bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring well‐being: medical students and staff
Authors: Simpson Victoria , Halpin Laura , Chalmers Kirk , Joynes Viktoria
Published: July 2019

Background

Mental illness in young people is a major public health challenge, with a higher prevalence amongst medical students. This study explores the perspectives of both students and staff in relation to the provision of well‐being support within one medical school in the United Kingdom.

Methods

A total of 17 second‐year medical students and five members of academic and well‐being staff at Liverpool Medical School participated in one‐to‐one semi‐structured interviews. Staff and students were asked for their views on existing support services, exploring challenges and ideas for development. Interviews were recorded, transcribed and analysed thematically to identify common themes amongst both students and staff.

Results

Students wanted to have more obvious support during their transition from sixth form to undergraduate studies. Perceived stigma surrounding mental health continues to prevent students seeking help over concerns this might have upon academic progress. Staff reported concerns that student expectations did not always match with what could realistically be provided by the medical school well‐being service.

Discussion

The provision of opportunities for students to ‘check‐in’ with staff, and the introduction of well‐being topics within the curriculum, were perceived by students and staff as being of potential benefit to the mental health of students. Such interventions may also help to build rapport and encourage students to engage with medical school support services. All well‐being support services are increasingly in demand amongst medical students, showing a need for them to expand and well‐being to be further incorporated into the course.
Hypoxia alters the thermogenic response to cold in adult homeothermic and heterothermic rodents
Authors: Dzal Yvonne A. , Milsom William K.
Published: July 2019

Key points

For small mammals living in a cold, hypoxic environment, supplying enough O2 to sustain thermogenesis can be challenging. While heterothermic mammals are generally more tolerant of cold and hypoxia than homeothermic mammals, how they regulate O2 supply and demand during progressive cooling in hypoxia is largely unknown.

We show that as ambient temperature is reduced in hypoxia, body temperature falls in both homeotherms and heterotherms.

In the homeothermic rat, a decrease in O2 consumption rate and lung O2 extraction accompany this fall in body temperature, despite a relative hyperventilation.

Paradoxically, in heterothermic mice, hamsters and ground squirrels, body temperature decreases more than in the homeothermic rat, even though they maintain ventilation, increase lung O2 extraction and maintain or elevate their O2 consumption rates.

Variation in cold and hypoxia tolerance among homeotherms and heterotherms reflects divergent strategies in how O2 supply and demand are regulated under thermal and hypoxic challenges.

Compared to homeothermic mammals, heterothermic mammals are reported to be exceptionally tolerant of cold and hypoxia. We hypothesised that this variation in tolerance stems from divergent strategies in how homeotherms and heterotherms regulate O2 supply versus O2 demand when exposed to hypoxia during progressive cooling. To test this hypothesis, we exposed adult rodents ranging in their degree of heterothermic expression (homeotherm: rats, facultative heterotherms: mice and hamsters, and obligate heterotherm: ground squirrels) to either normoxia (21% O2) or environmental hypoxia (7% O2), while reducing ambient temperature from 38 to 5°C. We found that when ambient temperature was reduced in normoxia, all species increased their O2 consumption rate and ventilation in parallel, maintaining a constant ventilatory equivalent and level of lung O2 extraction. Surprisingly, body temperature fell in all species, significantly so in the heterotherms. When ambient temperature was reduced in hypoxia, however, the homeothermic rat decreased their O2 consumption rate and lung O2 extraction despite an increase in their ventilatory equivalent, indicative of a relative hyperventilation. Heterotherms (mice, hamsters and ground squirrels), on the other hand, decreased their ventilatory equivalent, but increased lung O2 extraction and maintained or elevated their O2 consumption rates, yet their body temperature fell even more than in the rat. These results are consistent with the idea that homeotherms and heterotherms diverge in the strategies they use to match O2 supply and O2 demand, and that enhanced cold and hypoxia tolerance in heterotherms may stem from an improved ability to extract O2 from the inspired air.
Performance of a Solar Chimney With a Modified Collector Geometry: A Case Study From Erbil to the North of Iraq
Authors: Khidhir Dara Khalid , Atrooshi Soorkeu A.
Published: July 2019

The principle of solar chimney power plant (SCPP) is based on harvesting the thermal spectrum of solar radiation and converting it to mechanical energy by the means of a collector, a wind turbine, and a chimney. In this work, a number of experiments were performed on a modified model made up of one-third of the circular collector area. Field data from selected clear, sunny days were recorded and studied. The analysis focused on time-temperature relations for ambient, near chimney entry point and the collector periphery, in addition to hourly solar radiation intensity and air velocity inside the chimney. The results show that for this geometry arrangement, the maximum temperature of the air entering the chimney is achieved before the ambient temperature reaches its peak value. Air velocity inside the chimney depends on the intensity of solar radiation and the temperature difference between the air temperature entering the chimney and the ambient temperature. Solar intensity directly affects the temperature of air beneath the collector, and a part of this energy is stored in the ground. Later, when the solar radiation is impaired, the stored energy can be utilized. Air velocity of 2.1 m/s is obtained after the solar noon, when the solar intensity is 737 W/m2 and the maximum temperature difference is 11.2 °C. Due to the unique geometrical shape of the rig, a minor temperature loss of up to 1.3 °C occurs for the air near the center of the chimney.
Breather arrest, localization, and acoustic non-reciprocity in dissipative nonlinear lattices
Authors: Mojahed Alireza , Gendelman Oleg V. , Vakakis Alexander F.
Published: July 2019

