bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of two sample preparation methods for the determination of cadmium, nickel and lead in natural foods by Graphite Furnace Atomic Absorption Spectrophotometry
Authors: Romero-Estévez David , Yánez-Jácome Gabriela S , Simbaña-Farinango Karina , Vélez-Terreros Pamela Y , Navarrete Hugo
Published: November 2019

Environmental pollution allows heavy metals to interact with ecosystems, bioaccumulating and passing through the food chain. Animals and human scan consume contaminated species and reach toxic and harmful concentrations in their organisms. While there are international regulatory frameworks for heavy metal contents, these are not always known or suitable for local conditions. This situation calls for the development of locally-applicable analytical methods for the determination of heavy metal concentrations in common vegetal and animal food products. Two established methods (AOAC999.11, based on sample drying and calcination, and IPNAC-06-00, based on microwave-assisted acid digestion) were comparatively tested at the CESAQ-PUCE laboratory in Quito, Ecuador, to determine their suitability. Sample matrices used were non industrial, non-organic tomato, lettuce, and beef commonly found in local markets. Heavy metals tested were cadmium, nickel, and lead. Test guidelines and comparative parameters were based on AOAC(2002) and included quantification limits, repeatability variation coefficients, intermediate precision percentages, accuracy and calculated expanded uncertainties. Unlike method AOAC999.11, method IPNAC 06-00 performance for all parameters was with in the range of recommended expected values as per AOAC, and was therefore deemed more suitable to be applied under the local CESAQ-PUCE laboratory conditions. The validation of method IPNAC-06-00 demonstrated its local applicability. In addition, IPNAC 06-00 can beused by similar laboratories to assess contaminants concentrations and improve the base line information concerning human exposure to toxic metals.
Influence of Texture Evolution on Mechanical and Damping Properties of SiC/Li2ZrO3/Al Composite Through Friction Stir Processing
Authors: Singh Subhash , Pal Kaushik
Published: November 2019

In this study, parent aluminum (Al), silicon carbide (SiC) reinforced Al, zirconia (ZrO2) coated SiC reinforced Al, and lithium zirconate spinel (Li2ZrO3, LZO) encapsulated SiC incorporated Al metal matrix composites were processed via friction stir processing (FSP) technique to observe the influence of grain refinement on mechanical and damping properties. Electron backscattered diffraction (EBSD) analysis were conducted for detailed and deep understanding of possible mechanism and microstructure at longitudinal cross sections of the samples. Further, the room temperature mechanical properties and thermal cyclic (−100 to 400 °C) damping performance of the friction stir processed composites were studied. The results obtained in this investigation show that storage modulus of pristine Al, SiC reinforced Al, ZrO2 coated SiC reinforced Al, and LZO coated SiC reinforced Al were improved by a factor of 1.09, 1.17, 1.09, and 1.38, respectively, after FSP. Additionally, the ultimate tensile strength (UTS) and hardness of the friction stir processed SiC/Li2ZrO3/Al composite were improved by a factor of 1.08 and 1.11, respectively, after FSP was compared with an unprocessed composite.
The Role of the Commonwealth Youth Games in Pre-elite Athlete Development
Authors: MacIntosh Eric W. , Sotiriadou Popi
Published: November 2019

Through the lens of the theory of reasoned action and the framework of attraction, retention, transition, and nurturing of athletes, this study examined how athletes’ experiences at the Commonwealth Youth Games contributed to satisfaction with the event, while encouraging transition into higher levels of competition. A total of 244 athletes from 23 different countries who completed a survey helped identify the environment-related aspects that created positive and negative experiences. The participants noted that learning from various social and cultural experiences influenced their event satisfaction and their future intention to remain in high-performance sport. Aspects of the event service environment, including poor accommodation and nutrition, were found to negatively impact performance. This paper contributes to the role of pre-elite events as athletic development agents that aid in talent transition. The results have implications for event organizers and high-performance managers regarding the influence of athletes’ experiences on performances and intention to transition.
Effects of Toe Direction on Biomechanics of Trunk, Pelvis, and Lower-Extremity During Single-Leg Drop Landing
Authors: Sakurai Aiko , Harato Kengo , Morishige Yutaro , Kobayashi Shu , Niki Yasuo , Nagura Takeo
Published: November 2019

