bluuebunny/crossref_metadata_2025 huggingface dataset:
Ocular hemorrhage secondary to thioguanine‐associated veno‐occlusive disease in a child with acute lymphoblastic leukemia in delayed intensification
Authors: Bhunia Nabanita , Yeager Nicholas D. , Colace Susan I. , Buzzaco Dominic , Bajwa Rajinder P. S.
Published: December 2019

Hepatic VOD is a potentially fatal complication during stem cell transplantation and is rarely seen in the non‐transplant setting. We report the case of a five‐year‐old boy who presented with visual complaints during delayed intensification phase of treatment for ALL. He was found to have bilateral retinal hemorrhages associated with profound thrombocytopenia due to chemotherapy. VOD was diagnosed based on EBMT criteria and was managed with supportive care. Despite resolution of VOD, his vision progressively deteriorated and resulted in blindness. This case highlights the significance of close monitoring of ALL patients in delayed intensification when they are at risk for developing VOD, the importance of refractory thrombocytopenia as a diagnostic feature and the potential for VOD to manifest with intraocular bleeding.
Decolonizing Philosophy
Authors: Gordon Lewis R.
Published: December 2019

This article explores five ways in which philosophy could be colonized: (1) racial and ethnic origins, (2) coloniality of its norms, (3) market commodification, (4) disciplinary decadence, (5) solipsism—and what the author calls a teleological suspension of philosophy as consideration among other practices of thought.
Rethinking the Decolonization Trope in Philosophy
Authors: Táíwò Olúfẹ́mi
Published: December 2019

This piece takes a close look at the contributions of two very important thinkers whose works have, on the whole, framed the deployment of what I call the decolonizing trope in contemporary African philosophy: Ngũgĩ wa Thiong'o and Kwasi Wiredu. I argue that, in light of current discussions in African life and politics and current trends in African philosophical discourse dominated by this trope, it may be time to, at least, rethink, if not abandon, the trope. The viability of a conceptual decolonization in philosophy may have been oversold; the trope may give a false impression of the complexity of the situation it is designed to help attenuate; and it may be having deleterious consequences on discourse and its progress even if they are unintended.
Alterity, Analectics, and the Challenges of Epistemic Decolonization
Authors: Kim David Haekwon
Published: December 2019

This essay explores some conceptual and diagnostic frameworks to advance epistemic decolonization in the US philosophical profession. A central focus is the distinction between those philosophies of formerly colonized peoples that are culturally alterior or, simply, alterior and those that are analectical in the Dusselian sense of emerging from a subordinated political position. The paper begins by reflecting upon connections between coloniality, the alterior, and the analectical to frame the discussion of epistemic decolonization in the philosophy profession. It then considers a knower's core theoretic reconstruction in the task of epistemic decolonization and identifies some ambiguities in reconciling alterior traditions with analectical theoretical reconstruction. The work of Charles Mills and Enrique Dussel are considered as case studies. The paper concludes with critical reflections on the institutional network of canon, curriculum, and other conceptual and credentialization structures that constitute institutional Eurocentrism.
Revising the conventional tax‐effort principle
Authors: Dalamagas Basil , Leventides John , Palaios Panagiotis , Tantos Stefanos
Published: December 2019

The standard methodology on tax‐effort (i.e., the ratio of actual tax revenue to its optimal level) is to run a regression of actual tax revenue on countries’ specific (macroeconomic, demographic, geographical, political, social, and institutional) variables. The resulting predicted (fitted) values are then taken to represent the optimal (desired or maximum) level of tax revenue. The crucial issue of tracing out how the optimal tax revenue should be allocated to the fiscal objectives (equity, efficiency) does not seem to be of any interest to the researchers on tax‐effort. The present paper argues that the standard methodology is not without faults and needs revising. We demonstrate that an optimal tax system can be safely derived from maximizing a utility function with respect to (in)direct tax rates. The manipulation of the first‐order conditions, using a novel mathematical module, leads to an infinite number of optimal direct–indirect tax rates. The selection of the optimal mix of these tax rates is dependent on the country‐specific households’ preferences over equity/efficiency, as they are formulated by voters’ volition in election periods. A simulation procedure helps understanding how the optimal tax revenue is chosen and how it can be optimally allocated to fiscal objectives, in the context of a panel data set including a large number of developed and developing countries. Throughout our text, the optimal tax revenue is defined as the sum of the products of the optimal (in)direct tax rates and their corresponding tax bases. In the simple Arrow–Debreu economy, the above sum is shown to be equal to the difference between income and consumption.
Solvent detergent treated pooled plasma and reduction of allergic transfusion reactions
Authors: McGonigle Andrea M. , Patel Eshan U. , Waters Kevin M. , Moliterno Alison R. , Thoman Sandra K. , Vozniak Sonja O. , Ness Paul M. , King Karen E. , Tobian Aaron A. R. , Lokhandwala Parvez M.
Published: December 2019

BACKGROUND

Thrombotic thrombocytopenic purpura (TTP) patients have increased risk for allergic transfusion reactions (ATR) due to the number of plasma products they require. This study evaluated the efficacy of solvent detergent treated plasma (S/D treated plasma) to reduce ATRs.