The effect of on-site damping on breather arrest, localization, and non-reciprocity in strongly nonlinear lattices is analytically and numerically studied. Breathers are localized oscillatory wavepackets formed by nonlinearity and dispersion. Breather arrest refers to breather disintegration over a finite “penetration depth” in a dissipative lattice. First, a simplified system of two nonlinearly coupled oscillators under impulsive excitation is considered. The exact relation between the number of beats (energy exchanges between oscillators), the excitation magnitude, and the on-site damping is derived. Then, these analytical results are correlated to those of the semi-infinite extension of the simplified system, where breather penetration depth is governed by a similar law to that of the finite beats in the simplified system. Finally, motivated by the experimental results of Bunyan, Moore, Mojahed, Fronk, Leamy, Tawfick, and Vakakis [Phys. Rev. E 97, 052211 (2018)], breather arrest, localization, and acoustic non-reciprocity in a non-symmetric, dissipative, strongly nonlinear lattice are studied. The lattice consists of repetitive cells of linearly grounded large-scale particles nonlinearly coupled to small-scale ones, and linear intra-cell coupling. Non-reciprocity in this lattice yields either energy localization or breather arrest depending on the position of excitation. The nonlinear acoustics governing non-reciprocity, and the surprising effects of existence of linear components in the coupling nonlinear stiffnesses, in the acoustics, are investigated.
Non-reciprocal wave phenomena in energy self-reliant gyric metamaterials
Authors: Attarzadeh M. A. , Maleki S. , Crassidis J. L. , Nouh M.
Published: July 2019

This work presents a mechanism by which non-reciprocal wave transmission is achieved in a class of gyric metamaterial lattices with embedded rotating elements. A modulation of the device's angular momentum is obtained via prescribed rotations of a set of locally housed spinning motors and is then used to induce space-periodic, time-periodic, as well as space-time-periodic variations, which influence wave propagation in distinct ways. Owing to their dependence on gyroscopic effects, such systems are able to break reciprocal wave symmetry without stiffness perturbations rendering them consistently stable as well as energy self-reliant. Dispersion patterns, band gap emergence, as well as non-reciprocal wave transmission in the space-time-periodic gyric metamaterials are predicted both analytically from the gyroscopic system dynamics as well as numerically via time-dependent full wave simulations. In addition to breaking reciprocity, the authors show that the energy content of a frictionless gyric metamaterial is conserved over one temporal modulation cycle enabling it to exhibit a stable response irrespective of the pumping frequency.
A comparison study between acoustic topological states based on valley Hall and quantum spin Hall effects
Authors: Deng Yuanchen , Lu Minghui , Jing Yun
Published: July 2019

Over the past few years, the rapid development in the fields of condensed matter physics, electronic, and photonic systems have inspired the design and experimental demonstration of various acoustic topological insulators (TIs). Among these, the topologically protected one-way propagation is a phenomenon that is gaining increased attention. Pseudospin states, which is the analogue of the quantum spin Hall effect from electronic systems, has been proven to enable topological edge states in acoustics. Similarly, the valley Hall (VH) effect is also observed in acoustic systems and provides a pair of valley vortex states with opposite chirality. These valley vortex states can similarly form topologically protected edge states and, in turn, realize robust one-way propagation. However, the differences in the physics behind these acoustic systems give rise to distinct features such as different angle selections and immunization levels to various types of defects. This article conducts a comparison study between topological states in valley Hall phononic crystals and TIs that reveals the differences and similarities in several aspects. Both of them have topologically protected edge states and thus the robust one-way propagation. For the maximum transmission incident angle and defect immunization, however, VH topological waveguides and TI waveguides show different characteristics.
On the limits of automatic speaker verification: Explaining degraded recognizer scores through acoustic changes resulting from voice disguise
Authors: González Hautamäki Rosa , Hautamäki Ville , Kinnunen Tomi
Published: July 2019

In speaker verification research, objective performance benchmarking of listeners and automatic speaker verification (ASV) systems are of key importance in understanding the limits of speaker recognition. While the adoption of common data and metrics has been instrumental to progress in ASV, there are two major shortcomings. First, the utterances lack intentional voice changes imposed by the speaker. Second, the standard evaluation metrics focus on average performance across all speakers and trials. As a result, a knowledge gap remains in how the acoustic changes impact recognition performance at the level of individual speakers. This paper addresses the limits of speaker recognition in ASV systems under voice disguise using a linear mixed effects model to analyze the impact of change in long-term statistics of selected features (formants F1–F4, the bandwidths B1–B4, F0, and speaking rate) to ASV log-likelihood ratio (LLR) score. The correlations between the proposed predictive model and the LLR scores are 0.72 for females and 0.81 for male speakers. As a whole, the difference in long-term F0 between enrollment and test utterances was found to be the individually most detrimental factor, even if the ASV system uses only spectral, rather than prosodic, features.
Sitting and Screen Time Outside School Hours: Correlates in 6- to 8-Year-Old Children
Authors: Downing Katherine L. , Salmon Jo , Timperio Anna , Hinkley Trina , Cliff Dylan P. , Okely Anthony D. , Hesketh Kylie D.
Published: July 2019

