bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of cross‐campus multidisciplinary team meetings in decision‐making for children and adolescents with differences of sex development/intersex
Authors: Vora Komal A , Hanna Chloe A , Neville Kristen A , Bergman Philip B , Grover Sonia R , O'Connell Michele A , Srinivasan Shubha
Published: April 2021

Aim

Management of children with differences/disorders of sex development (DSD) is complex with limited evidence to guide clinical decisions. Regular multidisciplinary team meetings were set up in Sydney and Melbourne paediatric hospitals to enable systematic peer review of complex decision‐making. We aim to describe the workload and role of these meetings.

Methods

The multidisciplinary team forum includes invited representatives from endocrinology, urology, gynaecology, genetics, psychology, social work, clinical ethics, laboratory and hospital executive and meetings occur 1–3 times monthly. Descriptive data were collected from de‐identified meeting referrals and minutes between August 2012 to August 2018 (Sydney) and January 2014 to August 2018 (Melbourne).

Results

A total of 192 referrals (142 new and 50 follow‐ups) aged 1 week to 17 years were discussed across the two sites. 46, XY DSD (n = 81) was the most common sub‐classification. Consideration of surgical options and optimal management of gonads with malignant potential were amongst the common reasons for referral to the multidisciplinary team meetings. Surgical interventions were considered but not recommended after review for 38 of 154 (24.7%) procedures. Gonad retention to allow potential functional benefit was recommended in 15/46 (32.6%) referrals. Evidence of premalignant or malignant changes was found in 20/57 (35%) gonads removed, with dysgenetic features and atrophy/streak features in 6 (10.5%) and 27 (47.4%) gonads respectively.

Conclusion

Formal DSD multidisciplinary team meetings provide a framework and opportunity for multi and interdisciplinary discussions amongst representatives from several specialities to help make complex decision‐making.
A supermultiplier model of the natural rate of growth
Authors: Allain Olivier
Published: May 2021

We propose a supermultiplier model that includes formal and informal wage redistributive devices enabling everyone in the population to satisfy their primary needs. By introducing population growth and technical progress into the model, we show that wage redistribution gives rise to an autonomous consumption component, the growth rate of which corresponds to the natural rate of growth. The three main outcomes of the model are as follows: (a) Harrodian knife‐edge instability can be tamed, (b) the long‐run rate of growth of the economy converges toward the natural rate of growth, and (c) the rate of employment stabilizes but at a level that can differ from that of full employment.
Small‐scale spatial distributions of long‐finned pilot whales change over time, but foraging hot spots are consistent: Significance for marine wildlife tourism management
Authors: McComb‐Turbitt Sarah , Costa Joana , Whitehead Hal , Auger‐Méthé Marie
Published: April 2021

Data collected opportunistically aboard marine wildlife tourism vessels are an inexpensive source of spatial information on the target species. Although these data are often challenging to analyze, they can be used to monitor spatiotemporal changes in species distribution and behavior. Disruptions from whale‐watching vessels to behaviors such as foraging can be particularly harmful to cetaceans, but impacts could be reduced if areas essential for these sensitive behaviors are identified. We used data collected onboard whale‐watching vessels to explore space‐use patterns in long‐finned pilot whales (Globicephala melas) off northern Cape Breton Island, Canada, an area where tourism is essential. Encounters with pilot whales between 2011–2016 occurred twice as far offshore than during 2003–2006 and 2008, and foraging activity decreased. Despite the changes in distribution and activity budgets, we identified two hot spots of foraging activity that persisted through time. These identified foraging hot spots comprised only a small proportion (20 km2) of the range used by whale‐watching vessels. Adaptive local management (e.g., voluntary codes of conduct) focused on limiting interactions in these energetically important areas may help reduce any potential impacts from whale‐watching and promote the continued viability of the whale population and the tourism industry that relies on it.
MRC Hot Topic workshop report: Reshaping the food environment – applying interdisciplinary perspectives in appetite research
Authors: Johnstone Alexandra M. , Brown Adrian
Published: May 2021

The prevalence of obesity, both worldwide and in the UK, continues to rise and has been classified by the NHS as a major public health issue with current public health survey data indicating that nearly two thirds of adults are living with overweight and obesity. We know from existing appetite research that it is easy to overconsume calories, but difficult to reduce calorie intake below requirements and we seek to expand this evidence base to seek future research themes to provide the evidence on how to manage obesity. This Medical Research Council (MRC)‐funded hot topic workshop explored issues that are evolving from current literature to create discussion about potential future collaborative research around 4 themes: (i) Food reformulation/innovation – how appetite research can influence sustainable and healthy diets, (ii) One diet does not fit all – how should we conduct appetite research to embrace inter‐individual differences (e.g. responder/non‐responders), (iii) Environmental drivers of obesity/food choices – bridging the gap between appetite research and obesity services – future research themes, (iv) Big data approaches to develop understanding of drivers of appetite and food choice. Appetite forms a bridge to understanding the interaction between the internal and external environments and therefore has both biological and behavioural relevance for behaviour change associated with eating. This report summarises how future research can embrace this multidisciplinary challenge.
Group motivation
Authors: Brown Jessica
Published: May 2021