STUDY DESIGN AND METHODS

All TTP patients who presented from April 2014 to February 2015 and experienced a moderate–severe ATR to untreated plasma with TPE were switched to S/D treated plasma (Octaplas) for their remaining procedures and included in the study. Patient records were retrospectively reviewed.

RESULTS

The overall ATR rate per procedure decreased from 35.0% (95% CI = 15.4%‐59.2%) with untreated plasma to 1.4% ([1/73] 95% CI = 0.0%‐7.4%) with S/D treated plasma. The moderate–severe ATR rate decreased from 20.0% ([4/20] 95% CI = 5.7%‐43.7%) with untreated plasma to 0.0% ([0/73] 95% CI = 0.0%‐4.9%) with S/D treated plasma. The overall ATR rate per plasma unit decreased from 2.6% (95%CI = 1.0%‐5.1%) with untreated plasma to 0.1% (95% CI = 0.0%‐0.4%) with S/D treated plasma. No patients experienced VTE while receiving untreated plasma. Four patients experienced VTE events while receiving S/D treated plasma. All patients who experienced a VTE had additional risk factors for VTE.

CONCLUSION

S/D plasma has promise as an effective product to reduce the risk of ATRs in TTP patients. Given the high risk of ATR in TTP patients, consideration of S/D plasma instead of untreated plasma for TPE in these patients may be warranted, especially for patients with a history of moderate to severe ATR. More extensive studies are needed to confirm these findings.
Association of abdominal effusion with a single decompressive cystocentesis prior to catheterization in male cats with urethral obstruction
Authors: Gerken Katherine K. , Cooper Edward S. , Butler Amy L. , Chew Dennis J.
Published: December 2019

Objective

To evaluate the occurrence of abdominal effusion and its association with decompressive cystocentesis in male cats with urethral obstruction.

Design

Prospective observational clinical study.

Animals

Forty‐five male neutered, client‐owned cats with naturally occurring urethral obstruction.

Procedures

Laboratory testing and point‐of‐care ultrasonography were performed. Presence of abdominal effusion was evaluated using the Focused Assessment with Sonography for Trauma (FAST) technique at presentation. Decompressive cystocentesis was then performed prior to catheterization by a standardized technique. Repeat FAST examination was performed 15 minutes after cystocentesis and the following day to further assess for the presence of abdominal effusion.

Results

A mean volume of 92.3 ± 35.2 mL of urine was removed from each cat via cystocentesis prior to catheterization. At presentation, 15 of 45 (33%) had abdominal effusion (13/15 with scant effusion, 2/15 with mild), with an additional 7 cats developing scant effusion 15 minutes post‐cystocentesis. By the following day, 4 cats still had scant effusion present. No significant complications secondary to cystocentesis were reported. No association was found between severity of azotemia, or volume removed by cystocentesis, and the presence of effusion at presentation or after decompressive cystocentesis was performed.

Conclusions and Clinical Relevance

A single decompressive cystocentesis prior to catheterization did not lead to development of clinically significant abdominal effusion or other discernable complications and appears to be a safe procedure in this population of patients. Abdominal effusion may be found at presentation in cats with urethral obstruction. The significance of this effusion remains to be determined.
El antiguo convento de El Carmen a la luz del trabajo de la Oficina de Monumentos Coloniales y de la República, 1929-1939
Authors: Ramírez Méndez Jessica , Salinas Córdova Daniel
Published: December 2019

Los monumentos históricos y arqueológicos tuvieron un importante papel en las políticas educativas y culturales de los gobiernos posrevolucionarios en México. En el presente artículo exploramos el funcionamiento y responsabilidades de las instancias gubernamentales encargadas de proteger y conservar los monumentos históricos, a la par de cómo algunos de ellos funcionaron como museos, los cuales fueron concebidos como espacios educativos. En este contexto es que estudiamos el caso del antiguo convento de El Carmen en San Ángel entre 1929 y 1939, y señalamos las problemáticas que tuvo a causa de una división simbólica y administrativa entre el templo, que continuó siendo un espacio principalmente destinado al culto, y el que fuera el convento, en donde se instaló un museo que promovía una educación laica y nacionalista. No obstante esta diferencia, en conjunto El Carmen se presentó ante los visitantes locales y extranjeros como un representante de la época colonial en el marco de la historia nacional promovida por el Estado.
El enfoque hacia el estudio de las particularidades locales en la evolución arquitectónica de las iglesias de los pueblos de indios del Altiplano Cundiboyacense entre mediados del siglo XVI y el siglo XIX
Authors: Chica Segoviaa Angélica Chica Segoviaa
Published: December 2019

