bluuebunny/crossref_metadata_2025 huggingface dataset:
Potentially preventable hospitalizations—The ‘pre‐hospital syndrome’: Retrospective observations from the MonashWatch self‐reported health journey study in Victoria, Australia
Authors: Martin Carmel , Hinkley Narelle , Stockman Keith , Campbell Donald
Published: August 2020

Rationale, Aims, and Objectives

HealthLinks: Chronic Care is a state‐wide public hospital initiative designed to improve care for cohorts at‐risk of potentially preventable hospitalizations at no extra cost. MonashWatch (MW) is an hospital outreach service designed to optimize admissions in an at‐risk cohort. Telehealth operators make regular phone calls (≥weekly) using the Patient Journey Record System (PaJR). PaJR generates flags based on patient self‐report, alerting to a risk of admission or emergency department attendance. ‘Total flags’ of global health represent concerns about self‐reported general health, medication, and wellness. ‘Red flags’ represent significant disease/symptoms concerns, likely to lead to hospitalization.

Methods

A time series analysis of PaJR phone calls to MW patients with ≥1 acute non‐surgical admissions in a 20‐day time window (10 days pre‐admission and 10 days post‐discharge) between 23 December 2016 and 11 October 2017. Pettitt's hypothesis‐testing homogeneity measure was deployed to analyse Victorian Admitted Episode/Emergency Minimum Datasets and PaJR data.

Findings

A MW cohort of 103 patients (mean age 74 ± 15 years; with 59% males) had 263 admissions was identified. Bed days ranged from <1 to 37.3 (mean 5.8 ± 5.8; median 4.1). The MW cohort had 7.6 calls on average in the 20‐day pre‐ and post‐hospital period. Most patients reported significantly increased flags ‘pre‐hospital’ admission: medication issues increased on day 7.0 to 8.5; total flags day 3, worse general health days 2.5 to 1.8; and red flags of disease symptoms increased on day 1. These flags persisted following discharge.

Discussion/Conclusion

This study identified a ‘pre‐hospital syndrome’ similar to a post‐hospital phase aka the well‐documented ‘post‐hospital syndrome’. There is evidence of a 10‐day ‘pre‐hospital’ window for interventions to possibly prevent or shorten an acute admission in this MW cohort. Further validation in a larger diverse sample is needed.
Cognitive Function and Cardiometabolic‐Inflammatory Risk Factors Among Older Indians and Americans
Authors: Hu Peifeng , Lee Jinkook , Beaumaster Sidney , Kim Jung Ki , Dey Sharmistha , Weir David , Crimmins Eileen M.
Published: August 2020

OBJECTIVES

To investigate how cardiometabolic‐inflammatory risk factors are related to cognition among older adults in India and the United States.

DESIGN

The Longitudinal Aging Study in India–Diagnostic Assessment of Dementia (LASI‐DAD) and the Harmonized Cognitive Assessment Protocol of the Health and Retirement Study (HRS‐HCAP) in the United States conducted an in‐depth assessment of cognition, using protocols designed for international comparison.

SETTING

Cognitive tests were conducted in hospital or household settings in India and in household settings in the United States.

PARTICIPANTS

Respondents aged 60 years and older from LASI‐DAD (N = 1,865) and respondents aged 65 years and older from HRS‐HCAP (N = 2,111) who provided venous blood specimen.

MEASUREMENTS

We used total composite scores from the common cognitive tests administered. Cardiovascular risk was indicated by systolic and diastolic blood pressure, pulse rate, pro‐B‐type natriuretic peptide (proBNP), and homocysteine. Metabolic risk was measured by body mass index, glycosylated hemoglobin (HbA1c), high‐density lipoprotein cholesterol, and lipoprotein (a) (only in India). Inflammatory risk was indicted by white blood cell count, C‐reactive protein, albumin, and uric acid (only in India).

RESULTS

The distribution of both total cognition scores and of cardiometabolic risk factors differed significantly between India and the United States. In both countries, lower cognition was associated with older age, lower education, elevated homocysteine, elevated proBNP, and lower albumin levels. The associations between HbA1c levels and cognitive measures were statistically significant in both countries, but in the opposite direction, with a coefficient of 1.5 (P < .001) in India and −2.4 (P < .001) in the United States for one percentage increase in absolute HbA1c value.