Context:Toe direction is an important factor affecting knee biomechanics during various movements. However, it is still unknown whether toe direction will affect trunk and pelvic movements.Objective:To examine and clarify the effects of toe directions on biomechanics of trunk and pelvis as well as lower-extremities during single-leg drop landing (SLDL).Design:Descriptive laboratory study.Setting:Research laboratory.Participants:A total of 27 male recreational-level athletes.Intervention(s):Subjects performed SLDL under 3 different toe directions, including 0° (toe neutral), 20° (toe-in [TI]), and −20° (toe-out). SLDL was captured using a motion analysis system. Nondominant leg (27 left) was chosen for the analysis.Main Outcome Measures:Peak values of kinematic and kinetic parameters during landing phase were assessed. In addition, those parameters at the timing of peak vertical ground reaction force were also assessed. The data were statistically compared among 3 different toe directions using 1-way repeated measures of analysis of variance or Friedman χ2rtest.Results:Peak knee abduction angle and moment in TI were significantly larger than in toe neutral and toe-out (P < .001). Moreover, peak greater anterior inclination, greater inclination, and rotation of trunk and pelvis toward the nonlanding side were seen in TI (P < .001). At the timing of peak vertical ground reaction force, trunk inclined to the landing side with larger knee abduction angle in TI (P < .001).Conclusions:Several previous studies suggested that larger knee abduction angle and moment on landing side as well as trunk and pelvic inclinations during landing tasks were correlated with knee ligament injury. However, it is still unknown concerning the relationship between toe direction and trunk/pelvis movements during landing tasks. From the present study, TI during SLDL would strongly affect biomechanics of trunk and pelvis as well as knee joint, compared with toe neutral and toe-out.
Patterns of Preservice Teacher–Student Negotiation Within the Teaching Personal and Social Responsibility Model
Authors: McEntyre Kelsey , Curtner-Smith Matthew D. , Richards K. Andrew R.
Published: November 2019

Purpose: The purpose of this study was to describe the patterns of teacher–student negotiation that occurred when preservice teachers (PTs) taught within the teaching personal and social responsibility (TPSR) model.Method: The participants were seven PTs enrolled in an elementary early field experience. They taught three to four mini-units of TPSR. Seven qualitative techniques were employed to collect data, and standard interpretive techniques were used to analyze them.Results: Three general patterns of negotiation were identified. In the units taught by two of the PTs, the negotiations became more positive. For three of the PTs, the rates of negotiation were constant. In the units taught by the remaining two PTs, the negotiations became more negative. Key factors influencing the patterns of negotiation were PTs’ comprehension of and comfort with the TPSR model; class size; and students’ age, gender, and skill level.Conclusion: These findings may help faculty develop more nuanced and effective training for PTs learning to teach through TPSR.
Short-Chain
N
-Acylhomoserine Lactone Quorum-Sensing Molecules Promote Periodontal Pathogens in
In Vitro
Oral Biofilms
Authors: Muras Andrea , Mayer Celia , Otero-Casal Paz , Exterkate Rob A. M. , Brandt Bernd W. , Crielaard Wim , Otero Ana , Krom Bastiaan P.
Published: November 2019

Dental plaque is omnipresent in healthy oral cavities and part of our commensal microbial colonization. At the same time, dental plaque is the cause of the most common human diseases, caries and gum disease. Dental plaque consists of billions of microbes attached to the surface of your teeth. Communication among these microbes is pivotal for development of these complex communities yet poorly studied in dental plaque. In the present study, we show that a specific communication molecule induces changes within the community related to the development of gum disease. This finding suggests that interfering with microbial communication may represent an interesting novel strategy to prevent gum disease that should be further investigated.
Synechocystis
KaiC3 Displays Temperature- and KaiB-Dependent ATPase Activity and Is Important for Growth in Darkness
Authors: Wiegard Anika , Köbler Christin , Oyama Katsuaki , Dörrich Anja K. , Azai Chihiro , Terauchi Kazuki , Wilde Annegret , Axmann Ilka M.
Published: November 2019

The circadian clock influences the cyanobacterial metabolism, and deeper understanding of its regulation will be important for metabolic optimizations in the context of industrial applications. Due to the heterogeneity of cyanobacteria, characterization of clock systems in organisms apart from the circadian model
Synechococcus elongatus
PCC 7942 is required.
Synechocystis
sp. strain PCC 6803 represents a major cyanobacterial model organism and harbors phylogenetically diverged homologs of the clock proteins, which are present in various other noncyanobacterial prokaryotes. By our
in vitro
studies we unravel the interplay of the multiple
Synechocystis
Kai proteins and characterize enzymatic activities of the nonstandard clock homolog KaiC3. We show that the deletion of
kaiC3
affects growth in constant darkness, suggesting its involvement in the regulation of nonphotosynthetic metabolic pathways.
A Live Attenuated Influenza Vaccine Elicits Enhanced Heterologous Protection When the Internal Genes of the Vaccine Are Matched to Those of the Challenge Virus
Authors: Smith Andrew , Rodriguez Laura , El Ghouayel Maya , Nogales Aitor , Chamberlain Jeffrey M. , Sortino Katherine , Reilly Emma , Feng Changyong , Topham David J. , Martínez-Sobrido Luis , Dewhurst Stephen
Published: November 2019

Seasonal influenza infection remains a major cause of disease and death, underscoring the need for improved vaccines. Among current influenza vaccines, the live attenuated influenza vaccine (LAIV) is unique in its ability to elicit T-cell immunity to the conserved internal proteins of the virus. Despite this, LAIV has shown limited efficacy in recent years. One possible reason is that the conserved, internal genes of all current LAIVs derive from virus strains that were isolated between 1957 and 1960 and that, as a result, do not resemble currently circulating influenza viruses. We have therefore developed and tested a new LAIV, based on a currently circulating pandemic strain of influenza. Our results show that this new LAIV elicits improved protective immunity compared to a more conventional LAIV.
Nearly Complete Genome Sequence of Human Influenza Virus Strain A/Almaty/6327/2014 (H1N1) from Central Asia
Authors: Karamendin Kobey , Kydyrmanov Aidyn , Asanova Saule , Khan Elizaveta , Daulbayeva Klara , Kasymbekov Yermukhammet , Zhumatov Kainar , Asanova Nazgul , Sayatov Marat
Published: November 2019