Las particularidades locales de cada bien de interés cultural y su contexto nutren su consideración como patrimonio, y permiten acercarse a reconocer la realidad del objeto y su evolución en el tiempo, marcando las diferencias entreellos. Esto motivó el estudio de la evolución de las iglesias de pueblos de indios del Altiplano Cundiboyacense, a través de un enfoque histórico-tecnológico que parte del estudio de la materialidad, a la luz de las coyunturas de sucontexto entre finales del siglo XVI y el XIX. A partir de las fuentes documentales de archivo, la comprensión de su contexto espacial e histórico y su confrontación en sitio, se identificaron las variables de su concepción y construcción, esenciales en su interpretación como evidencia y huella de diferentes momentos que las hacen un conjunto no homogéneo. Se dedujeron siete etapas arquitectónicas relacionadas con las transformaciones de su contexto específico, con énfasis en los fenómenos locales, para determinar la amplitud y diversidad del patrimonio local cuando se logra profundizar la mirada más allá de los referentes generales, foráneos o estilísticos, al enfocarse en las particularidades del sitio. De allí se concluyó que el entender las edificaciones como resultado de fenómenos y condiciones particulares del contexto local, y no solo el de referentes foráneos, es fundamental en la interpretación y la conservación del patrimonio, pues es de allí que se deducen sus diferencias y aquello que las hace únicas.
The Novel Arylamidine T-2307 Demonstrates
In Vitro
and
In Vivo
Activity against Candida auris
Authors: Wiederhold Nathan P. , Najvar Laura K. , Jaramillo Rosie , Olivo Marcos , Patterson Hoja , Connell April , Fukuda Yoshiko , Mitsuyama Junichi , Catano Gabriel , Patterson Thomas F.
Published: December 2019

The
in vitro
and
in vivo
activity of the arylamidine T-2307 against
Candida auris
was evaluated. T-2307 demonstrated
in vitro
activity (MIC ranges ≤ 0.008 to 0.015 μg/ml at 50% inhibition; 0.125 to >4 μg/ml at 100% inhibition).
Characteristics of Wetting-Induced Bacteriophage Blooms in Biological Soil Crust
Authors: Van Goethem Marc W. , Swenson Tami L. , Trubl Gareth , Roux Simon , Northen Trent R.
Published: December 2019

This work forms part of an overarching research theme studying the effects of a changing climate on biological soil crust (biocrust) in the Southwestern United States. To our knowledge, this study was the first to characterize bacteriophages in biocrust and offers a view into the ecology of phages in response to a laboratory wetting experiment. The phages identified here represent lineages of
Caudovirales
, and we found that the dynamics of their interactions with their
Firmicutes
hosts explain the collapse of a bacterial bloom that was induced by wetting. Moreover, we show that phages carried host-altering metabolic genes and found evidence of proviral infection and CRISPR-Cas repeats within host genomes. Our results suggest that phages exert controls on population density by lysing dominant bacterial hosts and that they further impact biocrust by acquiring host genes for sporulation. Future research should explore how dominant these phages are in other biocrust communities and quantify how much the control and lysis of blooming populations contributes to nutrient cycling in biocrusts.
Ubiquitination of
Listeria
Virulence Factor InlC Contributes to the Host Response to Infection
Authors: Gouin Edith , Balestrino Damien , Rasid Orhan , Nahori Marie-Anne , Villiers Véronique , Impens Francis , Volant Stevenn , Vogl Thomas , Jacob Yves , Dussurget Olivier , Cossart Pascale
Published: December 2019

The pathogenic potential of
Listeria monocytogenes
relies on the production of an arsenal of virulence determinants that have been extensively characterized, including surface and secreted proteins of the internalin family. We have previously shown that the
Listeria
secreted internalin InlC interacts with IκB kinase α to interfere with the host immune response (E. Gouin, M. Adib-Conquy, D. Balestrino, M.-A. Nahori, et al., Proc Natl Acad Sci USA, 107:17333–17338, 2010,
https://doi.org/10.1073/pnas.1007765107
). In the present work, we report that InlC is monoubiquitinated on K
224
upon infection of cells and provide evidence that ubiquitinated InlC interacts with and stabilizes the alarmin S100A9, which is a critical regulator of the immune response and inflammatory processes. Additionally, we show that ubiquitination of InlC causes an increase in reactive oxygen species production by neutrophils in mice and restricts
Listeria
infection. These findings are the first to identify a posttranscriptional modification of an internalin contributing to host defense.
A Multiorgan Trafficking Circuit Provides Purifying Selection of Listeria monocytogenes Virulence Genes
Authors: Louie Alexander , Zhang Ting , Becattini Simone , Waldor Matthew K. , Portnoy Daniel A.
Published: December 2019

Listeria monocytogenesmaintains capabilities for free-living growth in the environment and for intracellular replication in a wide range of hosts, including livestock and humans. Here, we characterized an enterocolitis model of foodborneL. monocytogenesinfection. This work highlights a multiorgan trafficking circuit and reveals a fitness advantage for bacteria that successfully complete this cycle. Because virulence factors play critical roles in systemic dissemination and multiple bottlenecks occur as the bacterial population colonizes different tissue sites, this multiorgan trafficking circuit likely provides purifying selection of virulence genes. This study also serves as a foundation for future work using theL. monocytogenes-induced enterocolitis model to investigate the biology ofL. monocytogenesin the intestinal environment.
Genomewide and Enzymatic Analysis Reveals Efficient
d
-Galacturonic Acid Metabolism in the Basidiomycete Yeast Rhodosporidium toruloides
Authors: Protzko Ryan J. , Hach Christina A. , Coradetti Samuel T. , Hackhofer Magdalena A. , Magosch Sonja , Thieme Nils , Geiselman Gina M. , Arkin Adam P. , Skerker Jeffrey M. , Dueber John E. , Benz J. Philipp
Published: December 2019

