bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of maternal prepregnancy weight and early childhood weight with obesity in adolescence: A population‐based longitudinal cohort study in Japan
Authors: Yoshida Satomi , Kimura Takeshi , Noda Masahiro , Takeuchi Masato , Kawakami Koji
Published: January 2020

Background

The impact of birth weight and obesity in early childhood on obesity in adolescence remains unclear.

Objectives

To examine the association of overweight/obesity at age 15 years with birth weight, overweight/obesity in early childhood and overweight/obesity in mothers.

Methods

This population‐based retrospective cohort study used early childhood and school age health check‐up data of 1581 children in Japan, followed‐up until age 15 years. Generalized estimation equation analyses were used to investigate the association of overweight/obesity at age 15 years with low/high birth weight, overweight/obesity in 3 years of age and overweight/obesity in mothers. The cutoff points for all variables were defined by international criteria.

Results

Of 1581 mother‐child pairs, 130 (8.2%) children had low birth weight, while 93 (5.9%) and 167 (10.6%) were overweight/obese at age 3 and 15 years, respectively. Overweight/obesity at age 3 years and overweight/obesity in mothers were associated with overweight/obesity at age 15 years (adjusted odds ratio [aOR], 4.26; 95% confidence interval [CI]: 2.51–7.25 and (aOR, 2.46; 95% CI: 1.41–4.30). No association between low birth weight and overweight/obesity at age 15 years was observed.

Conclusions

Overweight/obesity in mothers and overweight/obesity at 3 years of age, but not birth weight, were associated with overweight/obesity at age 15 years.
The 2015 welfare reform of the National Basic Livelihood Security System in South Korea: Effects on economic outcomes
Authors: Nam Jaehyun , Park Hyungjohn
Published: January 2020

In July 2015, South Korea’s National Basic Livelihood Security System (NBLSS) was reformed for the purposes of eliminating welfare blind spots and reducing poverty. The reform is expected to affect the recipients’ economic behaviours and choices. In this study, we used changes in benefits and eligibility for the NBLSS under the customised benefit system to identify the effects of the change in the NBLSS on a proposed set of economic outcomes – income, labour supply, consumption, savings, poverty reduction. To estimate the effects, we used data from the 10th–12th waves of the Korea Welfare Panel Study and employed a difference‐in‐differences framework integrated with the propensity scores. We found that the NBLSS helps the poor to reduce financial and material hardships through income and consumption increments, but that it does not provide disincentives to the recipients from participating in the labour market or from saving.
Shrinkage Estimation Strategies in Generalised Ridge Regression Models: Low/High‐Dimension Regime
Authors: Yüzbaşı Bahadır , Arashi Mohammad , Ejaz Ahmed S.
Published: January 2020

In this study, we suggest pretest and shrinkage methods based on the generalised ridge regression estimation that is suitable for both multicollinear and high‐dimensional problems. We review and develop theoretical results for some of the shrinkage estimators. The relative performance of the shrinkage estimators to some penalty methods is compared and assessed by both simulation and real‐data analysis. We show that the suggested methods can be accounted as good competitors to regularisation techniques, by means of a mean squared error of estimation and prediction error. A thorough comparison of pretest and shrinkage estimators based on the maximum likelihood method to the penalty methods. In this paper, we extend the comparison outlined in his work using the least squares method for the generalised ridge regression.
Biotic interactions help explain variation in elevational range limits of birds among Bornean mountains
Authors: Burner Ryan C. , Boyce Andy J. , Bernasconi David , Styring Alison R. , Shakya Subir B. , Boer Chandradewana , Rahman Mustafa Abdul , Martin Thomas E. , Sheldon Frederick H.
Published: January 2020

Aim

Physiological tolerances and biotic interactions along habitat gradients are thought to influence species occurrence. Distributional differences caused by such forces are particularly noticeable on tropical mountains, where high species turnover along elevational gradients occurs over relatively short distances and elevational distributions of particular species can shift among mountains. Such shifts are interpreted as evidence of the importance of spatial variation in interspecific competition and habitat or climatic gradients. To assess the relative importance of competition and compression of habitat and climatic zones in setting range limits, we examined differences in elevational ranges of forest bird species among four Bornean mountains with distinct features.

Location

Bornean mountains Kinabalu, Mulu, Pueh and Topap Oso.

Taxon

Rain forest bird communities along elevational gradients.

Methods

We surveyed the elevational ranges of rain forest birds on four mountains in Borneo to test which environmental variables—habitat zone compression or presence of likely competitors—best predicted differences in elevational ranges of species among mountains. For this purpose, we used two complementary tests: a comparison of elevational range limits between pairs of mountains, and linear mixed models with naïve occupancy as the response variable.

Results

We found that lowland species occur higher in elevation on two small mountains compared to Mt. Mulu. This result is inconsistent with the expectation that distributions of habitats are elevationally compressed on small mountains, but is consistent with the hypothesis that a reduction in competition (likely diffuse) on short mountains, which largely lack montane specialist species, allows lowland species to occur higher in elevation. The relative influence of competition changes with elevation, and the correlation between lower range limits of montane species and the distribution of their competitors was weaker than in lowland species.