Background: Although there is increasing evidence regarding children’s screen time, little is known about children’s sitting. This study aimed to determine the correlates of screen time and sitting in 6- to 8-year-old children. Methods: In 2011–2012, parents in the Healthy Active Preschool and Primary Years (HAPPY) study (n = 498) reported their child’s week/weekend day recreational screen time and potential correlates. ActivPALs™ measured children’s nonschool sitting. In model 1, linear regression analyses were performed, stratified by sex and week/weekend day and controlling for age, clustered recruitment, and activPAL™ wear time (for sitting analyses). Correlates significantly associated with screen time or sitting (P < .05) were included in model 2. Results: Children (age 7.6 y) spent 99.6 and 119.3 minutes per day on week and weekend days engaging in screen time and sat for 119.3 and 374.6 minutes per day on week and weekend days, respectively. There were no common correlates for the 2 behaviors. Correlates largely differed by sex and week/weekend day. Modifiable correlates of screen time included television in the child’s bedroom and parental logistic support for, encouragement of, and coparticipation in screen time. Modifiable correlates of sitting included encouragement of and coparticipation in physical activity and provision of toys/equipment for physical activity. Conclusions: Interventions may benefit from including a range of strategies to ensure that all identified correlates are targeted.
A Contemporary Functional Form for NCAA Division I FBS Contributions: Internal and External Considerations
Authors: Wanless Liz , Stinson Jeffrey L.
Published: July 2019

While managing the intercollegiate athletic development office is critical to contributions generation, the nearly 40 years of research modeling intercollegiate athletic fundraising emphasized limited factors external to this department. Both theoretical and statistical justification warrants a broader scope in contemporary factor identification. With a resource-based view as the theoretical foundation, a list of 43 variables both internal and external to the intercollegiate athletic development office was generated through an extensive literature review and semistructured interviews with athletic and nonathletic fundraising professionals. Based on the factors identified, random and fixed effects regression models were developed via test statistic model reduction across a 5-year panel (FY2011–FY2015). Ninety-three schools were included, representing 73% of the Football Bowl Subdivision (FBS) membership (85% of public FBS institutions). The results highlight the role of both internal and external factors in explaining intercollegiate athletic fundraising procurement.
Draft Genome Sequence of
Mediterraneibacter
sp. nov. Strain gm002, Isolated from Human Feces
Authors: Huang Chien-Hsun , Liou Jong-Shian , Wang Chun-Lin , Huang Lina
Published: July 2019

Here, we report a draft genome sequence of
Mediterraneibacter
sp. strain gm002, isolated from human feces in Taiwan. This strain represents a novel species according to whole-genome-based comparisons using the average nucleotide identity (ANI) and digital DNA-DNA hybridization (dDDH) thresholds. The genome assembly comprised 3,568,768 bp, with a 38.7% G+C content.
Draft Genome Sequence of
Rummeliibacillus
sp. Strain TYF005, a Physiologically Recalcitrant Bacterium with High Ethanol and Salt Tolerance Isolated from Spoilage Vinegar
Authors: Li Min , Li Yao , Fan Xiaojun , Qin Yuhong , He Yongji , Lv Yongkang
Published: July 2019

Rummeliibacillus
sp. strain TYF005 is a thermophilic bacterium with high ethanol (8% vol/vol) and salt (13% wt/vol) tolerance that was isolated from spoilage vinegar. Here, we report the draft genome sequence of this strain, which has 117 scaffolds with a total genome size of 3.7 Mb and a 34.4% GC content.
Genome Sequence of the Caproic Acid-Producing Bacterium Caproiciproducens galactitolivorans BS-1
T
(JCM 30532)
Authors: Bengelsdorf Frank R. , Poehlein Anja , Daniel Rolf , Dürre Peter
Published: July 2019

Caproiciproducens galactitolivorans
BS-1
T
is an anaerobic bacterium that produces acetate, butyrate, and caproate. The genome has a size of 2.57 Mbp and harbors 2,439 predicted protein-coding genes.
Draft Genome Sequence of Desulfosporosinus fructosivorans Strain 63.6F
T
, Isolated from Marine Sediment in the Baltic Sea
Authors: Hausmann Bela , Vandieken Verona , Pjevac Petra , Schreck Katharina , Herbold Craig W. , Loy Alexander
Published: July 2019

Desulfosporosinus fructosivorans
strain 63.6F
T
is a strictly anaerobic, spore-forming, sulfate-reducing bacterium isolated from marine sediment in the Baltic Sea. Here, we report the draft genome sequence of
D. fructosivorans
63.6F
T
.
Complete Genome Sequences of Highly Arsenite-Resistant Bacteria
Brevibacterium
sp. Strain CS2 and Micrococcus luteus AS2
Authors: Sher Shahid , Rehman Abdul , Hansen Lars Hestbjerg , Nielsen Tue Kjærgaard
Published: July 2019