The switch from the traditional fossil-based industry to a green and sustainable bioeconomy demands the complete utilization of renewable feedstocks. Many currently used bioconversion hosts are unable to utilize major components of plant biomass, warranting the identification of microorganisms with broader catabolic capacity and characterization of their unique biochemical pathways.
d
-Galacturonic acid is a plant component of bioconversion interest and is the major backbone sugar of pectin, a plant cell wall polysaccharide abundant in soft and young plant tissues. The red basidiomycete and oleaginous yeast
Rhodosporidium toruloides
has been previously shown to utilize a range of sugars and aromatic molecules. Using state-of-the-art functional genomic methods and physiological and biochemical assays, we elucidated the molecular basis underlying the efficient metabolism of
d
-galacturonic acid. This study identified an efficient pathway for uronic acid conversion to guide future engineering efforts and represents the first detailed metabolic analysis of pectin metabolism in a basidiomycete fungus.
Global Screening of Genomic and Transcriptomic Factors Associated with Phenotype Differences between Multidrug-Resistant and -Susceptible Candida haemulonii Strains
Authors: Zhang Hao , Niu Yifei , Tan Jingwen , Liu Weixia , Sun Ming-an , Yang Ence , Wang Qian , Li Ruoyu , Wang Yejun , Liu Wei
Published: December 2019

A comprehensive, multi-omic survey was performed to disclose the genetic backgrounds and differences between multidrug-resistant and -susceptible
C. haemulonii
strains. Genes were identified with mutations or significant expression differences in multidrug-resistant compared to multidrug-susceptible strains, which were mainly involved in multidrug resistance, stress fitness, and morphology. The Cdr1-encoding gene,
C. haemulonii
2486
(
CH_2486
), was expressed at a significantly increased level in multidrug-resistant strains. Functional inhibition experiments further implicated potential roles of
CH_2486
in drug resistance. A gene spontaneously mutated in resistant strains,
CH_4347
, was experimentally validated to influence the morphology of spores, possibly by controlling cell wall integrity.
Retrograde open superior mesenteric artery stenting: a novel approach to managing occluded ilio-superior mesenteric artery grafts
Authors: Fadel Michael G , Andrews Brian
Published: December 2019

Acute mesenteric ischaemia (AMI) can be treated either by open bypass grafting or occasionally by antegrade endovascular stenting. We present a patient with symptoms of AMI, in the early postoperative period, following thrombosis of an iliac to superior mesenteric bypass to treat chronic mesenteric ischaemia. A hybrid technique combining open surgery with a retrograde endovascular approach was performed. This allowed for direct visualisation of the bowel and immediate revascularisation of the mesenteric circulation.
Development of a home-visit nursing scale for helping spousal caregivers of terminal cancer patients develop positive perspectives of their caregiving experiences: a cross-sectional study
Authors: Karikawa Mari , Nakatani Hisae
Published: December 2019

Objective

Home-visit nurses play a key role in supporting the spouses of terminal cancer patients and encouraging positive perspectives of the caregiving experience. This study aimed to develop a scale to support nurses in self-assessing their practice around this important role.

Design

Cross-sectional questionnaire study.

Setting

The Home Nursing Scale to Help Spousal Caregivers (HNS-HSC) questionnaire for self-assessment of home-visit nursing to spouses was developed based on interviews with spouses and literature reviews.

Participants

Overall, 1500 home-visit nurses nationwide who had experience in supporting spousal caregivers and their patients in the predeath and postdeath periods were approached for participation.

Main outcome measure

Planned exploratory and confirmatory factor analyses were used to assess the underlying dimensions of the HNS-HSC; Cronbach’s α was used to determine the reliability. The Japanese version of Frommelt Attitude Toward Care of the Dying Scale Form B (FAT-COD-B-J) and Grief Care scale were administered to assess convergent and discriminant validity.

Results

Exploratory and confirmatory factor analyses identified 26 items on five factors: ‘helping spouses plan their futures’ ‘helping caregivers alleviate any regrets regarding their care’, ‘understanding the bond between a couple’, ‘providing support for anticipatory grief’, and ‘addressing spousal caregivers’ emotions after their spouses’ deaths’. The final model showed acceptable goodness-of-fit indices. The Cronbach’s α for the entire scale was 0.949 and exceeded 0.822 for each factor. The correlation coefficient with the FAT-COD-B-J, which served as an external validation, was 0.35. The correlation coefficients for the three grief care scales were 0.64, 0.45 and 0.72, respectively.

Conclusions

This scale is a reliable and valid tool for visiting nurses to self-assess their knowledge, skills and practice around helping spousal caregivers. By using this scale, it is expected to change nursing practice in pursuit of improving quality of life of spouses.
Emerging cancer incidence, mortality, hospitalisation and associated burden among Australian cancer patients, 1982 – 2014: an incidence-based approach in terms of trends, determinants and inequality
Authors: Mahumud Rashidul Alam , Alam Khorshed , Dunn Jeff , Gow Jeff
Published: December 2019

Objective

Cancer is a leading killer worldwide, including Australia. Cancer diagnosis leads to a substantial burden on the individual, their family and society. The main aim of this study is to understand the trends, determinants and inequalities associated with cancer incidence, hospitalisation, mortality and its burden over the period 1982 to 2014 in Australia.