In this paper I discuss a key issue for group moral responsibility, namely whether we can make sense of a group acting for one reason rather than another. The notion of acting for one reason rather than another is central to standard accounts of individual agency and responsibility; and also determines whether an individual is blameworthy or praiseworthy for an action. Thus if we model group responsibility on individual responsibility, we need to be able to make sense of a group acting for one reason rather than another. In this paper, I raise problems for both summative and inflationary accounts of what it is for a group to act on a reason, before suggesting several potential solutions at the end.
A fresh look at thiamine deficiency—new analyses by the global thiamine alliance
Authors: Bourassa Megan W. , Bergeron Gilles , Brown Kenneth H.
Published: May 2021

Severe thiamine (vitamin B1) deficiency is generally regarded as a problem affecting mostly infants in low‐income communities of Southeast Asia and adult alcoholics regardless of their location. However, recent scholarship shows that the disorders associated with thiamine deficiency may also affect heretofore unsuspected populations, and that the scope of disorders, including some long‐lasting neurocognitive consequences, is broader than previously thought.
Micronutrient status in bariatric surgery patients receiving postoperative supplementation per guidelines: Insights from a systematic review and meta‐analysis of longitudinal studies
Authors: Ha Jane , Kwon Yeongkeun , Kwon Jin‐Won , Kim Dohyang , Park Shin‐Hoo , Hwang Jinseub , Lee Chang Min , Park Sungsoo
Published: May 2021

The micronutrient status and optimal monitoring schedule after bariatric surgery have not been sufficiently assessed. This systematic review and meta‐analysis investigated the longitudinal changes in micronutrient status after bariatric surgery. PubMed, EMBASE, and Cochrane Library were searched for articles that measured preoperative and postoperative serum micronutrient levels in patients undergoing Roux‐en‐Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Among guideline‐adherent studies, the longitudinal changes in micronutrient status were investigated using weighted mean difference (WMD) using a random‐effects model. Among the 82 included studies, the guideline adherence rates for micronutrient supplementation after bariatric surgery did not exceed 20%. In patients supplemented per guidelines, vitamin A significantly decreased after RYGB by −7.54 (95% confidence interval [CI], −10.16 to −4.92) μg/dl at 12–23 months, vitamin E decreased after RYGB by −2.35 (95% CI, −3.65 to −1.05) μg/dl at ≥24 months, and ferritin by −54.93 (95% CI, −77.19 to −32.67] μg/L at ≥24 months after SG, compared with baseline, with moderate level of evidence. Significant decreases in micronutrient levels at certain follow‐up intervals in studies with supplementation per guidelines need to be considered to establish a post‐bariatric micronutrient monitoring schedule for timely detection and management of micronutrient deficiencies.
School‐based physical activity interventions in rural and urban/suburban communities: A systematic review and meta‐analysis
Authors: Pfledderer Christopher D. , Burns Ryan D. , Byun Wonwoo , Carson Russell L. , Welk Gregory J. , Brusseau Timothy A.
Published: May 2021

Disparities in physical activity and health outcomes exist between urban and rural youth. School settings can be utilized to promote physical activity in youth regardless of urban–rural status. This systematic review and meta‐analysis aimed to assess and compare the effect of rural and urban/suburban school‐based physical activity programs on total physical activity in youth. A search of five databases was conducted. A total of 33 studies remained after the exclusion process, 28 of which took place in urban/suburban schools and five of which took place in rural schools. The DerSimonian and Laird random effects model was employed with the estimates of heterogeneity taken from the inverse‐variance fixed‐effect model. For rural studies, the Hartung–Knapp–Sidak–Jonkman method was used to obtain error estimates. Results from the total sample indicated a significant but small pooled increase in daily physical activity (Hedge's g = 0.12, 95% confidence interval [CI]: 0.06–0.18), which held for interventions conducted in urban/suburban schools (Hedge's g = 0.12, 95% CI: 0.06–0.19). For rural school‐based interventions, there was no significant pooled effect (Hedge's g = 0.06, 95% CI: −0.50 to 0.61). This meta‐analysis provides evidence that school‐based interventions can be marginally effective for increasing daily physical activity in children and adolescents; however, no effect was observed for interventions implemented in rural settings.
Association between oral health and thyroid disorders: A population‐based cross‐sectional study
Authors: Kwon Minsu , Jeong Yu‐Jin , Kwak Jiwon , Jung Kwang‐Yoon , Baek Seung‐Kuk
Published: April 2021

Objectives

In this study, we aimed to determine the relationship between oral health status and thyroid dysfunction.

Methods

A population‐based cross‐sectional analysis using data from the Korean National Health and Nutrition Examination Survey (KNHNES) was performed. We investigated the association between oral health‐related parameters and the prevalence of thyroid diseases. In addition, the relationship between oral health status and thyroid function test (TFT) results was analyzed. One‐way analysis of variances or chi‐square test was used for comparisons between oral health‐related parameters and presence of thyroid diseases. Univariable and multivariable logistic regression analyses were conducted to evaluate the associations between participants’ characteristics including oral health‐related parameters and the abnormal results of TFTs.

Results

A total of 18,034 adults were surveyed. Histories of thyroid diseases were found to be more common in people who brushed their teeth frequently or used oral hygiene products. However, histories of periodontitis and community periodontal index (CPI) did not show significant associations with histories of thyroid diseases. Among 14,860 participants without history of thyroid disorders, people having higher CPI values demonstrated higher probabilities of abnormal TFTs (OR 1.381, 95% CI 1.241‒1.537, p < .0001); however, statistical significance was not found after adjusting for the other variables.