An influenza virus strain, A/Almaty/6327/2014 (H1N1), was isolated in Almaty (in southeastern Kazakhstan) during a human population surveillance study in 2014. Here, we present the nearly complete genome sequence of this epidemic strain that was compared to the postpandemic variants of A(H1N1)pdm09.
Complete Genome Sequences of 11
Staphylococcus
sp. Strains Isolated from Buffalo Milk and Milkers’ Hands
Authors: Pizauro Lucas J. L. , de Almeida Camila C. , Gohari Iman M. , MacInnes Janet I. , Zafalon Luiz Francisco , Kropinski Andrew M. , Varani Alessandro M.
Published: November 2019

Here, we present data on the complete genome sequences of 11
Staphylococcus
sp. isolates (three
S. chromogenes
isolates and one isolate each of
S. saprophyticus
,
S. xylosus
,
S. hominis
,
S. agnetis
,
S. caprae
,
S. aureus
, and
S. warneri
), obtained as part of a mastitis study of buffalo milk (from healthy animals and from those with subclinical mastitis) and milkers’ hands.
Complete Genome Sequence of
Alteromonas
sp. Strain I4, Isolated from the Japan Sea
Authors: Miyazaki Kentaro , Izumi Kouki
Published: November 2019

A novel strain of
Alteromonas
, I4, was isolated from a shallow beach of the Japan Sea. Here, we report the complete genome sequence of I4; this strain contains a single circular chromosome (5,133,645 bp; G+C content, 48.4%) and a single circular putative plasmid (123,836 bp; G+C content, 45.1%).
16S rRNA Gene Amplicon Sequencing of Microbiota in Polybutylene Succinate Adipate-Packed Denitrification Reactors Used for Water Treatment of Land-Based Recirculating Aquaculture Systems
Authors: Yamada Takeshi , Hamada Masako , Nakagawa Miku , Sato Nobukazu , Ando Akinori , Ogawa Jun , Yasuda Mari , Kawagishi Tomoki
Published: November 2019

Information on the microbiota in polybutylene succinate adipate (PBSA)-packed denitrification reactors is limited. Here, we provide 439,817 high-quality reads of the 16S rRNA gene sequences of microbiota in PBSA-packed denitrification reactors used for land-based recirculating aquaculture. The predominant microorganisms belonged to the following families:
Nocardiaceae
,
Chitinophagaceae
,
Xanthobacteraceae
,
Burkholderiaceae
,
Rhodocyclaceae
,
Pseudomonadaceae
,
Rhodanobacteraceae
, and
Xanthomonadaceae
.
Draft Genome Sequence of the Caffeine-Degrading Methylotroph
Methylorubrum populi
Pinkel
Authors: Parales Rebecca E. , Sharma Gaurav , Zhang Xiangsheng , Subuyuj Gabriel A. , Langner Jordan T. , Wright Matthew E. , Ditty Jayna L. , Dawson Scott C.
Published: November 2019

A pink-pigmented facultative methylotroph,
Methylorubrum populi
Pinkel, was isolated from compost by selective enrichment with caffeine (3,5,7-trimethylxanthine) as the sole carbon, nitrogen, and energy source. We report here its high-quality draft genome sequence, assembled in 35 contigs totaling 5,630,907 bp. We identified 5,681 protein-coding sequences, including those putatively involved in caffeine degradation.
Draft Genome Sequence of a Bombella apis Strain Isolated from Honey Bees
Authors: Smith Eric A. , Martin-Eberhardt Sylvie A. , Miller Delaney L. , Parish Audrey J. , Newton Irene L. G.
Published: November 2019

Bombella apis
occupies a variety of distinct niches within a honey bee hive, including queen guts, royal jelly, and larval food. In an effort to better understand its evolution and identify signatures of honey bee association, we sequenced a strain isolated from hive honey stores. This genome is 2,086,308 bp long and contains 1,975 protein-coding genes.
Daily life participation in childhood chronic disease: a qualitative study
Authors: Nap-van der Vlist Merel M , Kars Marijke C , Berkelbach van der Sprenkel Emma E , Nijhof Linde N , Grootenhuis Martha A , van Geelen Stefan M , van der Ent Cornelis K , Swart Joost F , van Royen-Kerkhof Annet , van Grotel Martine , van de Putte Elise M , Nijhof Sanne L
Published: November 2019

Objective

Opportunities to participate in daily life have improved considerably for children with chronic disease. Nevertheless, they still face challenges associated with their ever-present illness affecting every aspect of their lives. To best help these children, we aimed to assess the child’s own perspective on participation and the main considerations that affect participation in a stable phase of disease.

Methods

Qualitative study design was applied. Semistructured, indepth interviews were conducted and analysed by a general inductive approach using constant comparison, coding and categorisation. Children 8–18 years old with a chronic disease were recruited from a cohort study involving cystic fibrosis, autoimmune disease and post-treatment paediatric cancer.