Settings

The study was conducted in Australia.

Study design

An incidence-based study design was used.

Methods

Data came from the publicly accessible Australian Institute of Health and Welfare database. This contained 2 784 148 registered cancer cases over the study period for all types of cancer. Erreygers’ concentration index was used to examine the magnitude of socioeconomic inequality with regards to cancer outcomes. Furthermore, a generalised linear model was constructed to identify the influential factors on the overall burden of cancer.

Results

The results showed that cancer incidence (annual average percentage change, AAPC=1.33%), hospitalisation (AAPC=1.27%), cancer-related mortality (AAPC=0.76%) and burden of cancer (AAPC=0.84%) all increased significantly over the period. The same-day (AAPC=1.35%) and overnight (AAPC=1.19%) hospitalisation rates also showed an increasing trend. Further, the ratio (least-most advantaged economic resources ratio, LMR of mortality (M) and LMR of incidence (I)) was especially high for cervix (M/I=1.802), prostate (M/I=1.514), melanoma (M/I=1.325), non-Hodgkin's lymphoma (M/I=1.325) and breast (M/I=1.318), suggesting that survival inequality was most pronounced for these cancers. Socioeconomically disadvantaged people were more likely to bear an increasing cancer burden in terms of incidence, mortality and death.

Conclusions

Significant differences in the burden of cancer persist across socioeconomic strata in Australia. Policymakers should therefore introduce appropriate cancer policies to provide universal cancer care, which could reduce this burden by ensuring curable and preventive cancer care services are made available to all people.
Barriers and facilitators to buprenorphine use for opioid agonist treatment: protocol for a scoping review
Authors: Leece Pamela , Khorasheh Triti , Corace Kimberly , Strike Carol , Bayoumi Ahmed M , Taha Sheena , Marks Elisabeth , Pach Beata , Ahamad Keith , Grennell Erin , Holowaty Melissa , Manson Heather , Straus Sharon E
Published: December 2019

Introduction

In the context of the opioid crisis in North America, the benefits of evidence-based opioid agonist treatments such as buprenorphine/naloxone have not been optimised due to low uptake. Numerous factors contribute to the underuse of buprenorphine, and theory-informed approaches to identify and address implementation barriers and facilitators are needed. This scoping review aims to characterise the barriers and facilitators at the patient, healthcare professional, organisation and system level according to the Theoretical Domains Framework (TDF), and identify gaps to inform practice and policy.

Methods and analysis

We will conduct a scoping review using established methods and follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. We will identify English and French-language peer-reviewed literature by searching five electronic bibliographic databases (MEDLINE, Embase, PsychINFO, CINAHL, and SocINDEX), from inception and use Google, websites of key organisations, and two or more custom search engines to identify relevant grey literature. Eligible records will be quantitative or qualitative studies that examine barriers and facilitators to buprenorphine use at the patient, healthcare professional, organisation and system level, and involve participants with diagnosis of opioid use disorder or professionals involved in their care. Two reviewers will be involved in independently screening, reviewing and charting the data and calibration exercises will be conducted at each stage. We will conduct descriptive analysis for the charted data, and deductively code barriers and facilitators using the TDF.

Ethics and dissemination

As a scoping review of the literature, this study does not require ethics approval. Our dissemination strategy will focus on developing tailored activities to meet the needs of diverse knowledge user audiences. Barriers and facilitators mapped to the TDF can be linked to evidence-based strategies for change to improve buprenorphine use and access, and enable practice to reduce opioid-related harms.
‘Beyond Cancer’: a study protocol of a multimodal occupational rehabilitation programme to support breast cancer survivors to return work
Authors: Sheppard Dianne Melinda , Frost Dorothy , Jefford Michael , O'Connor Moira , Halkett Georgia
Published: December 2019

Introduction

With more women working and surviving breast cancer, issues concerning sustainable employment must be addressed. Support to transition back to work is a gap in survivorship care. This paper describes the feasibility trial protocol for ‘Beyond Cancer’, a multimodal occupational rehabilitation programme to support breast cancer survivors’ return to work. Breast cancer survivors are hypothesised to show improved work status, work capacity and perceived support at work at 6 months postintervention relative to baseline and a historical usual care group.

Methods and analysis

The prospective feasibility design allows determination of change in primary (work status) as well as secondary outcome measures work capacity and perceived support at work. Participants: breast cancer survivors of working age, unable to work in their prediagnosis capacity for >3 months, their employers and a historical usual care group. Key intervention elements: an evidence-based biopsychosocial assessment and health coaching programme, employer education and support, and return to work (RTW) planning and monitoring. Health coaching empowers survivors to return to social function, including work. Employer education and support facilitates communication and improves workplace support. For employers, we predict change in confidence in effectively supporting employees’ RTW. Multilevel regression modelling will provide indications of efficacy for primary and secondary outcomes, and thematic analysis will examine perceived efficacy and acceptability.