The complete genome sequences of two highly arsenite-resistant
Actinomycetales
isolates are presented. Both genomes are G+C rich and consist of a single chromosome containing homologs of known arsenite resistance genes.
Genome Sequences of Multidrug-Resistant Salmonella enterica Serovar Dublin Isolates
Authors: Abdalhamid Baha , Mccutchen Emily L. , Flaherty Kacie D. , Hinrichs Steven H. , Iwen Peter C.
Published: July 2019

Salmonella enterica
serovar Dublin, which can cause enteritis and systemic infections in humans, has been associated with antimicrobial resistance. Here, we report draft genome sequences of seven multidrug-resistant
S
. Dublin isolates from human samples. These sequences will contribute to an understanding of pathogenesis and resistance determinants in this serovar.
Chemical pneumonitis in a 9-year-old following chlorine gas exposure
Authors: Cromie Suzanne , Flannigan Christopher
Published: July 2019

A previously fit and well 9-year-old boy developed shortness of breath and chest pain after playing with friends on a building site where bonfire materials were being collected. Firstline investigations failed to explain his symptoms, which worsened over the next 24 hours, necessitating endotracheal intubation and mechanical ventilation. When public health and the police retraced his steps, they found barrels of sodium hypochlorite and red diesel at the bonfire site, which when mixed had the potential to form chlorine gas leading to the diagnosis of a chemical pneumonitis secondary to chlorine gas inhalation. Supportive care was continued, and he was successfully extubated after 48 hours. At 6-week follow-up, he had no ongoing pulmonary symptoms.
Endobronchial metastasis as an uncommon pattern of metastatic dissemination from small cell osteosarcoma
Authors: Kadamkulam Syriac Arun , Bhaskarla Amrit Ved , Elrifai Mohamed , Alraiyes Abdul Hamid
Published: July 2019

Endobronchial metastasis (EBM) from extrapulmonary primary malignancy is a rare entity. Although the most common site of metastasis of osteosarcoma is the lungs, EBM remains a rare occurrence. Cough and dyspnea are the most common symptoms. A significant number of patients are asymptomatic, making the diagnosis without any radiographic imaging challenging. CT scan of the lung, along with bronchoscopy and biopsy, is the mainstay of diagnosis and staging. A 36-year-old man presented with small cell osteosarcoma of the left maxillary region and was treated with surgery and adjuvant chemotherapy. The patient presented 8 years later with axillary metastasis and was found to have lung metastasis on further workup. Bronchoscopy and biopsy proved an EBM that was debulked by hot snare technique. The patient was then started on chemotherapy for recurrent small cell osteosarcoma.
Using mobile technologies to support the training of community health workers in low-income and middle-income countries: mapping the evidence
Authors: Winters Niall , Langer Laurenz , Nduku Promise , Robson James , O'Donovan James , Maulik Pallab , Paton Chris , Geniets Anne , Peiris David , Nagraj Shobhana
Published: July 2019

Introduction

This paper maps the evidence published between 2000 and 2018 on the use of mobile technologies to train community health workers (CHWs) in low- and middle-income countries (LMICs) across nine areas of global healthcare, including the neglected areas of disability and mental health.

Methods

We used an evidence mapping methodology, based on systematic review guidelines, to systematically and transparently assess the available evidence-base. We searched eight scientific databases and 54 grey literature sources, developed explicit inclusion criteria, and coded all included studies at full text for key variables. The included evidence-base was visualised and made accessible through heat mapping and the development of an online interactive evidence interface.

Results

The systematic search for evidence identified a total of 2530 citations of which 88 met the full inclusion criteria. Results illustrate overall gaps and clusters of evidence. While the evidence map shows a positive shift away from information dissemination towards approaches that use more interactive learner-centred pedagogies, including supervision and peer learning, this was not seen across all areas of global health. Areas of neglect remain; no studies of trauma, disability, nutrition or mental health that use information dissemination, peer learning or supervision for training CHWs in LMICs were found.

Conclusion

The evidence map shows significant gaps in the use of mobile technologies for training, particularly in the currently neglected areas of global health. Significant work will be needed to improve the evidence-base, including assessing the quality of mobile-based training programmes.
Are service and patient indicators different in the presence or absence of nurse practitioners? The EDPRAC cohort study of Australian emergency departments
Authors: Middleton Sandy , Gardner Glenn , Gardner Anne , Considine Julie , Fitzgerald Gerard , Christofis Luke , Doubrovsky Anna , Della Phillip , Fasugba Oyebola , D'Este Catherine
Published: July 2019

Objectives

To evaluate the impact of nurse practitioner (NP) service in Australian public hospital emergency departments (EDs) on service and patient safety and quality indicators.

Design and setting

Cohort study comprising ED presentations (July 2013–June 2014) for a random sample of hospitals, stratified by state/territory and metropolitan versus non-metropolitan location; and a retrospective medical record audit of ED re-presentations.

Methods

Service indicator data (patient waiting times for Australasian Triage Scale categories 2, 3, 4 and 5; number of patients who did not-wait; length of ED stay for non-admitted patients) were compared between EDs with and without NPs using logistic regression and Cox proportional hazards regression, adjusting for hospital and patient characteristics and correlation of outcomes within hospitals. Safety and quality indicator data (rates of ED unplanned re-presentations) for a random subset of re-presentations were compared using Poisson regression.

