = 2) and 1.2% (95% CI 0.7% to 5.1%) (n = 1), respectively.

Conclusions

In this review of the largest Fontan cohort using NOACs with prospective follow-up, NOACs appear to be well tolerated and their efficacy and safety during short-term follow-up seem comparable to VKAs. Longer term data are required to confirm these promising short-term results.
Exploiting a low tax system: non-tax-induced cigarette price increases in Taiwan 2011–2016
Authors: Gao Wayne , Sanna Mattia , Branston J Robert , Chiou Hung-Yi , Chen Yi-Hua , Wu Allison , Wen Chi Pang
Published: June 2019

Introduction

This study aims to analyse the non-tax-induced price increasing strategies adopted by tobacco industry in Taiwan, a high-income country with comprehensive tobacco control policies but low tobacco taxes and a declining cigarette market.

Methods

Using governmental tax, price and inflation data, we analysed cigarette sales volume, affordability, affordability elasticity of demand, market share, pricing and net revenue of the top five tobacco companies in Taiwan from 2011 to 2016 when no tax increases occurred.

Results

Total revenue after tax grew significantly for all the major transnational tobacco companies between 2011 and 2016 at the expense of the state-owned Taiwan Tobacco and Liquor Corporation. In terms of market share, Japan Tobacco (JT) was the leading company, despite experiencing a small decline, while British American Tobacco and Imperial Brands remained stable, and Philip Morris International increased from 4.7% to 7.0%. JT adopted the most effective pricing strategy by increasing the real price of its two most popular brands (Mevius and Mi-Ne) and, at the same time, doubling the sales of its cheaper and less popular brand Winston by leaving its nominal retail price unaltered.

Conclusions

Low and unchanged tobacco taxes enable tobacco companies to use aggressive pricing and segmentation strategies to increase the real price of cigarettes without making them less affordable while simultaneously maintaining customers’ loyalty. It is crucial to continue monitoring the industry’s pricing strategies and to regularly increase taxes to promote public health and to prevent tobacco industry from profiting at the expense of government revenues.
Heated tobacco product use among Korean adolescents
Authors: Kang Heewon , Cho Sung-il
Published: June 2019

Background

Heated tobacco products (HTPs) may compromise decades-long efforts to marginalise the tobacco industry. Their appeal to adolescents imposes a risk of a new tobacco epidemic. Empirical evidence on the behavioural patterns of HTP use among adolescents is required. We investigated the prevalence of HTP use and the association between use of HTPs and e-cigarettes and attempts to quit smoking cigarettes.

Methods

Nationally representative cross-sectional survey data of South Korean adolescents aged 12–18 years (mean age: 15 years) were used. The survey was conducted 1 year after the introduction of HTPs in Korea. A total of 59 532 adolescents were identified. Descriptive statistics and multiple logistic regression results are presented.

Results

In all, 2.8% of South Korean adolescents were ever HTP users. Among these, 75.5% were current cigarette users, 45.6% were current e-cigarette users and 40.3% were concurrent users of cigarettes and e-cigarettes. Unlike ever use of e-cigarettes, which was associated with a higher likelihood of cigarette quit attempts (adjusted OR (aOR)=1.35, 95% CI: 1.16 to 1.58), no difference in cigarette quit attempts was found for ever use of HTPs (aOR=1.07, 95% CI: 0.91 to 1.26).

Conclusion

Considering the recent introduction of HTPs to the Korean market and less than 1% prevalence of e-cigarette when first introduced, the prevalence of ever HTP use among Korean adolescents is an important concern. The results showing high polytobacco use and the lack of an association between HTP use and cigarette quit attempts call for a ban on HTP advertisements with modified harm claims.
How to evaluate diagnosis and management of biliary atresia in the era of liver Transplantation in China
Authors: Zhan Jianghua , Chen Yajun , Wong Kenneth K Y
Published: June 2019

Background

Biliary atresia (BA) is one of the most challenging hepatobiliary diseases in children. Notwithstanding the reasonable outcome of liver transplantation (LT), portoenteral anastomosis (Kasai operation) is still the first choice of treatment for patients with BA. How to improve the survival rate of the patients with BA in the era of LT is a new challenge.

Data sources

Based on recent original publications and the experience with the BA in China, we review many factors that influence BA survival situation, including early diagnosis and screen plan, defects of early treatment, Kasai operation, and LT and indicate present questions about BA diagnosis and treatment in China.

Results

BA diagnosis may also be delayed due to insufficient understanding of BA and lack of jaundice monitoring methods at different levels of the hospitals in China. Further education of the physicians at smaller city hospitals about BA, neonatal jaundice and cholestasis would be helpful in improving early diagnosis of BA. Early surgical intervention is still the only guarantee to improve the survival rate of BA with native liver.