Results

31 of the 56 (55%) invited patients participated. From the perspective of children with chronic disease, participation is considered more than merely engaging in activities; rather, they view having a sense of belonging, the ability to affect social interactions and the capacity to keep up with peers as key elements of full participation. Some children typically placed a higher priority on participation, whereas other children typically placed a higher priority on their current and/or future needs, both weighing the costs and benefits of their choices and using disclosure as a strategy.

Conclusions

Enabling full participation from the child’s perspective will help realise patient-centred care, ultimately helping children self-manage their participation. Caregivers can stimulate this participation by evaluating with children how to achieve a sense of belonging, active involvement and a role within a peer group. This requires active collaboration between children, healthcare providers and caregivers.
Resolution of papilledema associated with cyclosporine use after change to tacrolimus
Authors: Yu Caberry W , Kwok Jason M , Micieli Jonathan A
Published: November 2019

Use of medications including vitamin A derivatives and tetracyclines have been associated with papilledema and raised intracranial pressure. A 46-year-old woman was referred to neuro-ophthalmology for bilateral optic disc oedema and had a 7-year history of cyclosporine use after renal transplantation. She had preserved visual function and moderate bilateral optic disc oedema. Magnetic resonance imaging and magnetic resonance venography of the brain were normal apart from signs of raised intracranial pressure. Lumbar puncture revealed an elevated opening pressure of 40 cm of water with normal cerebrospinal fluid contents. Nephrology was consulted and cyclosporine was switched to tacrolimus and she was treated with acetazolamide. The papilledema resolved within 1 month of her initial visit. It is important to recognise the role that cyclosporine plays in raising intracranial pressure, especially in patients requiring immunosuppression, such as transplant patients. Tacrolimus is a suitable alternative in these cases.
Early implementation of guidelines for managing young infants with possible serious bacterial infection in Bangladesh
Authors: Applegate Jennifer A , Ahmed Sabbir , Khan Marufa Aziz , Alam Sanjida , Kabir Nazmul , Islam Munia , Bhuiyan Mamun , Islam Jahurul , Rashid Iftekhar , Wall Steve , de Graft-Johnson Joseph , Baqui Abdullah H , George Joby
Published: November 2019

Neonatal infections remain a leading cause of newborn deaths globally. In 2015, WHO issued guidelines for managing possible serious bacterial infection (PSBI) in young infants (0–59 days) with simpler antibiotic regimens if hospital referral is not feasible. Bangladesh was one of the first countries to adapt WHO guidance into national guidelines for implementation in primary healthcare facilities. Early implementation was led by the Ministry of Health and Family Welfare (MOHFW) in 10 subdistricts of Bangladesh with support from USAID’s MaMoni Health System Strengthening project. This mixed methods implementation research case study explores programme feasibility and acceptability through analysis of service delivery data from 4590 sick young infants over a 15-month period, qualitative interviews with providers and MOHFW managers and documentation by project staff. Multistakeholder collaboration was key to ensuring facility readiness and feasibility of programme delivery. For the 514 (11%) infants classified as PSBI, provider adherence to prereferral treatment and follow-up varied across infection subcategories. Many clinical severe infection cases for whom referral was not feasible received the recommended two doses of injectable gentamicin and follow-up, suggesting delivery of simplified antibiotic treatment is feasible. However, prereferral antibiotic treatment was low for infants whose families accepted hospital referral, which highlights the need for additional focus on managing these cases in training and supervision. Systems for tracking sick infants that accept hospital referral are needed, and follow-up of all PSBI cases requires strengthening to ensure sick infants receive the recommended treatment, to monitor outcomes and assess the effectiveness of the programme. Only 11.2% (95% CI 10.3 to 12.1) of the expected PSBI cases sought care from the selected service delivery points in the programme period. However, increasing trends in utilisation suggest improved awareness and acceptability of services among families of young infants as the programme matured. Future programme activities should include interviews with caregivers to explore the complexities around referral feasibility and acceptability of simplified antibiotic treatment.
The role of education in the association between self-rated health and levels of C-reactive protein: a cross-sectional study in rural areas of China
Authors: Tu Raoping , Pan Kuan-Yu , Cai Guoxi , Yamamoto Taro , Wang Hui-Xin
Published: November 2019

Objectives

This study aims to examine the association between self-rated health (SRH) and levels of C-reactive protein (CRP) among adults aged 45 to 101 years old in rural areas of China, and to explore the role of education in the association.

Design

Cross-sectional study.

Setting

The study population was derived from two databases in China: Nanping project (NP) and the China Health and Retirement Longitudinal Study (CHARLS).

Participants

There were 646 participants from a rural area of Nanping (NP) and 8555 rural participants from a national representative sample of China (CHARLS).

Methods

CRP was measured using a high sensitivity sandwich enzyme immunoassay in the NP and immunoturbidimetric assay in the CHARLS. SRH was assessed by SRH questionnaires and categorised into good and poor. Education was measured by the maximum years of schooling and dichotomised into illiterate and literate. Multivariate linear regression models were used to study the associations.