Ethics and dissemination

Ethics approval has been granted by Monash and Curtin University Human Research Ethics Committees (HREC: 13300, HRE2019-0280, respectively). The evaluation of this innovative programme will provide the foundation for an Randomised Controlled Trial (RCT) and national roll-out, thus improving the quality of life of those who have been directly affected by breast cancer across Australia. Results will be published in peer-reviewed journals, presented at relevant conferences and disseminated to survivorship-focused organisations.

Trial registration number

Registered trial with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12618001985279); Pre-results.
‘I mean what is depression?’ A qualitative exploration of UK general practitioners’ perceptions of distinctions between emotional distress and depressive disorder
Authors: Geraghty Adam W A , Santer Miriam , Beavis Charlotte , Williams Samantha J , Kendrick Tony , Terluin Berend , Little Paul , Moore Michael
Published: December 2019

Objective

Detection of depression is a key part of primary mental healthcare. However, determining whether depressive disorder is or is not present in primary care patients is complex. The aim of this qualitative study was to explore general practitioners’ (GPs) perceptions of distinctions between emotional distress and depressive disorder.

Design

Qualitative interview study.

Setting

Face-to-face and telephone interviews with GPs from the South of England.

Participants

GPs working in UK primary care practices (n=21).

Method

Interviews followed a semi-structured interview guide, were audio recorded and transcribed. Data were analysed thematically.

Results

Views were divergent when directly considering whether emotional distress could be distinguished from depressive disorder. Some GPs suggested a distinction was not possible as symptoms lay on a continuum, with severity as a proxy for disorder. Others focused on the difficulty of the distinction and were uncertain. Some GPs perceived a distinction and referred to emotional distress as more likely in the presence of a stressor with the absence of biological symptoms. It was also common for GPs to refer to endogenous and reactive depression when considering possible distinctions between distress and depressive disorder.

Conclusions

GPs’ perceptions of when emotional symptoms reflect disorder varied greatly, with a broad range of views presented. Further research is needed to develop more consistent frameworks for understanding emotional symptoms in primary care.
Influence of leftover antibiotics on self-medication with antibiotics for children: a cross-sectional study from three Chinese provinces
Authors: Sun Chenhui , Hu Yanhong Jessika , Wang Xiaomin , Lu Jingjing , Lin Leesa , Zhou Xudong
Published: December 2019

Objectives

To investigate leftover antibiotics and their influence on self-medication with antibiotics (SMA) for Chinese children, and further explore the different influences of leftovers from two main sources: previous prescriptions and pharmaceutical purchases.

Design

A cross-sectional questionnaire study.

Setting

The participants were approached through kindergartens and primary schools as well as in vaccination clinics.

Participants

A total of 9526 parents from three Chinese provinces whose children were aged 0–13 years completed the survey.

Outcome measures

The prevalence of keeping antibiotics at home for children and the proportion of leftover antibiotics from two main sources were measured by a self-administrated questionnaire. Logistic regression models were established to examine the association between keeping antibiotics at home and SMA for children, specifically the risks of leftovers from two main sources.

Results

Overall, 4580 (48.1%) reported keeping antibiotics at home for children. Among those who had leftovers, 2891 (63.1%) reported that their leftovers came from previous prescriptions and 1619 (35.3%) reported that their leftovers came from pharmaceutical purchases. Mothers, older age of child, higher household income, higher education level and medical background were significantly associated with keeping antibiotics at home. Keeping antibiotics at home was significantly associated with SMA for children (adjusted OR=4.91, 95% CI 3.84 to 6.28). Particularly, compared with parents who did not keep antibiotics at home, parents who kept leftover antibiotics from previous prescriptions and those whose leftovers came from pharmaceutical purchases were 3.80 (95% CI 2.89 to 5.00) and 6.45 (95% CI 4.89 to 8.51) times more likely to engage in SMA for children, respectively.

Conclusions

Keeping antibiotics at home for children was pervasive in China. Most leftovers came from previous prescriptions, while those from pharmacies had a higher risk of SMA for children.
Murcia atrial fibrillation project II: protocol for a prospective observational study in patients with atrial fibrillation
Authors: Rivera-Caravaca José Miguel , Marín Francisco , Esteve-Pastor María Asunción , Gálvez Josefa , Lip Gregory Y.H. , Vicente Vicente , Roldán Vanessa
Published: December 2019

Introduction

Atrial fibrillation (AF) is characterised by a high stroke risk. Vitamin K antagonists (VKAs) are the most commonly used oral anticoagulants (OACs) in Spain, but their efficacy and safety depend on the time in therapeutic range of International Normalized Ratio (INR) 2.0–3.0 over 65%–70%. Unfortunately, the difficulties of maintaining an optimal level of anticoagulation and the complications of VKAs (particularly haemorrhagic ones), frequently lead to cessation of this therapy, which has been associated with higher risk of adverse events (AEs), including ischaemic stroke. Our aims are as follows: (1) to evaluate the quality of oral anticoagulation with VKAs, the prevalence of poor quality of anticoagulation, and to identify factors predisposing to poor quality anticoagulation; and (2) to identify patients who will stop OAC and to investigate what factors influence the decision of OAC withdrawal.