Main conclusions

These findings provide support for the importance of biotic interactions in setting elevational range limits of tropical bird species, although abiotic gradients explain the majority of distribution patterns. Thus, models predicting range shifts under climate change scenarios must include not only climatic variables, as is currently most common, but also information on potentially resulting changes in species interactions, especially for lowland species.
Follicular helper T cells recruit eosinophils into host liver by producing CXCL12 during Schistosoma japonicum infection
Authors: Chen Xiaojun , Xu Zhipeng , Wei Chuan , Yang XiaoWei , Xu Lei , Zhou Sha , Zhu Jifeng , Su Chuan
Published: January 2020

Schistosomiasis affects at least 200 million people in tropical and subtropical areas. The major pathology of schistosomiasis is egg‐induced liver granuloma characterized by an eosinophil‐rich inflammatory infiltration around the eggs, which subsequently leads to hepatic fibrosis and circulatory impairment in host. However, the mechanisms how eosinophils are recruited into the liver, which are crucial for the better understanding of the mechanisms underlying granuloma formation and control of schistosomiasis, remain unclear. In this study, we showed that follicular helper T (Tfh) cells participate in recruitment of eosinophils into liver partially by producing CXCL12 during schistosome infection. Our findings uncovered a previously unappreciated role of Tfh cells in promotion of the development of liver granuloma in schistosomiasis, making Tfh‐CXCL12‐eosinophil axis a potential target for intervention of schistosomiasis.
Impact of risk factor control interventions for smoking cessation and promotion of healthy lifestyles in patients with periodontitis: A systematic review
Authors: Ramseier Christoph A. , Woelber Johan P. , Kitzmann Julia , Detzen Laurent , Carra Maria Clotilde , Bouchard Philippe
Published: January 2020

Aim

The aim of this systematic review was to identify the most recent widely accepted guidelines for risk factor control interventions and to assess their impact in patients with periodontitis.

Materials and methods

The electronic search strategy included a first systematic search to identify guidelines for interventions for smoking cessation, diabetes control, physical exercise (activity), change of diet, carbohydrate (dietary sugar) reduction and weight loss in the general population and a second systematic search to identify the studies evaluating these interventions in periodontitis patients.

Results

A total of 13 guidelines and 25 studies were selected. Most guidelines included recommendations for all healthcare providers to provide interventions and follow‐up counselling with the risk factors considered in the present review. In patients with periodontitis, interventions for smoking cessation and diabetes control were shown to improve periodontal health while the impact of dietary interventions and the promotion of other healthy lifestyles were moderate or limited.

Conclusions

While aiming to improve treatment outcomes and the maintenance of periodontal health, current evidence suggests that interventions for smoking cessation and diabetes control are effective, thus emphasizing the need of behavioural support in periodontal care.
Sex differences in brain oscillatory activity during sleep and wakefulness in obstructive sleep apnea
Authors: Muñoz‐Torres Zeidy , Jiménez‐Correa Ulises , Montes‐Rodríguez Corinne J.
Published: January 2020

Epidemiological studies consistently show a male predominance in obstructive sleep apnea (OSA). Hormonal differences, breathing control, upper airway anatomy and fat distribution have been proposed as causes of gender differences in OSA. Clinical manifestations are accentuated in men, although white matter structural integrity is affected in women. To the best of our knowledge, no previous studies have explored gender differences in the electrical brain activity features of OSA. Polysomnography was performed on 43 patients with untreated OSA (21 women, 22 men), and power spectral density (1–50 Hz) was compared between groups across sleep and wakefulness at two levels of OSA severity. Severe versus moderate OSA showed decreased power for fast frequencies (25–29 Hz) during wakefulness. OSA men displayed decreased power of a large frequency range (sigma, beta and gamma) during sleep compared with women. Comparisons of men with severe versus moderate OSA presented significantly decreased sigma power during non‐rapid eye movement (NREM) sleep, but significantly increased delta activity during REM sleep. Meanwhile, women with severe versus moderate OSA showed no significant power differences in any condition. These findings indicated a different evolution of brain oscillations between OSA men and women with significant impairment of brain activity related to cognitive processes. Our study emphasizes the importance of understanding the differential effects of sleep disorders on men and women in order to develop more precise diagnostic criteria according to gender, including quantitative electroencephalogram (EEG) analysis tools.
Critically reflective practice and its sources: A qualitative exploration
Authors: Ng Stella L. , Mylopoulos Maria , Kangasjarvi Emilia , Boyd Victoria A. , Teles Sabrina , Orsino Angela , Lingard Lorelei , Phelan Shanon
Published: January 2020

Context

Critical reflection may improve health professionals’ performance of the social roles of care (eg collaboration) in indeterminate zones of practice that are ambiguous, unique, unstable or value‐conflicted. Research must explore critical reflection in practice and how it is developed. In this study, we explored what critical reflection consisted of in a context known for indeterminacy, and to what sources participants attributed their critically reflective insights and approaches.

Methods

The study context was the interface between health care and education for children with chronic conditions or disabilities necessitating health‐related recommendations and supports (eg accommodations or equipment) at school. We conducted a secondary analysis of 42 interview transcripts from an institutional ethnographic study involving health professionals, school‐based educators and parents of children with chronic conditions or disabilities. We coded all transcripts for instances of critical reflection, moments that seemed to lack but could benefit from critical reflection, and participant‐attributed sources of critically reflective insights.