Results

Compared to people with good SRH, those with poor SRH had higher levels of CRP in NP (β=0.16, 95% CI −0.02 to 0.34) and in CHARLS (β=0.07, 95% CI 0.02 to 0.11) after adjusting for potential confounders. Similar findings were observed in the pooled population (β=0.08, 95% CI 0.03 to 0.12), especially in men (β=0.13, 95% CI 0.06 to 0.20) and in literate people (β=0.12, 95% CI 0.06 to 0.18).

Conclusion

Poor SRH may be a predicator of elevated levels of CRP among middle-aged and older people in rural areas, especially in men and literate people.
Decomposition of the US black/white inequality in premature mortality, 2010–2015: an observational study
Authors: Kiang Mathew V , Krieger Nancy , Buckee Caroline O , Onnela Jukka Pekka , Chen Jarvis T
Published: November 2019

Objective

Decompose the US black/white inequality in premature mortality into shared and group-specific risks to better inform health policy.

Setting

All 50 US states and the District of Columbia, 2010 to 2015.

Participants

A total of 2.85 million non-Hispanic white and 762 639 non-Hispanic black US-resident decedents.

Primary and secondary outcome measures

The race-specific county-level relative risks for US blacks and whites, separately, and the risk ratio between groups.

Results

There is substantial geographic variation in premature mortality for both groups and the risk ratio between groups. After adjusting for median household income, county-level relative risks ranged from 0.46 to 2.04 (median: 1.03) for whites and from 0.31 to 3.28 (median: 1.15) for blacks. County-level risk ratios (black/white) ranged from 0.33 to 4.56 (median: 1.09). Half of the geographic variation in white premature mortality was shared with blacks, while only 15% of the geographic variation in black premature mortality was shared with whites. Non-Hispanic blacks experience substantial geographic variation in premature mortality that is not shared with whites. Moreover, black-specific geographic variation was not accounted for by median household income.

Conclusion

Understanding geographic variation in mortality is crucial to informing health policy; however, estimating mortality is difficult at small spatial scales or for small subpopulations. Bayesian joint spatial models ameliorate many of these issues and can provide a nuanced decomposition of risk. Using premature mortality as an example application, we show that Bayesian joint spatial models are a powerful tool as researchers grapple with disentangling neighbourhood contextual effects and sociodemographic compositional effects of an area when evaluating health outcomes. Further research is necessary in fully understanding when and how these models can be applied in an epidemiological setting.
Needlestick prevention devices: data from hospital surveillance in Piedmont, Italy—comprehensive analysis on needlestick injuries between healthcare workers after the introduction of safety devices
Authors: Ottino Maria Chiara , Argentero Andrea , Argentero Pier Angelo , Garzaro Giacomo , Zotti Carla Maria
Published: November 2019

Objective

Needlestick and sharps injuries (NSIs) involving healthcare workers (HCWs) are worldwide under surveillance since long time; the implementation of the European Directive 32/2010 regarding the mandatory use of safety-engineered devices (SEDs) seems to have reduced the number of these accidents. Our surveillance investigated the frequency and the modality of SED-related NSIs in the Piedmont region to verify changes in the epidemiology of these events.

Methods

We analysed the exposure records of NSIs, device usage data and structural data of 42 acute care hospitals and compared conventional and safety devices. We calculated the accident rates per 100 000 needles and, as a measure of SED efficacy, the relative risk between the use of safety and non-safety devices with a 95% CI. We also described the dynamics of the NSIs and the most involved professional groups of HCWs, procedures and devices.

Results

Total and specific device accident rates for 100 000 needles were lower with the use of SEDs. In 2015–2016, there were 1640 NSIs, with a decreasing absolute number during the observation period; 18% were SEDs related. Half of the total accidents with SEDs occurred in the patient’s room, and nurses were involved in 78% of the cases. The most involved devices were the butterfly needles and peripheral venous catheters, and the most involved procedures were venous sampling (40%) and phlebotherapy (16%). The exposures occurred mostly during the procedure, and 45% of the SED-related injuries occurred during the disposal of the device; 92% of the SEDs involved had a manual activation mechanism.

Conclusion

In agreement with the results of other European studies, our results show that SEDs reduce the risk of percutaneous exposure of HCWs, but in introducing SEDs, we must select those with a higher level of safety (with a passive activation mechanism) and improve the healthcare staff training programmes.
Implementation and refinement of a community health nurse model of support for people experiencing homelessness in Australia: a collaborative approach
Authors: Goeman Dianne , Howard Jane , Ogrin Rajna
Published: November 2019

Objective

To implement, refine and evaluate an assertive community health nurse (CHN) model of support for people experiencing or at risk of homelessness that aims to improve their access to health and social care services.

Methods

Participants were recruited between 30 August 2013 and 31 October 2015, including clients residing in a Victorian southern Melbourne metropolitan suburb, who registered with the CHN and stakeholders from local service provider organisations engaging with the CHN. A collaborative approach using demographic data collected from client records to identify need and measure the time clients took to engage and access services, qualitative data gathered during Stakeholder Advisory Group meetings and feedback from face-to-face interviews with service organisation representatives informed refinement of the CHN model.