Results

Of 66 EDs, 55 (83%) provided service indicator data on 2 463 543 ED patient episodes while 58 (88%) provided safety and quality indicator data on 2853 ED re-presentations. EDs with NPs had significantly (p<0.001) higher rates of waiting times compared with EDs without NPs. Patients presenting to EDs with NPs spent 13 min (8%) longer in ED compared with EDs without NPs (median, (first quartile–third quartile): 156 (93–233) and 143 (84–217) for EDs with and without NPs, respectively). EDs with NPs had 1.8% more patients who did not wait, but similar re-presentations rates as EDs with NPs.

Conclusions

EDs with NPs had statistically significantly lower performance for service indicators. However, these findings should be treated with caution. NPs are relatively new in the ED workforce and low NP numbers, staffing patterns and still-evolving roles may limit their impact on service indicators. Further research is needed to explain the dichotomy between the benefits of NPs demonstrated in individual clinical outcomes research and these macro system-wide observations.
Incidence of Lyme disease in the UK: a population-based cohort study
Authors: Cairns Victoria , Wallenhorst Christopher , Rietbrock Stephan , Martinez Carlos
Published: July 2019

Objectives

The purpose of this study was to estimate the annual incidence of Lyme disease (LD) in the UK.

Design

This was a retrospective descriptive cohort study.

Setting

Study data were extracted from the Clinical Practice Research Datalink (CPRD), a primary care database covering about 8% of the population in the UK in 658 primary care practices.

Participants

Cohort of 8.4 million individuals registered with general practitioners with 52.4 million person-years of observation between 1 January 2001 and 31 December 2012.

Primary and secondary outcome measures

LD was identified from recorded medical codes, notes indicating LD, laboratory tests and use of specific antibiotics. Annual incidence rates and the estimated total number of LD cases were calculated separately for each UK region.

Results

The number of cases of LD increased rapidly over the years 2001 to 2012, leading to an estimated incidence rate of 12.1 (95% CI 11.1 to 13.2) per 100 000 individuals per year and a UK total of 7738 LD cases in 2012. LD was detected in every UK region with highest incidence rates and largest number of cases in Scotland followed by South West and South England. If the number of cases has continued to rise since the end of the study period, then the number in the UK in 2019 could be over 8000.

Conclusions

The incidence of LD is about threefold higher than previously estimated, and people are at risk throughout the UK. These results should lead to increased awareness of the need for preventive measures.

Trial registration number

This study was approved by the Independent Scientific Advisory Committee for CPRD research (Protocol number 13_210R).
Taking an integrated knowledge translation approach in research to develop the CONSORT-Equity 2017 reporting guideline: an observational study
Authors: Jull Janet , Graham Ian D , Kristjansson Elizabeth , Moher David , Petkovic Jennifer , Yoganathan Manosila , Tugwell Peter , Welch Vivian A
Published: July 2019

Objective

We describe the use of an integrated knowledge translation (KT) approach in the development of the CONsolidated Standards Of Reporting Trials extension for equity (‘CONSORT-Equity 2017’), and advisory board-research team members’ (‘the team’) perceptions of the integrated KT process.

Design

This is an observational study to describe team processes and experience with a structured integrated KT approach to develop CONSORT-Equity 2017. Participant observation to describe team processes and a survey were used with the 38 team members.

Setting

Use of the CONSORT health research reporting guideline contributes to an evidence base for health systems decision-making, and CONSORT-Equity 2017 may improve reporting about health equity-relevant evidence. An integrated KT research approach engages knowledge users (those for whom the research is meant to be useful) with researchers to co-develop research evidence and is more likely to produce findings that are applied in practice or policy.

Participants

Researchers adopted an integrated KT approach and invited knowledge users to form a team.

Results

An integrated KT approach was used in the development of CONSORT-Equity 2017 and structured replicable steps. The process for co-developing the reporting guideline involved two stages: (1) establishing guiding features for co-development and (2) research actions that supported the co-development of the reporting guideline. Stage 1 consisted of four steps: finding common ground, forming an advisory board, committing to ethical guidance and clarifying theoretical research assumptions. Bound by the stage 1 guiding features of an integrated KT approach, stage 2 consisted of five steps during which studies for consensus-based reporting guidelines were conducted. Of 38 team members, 25 (67.5%) completed a survey about their perceptions of the integrated KT approach.

Conclusions

An integrated KT approach can be used to engage a team to co-develop reporting guidelines. Further study is needed to understand the use of an integrated KT approach in the development of reporting guidelines.
Antipsychotic initiation among adults with intellectual and developmental disabilities in Ontario: a population-based cohort study
Authors: Gomes Tara , Khuu Wayne , Tadrous Mina , Vigod Simone , Cobigo Virginie , Lunsky Yona
Published: July 2019

Objectives

To describe factors associated with initiating antipsychotics and patterns of persistence to antipsychotic therapy in a large cohort of adults with intellectual and developmental disabilities.

Design

Population-based cohort study.

Setting

Ontario, Canada.

Participants

Adults with intellectual and developmental disabilities (IDD) in Ontario.

Outcome measures

We used multivariable logistic regression to investigate patient characteristics associated with antipsychotic initiation. Patient characteristics studied included sociodemographic characteristics, measures of clinical comorbidity and health service use.