Results

Critically reflective practice involved getting to know the other, valuing and leveraging different forms and sources of knowledge, identifying and communicating workarounds (ie strategies to circumvent imperfect systems), seeing inequities, and advocating as collaborators, not adversaries. Participants invariably attributed critically reflective insights to personal experiences such as former careers or close personal relationships.

Conclusions

This study shows that personal experiences and connections inspire critically reflective views, and that being critically reflective is not a binary trait possessed (or not) by individuals. It is learnable through personally meaningful experiences. Health professions education could aim to preserve philosophical space for personal experience as a source of learning and integrate evidence‐informed approaches to foster critically reflective practice.
Cell envelope defects of different capsule‐null mutants in K1 hypervirulentKlebsiella pneumoniaecan affect bacterial pathogenesis
Authors: Tan Yi Han , Chen Yahua , Chu Wilson H. W. , Sham Lok‐To , Gan Yunn‐Hwen
Published: January 2020

HypervirulentKlebsiella pneumoniae(hvKP) causesKlebsiella‐induced liver abscess. Capsule is important for the pathogenesis ofKlebsiellain systemic infection, but its role in gut colonisation is not well understood. By generating ΔwcaJ, Δwzaand Δwzycapsule‐null mutants in a prototypical K1 hypervirulent isolate, we show that inactivation ofwza(capsule exportase) andwzy(capsule polymerase) confer cell envelope defects in addition to capsule loss, making them susceptible to bile salts and detergent stress. Bile salt resistance is restored when the initial glycosyltransferasewcaJwas inactivated together withwzy, indicating that build‐up of capsule intermediates contribute to cell envelope defects. Mouse gut colonisation competition assays show that the capsule and its regulator RmpA were not required for hvKP to persist in the gut, although initial colonisation was decreased in the mutants. Both ΔrmpAand ΔwcaJmutants gradually outcompeted the wild type in the gut, whereas Δwzaand Δwzymutants were less fit than wild type. Together, our results advise caution in using the right capsule‐null mutant for determination of capsule's role in bacterial pathogenesis. With the use of ΔwcaJmutant, we found that although the capsule is important for bacterial survival outside the gut environment, it imposes a fitness cost in the gut.
Behavioural response of the house mosquitoes Culex quinquefasciatus and Culex pipiens molestus to avian odours and its reliance on carbon dioxide
Authors: Spanoudis C. G. , Andreadis S. S. , Bray D. P. , Savopoulou‐Soultani M. , Ignell R.
Published: January 2020

How Culex (Diptera: Culicidae) mosquitoes select and discriminate between potential avian hosts is critical for understanding the epidemiology of West Nile virus. Therefore, the present authors studied the behavioural responses of Culex quinquefasciatus (Say) and Culex pipiens molestus (Forsskål) to headspace volatiles of three avian species [chicken and pigeon (sexes analysed separately), and magpie], presented either alone or in combination with 600 p.p.m. carbon dioxide (CO2). The attraction of Cx. quinquefasciatus to the headspace volatiles of both sexes of chicken, and of female pigeon, in combination with CO2 was significantly higher than that achieved by the CO2 and solvent control. Although Cx. p. molestus was attracted to headspace volatiles of chickens and magpies, it was repelled by those of female pigeons when combined with CO2. An increased effect between the avian volatiles and CO2 was observed for Cx. quinquefasciatus, whereas the addition of CO2 had no effect on the attraction of Cx. p. molestus females. The results of this study demonstrate that Cx. quinquefasciatus and Cx. p. molestus are attracted to the odour of potential avian hosts. Future studies aimed at identifying the bioactive volatile compounds in the headspace of chickens may contribute to the potential development of effective surveillance and control tools against Culex species.
Moral perception
Authors: Werner Preston J.
Published: January 2020

Moral perceptualism is the theory that perception and perceptual experience is attuned to moral features in our environment. This idea has received renewed attention in the last 15–20 years, for its potential to do theoretical work in moral epistemology and moral psychology. In this paper, I review the main motivations and arguments for moral perceptualism, the variety of theories that go under the heading of “moral perception,” and the three biggest challenges to moral perception.

https://youtu.be/9cC_1ZYKq80
Canine fertility: The consequences of selection for special traits
Authors: Marelli Stefano P. , Beccaglia Michela , Bagnato Alessandro , Strillacci Maria G.
Published: January 2020

Pedigree dogs and cats are bred aiming to conform breed standards with very poor consideration for breeding stock fertility. At the same time, the genetic asset underlining reproductive traits could be effectively analysed like in other species under selection. The definition of selection targets is very important in breeding protocols determination. The aim of the present work is to present an overview of the different correlations between reproduction and genetics, starting from selection procedure and inbreeding coefficient moving to genomic and the application of SNPs and GWAS on population study and identification of genes involved in phenotypical variation of reproductive traits in dogs. Particular relevance has been given to the concept of inbreeding which effects on canine reproduction have been presented. The use of genomic information in inbreeding coefficient calculation can be considered an improved effective procedure in the evaluation of the genetic variability loss in canine population and its negative effects on reproductive traits.
An experimental study of the feasibility of phase‐based video magnification for damage detection and localisation in operational deflection shapes
Authors: Civera M. , Zanotti Fragonara L. , Surace C.
Published: January 2020

Optical measurements from high‐speed, high‐definition video recordings can be used to define the full‐field dynamics of a structure. By comparing the dynamic responses resulting from both damaged and undamaged elements, structural health monitoring can be carried out, similarly as with mounted transducers. Unlike the physical sensors, which provide point‐wise measurements and a limited number of output channels, high‐quality video recording allows very spatially dense information. Moreover, video acquisition is a noncontact technique. This guarantees that any anomaly in the dynamic behaviour can be more easily correlated to damage and not to added mass or stiffness due to the installed sensors.