Conclusions

Our study demonstrated that good oral health‐related behavior was associated with more frequent thyroid disease history. High CPI showed a significant association with TFT abnormalities; however, the significance of this association became lower when other variables such as age and sex were adjusted. Further studies will be needed to determine how the control of oral health‐related conditions actually has a causal relationship with thyroid disease/dysfunction through prospective cohort studies.
Individual variation in thermal plasticity and its impact on mass‐scaling
Authors: Kar Fonti , Nakagawa Shinichi , Friesen Christopher R. , Noble Daniel W. A.
Published: April 2021

Physiological processes vary widely across individuals and can influence how individuals respond to environmental change. Repeatability in how metabolic rate changes across temperatures (i.e. metabolic thermal plasticity) can influence mass‐scaling exponents in different thermal environments. Moreover, repeatable plastic responses are necessary for reaction norms to respond to selective forces which is important for populations living in fluctuating environments. Nonetheless, only a small number of studies have explicitly quantified repeatability in metabolic plasticity, and fewer have explored how it can impact mass‐scaling. We repeatedly measured standard metabolic rate of n = 42 delicate skinks Lampropholis delicata at six temperatures over the course of four months (N[observations] = 4952). Using hierarchical statistical techniques, we accounted for multi‐level variation and measurement error in our data in order to obtain more precise estimates of reaction norm repeatability and mass‐scaling exponents at different acute temperatures. Our results show that individual differences in metabolic thermal plasticity were somewhat consistent over time (Rslope = 0.25, 95% CI = 2.48 × 10−8 – 0.67), however estimates were associated with a large degree of error. After accounting for measurement error, which decreased steadily with temperature, we show that among individual variance remained consistent across all temperatures. Congruently, temperature specific repeatability of average metabolic rate was stable across temperatures. Cross‐temperature correlations were positive but were not uniform across the reaction norm. After taking into account multiple sources of variation, our estimates for mass‐scaling did not change with temperature and were in line with published values for snakes and lizards. This implies that repeatable plastic responses may promote thermal stability of scaling exponents. Our work contributes to understanding how energy expenditure scales with abiotic and biotic factors and the capacity for reaction norms to respond to selection.
TERMINAL FLOWER1 andTERMINAL FLOWER1d respond to temperature and photoperiod signals to inhibit determinate growth in cucumber
Authors: Wen Haifan , Pan Jian , Chen Yue , Chen Guanqun , Du Hui , Zhang Leyu , Zhang Keyan , He Huanle , Wang Gang , Cai Run , Pan Junsong
Published: May 2021

Plants monitor environmental cues to balance their vegetative and productive growth by optimizing their inflorescence architecture. TERMINAL FLOWER 1 (TFL1) and its orthologs regulate the inflorescence structure in cucumber, yet the mechanisms underlying their responses to environmental factors and the formation of terminal flowers remain elusive. Here, we performed map‐based cloning to identify the gene that controls a season‐dependent determinate growth phenotype and found that it was caused by the complete deletion ofCsTFL1in the genome of cucumber lineWI1983Hde. In theCsTFL1deletion plants (CsTFL1del), determinate growth could be partially rescued by high‐temperature and long‐day conditions. The expressions ofCsTFL1and its orthologCsTFL1dcould be upregulated by long‐day and high‐temperature signals. Knockdown ofCsTFL1dresulted in determinate growth and the formation of terminal flowers in WT. These results indicate that the induction ofCsTFL1dexpression by long‐day and high‐temperature might partially rescue determinate growth ofCsTFL1del. Furthermore, biochemical analyses showed that CsTFL1d interacts directly with CsNOT2a, which indicated that CsTFL1d and CsTFL1 function via similar regulatory mechanism. Our data suggest thatCsTFL1andCsTFL1dco‐contribute to inhibit determinate growth by responding to temperature and photoperiod signals. It provides mechanistic insights into how environmental cues sculpt the inflorescence architecture of cucumber.
Capacity Reservation and Wholesale Price Contracts under Forecast Sharing: A Behavioral Assessment
Authors: Schiffels Sebastian , Voigt Guido
Published: May 2021

We study a supply chain setup in which a buyer has private end customer demand information that she can share with the supplier. The demand information is relevant to the supplier's capacity decision. We address the question of whether the supplier benefits from installing nonlinear capacity reservation contracts rather than wholesale price contracts. We contribute to the literature by providing the first internally valid comparison of both contracts with human decision makers. We setup an experimental study with four treatments (both contracts as well as different supplier margins). From a supplier's perspective, we observe that the capacity reservation contract significantly outperforms the wholesale price contract; however, the supplier's benefit from using capacity reservation is much higher under low margins than under high margins. Regarding supply chain performance, the positive effect for the supplier exceeds the negative effect for the buyer in the low margin setting, while the two effects neutralize each other in the high margin setting. We identify behavioral factors explaining deviations from the theoretical predictions. In particular, we observe naïve anchoring and trust as strong behavioral drivers common to both contract types. Even though the complexity of the nonlinear contract results in weaker performance than that predicted by theory, our study reveals that suppliers can still benefit from installing them; thus, providing important managerial implications for the choice of the contract type.
A novel fractional‐order reaction diffusion system for the multiplicative noise removal
Authors: Gao Juanjuan , Sun Jiebao , Yao Wenjuan , Guo Zhichang
Published: April 2021