Results

Among 39 244 individuals eligible for this study, 6924 (17.6%) initiated an antipsychotic over the accrual window, of whom 1863 (26.9%) had no psychiatric diagnosis in the prior 2 years. A number of factors were significantly associated with antipsychotic initiation, including male gender, residence in a group home, prior use of benzodiazepines, antidepressants or cognitive enhancers, a recent emergency department visit or mental health hospitalisation and a visit to a psychiatrist or family physician in the prior 90 days. In a secondary analysis, the association between antipsychotic initiation and age, prior diagnosis of diabetes or myocardial infarction and polypharmacy differed slightly on the basis of whether an individual had a previously diagnosed psychiatric disorder.

Conclusions

Factors associated with the initiation of an antipsychotic differ according to the presence of a psychiatric diagnosis. Given the long duration of antipsychotic use in this population, future research is needed to understand the appropriateness of antipsychotic initiation among adults with IDD and the safety implications of long-term use of these products.
Prevalence and correlates of physical violence and rape among female sex workers in Ethiopia: a cross-sectional study with respondent-driven sampling from 11 major towns
Authors: Amogne Minilik Demissie , Balcha Taye Tolera , Agardh Anette
Published: July 2019

Objective

This study examined the prevalence and correlates of physical violence and rape among female sex workers (FSWs) in Ethiopia.

Design

A cross-sectional study using respondent-driven sampling technique.

Setting

Eleven major towns in Ethiopia.

Participants

4900 FSWs.

Main outcome measures

The prevalence of experiences of physical beating and rape.

Results

Among FSWs, 17.5% reported physical beating within the last year and 15.2% reported rape since they started selling sex. FSWs aged 35+ years (AOR 0.59, 95% CI 0.38 to 0.92) were less exposed to physical beating than those aged 15–24 years. FSWs working on the street (AOR 1.92, 95% CI 1.53 to 2.39), in red-light houses (AOR 1.63, 95% CI 1.12 to 2.38) and in local drinking houses (AOR 1.35, 95% CI 1.02 to 1.78) experienced more physical beating than FSWs working in bars/hotels. FSWs who consumed alcohol four or more days in a week (AOR 1.92, 95% CI 1.21 to 3.04), and who chewed khat frequently experienced more physical violence. Rape was associated with having a low monthly income, drinking alcohol four or more days per week (AOR 2.33, 95% CI 1.47 to 3.7), experience of heavy episodic drinking in a month (AOR 1.71, 95% CI 1.24 to 2.38) and chewing khat 3–4 days per week (AOR 2.15, 95% CI 1.55 to 2.98). Condom breakage was more frequent among FSWs who reported both physical beating (AOR 1.51, 95% CI 1.25 to 1.84) and rape (AOR 1.26, 95% CI 1.03 to 1.55).

Conclusion

FSWs in Ethiopia are vulnerable to physical and sexual violence, and the risk increases when they are younger, street-based and high consumers of alcohol or khat. Therefore, targeted efforts are needed for prevention and harm reduction.
What is an invasive procedure? A definition to inform study design, evidence synthesis and research tracking
Authors: Cousins Sian , Blencowe Natalie S , Blazeby Jane M
Published: July 2019

Worldwide, there are at least 230 million invasive procedures performed annually and most of us will undergo several in our lifetime. There is therefore a need for high-quality evidence to underpin this clinical area. Currently, however, there is no widely accepted definition of an invasive procedure and the terms ‘surgery’ and ‘interventional procedure’ are characterised inconsistently. We propose a definition for invasive procedures which addresses the limitations of those currently available. Our definition was developed from an analysis of the 3946 papers from the last decade. A preliminary definition was created based on existing definitions and applied to a variety of papers reporting all types of procedures. This definition was continuously updated and applied iteratively to all articles. The definition has three key components: (1) method of access to the body, (2) instrumentation and (3) requirement for operator skill. It therefore encapsulates all types of invasive procedure regardless of the method of access to the body (incision, natural orifice or percutaneous access), and is relevant whatever the clinical discipline (eg, obstetric, cardiac, dental, interventional cardiology or radiology). Crucially, the definition excludes medicinal products, except where their administration occurs within an invasive procedure (and thereby involves operator skill). The application of a universal definition of an invasive procedure will (1) inform the selection of relevant methods for study design, (2) streamline evidence synthesis and (3) improve research tracking, helping to identify evidence gaps and direct research funds.
Informed consent, shared-decision making and a reasonable patient’s wishes based on a cross-sectional, national survey in the USA using a hypothetical scenario
Authors: James John T , Eakins Darwin Jay , Scully Robert R
Published: July 2019

Objective

In approximately half the states in the USA, and more recently in the UK, informed consent is legally defined as what a reasonable patient would wish to know. Our objective was to discern the information needs of a hospitalised, ‘reasonable patient’ during the informed-consent process.

Design

We performed a cross-sectional study to develop a survey instrument and better define ‘reasonable person’ in relation to informed consent in a hypothetical scenario where an invasive procedure may be an option.

Setting

A 10-question survey was administered from April 19 through 22 October 2018 to three groups: student nurses (n=76), health professions educators (n=63) and a US national population (n=1067).

Primary and secondary outcome measures

The primary outcome measure was the average intensity, on a 5-point scale, by which survey groups wished to have each of 10 questions answered. The secondary outcome was to discern relationships between survey demographics and the intensity by which participants wanted an answer.