However, in real‐life scenarios, the vibrations due to environmental input are often so small that they are indistinguishable from measurement noise if conventional image‐based techniques are applied. In order to improve the signal‐to‐noise ratio in low‐amplitude measurements, phase‐based motion magnification has been recently proposed.

This study intends to show that model‐based structural health monitoring can be performed on modal data and time histories processed with phase‐based motion magnification, whereas unamplified vibrations would be too small for being successfully exploited. All the experiments were performed on a multidamaged box beam with different damage sizes and angles.
Evaluating the Outcomes of a Web‐Based Stress Management Program for Nurses and Nursing Assistants
Authors: Dutton Suzanne , Kozachik Sharon L.
Published: January 2020

Objective

The purpose of this quality improvement project was to determine the utilization, satisfaction, and effect of a web‐based stress management program for nurses and nursing assistants (NAs).

Methods

This quality improvement project provided BREATHE, a web‐based stress management program that consisted of six modules that describe, identify, and help nurses manage stress for 31 nurses and NAs working on a subacute rehabilitation unit at a mid‐Atlantic community hospital.

Measurements

The number of login attempts and time spent on the program were included, as were the nurse stress scale (NSS), a 34‐item validated instrument that captures seven dimensions of stress, and a seven‐item satisfaction survey given at the end of the modules.

Results

Nurses utilized and were satisfied with the evidence‐based program BREATHE and reported significant improvement in NSS scores.

Linking Evidence to Action

Findings suggest that BREATHE was effective at reducing the NSS score among nurses and NAs. The web‐based nature of the program allowed nurses to engage in it at times most convenient for them, which added to the program’s acceptability and overall satisfaction.
Topology Optimization With Many Right-Hand Sides Using Mirror Descent Stochastic Approximation—Reduction From Many to a Single Sample
Authors: Zhang Xiaojia Shelly , de Sturler Eric , Shapiro Alexander
Published: January 2020

Practical engineering designs typically involve many load cases. For topology optimization with many deterministic load cases, a large number of linear systems of equations must be solved at each optimization step, leading to an enormous computational cost. To address this challenge, we propose a mirror descent stochastic approximation (MD-SA) framework with various step size strategies to solve topology optimization problems with many load cases. We reformulate the deterministic objective function and gradient into stochastic ones through randomization, derive the MD-SA update, and develop algorithmic strategies. The proposed MD-SA algorithm requires only low accuracy in the stochastic gradient and thus uses only a single sample per optimization step (i.e., the sample size is always one). As a result, we reduce the number of linear systems to solve per step from hundreds to one, which drastically reduces the total computational cost, while maintaining a similar design quality. For example, for one of the design problems, the total number of linear systems to solve and wall clock time are reduced by factors of 223 and 22, respectively.
Oscillating Wave Surge Converter-Type Attachment for Extracting Wave Energy While Reducing Hydroelastic Responses of Very Large Floating Structures
Authors: Nguyen H. P. , Wang C. M.
Published: January 2020

This paper presents an oscillating wave surge converter (OWSC)-type attachment, comprising a submerged vertical flap connected to the fore edge of a very large floating structure (VLFS) with hinges and linear power take-off (PTO) systems, for extracting wave energy while reducing hydroelastic responses of VLFS. In terms of reductions in hydroelastic responses of VLFS, the OWSC-type attachment is better than the recently proposed raft wave energy converter (WEC)-type attachment for relatively short waves (T < 7 s) and better than the conventional anti-motion device comprising a submerged vertical flap rigidly connected to the fore edge of VLFS for all wave periods. Importantly, the horizontal wave force acting on the submerged flap for the OWSC-type attachment is smaller than that for the conventional anti-motion device, leading to a more economical mooring system. In terms of wave energy extraction, the OWSC-type attachment is better than the raft WEC-type attachment for intermediate and long waves (T ≥ 7 s). In addition, for maximizing power production, the required flap length for the OWSC-type attachment is much smaller than the required pontoon length for the raft WEC-type attachment (about λ/10 as compared to about λ/3, where λ is the incident wavelength).
New Simplified Dynamic Modeling Method of Bolted Flange Joints of Launch Vehicle
Authors: Li Gang , Nie Zhaokun , Zeng Yan , Pan Jiacheng , Guan Zhenqun
Published: January 2020