In this paper, a fractional‐order nonlinear reaction diffusion system is proposed to remove the multiplicative Gamma noise. The new reaction diffusion system consists of three equations: the regularized Perona and Malik (PM) equation , which is used for presmoothing the image that is contaminated by noise; the time‐delay regularization equation, which is used for incorporating the past information into the diffusion process and adjusting oversmoothing; and the fractional‐order diffusion equation, which is used for removing the multiplicative Gamma noise and maintaining texture. The new reaction diffusion system is coupled, leading to the difficulty in theoretical analysis. To this end, we use decoupled and Schauder's fixed‐point theorem to obtain the existence and uniqueness of weak solution of the system. The explicit finite difference scheme is employed to implement the fractional‐order nonlinear reaction diffusion system. In addition, we test both texture images and nontexture images. Experimental results show that the new model achieves a better trade‐off between denoising performance and texture preservation than the other three models.
The provision of work–life balance practices across welfare states and industries and their impact on extraordinary turnover
Authors: Joecks Jasmin
Published: May 2021

This study focusses on the provision of work–life balance practices across welfare states and industries and its effect on extraordinary turnover. Given the welfare states and the industry's differences, it is important to focus on extraordinary employee turnover defined as positive and negative deviations from the relevant means per year and by welfare state and industry. Based on a sample of 199 listed companies in these European welfare states from 2002 to 2011, the results showed that the provision of daycare services is higher in socially oriented welfare states (e.g., Sweden, Germany) or in low‐technology industries (consumer services) than in liberally oriented welfare states (e.g., Italy, the United Kingdom) or in high‐technology industries (e.g., IT). For the provision of daycare services, the findings support a decreasing effect on extraordinary employee turnover, whereas other practices such as flexible working, generous vacations and additional maternity leave have no effect.
Three Redshifts: Doppler, Cosmological, and Gravitational
Authors: Simionato Silvia
Published: April 2021

The concept of redshift is very often used in teaching physics and astronomy, as well as in science public outreach. Redshift is an interesting topic, used to describe many physical processes such as the Doppler effect or the expansion of the universe. Nevertheless, there are unfortunately also misconceptions about redshift. When facing the redshift topic with students and teachers, we have to focus sometimes on dissolving these misconceptions. Therefore, the idea of this paper, in which the most common misconceptions are treated, arose from direct experience and discussions with colleagues in the field. This article explains what redshift is and how it works. Moreover, since redshift has a great potential for teaching and is usable in many physics and astronomy problems, examples and specifically developed exercises are also used in this article.
Age-Related Changes in Concentric and Eccentric Isokinetic Peak Torque of the Trunk Muscles in Healthy Older Versus Younger Men
Authors: Dallaway A. , Hattersley J. , Tallis J. , Renshaw D. , Griffen C. , Duncan M.
Published: April 2021

This study investigated age-related changes in trunk muscle function in healthy men and the moderating effect of physical activity. Twelve older (67.3 ± 6.0 years) and 12 younger (24.7 ± 3.1 years) men performed isokinetic trunk flexion and extension tests across a range of angular velocities (15°/s–180°/s) and contractile modes (concentric and eccentric). For concentric trunk extension, mixed-effects analysis of covariance revealed a significant interaction between Angular velocity × Age group (p = .026) controlling for physical activity. Follow-up univariate analysis of covariance revealed that the younger group produced significantly greater peak torque for all concentric extension conditions. Eccentric trunk strength was somewhat preserved in the older group. Age-related changes in trunk strength were independent of physical activity. The normal loss of trunk muscle strength in older age is muscle- and contractile-mode specific. These findings provide guidance for effective intervention strategies to offset adverse health outcomes related to trunk strength loss in older adults.
Inferring non-equilibrium interactions from tracer response near confined active Janus particles
Authors: Katuri Jaideep , Uspal William E. , Popescu Mihail N. , Sánchez Samuel
Published: April 2021

Activity-induced osmotic flows near surfaces play a key role in determining non-equilibrium interactions with active particles.
Control of synaptic vesicle release probability via VAMP4 targeting to endolysosomes
Authors: Ivanova Daniela , Dobson Katharine L. , Gajbhiye Akshada , Davenport Elizabeth C. , Hacker Daniela , Ultanir Sila K. , Trost Matthias , Cousin Michael A.
Published: April 2021

VAMP4 is a molecular rheostat that adjusts neurotransmitter release to both the activity and degradative status of neurons.
Viral genomes reveal patterns of the SARS-CoV-2 outbreak in Washington State
Authors: Müller Nicola F. , Wagner Cassia , Frazar Chris D. , Roychoudhury Pavitra , Lee Jover , Moncla Louise H. , Pelle Benjamin , Richardson Matthew , Ryke Erica , Xie Hong , Shrestha Lasata , Addetia Amin , Rachleff Victoria M. , Lieberman Nicole A. P. , Huang Meei-Li , Gautom Romesh , Melly Geoff , Hiatt Brian , Dykema Philip , Adler Amanda , Brandstetter Elisabeth , Han Peter D. , Fay Kairsten , Ilcisin Misja , Lacombe Kirsten , Sibley Thomas R. , Truong Melissa , Wolf Caitlin R. , Boeckh Michael , Englund Janet A. , Famulare Michael , Lutz Barry R. , Rieder Mark J. , Thompson Matthew , Duchin Jeffrey S. , Starita Lea M. , Chu Helen Y. , Shendure Jay , Jerome Keith R. , Lindquist Scott , Greninger Alexander L. , Nickerson Deborah A. , Bedford Trevor
Published: May 2021