Results

Thirty-nine clients (22 Female, mean age 50±11 years) participated. Clients engaged with services after an average of seven CHN visits. Eighteen clients independently accessed services after approximately 9 weeks, including medical and housing services. Client need and feedback from 20 stakeholders and three community nurses contributed to refining the model to ensure it met local needs and informed the necessary organisational framework, the CHN role and the attributes, knowledge and the skills required.

Conclusion

A collaborative CHN model of support for people at risk of or experiencing homelessness has been articulated. Evaluation of the role demonstrated increased client engagement with health and community services and social activities. Additionally, the CHN assisted other service providers in their delivery of care to this very complex client group.
Healthy lifestyle behaviour and risk of long-duration troublesome neck pain among men and women with occasional neck pain: results from the Stockholm public health cohort
Authors: Bohman Tony , Holm Lena W , Hallqvist Johan , Pico-Espinosa Oscar J , Skillgate Eva
Published: November 2019

Objectives

The effect of a healthy lifestyle on the prognosis of neck pain is unknown. This study aimed to investigate if a healthy lifestyle behaviour influences the risk of long-duration troublesome neck pain among men and women with occasional neck pain.

Design

Longitudinal cohort study.

Settings

General population, and a subsample of the working population, in Stockholm County, Sweden.

Participants

This study involved 5342 men and 7298 women, age 18 to 84, from the Stockholm Public Health Cohort, reporting occasional neck pain at baseline in 2006.

Measures

Baseline information about leisure physical activity, smoking, alcohol consumption and consumption of fruits and vegetables were dichotomised into recommendations for healthy/not healthy behaviour. The exposure, a healthy lifestyle behaviour, was categorised into four levels according to the number of healthy behaviours (HB) met. Generalised linear models were applied to assess the exposure on the outcome long-duration troublesome neck pain (activity-limiting neck pain ≥2 days/week during the past 6 months), at follow-up in 2010.

Results

The adjusted risk of long-duration troublesome neck pain decreased with increasing adherence to a healthy lifestyle behaviour among both men and women (trend test: p<0.05). Compared with the reference category, none or one HB, the risk decreased by 24% (risk ratio 0.76, 95% CI 0.58 to 0.98) among men and by 34% (0.66, 0.54 to 0.81) among women, with three or four HBs. The same comparison showed an absolute reduction of the outcome by 3% in men (risk difference −0.03, 95% CI −0.05 to −0.01) and 5% in women (-0.05,–0.08 to −0.03). Similar results were found in the working population subsample.

Conclusion

Adhering to a healthy lifestyle behaviour decreased the risk of long-duration troublesome neck pain among men and women with occasional neck pain. The results add to previous research and supports the importance of promoting a healthy lifestyle behaviour.
Effectiveness of prehabilitation for patients undergoing orthopaedic surgery: protocol for a systematic review and meta-analysis
Authors: Punnoose Anuj , Weiss Ori , Khanduja Vikas , Rushton Alison B
Published: November 2019

Introduction

Undergoing major surgery can induce physical and functional decline. Prehabilitation programmes aim to improve physical fitness and function preoperatively and could enhance postoperative recovery and outcomes. Prehabilitation interventions have been utilised across a range of orthopaedic populations of all ages and can be multimodal in nature. The aim of this study is to evaluate the effectiveness of prehabilitation for patients undergoing orthopaedic surgery including day surgery procedures. It will also investigate the components of prehabilitation to understand optimum duration and frequency of programmes.

Methods/design

Systematic review and meta-analysis designed in accordance with Preferred
Reporting Items for Systematic Review and Meta-Analysis Protocols. A comprehensive electronic search will be performed in MEDLINE, CINAHL, AMED, Embase, PEDro and Cochrane CENTRAL databases in order to identify randomised control trials published between January 2000 to 25 March 2019. ISI Web of Science, System for information on grey literature and the European Union clinical trials registry will identify studies that are underway or unpublished. Two independent reviewers will carry out the searches, study selection (title and abstract and full text stages), data extraction, risk of bias assessment (Cochrane Risk of Bias tool 2.0) and evaluation of overall strength of evidence. Meta-analyses will be used for data which demonstrates homogeneity, otherwise a narrative synthesis will be performed for groups of studies of high heterogeneity (I2 >50%). The overall strength of the body of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation.

Ethics and dissemination

This study raises no ethical issues. This study aims to identify the effectiveness of prehabilitation interventions and may assist clinicians in determining which components, duration, frequency and the method of delivery would form the most effective prehabilitation intervention for patients undergoing an orthopaedic surgical procedure. The findings will be disseminated through publication in a peer-reviewed journal and conference presentations.

PROSPERO registration number

CRD42019123268.
Are there gender disparities in symptom presentation or triage of patients with chest discomfort at primary care out-of-hours services? An observational study
Authors: van der Meer Manon G. , Appelman Yolande , Rutten Karlijn H.G. , van der Graaf Yolanda , Nathoe Hendrik M. , Doevendans Pieter A. , Smit Michelle , Verheij Emmy , Botermans Anne , Rutten Frans H.
Published: November 2019

Objectives

Previous hospital-based studies have suggested delayed recognition of acute coronary syndrome (ACS) in women. We wanted to assess differences in symptom presentation or triage among women and men who contacted primary care out-of-hours services (OHS) for chest discomfort.

Design

Retrospective observational study.