The bolted flange joint is an important source of nonlinearity in dynamical analysis of launch vehicles, which will lead to both longitudinal and transversal responses simultaneously subject to transversal dynamic loads, and may result in the failure of the connection structure. In this paper, a novel simplified dynamic modeling method via structural static analysis is proposed to simulate dynamical response of nonlinear bolted flange joints of launch vehicle, in which only static analysis of the detailed finite element model or static experiment is used for parameter identification of the model. Two types of nonlinear springs are designed for different tensile and compressive stiffness of the bolted flange joint, which affect longitudinal dynamic behaviour of the connection, and a shear spring is used to modify the transversal stiffness. The sections of launch vehicle are modeled as linear beams for efficiency. Effectiveness of the proposed modeling method is confirmed by a typical connection structure, bolted flange connected cylindrical shells, whose finite element models are verified with dynamic experiments. Superiority of the simplified dynamic model from the proposed method is demonstrated by comparing with the previous simplified model. The connection structures with different numbers of bolts are studied, and most of the dynamic responses calculated from the proposed model agree well with those from the finite element model. The coupling vibration of the connection structure is predicted successfully, in which longitudinal response of the structure is excited by the transversal load.
Complete Genome Sequence of Rhodococcus ruber R1, a Novel Strain Showing a Broad Catabolic Potential toward Lignin-Derived Aromatics
Authors: Farkas Carlos , Donoso Raúl A. , Melis-Arcos Felipe , Gárate-Castro Carla , Pérez-Pantoja Danilo
Published: January 2020

Rhodococcus ruber
R1 was isolated from a pulp mill wastewater treatment plant because of its ability to use methoxylated aromatics as growth substrates. We report the 5.56-Mb genome sequence of strain R1, which can provide insights into the biodegradation of lignin-derived phenolic monomers and potentially support processes for lignocellulose conversion.
Draft Genome Sequence of
Bacillus
sp. Strain HY001, a High Producer of Isoprene, Isolated from Natto
Authors: Wang Jing , Yan Ming , Li Cheng
Published: January 2020

We report the draft genome sequence and annotation of
Bacillus
sp. strain HY001, a high producer of isoprene, isolated from natto. The total 446 contigs have 5,892,114 base pairs containing 6,429 genes and a G+C content of 35.39%.
Traumatic benign paroxysmal positional vertigo caused by cannon fire
Authors: Kauffman Ryan Dale
Published: January 2020

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vestibular vertigo. BPPV is characterised by brief episodes of vertigo that occur with movement of the head. Almost a quarter of cases of BPPV have a traumatic cause, but no cases of traumatic BPPV due to indirect trauma were found in the English literature. A 37-year-old woman presented for episodic vertigo that occurred with position change, which started after she was exposed to cannon fire. She had a positive hallpike which confirms the diagnosis of BPPV. Her BPPV was successfully treated using the Epley manoeuvre. The diagnosis of BPPV is made from a careful history and physical exam. Traumatic BPPV can occur with indirect trauma such as being downrange during cannon fire. The treatment of both idiopathic BPPV and traumatic BPPV is with canalith repositioning procedures.
Association of unhealthy dietary behaviors with renal function decline in patients with diabetes
Authors: Lin Cheng-Wei , Chen I-Wen , Lin Ying-Tzu , Chen Hsin-Yun , Hung Shih-Yuan
Published: January 2020

Objective

Balanced nutrition is important for patients with diabetes, and nutrition might well influence diabetes-related complications, although there is limited evidence for this supposition at present. Consequently, we investigate the association between dietary behaviors and renal function decline among patients with diabetes.

Research design and methods

From 2011 to 2013, a total of 2797 patients with type 2 diabetes participated in the Diabetes Shared Care Program at Chang Gung Memorial Hospital. All received nutritional consulting by dieticians and an eight-item list of unhealthy dietary behaviors, which included the excessive intake of carbohydrates, fats, protein, fruit, pickled foods, dessert and alcohol, as well as inadequate dietary vegetable. Estimated glomerular filtration rate (eGFR) decline ≥40% was defined as a surrogate end point for kidney damage. Independent dietary risk factors predicting poor renal outcomes were assessed.

Results

Stable mean glycated hemoglobin (A1c) (7.78% to 7.75%, p=0.151), improved cholesterol (174.04 to 170.13 mg/dL, p<0.001) and low-density lipoprotein (104.19 to 98.07 mg/dL, p<0.001) were found in patients throughout 2 years of therapy. However, significant eGFR decline was noted (94.20 to 88.08 mL/min/1.73 m2, p<0.001). A total of 125 subjects had eGFR decline ≥40% and 2672 had stable renal progression.

In regression analysis, 625 stable renal patients (selected via propensity score matching) and 125 subjects with eGFR decline ≥40% demonstrated excessive pickled foods to be predictive of poor renal outcomes (OR 1.861, 95% CI 1.230 to 2.814, p=0.003).