Initial SARS-CoV-2 dynamics in Washington State were driven by regional interventions and introductions of variants differing in viral loads.
Resilient Instructional Strategies: Helping Students Cope and Thrive in Crisis
Authors: Shay Jackie E. , Pohan Cathy
Published: April 2021

Recent times of excessive stress call for a reflection and reformation of how people interact and support one another. This is particularly true in science, technology, engineering, and mathematics (STEM) discipline–based education, where it is becoming increasingly important for course instructors to adopt student-centered teaching approaches that engage students, maintain rigor, and consider the students’ learning experiences, including stress.
Undergraduate Research in the Time of COVID-19: A Remote Imaging Protocol for Physically Distanced Students Studying Wildlife†
Authors: Tripepi Manuela , Landberg Tobias
Published: April 2021

The COVID-19 pandemic has shuttered many university research labs because campuses are closed, and faculty and students lack productive ways of working remotely. This presents major difficulties for students who need research opportunities to fulfill their intellectual growth potential and their undergraduate research and thesis requirements.
Impacts of a COVID-19 E-Service-Learning Module in a Non-Major Biology Course
†
Authors: Adkins-Jablonsky Sarah , Fleming Ryleigh , Esteban Marco , Bucio Diana , Morris J. Jeffrey , Raut Samiksha
Published: April 2021

Educators need to create an informed scientifically aware citizenry, especially in the era of the COVID-19 pandemic, where public health measures have focused on increasing adoption of safe behaviors for reducing the transmission of COVID-19.
Cutting-Edge Microscopy Systems as Remote Teaching and Research Tools for Undergraduate Students
Authors: Thompson Christopher R.
Published: April 2021

Whether due to illness, weather, safety, or other concerns, it is very difficult for biology students to gather meaningful and timely data without access to campus. This has been especially evident during the COVID-19 pandemic, in which most laboratory exercises have been conducted as a simulation.
Immune Gene Expression Covaries with Gut Microbiome Composition in Stickleback
Authors: Fuess Lauren E. , den Haan Stijn , Ling Fei , Weber Jesse N. , Steinel Natalie C. , Bolnick Daniel I.
Published: May 2021

Here, we document associations between host gene expression and gut microbiome composition in a nonmammalian vertebrate species. We highlight associations between expression of immune genes and both microbiome diversity and abundance of specific microbial taxa.
Supplemental Material: Conservative transport of dissolved sulfate across the Rio Madre de Dios floodplain in Peru
Authors: Burt Emily , al. et
Published: April 2021

Details on the chloride-based mixing model and oxygen isotope calculations, Table S1 (geochemical data), and Table S2 (sulfate and water mass balance calculations).
Prevalence of thrombotic complications in children with SARS-CoV-2
Authors: Aguilera-Alonso David , Murias Sara , Martínez-de-Azagra Garde Amelia , Soriano-Arandes, Antoni , Pareja Marta , Otheo Enrique , Moraleda Cinta , Tagarro Alfredo , Calvo Cristina
Published: April 2021

Knowledge of thrombosis in children with SARS-CoV-2 is scarce. In this multicentre national cohort of children with SARS-CoV-2 involving 49 hospitals, 4 patients out of 537 infected children developed a thrombotic complication (prevalence of 0.7% (95% CI: 0.2% to 1.9%) out of the global cohort and 1.1% (95% CI: 0.3% to 2.8%) out of the hospitalised patients). We describe their characteristics and review other published paediatric cases. Three out of the four patients were adolescent girls, and only two cases had significant thrombotic risk factors. In this paediatric cohort, D-dimer value was not specific enough to predict thrombotic complications. Adolescence and previous thrombotic risk factors may be considered when initiating anticoagulant prophylaxis on children with SARS-CoV-2 disease (COVID-19).
Aberrated supraventricular tachycardia associated with neonatal fever and COVID-19 infection
Authors: Hopkins Kali A , Webster Gregory
Published: April 2021

A 9-day-old girl presented during the 2020 SARS-CoV-2 pandemic in wide-complex tachycardia with acute, symptomatic COVID-19 infection. Because the potential cardiac complications of COVID-19 were unknown at the time of her presentation, we chose to avoid the potential risks of haemodynamic collapse associated with afterload reduction from adenosine. Instead, a transoesophageal pacing catheter was placed. Supraventricular tachycardia (SVT) with an aberrated QRS morphology was diagnosed and the catheter was used to pace-terminate tachycardia. This presentation illustrates that the haemodynamic consequences of a concurrent infection with largely unknown neonatal sequelae present a potentially high-risk situation for pharmacologic conversion. Oesophageal cannulation can be used to diagnose and terminate infantile SVT.
Superior oblique split lengthening procedure for brown syndrome, outcomes and complications
Authors: Alhamzah Albanderi , Alshareef Mozon F , Shabar Rasha , Alfreihi Shatha Hussein
Published: April 2021

Introduction

To evaluate the outcomes of the superior oblique split tendon lengthening (SOSL) procedure for Brown syndrome (BS).