Methods and analysis

Prospective observational cohort study including outpatients newly diagnosed with AF and naïve for OACs from July 2016 to June 2018 in an anticoagulation clinic. Patients with prosthetic heart valves, rheumatic mitral valves or valvular AF will be excluded. Follow-up will extend for up to 3 years. During this period, the INR results and changes in the anticoagulant therapy will be recorded, as well as all AEs, or any other information that would be relevant to the proper conduct of research.

Ethics and dissemination

All patients were informed about the nature and purpose of the study, and the protocol was approved by the Ethics Committee of Hospital General Universitario Morales Meseguer (reference: EST:20/16). This is an observational study focusing on ‘real life’ practice and therefore all treatments and follow-up will be performed in accordance to the routine clinical practice with no specific interventions or visits. The results of our study will be disseminated by presentations at national and international meetings, and publications in peer-reviewed journals.
Impact of multidrug-resistant tuberculosis and its medications on adverse maternal and perinatal outcomes: protocol for a systematic review and meta-analysis
Authors: Alene Kefyalew Addis , Adane Akilew Awoke , Jegnie Alemken
Published: December 2019

Introduction

Multidrug-resistant tuberculosis (MDR-TB) is a common public health problem affecting pregnant women. However, the impact of MDR-TB and its medication on pregnancy and perinatal outcomes has been poorly understood and inconsistently reported. Therefore, using the available literature, we aim to determine whether MDR-TB and its medications during pregnancy impact maternal and perinatal outcomes.

Methods and analysis

This systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches will be conducted in PubMed, Scopus and Web of Science on 10 February 2020 for studies that reported adverse maternal and perinatal outcomes due to MDR-TB and/or its medication. The search will be performed without language and time restrictions. Adverse birth outcomes include miscarriage or abortion, stillbirth, preterm birth, low birth weight, small and large for gestational age, and neonatal death. Two independent reviewers will screen search records, extract data and assess the quality of the studies. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the methodological quality of the included studies. In addition to a narrative synthesis, a random-effects meta-analysis will be conducted when sufficient data are available. I2 statistics will be used to assess the heterogeneity between studies.

Ethics and dissemination

As it will be a systematic review and meta-analysis based on previously published evidence, there will be no requirement for ethical approval. Findings will be published in a peer-reviewed journal and will be presented at various conferences.
Comparing the needs and preferences of patients with moderate and severe dry eye symptoms across four countries
Authors: Messmer Elisabeth , Chan Colin , Asbell Penny , Johnson Gary , Sloesen Brigitte , Cook Nigel
Published: December 2019

Background/aims

Understanding patients’ perspectives of their disease can inform drug development and treatment decisions. In this study, we compared the preferences and needs of patients with moderate and severe dry eye symptoms from four different countries.

Methods

A quantitative questionnaire was developed based on the self-explicated conjoint methodology and was administered to 160 patients with moderate or severe dry eye disease (DED) from Australia, Germany, UK and the USA.

Results

Patients with moderate dry eye symptoms ranked ‘treatment satisfaction’ as the most important aspect, whereas ‘symptom bother’ was more relevant for those in the severe group. Both the moderate and severe groups classified treatment effectiveness as the most important treatment attribute. This result was consistent across the four countries, although US patients gave significantly higher scores than patients from other countries (p<0.001). Furthermore, patients from Australia ranked ‘treatment experience’ as significantly more important than the concern of side effects, whereas respondents from Germany exhibited the opposite trend (p<0.05 for both). The health burden of DED is reflected in the average European Quality of Life-5 Dimensions 5-level (EQ-5D) scores of 0.764 and 0.658 for patients with moderate and severe disease, respectively.

Conclusion

Our results confirm that across the countries in the study, moderate and severe DED has a major impact on patients’ quality of life and daily activities. By providing insight into the patient perspective of DED, our study helps identify outcomes that are important to patients and may guide future drug development and clinical decision-making.
Current and upcoming anti-VEGF therapies and dosing strategies for the treatment of neovascular AMD: a comparative review
Authors: Khanna Saira , Komati Rahul , Eichenbaum David A , Hariprasad Ishani , Ciulla Thomas A , Hariprasad Seenu M
Published: December 2019

Age-related macular degeneration is the leading cause of vision loss in the developed world, with the expected number of affected elderly individuals reaching 17.8 million. Antivascular endothelial growth factor (anti-VEGF) injection therapy has been instrumental in treating a disease process that was previously thought to be untreatable. Over the past two decades, landmark studies have demonstrated the efficacy of different anti-VEGF medications and investigated the optimal dosing regimen and delivery mechanism to increase overall vision and minimise patient burden. In this review, we outline landmark neovascular age-related macular degeneration clinical trials that have demonstrated level 1 evidence for its usage or have contributed to the understanding of how to dose these agents.
Paediatric neuro-oncology rehabilitation in the UK: carer and provider perspectives
Authors: Treadgold Bethan , Kennedy Colin , Spoudeas Helen , Sugden Elaine , Walker David , Bull Kim
Published: December 2019

Objective

The provision of rehabilitation services after childhood brain tumour has not been established, despite a recent parliamentary call for urgent action. This service evaluation aimed to determine what specialist paediatric neuro-oncology rehabilitation services were available across the UK at the time of the surveys and whether the needs of patients and their families were being met.