Conclusions

Our study suggests that excessive pickled foods deteriorate renal function more than other unhealthy dietary behaviors in patients with diabetes.
Prognostic value of a combination of innovative factors (gut microbiota, sarcopenia, obesity, metabolic syndrome) to predict surgical/oncologic outcomes following surgery for sporadic colorectal cancer: a prospective cohort study protocol (METABIOTE)
Authors: Veziant Julie , Poirot Karine , Chevarin Caroline , Cassagnes Lucie , Sauvanet Pierre , Chassaing Benoit , Robin Frederic , Godfraind Catherine , Barnich Nicolas , Pezet Denis , Pereira Bruno , Gagniere Johan , Bonnet Mathilde
Published: January 2020

Introduction

Colorectal cancer (CRC) is still associated with poor prognosis, especially in patients with advanced disease. Development of new prognostic tools replacing or supplementing those routinely used is definitely needed, with the aim to optimise and personalise treatment strategies. Gut microbiota composition and body composition profile (obesity, sarcopenia and metabolic syndrome) have recently been reported separately as new relevant prognostic factors for postoperative surgical and oncologic outcomes following CRC surgery. However interactions that exist between these factors have been poorly studied. The purpose of this translational prospective cohort study (METABIOTE) is to investigate potential interactions between gut microbiota, body composition profile and postoperative outcomes and recurrence in patients undergoing surgery for non-metastatic sporadic CRC.

Methods and analysis

This single-centre project aims to prospectively enrol 300 consecutive patients undergoing surgery for non-metastatic sporadic CRC at the University Hospital of Clermont-Ferrand, France for the identification of specific microbial signatures (from tumour, colonic mucosa and stools samples) associated with particular metabolic profiles that could impact postoperative morbidity and oncologic outcomes, using microbiological, molecular and imaging approaches. The primary outcome is the 5-year overall survival (OS). Other outcomes are 5-year CRC-related OS, 5-year disease-free survival, 30-day postoperative morbidity, 90-day postoperative mortality and length of hospital stay.

Ethics and dissemination

This study protocol was reviewed and approved by an independent French regional review board (n°2018-A00352-53, ‘Comité de Protection des Personnes Ile de France VII’ on 4 July 2018, declared to the competent French authority (‘Agence Nationale de Sécurité du Médicament et des produits de santé’, France), and registered on the Clinical Trials web-based platform (NCT 03843905). Oral and written informed consent will be obtained from each included patient. Study results will be reported to the scientific community at conferences and in peer-reviewed scientific journals.

Trial registration number

NCT03843905.

.
Rationale and design for studying organisation of care for intra-arterial thrombectomy in the Netherlands: simulation modelling study
Authors: Lahr Maarten M H , Maas Willemijn J , van der Zee Durk-Jouke , Uyttenboogaart Maarten , Buskens Erik
Published: January 2020

Introduction

The introduction of intra-arterial thrombectomy (IAT) challenges acute stroke care organisations to provide fast access to acute stroke therapies. Parameters of pathway performance include distances to primary and comprehensive stroke centres (CSCs), time to treatment and availability of ambulance services. Further expansion of IAT centres may increase treatment rates yet could affect efficient use of resources and quality of care due to lower treatment volume. The aim was to study the organisation of care and patient logistics of IAT for patients with ischaemic stroke in the Netherlands.

Methods and analyses

Using a simulation modelling approach, we will quantify performance of 16 primary and CSCs offering IAT in the Netherlands. Patient data concerning both prehospital and intrahospital pathway logistics will be collected and used as input for model validation. A previously validated simulation model for intravenous thrombolysis (IVT) patients will be expanded with data of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry and trials performed in the Collaboration for New Treatments in Acute Stroke consortium to represent patient logistics, time delays and outcomes in IAT patients. Simulation experiments aim to assess effectiveness and efficiency of alternative network topologies, that is, IAT with or without IVT at the nearest primary stroke centre (PSC) versus centralised care at a CSC. Primary outcomes are IAT treatment rates and clinical outcome according to the modified Rankin Scale. Secondary outcomes include onset-to-treatment time and resource use. Mann-Whitney U and Fisher’s exact tests will be used to estimate differences for continuous and categorical variables. Model and parameter uncertainty will be tested using sensitivity analyses.

Ethics and dissemination

This will be the first study to examine the organisation of acute stroke care for IAT delivery on a national scale using discrete event simulation. There are no ethics or safety concerns regarding the dissemination of information, which includes publication in peer-reviewed journals and (inter)national conference presentations.

Trial registration number

ISRCTN99503308,ISRCTN76741621,ISRCTN19922220,ISRCTN80619088,NCT03608423; Pre-results.
Embedding best transfusion practice and blood management in neonatal intensive care
Authors: Flores Cindy J , Lakkundi Anil , McIntosh Joanne , Freeman Peter , Thomson Amanda , Saxon Ben , Parsons Justine , Spigiel Tracey , Milton Sarah , Ross Bryony
Published: January 2020

Background

Transfusion is a common procedure for neonates receiving intensive care management. Recognising a paucity of patient blood management (PBM) programmes in neonates, we aimed to embed blood management and best transfusion principles in the neonatal intensive care unit (NICU) by aligning local policies, providing targeted education and partnering with parents.

Methods

Practice-based evidence for clinical practice improvement (PBE-CPI) methodology was used. Previous hospital accreditation audits were reviewed and a neonate-specific transfusion audit was developed. Audit was performed at baseline and repeated following the intervention period. NICU clinicians received targeted education in obtaining informed consent, prescription and safe administration of blood components during a ‘Blood Month’ awareness period. A neonate-specific parent handout about transfusion was developed in partnership with parents. A pilot video demonstrating a shared consent discussion was also developed to assist in the consent process. Parents’ knowledge, concerns and feedback regarding transfusion practice was sought at baseline (survey) and on project completion (experience trackers).