Results

Despite substantial demographic differences in the nursing-student group and health-professions-educator group, the average intensity scores were within 0.2 units on nine of 10 questions. The national survey revealed a strong desire to have an answer to each question (range 3.98–4.60 units). It showed that women desired answers more than men and older adults desired answers more than younger adults.

Conclusions

Based on responses to 10 survey questions regarding wishes of people in a situation where an invasive procedure may be necessary, the vast majority want an answer to each question. They wanted to know about all treatment options, risky drugs, decision aids, who will perform the procedure, and the cost. They wanted their advocate present, periodic review of their medical record, a full day to review documents and expected outcomes and restrictions after the procedure.
Effectiveness of a mobile preconception lifestyle programme in couples undergoing in vitro fertilisation (IVF): the protocol for the PreLiFe randomised controlled trial (PreLiFe-RCT)
Authors: Boedt Tessy , Dancet Eline , Lie Fong Sharon , Peeraer Karen , De Neubourg Diane , Pelckmans Sofie , van de Vijver Arne , Seghers Jan , Van der Gucht Katleen , Van Calster Ben , Spiessens Carl , Matthys Christophe
Published: July 2019

Introduction

Infertility and in vitro fertilisation (IVF; with or without intracytoplasmic sperm injection) result in considerable emotional and financial burden. Increasing evidence suggests that lifestyle factors, including diet, physical activity and personal well-being, are associated with IVF-success rates. Currently, IVF is not routinely combined with a lifestyle programme. The preconception lifestyle (PreLiFe) randomised controlled trial (RCT) assesses the effects of a new mobile PreLiFe programme in couples undergoing IVF.

Methods and analysis

A multicentre RCT including 460 heterosexual couples starting IVF in Belgian fertility clinics. IVF couples are randomised between an attention control group or the PreLiFe programme for a period of 12 months or until an ongoing pregnancy is confirmed by ultrasound. The attention control programme includes a mobile application with treatment information (ie, appointments and medication instructions) in addition to standard care. The PreLiFe programme includes a mobile application with the same treatment information in combination with a lifestyle programme. This new lifestyle programme includes tailored advice and skills training on diet, physical activity and mindfulness in combination with text messages and telephone interaction with a healthcare professional trained in motivational interviewing. The primary outcome of this RCT is the cumulative ongoing pregnancy rate within 12 months after randomisation. Secondary outcomes include changes in diet, physical activity, emotional distress, body mass index, waist circumference, quality of life and other reproductive outcomes including IVF discontinuation, clinical pregnancy rate and time to pregnancy. Additionally, partner support and the feasibility (use and acceptability) of the PreLiFe programme will be evaluated in the intervention group. Analysis will be according to intention to treat.

Ethics and dissemination

This study has been approved by the Medical Ethical Committee of the Leuven University Hospital (Belgium) and the other recruiting clinics. The findings of this RCT will be disseminated through presentations at international scientific meetings and peer-reviewed publications.

Trial registration number

NCT03790449; Pre-results.
Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
Authors: Ellis Ryan J , Schlick Cary Jo R , Feinglass Joe , Mulcahy Mary F , Benson Al B , Kircher Sheetal M , Yang Tony D , Odell David D , Bilimoria Karl , Merkow Ryan P
Published: July 2019

Background

Chemotherapy quality measures consider hospitals compliant when chemotherapy is recommended, even if it is not received. This may mask shortcomings in cancer care delivery. Objectives of this study were to (1) identify patient factors associated with failure to receive recommended chemotherapy without a documented contraindication and (2) assess hospital variation in failure to administer recommended chemotherapy.

Methods

Patients from 2005 to 2015 with breast, colon and lung cancers who failed to receive recommended chemotherapy were identified using the National Cancer Database. Hospital-level rates of failure to administer recommended chemotherapy were calculated, and patient and hospital factors associated with failure to receive recommended chemotherapy were identified by multivariable logistic regression.

Results

A total of 183 148 patients at 1281 hospitals were analysed. Overall, 3.5% of patients with breast, 6.6% with colon and 10.7% with lung cancers failed to receive recommended chemotherapy. Patients were less likely to receive recommended chemotherapy in all cancers if uninsured or on Medicaid (p<0.05), as were non-Hispanic black patients with both breast and colon cancer (p<0.001). Significant hospital variation was observed, with hospital-level rates of failure to administer recommended chemotherapy as high as 21.8% in breast, 40.2% in colon and 40.0% in lung cancers.

Conclusions and relevance

Though overall rates are low, failure to receive recommended chemotherapy is associated with sociodemographic factors. Hospital variation in failure to administer recommended chemotherapy is masked by current quality measure definitions and may define a significant and unmeasured difference in hospital quality.
Epidemiology of chronic liver diseases in the USA in the past three decades
Authors: Younossi Zobair M , Stepanova Maria , Younossi Youssef , Golabi Pegah , Mishra Alita , Rafiq Nila , Henry Linda
Published: July 2019

Objective

Given significant advances in treatment of viral hepatitis and the growing epidemic of obesity, the burden of the different types of liver diseases in the USA may be changing. Our aim was to assess the shift in the prevalence of different liver disease aetiologies in the USA over the past three decades.