Setting

Primary care OHS.

Participants

276 women and 242 men with chest discomfort who contacted a primary care OHS in the Netherlands in 2013 and 2014.

Main outcome measures

Differences between women and men regarding symptom presentation and urgency allocation.

Results

8.4% women and 14.0% men had ACS. Differences in symptoms between patients with and without ACS were in general small, for both women and men. In women with ACS compared with women without ACS, mean duration of telephone calls was discriminative; 5.22 (SD 2.53) vs 7.26 (SD 3.11) min, p value=0.003. In men, radiation of pain (89.3% vs 54.9%, p value=0.011) was discriminative for ACS, and stabbing chest pain (3.7% vs 24.0%, p value=0.014) for absence of ACS . Women and men with chest discomfort received similar high urgency allocation (crude and adjusted OR after correction for ACS and age; 1.03 (95% CI 0.72 to 1.48) and 1.04 (95% CI 0.72 to 1.52), respectively). Women with ACS received a high urgency allocation in 22/23 (95.7%) and men with ACS in 30/34 (88.2%), p value=0.331.

Conclusions

Discriminating ACS in patients with chest discomfort who contacted primary care OHS is difficult in both women and men. Women and men with chest discomfort received similar high urgency allocation.
Cardiopulmonary resuscitation level of knowledge among allied health university students in Jordan: a cross-sectional study
Authors: Oteir Alaa O , Almhdawi Khader A , Kanaan Saddam F , Alwidyan Mahmoud T , Williams Brett
Published: November 2019

Objective

To explore the level of cardiopulmonary resuscitation (CPR) knowledge among allied health professions (AHPs) students and its associated factors.

Methods

This is a cross-sectional study assessing CPR knowledge among AHP students. A multidisciplinary expert panel designed a survey, which then was piloted to 20 potential participants. The survey had two sections, including demographics and knowledge questions. Knowledge questions scores ranged from 0 to 10, where 10 indicates all questions were answered correctly.

Results

A total of 883 students completed the surveys and were included in the study. The mean age was 21 years (±1.6) and the majority were females (73.1%). A total of 693 (78.5%) students did not receive previous CPR training and the top barriers to receiving CPR training were unawareness of training opportunities and a lack of time. Participants had a mean CPR knowledge score of 3.9 (±1.7) out of 10 maximum potential points. Trained participants had a higher mean score compared with the untrained (4.6 (±1.6) vs 3.8 (±1.6), p<0.001). Previous training (adjusted β=0.6; 95% CI 0.2 to 0.9; p<0.001) and being in the physical therapy programme (adjusted β=0.5; 95% CI 0.1 to 0.8; p=0.01) were associated with higher knowledge.

Conclusion

There is poor knowledge of CPR among AHP students including trained individuals. Efforts to increase the awareness of CPR should target students and professionals who are highly likely to encounter patients requiring CPR. Compulsory training courses, shorter training periods as well as recurrent and regular refreshing courses and use of various media devices are recommended.
Support Needs Approach for Patients (SNAP) tool: a validation study
Authors: Gardener A Carole , Ewing Gail , Mendonca Silvia , Farquhar Morag
Published: November 2019

Objectives

Patient-identified need is key to delivering holistic, supportive, person-centred care, but we lack tools enabling patients to express what they need to manage life with a long-term condition. The Support Needs Approach for Patients (SNAP) tool was developed to enable patients with advanced chronic obstructive pulmonary disease (COPD) identify and express their unmet support needs to healthcare professionals (HCPs), but its validity is unknown. This study aimed to establish face, content and criterion validity of the SNAP tool.

Design

Two-stage mixed-methods study involving patients with advanced COPD and their carers. Stage 1: Face and content validity assessed though focus groups involving patients and carers considering appropriateness, relevance and completeness of the SNAP tool. Data were analysed using conventional content analysis. Stage 2: Content and criterion validity assessed in a postal survey through patient self-completion of the SNAP tool and disease impact measures (Chronic Respiratory Questionnaire, COPD Assessment Test, and Hospital Anxiety and Depression Scale). Content validity assessed using summary statistics; criterion validity via correlations between tool items and impact measures.

Settings and participants

Two hundred and forty patients and carers participated. Stage 1 patient and informal carer participants were recruited from two primary care practices and Stage 2 patients from 28 practices. Participating practices located in the East of England were recruited via the NIHR Clinical Research Network: Eastern.

Results

Patients and carers found the tool patient-friendly and comprehensive, with potential clinical utility. No tool items were redundant. Clear correlations were found between tool items and the majority of items in the impact measures.

Conclusions

The SNAP tool has good face, content and criterion validity. It has potential to support the delivery of holistic, supportive, person-centred care by enabling patients to identify and express their unmet support needs to HCPs.
Key diagnostic characteristics of fever of unknown origin in Japanese patients: a prospective multicentre study
Authors: Naito Toshio , Tanei Mika , Ikeda Nobuhiro , Ishii Toshihiro , Suzuki Tomio , Morita Hiroyuki , Yamasaki Sho , Tamura Jun'ichi , Akazawa Kenichiro , Yamamoto Koji , Otani Hiroshi , Suzuki Satoshi , Kikuchi Motoo , Ono Shiro , Kobayashi Hiroyuki , Akita Hozuka , Tazuma Susumu , Hayashi Jun
Published: November 2019

Objective

To identify the key diagnostic features and causes of fever of unknown origin (FUO) in Japanese patients.