Methods

At a single institution, all patients who underwent SOSL surgery for BS from 2013 to 2019 were reviewed retrospectively. We looked at the surgical outcomes and complications in a total of 20 eyes of 18 patients. The superior oblique (SO) muscle was isolated and then extended. The tendon was then split centrally into equal halves. Two 6–0 polyglactin sutures were then placed on each end of the split tendon 6–10 mm apart. To complete the Z-cut, the split tendon was cut distal to the preplaced sutures. The sutures were then tied to produce the split Z-tendon lengthening.

Results

Eleven (55%) out of 20 eyes were female patients. The mean age was 6.6 years (range 2–17 years). The mean follow-up was 26.8 months (range 5–72 months). The mean degree of preoperative limitation of elevation on adduction was −3.6±0.58 preoperatively and −0.75±1.25 postoperatively (p=0.0001). Preoperatively, the mean degree of vertical deviation at near was 3.5±7.62 and at distance was 3.10±7.84 prism diopters (PD), respectively. Postoperatively, the mean vertical deviation was 2.77±4.75 and 2.10±4.08 PD at near and distance, respectively. Postoperative complications included haematoma in one patient (5%), overcorrection in two patients (10%) and one patient required reoperation (5%).

Conclusion

SOSL is a safe procedure that surgeons can consider in managing patients with BS.
Association of objective visual impairment with suicidal ideation and suicide attempts among adults aged ≥50 years in low/middle-income countries
Authors: Smith Lee , Shin Jae Il , Barnett Yvonne , Allen Peter M , Lindsay Rosie , Pizzol Damiano , Jacob Louis , Oh Hans , Yang Lin , Tully Mark A , Veronese Nicola , Koyanagi Ai
Published: April 2021

Background

There is currently limited literature on the association between visual impairment and suicidal thoughts and behaviours, especially among older adults from low/middle-income countries (LMICs). Thus, we aimed to investigate the associations of objectively measured distance visual impairment with suicidal ideation and suicide attempts among adults aged ≥50 years from six LMICs and to identify potential mediators.

Methods

Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health were analysed. Objective distance visual acuity was measured using the tumbling E logMAR chart, and vision impairment was categorised as none, mild, moderate and severe. Self-reported information on past 12-month suicidal ideation and suicide attempts was also collected. Multivariable logistic regression and mediation analysis were conducted.

Results

Data on 34 129 individuals aged ≥50 years (mean (SD) age, 62.4 (16.0) years; 47.9% men) were analysed. After adjustment for potential confounders, compared with no visual impairment, severe visual impairment was significantly associated with suicidal ideation (OR=9.50; 95% CI=2.47 to 36.52). Moderate and severe visual impairment were significantly associated with a 2.22 (95% CI=1.14 to 4.35) and 11.50 (95% CI=1.44 to 91.88) times higher odds of suicide attempts, respectively. Disability, poor self-rated health, mobility and loneliness explained 14.0%, 9.3%, 7.2% and 6.3% of the association between moderate/severe visual impairment and suicide attempts, respectively.

Conclusion

Interventions to reduce suicidal ideation and suicide attempts among older adults with visual impairment in LMICs are required, targeting identified mediators, while using tested strategies for suicide prevention per se in LMICs may yield beneficial outcomes.
Trabeculectomy with mitomycin C alone or coupled with intracamerular bevacizumab? A 2-year comparative study
Authors: José Patrícia , Teixeira Filipa Jorge , Barão Rafael , Sousa David Cordeiro , Marques Raquel Esteves , Barata Andre Diogo De Oliveira , Marques-Neves Carlos , Alves Marta , Papoila Ana Luísa , Stalmans Ingeborg , Silva José Pedro , Abegão Pinto Luis
Published: April 2021

Purpose

To compare outcomes of primary trabeculectomy using either mitomycin C (MMC) alone versus MMC augmented with intracamerular bevacizumab in patients with open-angle glaucoma.

Methods

Retrospective, cohort, two-centre, comparative study. Patients’ data were screened between October 2015 and March 2019, with inclusion requiring a minimum follow-up of 24 months. Primary outcome was intraocular pressure (IOP) lowering at 24 months, with surgical success defined with different maximum IOP targets (≤18, ≤16 and ≤14 mm Hg) and at least 30% reduction and higher than 5 mm Hg. Absolute success was achieved if no IOP-lowering medication was needed and a qualified success if otherwise. Safety outcomes were analysed.

Results

A total of 110 eyes underwent trabeculectomy with MMC, 51 of these combined with intracamerular bevacizumab. Both strategies were effective in terms of IOP lowering (baseline vs 2 years postoperatively: 24.4 (8.0) mm Hg vs 12.1 (5.3) mm Hg in the MMC group; 25.1 (8.7) vs 10.8 (3.8) mm Hg in the MMC+bevacizumab group; p<0.001 in both comparisons). The MMC+bevacizumab group had a significant difference towards higher efficacy on absolute success rates at all targets (IOP≤14 or ≤16 or ≤18 mm Hg; p=0.010, p=0.039 and p=0.007, respectively). The large majority (93%) of the MMC+bevacizumab group was drop-free at 24 months, and 41% had IOP below 10 mm Hg. Complication rates were low and similar between groups, with no systemic adverse events.

Conclusions

Intracamerular bevacizumab in MMC-augmented primary trabeculectomy increases the chances of obtaining low IOP outcomes. This strategy may be useful when planning for surgeries aiming at target pressures in the low teens.