Results

Neonate-specific baseline transfusion audit showed inconsistent consent, monitoring and documentation processes in neonatal transfusions. Post-targeted education audit showed improvement in these parameters. The targeted PBM and transfusion-related education delivered during ‘Blood Month’ was well-received by staff. Parents’ feedback about the NICU transfusion consenting process was consistently positive. NICU medical and nursing clinicians (n=25) surveyed agreed that the parent handout was well set out, easy to understand and recommended that it be used to complement practice.

Conclusion

PBE-CPI tools aligned with Australian PBM guidelines for clinicians and parents were well-accepted by clinical stakeholders and were associated with practice improvement in PBM awareness and transfusion consent processes. This PBE-CPI project developed NICU-specific consent information, not previously available, by partnering with parents to ensure quality of care in transfusion practice. Adoption of this also helps to meet accreditation for Australian Blood Management Standards. These strategies and tools translate readily into other NICUs to embed and support best PBM and transfusion practice.
Discrete event simulation modelling to evaluate the impact of a quality improvement initiative on patient flow in a paediatric emergency department
Authors: McKinley Kenneth W , Babineau John , Roskind Cindy G , Sonnett Meridith , Doan Quynh
Published: January 2020

Objective

We developed a discrete event simulation model to evaluate the impact on system flow of a quality improvement (QI) initiative that included a time-specific protocol to decrease the time to antibiotic delivery for children with cancer and central venous catheters who present to a paediatric ED with fever.

Methods

The model was based on prospective observations and retrospective review of ED processes during the maintenance phase of the QI initiative between January 2016 and June 2017 in a large, urban, academic children’s hospital in New York City, USA. We compared waiting time for full evaluation (WT) and length of stay (LOS) between a model with and a model without the protocol. We then gradually increased the proportion of patients receiving the protocol in the model and recorded changes in WT and LOS.

Results

We validated model outputs against administrative data from 2016, with no statistically significant differences in average WT or LOS for any emergency severity index (ESI). There were no statistically significant differences in these flow metrics between the model with and the model without the protocol. By increasing the proportion of total patients receiving this protocol, from 0.2% to 1.3%, the WT increased by 2.8 min (95% CI: 0.6 to 5.0) and 7.6 min (95% CI: 2.0 to 13.2) for ESI 2 and ESI 3 patients, respectively. This represents a 14.0% increase in WT for ESI 3 patients.

Conclusions

Simulation modelling facilitated the testing of system effects for a time-specific protocol implemented in a large, urban, academic paediatric ED, showing no significant impact on patient flow. The model suggests system resilience, demonstrating no detrimental effect on WT until there is a 7-fold increase in the proportion of patients receiving the protocol.
Physical multimorbidity patterns and depressive symptoms: a nationwide cross-sectional study in Japan
Authors: Aoki Takuya , Yamamoto Yosuke , Shimizu Sayaka , Fukuhara Shunichi
Published: January 2020

Objective

The associations of physical multimorbidity with depressive symptoms have been investigated in a number of studies. However, whether patterns of chronic physical conditions have comparatively different associations with depressive symptoms remains unclear. This study aimed to investigate the associations of physical multimorbidity patterns with depressive symptoms.

Design

This study was designed as a nationwide cross-sectional survey in Japan.

Setting

General sample of the Japanese population.

Participants

Adult Japanese residents were selected by a quota sampling method. Data were analysed from 1788 residents who reported one or more chronic health conditions.

Results

Among four physical multimorbidity patterns: cardiovascular-renal-metabolic (CRM), skeletal-articular-digestive (SAD), respiratory-dermal (RDE) and malignant-digestive-urologic (MDU), multivariable logistic regression analyses revealed that the RDE pattern showed the strongest association with depressive symptoms (aOR=1.68, 95% CI: 1.21 to 2.31 for the pattern score highest quartile, compared with the lowest quartile), followed by SAD and MDU patterns (aOR=1.41, 95% CI: 1.01 to 1.98 for the SAD pattern score highest quartile; 1.41, 95% CI: 1.01 to 1.96 for the MDU pattern score highest quartile, compared with the lowest quartile). In contrast, the CRM pattern score was not significantly associated with depressive symptoms (aOR=1.31, 95% CI: 0.90 to 1.89 for the pattern score highest quartile, compared with the lowest quartile).

Conclusions

Physical multimorbidity patterns have different associations with depressive symptoms. Among these patterns, patients with the RDE pattern may be at a higher risk for developing depressive symptoms. This study reinforces the evidence that cluster pattern of chronic health conditions is a useful measure for clinical management of multimorbidity as it is differently associated with mental health status, which is one of the crucial outcomes for multimorbid patients.
Burden of injuries in Nepal, 1990–2017: findings from the Global Burden of Disease Study 2017
Authors: Pant Puspa Raj , Banstola Amrit , Bhatta Santosh , Mytton Julie A , Acharya Dilaram , Bhattarai Suraj , Bisignano Catherine , Castle Chris D , Prasad Dhungana Govinda , Dingels Zachary V , Fox Jack T , Kumar Hamal Pawan , Liu Zichen , Bahadur Mahotra Narayan , Paudel Deepak , Narayan Pokhrel Khem , Lal Ranabhat Chhabi , Roberts Nicholas L S , Sylte Dillon O , James Spencer L
Published: January 2020

Background

Nepal is a low-income country undergoing rapid political, economic and social development. To date, there has been little evidence published on the burden of injuries during this period of transition.