Design

Multicentre prospective study.

Setting

Sixteen hospitals affiliated with the Japanese Society of Hospital General Medicine, covering the East and West regions of Japan.

Participants

Patient aged ≥20 years diagnosed with classic FUO (axillary temperature≥38.0°C at least twice within a 3-week period, cause unknown after three outpatient visits or 3 days of hospitalisation). A total of 141 cases met the criteria and were recruited from January 2016 to December 2017.

Intervention

Japanese standard diagnostic examinations.

Outcome measures

Data collected include usual biochemical blood tests, inflammatory markers (erythrocyte sedimentation rate (ESR), C reactive (CRP) protein level, procalcitonin level), imaging results, autopsy findings (if performed) and final diagnosis.

Results

The most frequent age group was 65–79 years old (mean: 58.6±9.1 years). The most frequent cause of FUO was non-infectious inflammatory disease. After a 6-month follow-up period, 21.3% of cases remained undiagnosed. The types of diseases causing FUO were significantly correlated with age and prognosis. Between patients with and without a final diagnosis, there was no difference in CRP level between patients with and without a final diagnosis (p=0.121). A significant difference in diagnosis of a causative disease was found between patients who did or did not receive an ESR test (p=0.041). Of the 35 patients with an abnormal ESR value, 28 (80%) had causative disease identified.

Conclusions

Age may be a key factor in the differential diagnosis of FUO; the ESR test may be of value in the FUO evaluation process. These results may provide clinicians with insight into the management of FUO to allow adequate treatment according to the cause of the disease.
Thematic analysis of spousal interaction patterns among Asian parents of children with chronic life-threatening illness
Authors: Ho Andy Hau Yan , Dutta Oindrila , Tan-Ho Geraldine , Choo Ping Ying , Low Xinyi Casuarine , Chong Poh Heng , Ng Carolyn , Ganapathy Sashikumar
Published: November 2019

Objective

This is the first known study which examines the evolutionary nature of spousal interaction patterns among Asian parents of children with chronic life-threatening illness, from the time of providing care to their child through bereavement. This study is informed by earlier findings that when a child is diagnosed with a chronic life-threatening illness, parents are faced with multiple stressors, leaving them with little time to invest in their spousal relationship.

Participants and setting

A constructivist-phenomenological research paradigm was adopted and meaning-oriented interviews were conducted with 20 parental units (i.e., 6 couples, 12 lone mothers and 2 lone fathers) of Chinese, Malay and Indian ethnicities who lost their child to chronic life-threatening illness in Singapore.

Results

Qualitative thematic analysis of the data revealed four themes, which describe the evolutionary nature of spousal interaction patterns among Asian parents of children with chronic life-threatening illness, from caregiving through bereavement. Findings reveal participants’ tendency to concentrate on pragmatic, solution-focused communication during the period of caregiving (pragmatic interaction), avoid discussion about their emotional pain as a means of protecting their spouse (partner-oriented self-regulation), respect and acknowledge their spouse’s personal coping strategies (empathic responding) and show greater appreciation and emotional expression within the spousal relationship after their child’s death (affective appreciation).

Conclusion

Engaging in pragmatic discussions, deferring emotion-focused and potentially distressing conversations, and acknowledging their spouse’s need for personal space are important coping strategies for Asian couples facing their child’s chronic life-threatening illness and in the immediate aftermath of his/her death. Bereaved couples who have processed their grief individually feel ready to share their reflections with their spouse, deriving meaning and greater relational closeness through such disclosure. These findings are discussed from a cultural lens, with recommendations for healthcare professionals working with Asian parents of children with chronic life-threatening illness.
Trends in burden of work-related upper limb amputation in South Korea, 2004–2013: a nationwide retrospective cohort study
Authors: Ro Jun-soo , Leigh Ja-Ho , Jeon Inpyo , Bang Moon Suk
Published: November 2019

Objectives

This study aimed to measure the burden of work-related upper limb amputation in Korea over a 10-year period and assess its trend.

Design

Ecological study.

Setting

National level data in Korea between 2004 and 2013.

Participants

49 535 subjects who claimed Korea industrial accident compensation insurance due to upper limb amputation.

Main outcome measures

The disability-adjusted life years (DALYs) were calculated by sex, age and the site of amputation using annual incidence.

Results

The burden of work-related upper limb amputations in Korea reached its peak in 2007 and decreased thereafter. Males showed a higher burden of disease. Finger amputations showed a decreasing trend from 2007, whereas arm amputations continued to show an increasing trend. An increasing trend was found among participants older than 50 years.

Conclusions

The decrease in the burden of finger amputations may be attributable to the lower incidence as a result of policy efforts. The increase in the burden of arm amputations was particularly noticeable among the elderly population over 50 years old. This could be attributable to the high proportion of the elderly population working in the manufacturing sector and the lack of policy efforts regarding major amputations in Korea. Future regulatory efforts are needed to prevent amputations.