Trial registration number

ISRCTN93098069.
Inappropriate intensification of glucose-lowering treatment in older patients with type 2 diabetes: the global DISCOVER study
Authors: Bongaerts Brenda , Arnold Suzanne V , Charbonnel Bernard H , Chen Hungta , Cooper Andrew , Fenici Peter , Gomes Marilia , Ji Linong , Khunti Kamlesh , Kosiborod Mikhail , Medina Jesús , Nicolucci Antonio , Shestakova Marina , Shimomura Iichiro , Tang Fengming , Watada Hirotaka , Rathmann Wolfgang
Published: May 2021

Introduction

Although individualized target glycated hemoglobin (HbA1c) levels are recommended in older people with type 2 diabetes, studies report high levels of potential overtreatment. We aimed to investigate the proportion of older patients (aged ≥65 years) who potentially received an inappropriately intensive treatment (HbA1clevel <7.0% (53.0 mmol/mol)) in a global study. Factors associated with intensive glycemic management and using glucose-lowering medications associated with a high risk of hypoglycemia (high-risk medications (insulin, sulfonylureas, and meglitinides)) were also assessed.

Research design and methods

DISCOVER is a 3-year observational study program of 15 992 people with type 2 diabetes initiating second-line glucose-lowering therapy in 38 countries. Data were collected at baseline (initiation of second-line therapy) and at 6, 12, and 24 months. Factors associated with an inappropriately intensive treatment or using high-risk medications were assessed using a hierarchical regression model.

Results

Of the 3344 older patients with baseline HbA1cdata in our analytic cohort, 23.5% received inappropriate treatment intensification. Among those who had follow-up HbA1cdata, 55.2%, 54.2%, and 53.5% were inappropriately tightly controlled at 6, 12, and 24 months, respectively, with higher proportions in high-income than in middle-income countries. The proportion of patients receiving high-risk medications was higher in middle-income countries than in high-income countries. Gross national income (per US$5000 increment) was associated with increased odds of inappropriately intensive treatment but with decreased odds of receiving high-risk medications.

Conclusions

A large proportion of older DISCOVER patients received an inappropriately intensive glucose-lowering treatment across the 2 years of follow-up, with substantial regional variation. The use of high-risk medications in these patients is particularly concerning.
Amyloid-related protein changes associated with dementia differ according to severity of hypoglycemia
Authors: Moin Abu Saleh Md , Kahal Hassan , Al-Qaissi Ahmed , Kumar Nitya , Sathyapalan Thozhukat , Atkin Stephen L , Butler Alexandra E
Published: April 2021

Introduction

Hypoglycemia in type 2 diabetes (T2D) may increase risk for Alzheimer’s disease (AD), but no data on changes in AD-related proteins with differing degrees of hypoglycemia exist. We hypothesized that milder prolonged hypoglycemia would cause greater AD-related protein changes versus severe transient hypoglycemia.

Research design and methods

Two prospective case-control induced hypoglycemia studies were compared: study 1, hypoglycemic clamp to 2.8 mmol/L (50 mg/dL) for 1 hour in 17 subjects (T2D (n=10), controls (n=7)); study 2, hypoglycemic clamp to 2.0 mmol/L (36 mg/dL) undertaken transiently and reversed in 46 subjects (T2D (n=23), controls (n=23)). Blood sampling at baseline, hypoglycemia and 24-hour post-hypoglycemia, with proteomic analysis of amyloid-related proteins performed.

Results

In control subjects, the percentage change from baseline to hypoglycemia differed between study 1 and study 2 for 5 of 11 proteins in the AD-related panel: serum amyloid A1 (SAA1) (p=0.009), pappalysin (PAPPA) (p=0.002), apolipoprotein E2 (p=0.02), apolipoprotein E3 (p=0.03) and apolipoprotein E4 (p=0.02). In controls, the percentage change from baseline to 24 hours differed between studies for two proteins: SAA1 (p=0.003) and PAPPA (p=0.004); however, after Bonferroni correction only SAA1 and PAPPA remain significant. In T2D, there were no differential protein changes between the studies.

Conclusions

The differential changes in AD-related proteins were seen only in control subjects in response to iatrogenic induction of hypoglycemic insults of differing length and severity and may reflect a protective response that was absent in subjects with T2D. Milder prolonged hypoglycemia caused greater AD-related protein changes than severe acute hypoglycemia in control subjects.

Trial registration numbers

NCT02205996,NCT03102801.
Effect of specificity of health expenditure questions in the measurement of out-of-pocket health expenditure: evidence from field experimental study in Ghana
Authors: Agorinya Isaiah Awintuen , Ross Amanda , Flores Gabriela , TanTorres Edejer Tessa , Dalaba Maxwell Ayindenaba , Mensah Nathan Kumasenu , Le My Lan , Dessie Yadeta , Sumboh Jemima , Oduro Abraham Rexford , Akazili J , Tediosi Fabrizio
Published: May 2021

Background

The effect of number of health items on out-of-pockets (OOPs) has been identified as a source of bias in measuring OOPs. Evidence comes mostly from cross-sectional comparison of different survey instruments to collect data on OOPs. Very few studies have attempted to validate these questionnaires, or distinguish bias arising from the comprehensiveness of the OOPs list versus specificity of OOPs questions.

Objectives

This study aims to estimate biases arising from the specificity of OOPs questions by comparing provider and household’s information.