Design

Cross-sectional on-line surveys.

Participants

Survey 1: neuro-oncologist and nurse specialist members of the Children’s Cancer and Leukaemia Group (CCLG) at Children’s Principle Treatment Centres (PTCs) in the UK; Survey 2: parents of paediatric neuro-oncology patients belonging to The Brain Tumour Charity (TBTC) Research Involvement Network (RIN).

Results

17 of the 20 (85%) PTCs in the UK and two teenagers and young adult cancer units responded to Survey 1, and 17 members of TBTC’s RIN responded to Survey 2. Access to inpatient and outpatient neuro-oncology rehabilitation services after treatment for a central nervous system (CNS) tumour varied across regions in the UK. Service users in the RIN identified a need for an established neuro-oncology rehabilitation service for young people, a need for better communication across services and with families, and a need to fill gaps in multidisciplinary teams.

Conclusion

The urgent need for specialist paediatric, teenage and young adult neuro-oncology rehabilitation services in the UK is often unmet, particularly for outpatients. Where services are not provided for those children and young people disadvantaged by the diagnosis of a CNS tumour, in clear breach of current guidelines, remedial action needs to be taken to ensure appropriate and equal access.
Monitoring the health of transitioning professional footballers: protocol of an observational prospective cohort study
Authors: Gouttebarge Vincent , Andersen Thor Einar , Cowie Charlotte , Goedhart Edwin , Jorstad Harald , Kemp Simon , Königs Marsh , Maas Mario , Orhant Emmanuel , Rantanen Jussi , Salo Jari , Serratosa Luis , Stokes Keith , Tol Johannes L , Verhagen Evert , Weber Alexis , Kerkhoffs Gino
Published: December 2019

Introduction

Transitioning out of professional football is a challenging time in most players’ lives. During these preretirement and postretirement years, professional footballers may struggle with their mental, musculoskeletal, neurocognitive and cardiovascular health. Currently, longitudinal data about these health conditions are lacking. This article presents the design of a prospective cohort study with the primary aim of gathering epidemiological evidence about the onset and course of mental, musculoskeletal, neurocognitive and cardiovascular health conditions in professional footballers during their preretirement and postretirement years and evaluating the associations between risk indicators and the health conditions under study in these players.

Methods and analysis

An observational prospective cohort study with repeated measurements over a follow-up period of 10 years will be conducted among at least 200 professional footballers (male; 27 (±1) years old). Mental health will be explored by assessing symptoms of distress, anxiety, depression, sleep disturbance, alcohol misuse, drug misuse and disordered eating. Musculoskeletal health will be explored by assessing severe joint injury and related surgery, clinical and radiological osteoarthritis, and joint function (hips, knees and ankles). Neurocognitive health will be explored by assessing the concussion, brain structure and functioning, and neurocognitive functioning. Cardiovascular health will be explored by assessing blood pressure, lipid profile and ECG abnormalities.

Ethics and dissemination

Ethical approval for the study was provided by the Medical Ethics Review Committee of the Amsterdam University Medical Centers. The results of the study will be submitted to peer-reviewed journals, will be presented at scientific conferences and will be released in the media (postpublication).

Trial registration number

The Dutch Trial Registry (Drake Football Study NL7999).
Time to surgery following chronic subdural hematoma: post hoc analysis of a prospective cohort study
Authors: Venturini Sara , Fountain Daniel M , Glancz Laurence J , Livermore Laurent J , Coulter Ian C , Bond Simon , Matta Basil , Santarius Thomas , Hutchinson Peter J , Brennan Paul M , Kolias Angelos G
Published: December 2019

Background

Chronic subdural hematoma (CSDH) is a common neurological condition; surgical evacuation is the mainstay of treatment for symptomatic patients. No clear evidence exists regarding the impact of timing of surgery on outcomes. We investigated factors influencing time to surgery and its impact on outcomes of interest.

Methods

Patients with CSDH who underwent burr-hole craniostomy were included. This is a subset of data from a prospective observational study conducted in the UK. Logistic mixed modelling was performed to examine the factors influencing time to surgery. The impact of time to surgery on discharge modified Rankin Scale (mRS), complications, recurrence, length of stay and survival was investigated with multivariable logistic regression analysis.

Results

656 patients were included. Time to surgery ranged from 0 to 44 days (median 1, IQR 1–3). Older age, more favorable mRS on admission, high preoperative Glasgow Coma Scale score, use of antiplatelet medications, comorbidities and bilateral hematomas were associated with increased time to surgery. Time to surgery showed a significant positive association with length of stay; it was not associated with outcome, complication rate, reoperation rate, or survival on multivariable analysis. There was a trend for patients with time to surgery of ≥7 days to have lower odds of favorable outcome at discharge (p=0.061).

Conclusions

This study provides evidence that time to surgery does not substantially impact on outcomes following CSDH. However, increasing time to surgery is associated with increasing length of stay. These results should not encourage delaying operations for patients when they are clinically indicated.