Methods

The Global Burden of Disease Study (GBD) is a comprehensive measurement of population health outcomes in terms of morbidity and mortality. We analysed the GBD 2017 estimates for deaths, years of life lost, years lived with disability, incidence and disability-adjusted life years (DALYs) from injuries to ascertain the burden of injuries in Nepal from 1990 to 2017.

Results

There were 16 831 (95% uncertainty interval 13 323 to 20 579) deaths caused by injuries (9.21% of all-cause deaths (7.45% to 11.25%)) in 2017 while the proportion of deaths from injuries was 6.31% in 1990. Overall, the injury-specific age-standardised mortality rate declined from 88.91 (71.54 to 105.31) per 100 000 in 1990 to 70.25 (56.75 to 85.11) per 100 000 in 2017. In 2017, 4.11% (2.47% to 6.10%) of all deaths in Nepal were attributed to transport injuries, 3.54% (2.86% to 4.08%) were attributed to unintentional injuries and 1.55% (1.16% to 1.85%) were attributed to self-harm and interpersonal violence. From 1990 to 2017, road injuries, falls and self-harm all rose in rank for all causes of death.

Conclusions

The increase in injury-related deaths and DALYs in Nepal between 1990 and 2017 indicates the need for further research and prevention interventions. Injuries remain an important public health burden in Nepal with the magnitude and trend of burden varying over time by cause-specific, sex and age group. Findings from this study may be used by the federal, provincial and local governments in Nepal to prioritise injury prevention as a public health agenda and as evidence for country-specific interventions.
Long-term functional outcome following minimally invasive endoscopic intracerebral hemorrhage evacuation
Authors: Kellner Christopher P , Song Rui , Pan Jonathan , Nistal Dominic A , Scaggiante Jacopo , Chartrain Alexander G , Rumsey Jamie , Hom Danny , Dangayach Neha , Swarup Rupendra , Tuhrim Stanley , Ghatan Saadi , Bederson Joshua B , Mocco J
Published: January 2020

Background and purpose

Preclinical studies suggest that clot removal may mitigate primary and secondary brain injury following intracerebral hemorrhage (ICH). Although the MISTIE trial did not demonstrate an overall outcome benefit, it did demonstrate outcome benefit from effective reduction of clot burden. Minimally invasive endoscopic ICH evacuation may provide an alternative option for clot evacuation.

Methods

Patients presenting to a single healthcare system from December 2015 to October 2018 with supratentorial spontaneous ICH were evaluated for minimally invasive endoscopic evacuation. Inclusion and exclusion criteria were prospectively established by a multidisciplinary group in the healthcare system. The prespecified primary analysis was the proportion of patients with modified Rankin Score (mRS) 0–3 at 6 months.

Results

One hundred patients met the inclusion and exclusion criteria and underwent minimally invasive endoscopic ICH evacuation. The mean (SD) hematoma size was 49.7 (30.6) mL, the mean (SD) evacuation percentage was 88.2 (20.3)%, and 86% of patients had postoperative residual hematoma ≤15 mL. At 6 months the proportion of patients with an mRS of 0–3 was 46%.

Conclusions

This study suggests that minimally invasive endoscopic ICH evacuation may produce favorable long-term functional outcomes. Further evaluation of this technique in a randomized clinical trial is necessary.
Distal radial access in the anatomical snuffbox for neurointerventions: a feasibility, safety, and proof-of-concept study
Authors: Kühn Anna Luisa , de Macedo Rodrigues Katyucia , Singh Jasmeet , Massari Francesco , Puri Ajit S
Published: January 2020

Purpose

To report the first use of distal radial artery (dRA) access for a variety of neurointerventions and to demonstrate the safety and feasibility of this approach.

Methods

A retrospective review of our prospective neurointerventional database of endovascular interventions was conducted and, between May and October 2019, all patients in whom the intervention was performed via dRA in the anatomical snuffbox were identified. Patient demographics, clinical information, procedural and radiographic data were collected.

Results

48 patients with a mean age of 64.4 years (range 35–84 years) were included. 27 patients were female. dRA access was achieved in all cases. Conversion to femoral access was required in five cases (10.4%) due to tortuous vessel anatomy and limited support of the catheters in the aortic arch. Interventions performed included aneurysm treatment (with flow diverters, Woven EndoBridge device placement, coiling or stent-assisted coiling), arteriovenous malformation and dural arteriovenous fistula embolization, carotid artery stentings, stroke thrombectomy, thrombolysis for central retinal artery occlusion, intracranial stenting, middle meningeal artery embolization, vasospasm treatment, and spinal angiography with embolization. Radial artery vasospasm was seen in two cases and successfully treated with antispasmolytic medication. No symptomatic radial artery occlusion or ischemic event was observed.

Conclusion

dRA access is safe and effective for a variety of neurointerventions. Our preliminary experience with this approach is very promising and shows high patient satisfaction.