Methods

A generic questionnaire to collect data on household’s OOPs was developed following the nomenclature proposed in division 6 of the classification of household final consumption 2018. The four categories within such division are used to set the comprehensiveness of the OOPs list, the specificity within each category was tailored to the design of the nationally representative living standard survey in Ghana where a field experiment was conducted to test the validity of different versions. Households were randomised to 11, 44 or 56 health items. Using data from provider records as the gold standard, we compared the mean positive OOPs, and estimated the mean ratio and variability in the ratio of household expenditures to provider data for the individual households using the Bland-Altman method of assessing agreement.

Findings

We found evidence of a difference in the overall mean ratio in the specificity for OOPs in inpatient care and medications. Within each of these two categories, a more detailed disaggregation yielded lower OOPs estimates than less detailed ones. The level of agreement between household and provider OOPs also decreased with increasing specificity of health items.

Conclusion

Our findings suggest that, for inpatient care and medications, systematically decomposing OOPs categories into finer subclasses tend to produce lower OOPs estimates. Less detailed items produced more accurate and reliable OOPs estimates in the context of a rural setting.
Cast immobilisation in situ versus open reduction and internal fixation of displaced medial epicondyle fractures in children between 7 and 16 years old. A study protocol for a randomised controlled trial
Authors: Hämäläinen Tero , Ahonen Matti , Helenius Ilkka , Jalkanen Jenni , Lastikka Markus , Nietosvaara Yrjänä , Salonen Anne , Sinikumpu Juha-Jaakko , Grahn Petra
Published: May 2021

Introduction

Medial epicondyle fracture of the humerus is a common injury in childhood. There is uniform agreement that minimally displaced fractures (dislocation ≤2 mm) can be treated nonoperatively with immobilisation. Open fractures, fractures with joint incarceration or ulnar nerve dysfunction require surgery. There is no common consensus in treatment of closed medial epicondyle fractures with >2 mm dislocation without joint incarceration or ulnar nerve dysfunction. We hypothesise that there is no difference in treatment outcomes between nonoperative and operative treatment.

Methods and analysis

This is a multicentre, controlled, prospective, randomised noninferiority study comparing operative treatment to non-operative treatment of >2 mm dislocated paediatric medial epicondyle fractures without joint incarceration or ulnar nerve dysfunction. A total of 120 patients will be randomised in 1:1 ratio to either operative or nonoperative treatment. The study will have a parallel nonrandomised patient preference arm. Operative treatment will be open reduction and internal fixation. Nonoperative treatment will be upper limb immobilisation in long arm cast for 4 weeks. Data will be collected at baseline and at each follow-up up to 2 years. Quick-DASH is used as primary outcome measure. Secondary outcomes are patient-reported pain, differences in range of motion, Pediatric Quality of Life Inventory, cosmetic visual analogue scale and Mayo Elbow Performance Score.

Ethics and dissemination

Ethical approval has been obtained from Helsinki University Hospital (HUS) ethical board HUS/1443/2019. Each study centre has obtained their own permission for the study. A written authorisation from legal guardian will be acquired and the child will be informed about the trial. Results of the trial will be disseminated as published articles in peer-reviewed journals.

Trial registration

The trial has been registered at clinicaltrials.gov with registration numberNCT04531085.
Reducing Self-harm in Adolescents. An individual participant data meta-analysis (RISA-IPD): systematic review protocol
Authors: Wright-Hughes Alexandra , Walwyn Rebecca , Wright Judy M , Farrin Amanda , Fonagy Peter , Ougrin Dennis , Stahl Daniel , Cottrell David
Published: May 2021

Introduction

Up to 10% of adolescents report self-harm in the previous year. Non-fatal repetition is common (18% in 1 year), death from any cause shows a fourfold and suicide a 10-fold excess. Despite the scale of the problem, there is insufficient evidence for effective interventions for self-harm. Those who self-harm do so for a variety of different reasons. Different treatments may be more effective for subgroups of adolescents; however, little is known about which subgroups are appropriate for further study. This protocol outlines a systematic review and individual participant data meta-analysis (IPD-MA) to identify subgroups of adolescents for which therapeutic interventions for self-harm show some evidence of benefit.

Methods and analysis

A systematic literature search was conducted in August 2019 (including Cochrane Library, Embase, trial registers and other databases). An update search is planned. Study selection will identify randomised controlled trials examining interventions to reduce self-harm in adolescents who have self-harmed and presented to services. Identified research teams will be invited to contribute data and form a collaborative group. Two-stage IPD-MA will be used to evaluate effectiveness of different therapeutic interventions compared with any active or non-active control on repetition of self-harm, general psychopathology, depression, suicidal ideation, quality of life and death. Subgroup analyses will identify adolescent subgroups in whom different therapeutic interventions may be more effective. Meta-regression will explore moderating study and intervention effects. Sensitivity analyses will incorporate aggregate data from studies lacking IPD and test the robustness of results to methods for handling missing data, within-study clustering, non-adherence and study quality.

Ethics and dissemination

Ethical approval is provided by the University of Leeds, Faculty of Medicine and Health Ethics Committee (18-098). Outcomes will inform research recommendations and will be disseminated internationally through the collaborative group, a service user advisory group, open-access peer-reviewed publication and conference presentations.

PROSPERO registration number

CRD42019152119.