Conclusions

In the era of LT, especially in China, Kasai operation can provide waiting time for living donor LT and improve the success rate of LT and minimize the rapid deterioration of liver function of the children with BA and decrease the mortality in patients with BA.
Use of transabdominal (external) ultrasound during balloon dilatation to diagnose tracheobronchial remnant in congenital esophageal stenosis
Authors: Hattori Kengo , Takamizawa Shigeru , Miyake Yuichiro , Hatata Tomoko , Yoshizawa Katsumi , Furukawa Tomoko , Kondo Yoshiaki
Published: June 2019

Preoperativedifferential diagnosis between tracheobronchial remnant (TBR) and other typesof congenital esophageal stenosis (CES) is challenging, even when usingendoscopic ultrasonography (EUS). This report is the first to demonstrate theuse of transabdominal (external) ultrasound during balloon dilatation todiagnose TBR in CES. This simple technique is a promising diagnostic tool forTBR as an alternative to EUS.
Newborn with a genital cystic lesion
Authors: Cascais Mafalda , Miranda Patrícia , Coimbra Diana , Tiago Joaquim , Henriques Raquel , Ramalho Rosa
Published: June 2019

Interlabial cysts in the newborn are rare findings and distinct entities are included in the differential diagnosis. Simple hymenal cysts are one of the most commonly reported and spontaneous regression frequently occurs. We report a case of a newborn with an introital cyst arising from the hymen.
Bishop Koop conversion of temporary stoma can be an option to establish gut continuity early when primary anastomosis is not safe
Authors: Hasan Md Samiul , Rahman Ashrarur , Huq Umama , Ferdous Kazi Nur Ul , Ali Md Ayub
Published: June 2019

Background

Intestinal perforation and sometimes obstruction in neonates demand diverting stomas which are associated with fluid, electrolytes and nutrient loss. Early establishment of gut continuity is the key to the best outcome, though primary anastomosis is not always safe. The aim of this study was to evaluate the effectiveness of Bishop Koop stoma in establishing early continuity of gut and confirming the function of distal gut.

Methods

Data of patients who underwent Bishop Koop conversion of diverting stoma from July 2016 to June 2018 were reviewed retrospectively. Demographic and outcome data were recorded and analyzed using Statistical Package for the Social Science (SPSS) V.22 software. Ethical permission was taken from hospital ethical committee.

Results

29 patients were included (16 male and 13 female). Mean age of conversion was 5.8±2.5 months and mean weight was 4.9±1.6. Normal bowel movement was established in 26 patients. One patient died of sepsis on sixth postoperative day and one had anastomotic leakage. There was no significant difference with respect to outcome between perforation and obstruction group. Bishop Koop stomas were closed after 6 weeks of formation.

Conclusions

Bishop Koop conversion of temporary stoma was turned out as a good choice for these patients.
Effect of inguinal hernia on the thickness and blood flow of spermatic cord in boys
Authors: Huang Shoujiang , Li Canping , Yang Xiuzhen , Liang Jianfeng , Wang Dongpi
Published: June 2019

Objective

To evaluate the effect of inguinal hernia (IH) on the spermatic cord using spermatic cord ultrasonography (SCU).

Methods

From January 2016 to January 2017, boys with IH who received SCU at the start of open herniorrhaphy (OH) were enrolled in this study. The age and weight at SCU, width of the spermatic cord (SC-W), peak systolic velocity (PSV) in the spermatic artery (SA-PSV) and velocity in the pampiniform plexus (PP-V), and the interval between the initial and the second OH in boys with metachronous inguinal hernia (MIH) were recorded, and the relationship among them was studied. Boys with unilateral IH comprised the IH group, and boys with MIH comprised the MIH group. Boys with polydactylism served as the control. One-way analysis of variance tested the differences among groups. Spearman’s r tested the relationship between SC-W in the MIH group and the interval.

Results

A total of 80 boys were enrolled in this study (IH group 29, MIH group 26, and control group 25). SA-PSV and PP-V in the hernia side were faster and slower than the control, respectively. There was no significant difference in PP-V and SA-PSV of the treated side in the MIH group and in the control group. After herniorrhaphy, SC-W was tapered down to normal size. SC-W, SA-PSV, and PP-V in the treated side were all highly correlated to the interval in a curvilinear manner.

Conclusion

PSV was positively correlated with SC-W in boys with IH, and PP-V was negatively correlated; herniorrhaphy could reverse the impairment.