Design

National Health and Nutrition Examination Surveys (NHANES; cross-sectional 1988–1994 and 1999–2016) were used.

Results

A total of 58 731 adults from NHANES (1988–2016) were included. Over the study period, the prevalence of chronic hepatitis B and alcoholic liver disease remained stable: 0.3%–0.4% and 0.8%–1.0%, respectively (p>0.05). The prevalence of chronic hepatitis C decreased nearly twofold: 1.6% in 1988–1994 to 0.9% in 2013–2016 (p=0.03). In contrast, the prevalence of non-alcoholic fatty liver disease (NAFLD; by US-Fatty Liver Index) increased from 20.0% (1988–1994) to 28.3% (1999–2004) to 33.2% (2009–2012) and 31.9% (2013–2016) (p<0.0001). Furthermore, steady increases were observed in the rates of obesity (22.2% in 1988–1994 to 31.0% in 1999–2004 to 38.9% in 2013–2016), type 2 diabetes mellitus (T2DM) (from 7.2% to 8.2% to 13.5% same years), insulin resistance and hypertension (all p<0.0001). Yearly trend analyses showed that the only LD with consistently increasing prevalence was NAFLD (trend p=0.01). Multivariable regression analysis showed that obesity (OR 10.4; 95% CI 9.5 to 11.3) and T2DM (OR 3.7; 95% CI 3.2 to 4.2) were the major independent predictors of NAFLD.

Conclusions

Over the past 30 years in the USA, NAFLD is the only liver disease with growing prevalence, synchronous with the increasing rates of obesity and T2DM.
Diagnosis of patients with angina and non-obstructive coronary disease in the catheter laboratory
Authors: Rahman Haseeb , Corcoran David , Aetesam-ur-Rahman Muhammad , Hoole Stephen P , Berry Colin , Perera Divaka
Published: July 2019

Around 40% of all patients undergoing angiography are found to have normal coronary arteries or non-obstructive coronary artery disease (NOCAD). Despite the high prevalence, this is a group who rarely receive a definitive diagnosis, are frequently labelled and managed inappropriately and by and large, continue to remain symptomatic. Half of this group will have coronary microvascular dysfunction (CMD), associated with a higher rate of major adverse cardiovascular events; identifying CMD represents a therapeutic target of unmet need. As the pressure wire has revolutionised our ability to interrogate epicardial coronary disease during the time of angiography, measuring flow can similarly classify NOCAD during a single procedure. Assessment of flow is a function that is already integral to some pressure wires and furthermore, the familiarity and usage of the combined Doppler and pressure wire is rapidly increasing—these are techniques that readily lend themselves to the skillset of a practising interventional cardiologist. We present a structured algorithm designed for cardiologists who frequently encounter NOCAD in the catheter laboratory, identifying specific disease phenotypes within this heterogeneous population with linked therapy. This review paper clearly explains the rationale for this algorithm and outlines its applicability to routine clinical practice and also, the importance of phenotyping for future research. Ultimately, personalised therapy could improve outcomes for both patients and healthcare providers; while these approaches in turn will need robust evaluation to ensure that they improve both clinical outcomes and health economic benefits, this proposal will provide a framework for future trials and evaluations.
Distinct features of bivalent direct thrombin inhibitors, hirudin and bivalirudin, revealed by clot waveform analysis and enzyme kinetics in coagulation assays
Authors: Wakui Masatoshi , Fujimori Yuta , Nakamura Shoko , Kondo Yoshino , Kuroda Yuko , Oka Shusaku , Nakagawa Terumichi , Katagiri Hisako , Murata Mitsuru
Published: July 2019

Aims

Bivalent direct thrombin inhibitors (DTIs), hirudin and bivalirudin, bind to the active site and exosite 1 of thrombin irreversibly and reversibly, respectively. The present study aims to assess in vitro effects of hirudin and bivalirudin through clot waveform analysis (CWA) and enzyme kinetics in coagulation assays.

Methods

The pooled normal plasma and its dilutions were spiked with hirudin or bivalirudin. The activated partial thromboplastin time (APTT) assay and the Clauss fibrinogen assay were performed using the CS-5100 (Sysmex). The APTT-CWA data were automatically gained by the CS-5100 programme.

Results

In APTT-CWA, the maximum coagulation velocity, acceleration and deceleration were decreased dependently on the drug concentrations, demonstrating evidence for the blockade of thrombin-positive feedback by hirudin or bivalirudin. The Hill plot analysis was applied to the dose-dependent curves in bivalirudin. The Hill coefficients were greater than 1, showing positive anticoagulant cooperativity. Regarding the dose-dependent curves in hirudin, all the parameters dropped to almost zero without making an asymptotic line. In the Clauss fibrinogen assay, the Lineweaver-Burk plots demonstrated that both drugs exhibit mixed inhibition mimicking uncompetitive binding. The Dixon plots in bivalirudin were linear and supported the inhibition type described above. The Dixon plots in hirudin were non-linear and inappropriate to use for determination of the inhibition type. In addition, the inverse function of the clotting time appeared to drop to zero without making an asymptotic line, suggesting complete loss of thrombin activity by irreversible binding.

Conclusions

The results provide insights into anticoagulation with bivalent DTIs.