CONCLUSION

Cardiometabolic‐inflammatory biomarkers are associated with cognitive functional levels in each country, but the relationships may vary across countries. J Am Geriatr Soc 68:S36‐S44, 2020.
Online Clinical Consensus Diagnosis of Dementia: Development and Validation
Authors: Lee Jinkook , Ganguli Mary , Weerman Albert , Chien Sandy , Lee Dong Young , Varghese Mathew , Dey Aparajit B.
Published: August 2020

OBJECTIVES

To introduce cost‐effective expert clinical diagnoses of dementia into population‐based research using an online platform and to demonstrate their validity against in‐person clinical assessment and diagnosis.

DESIGN

The online platform provides standardized data necessary for clinicians to rate participants on the Clinical Dementia Rating (CDR®). Using this platform, clinicians diagnosed 60 patients at a range of CDR levels at two clinical sites. The online consensus diagnosis was compared with in‐person clinical consensus diagnosis.

SETTING

All India Institute of Medical Sciences (AIIMS), Delhi, and National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.

PARTICIPANTS

Thirty patients each at AIIMS and NIMHANS with equal numbers of patients previously independently rated in person by experts as CDR is 0 (cognitively normal), CDR is 0.5 (mild cognitive impairment), and CDR is 1 or greater (dementia).

MEASUREMENTS

Multiple clinicians independently rate each participant on each CDR domain using standardized data and expert clinical judgment. The overall summary CDR is calculated by algorithm. When there are discrepancies among clinician ratings, clinicians discuss the case through a virtual consensus conference and arrive at a consensus overall rating.

RESULTS

Online clinical consensus diagnosis based on standardized interview data provides consistent clinical diagnosis with in‐person clinical assessment and consensus diagnosis (κ coefficient = 0.76).

CONCLUSION

A web‐based clinical consensus platform built on the Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India interview data is a cost‐effective way to obtain reliable expert clinical judgments. A similar approach can be used for other epidemiological studies of dementia. J Am Geriatr Soc 68:S54‐S59, 2020.
Hypertension and Cognitive Health Among Older Adults in India
Authors: Farron Madeline R. , Kabeto Mohammed U. , Dey Aparajit Ballav , Banerjee Joyita , Levine Deborah A. , Langa Kenneth M.
Published: August 2020

OBJECTIVES

To assess the prevalence of diagnosed and undiagnosed hypertension and their relationship to cognitive function in older adults in India.

DESIGN

Longitudinal Aging Study in India–Diagnostic Assessment of Dementia (LASI‐DAD), an in‐depth national study of late‐life cognition and dementia.

SETTING

Geriatric hospitals and respondentsʼ homes across 14 states in India.

PARTICIPANTS

N = 2,874 individuals aged 60 years and older from LASI‐DAD.

MEASUREMENTS

Hypertension was identified by self‐report of physician diagnosis or measured blood pressure (BP) of 140/90 mmHg or higher. Undiagnosed hypertension was defined as hypertensive BP measurements, but no physician diagnosis. Controlled hypertension was defined as BP lower than 140/90 mmHg among those with a physician diagnosis. Total hypertension included both diagnosed and undiagnosed hypertension. A summary cognition score, derived from the sum of 18 cognitive tests administered in the LASI‐DAD (range = 0–360) was used to assess cognitive function.

RESULTS

Total hypertension prevalence was 63.2% (41.5% diagnosed and 21.6% undiagnosed). Among those with hypertension, 34.5% were undiagnosed, 34.2% were diagnosed but uncontrolled, and 31.3% were diagnosed and controlled. Neither diagnosed nor undiagnosed hypertension was related to cognitive function in fully adjusted models. Older age, female sex, less education, being widowed, rural residence, residing in the north or central regions, being in a scheduled caste or tribe, low consumption, being underweight, and history of stroke were all independently associated with worse cognitive test performance.

CONCLUSION

Two‐thirds of older Indian adults had hypertension, with the majority being undiagnosed or diagnosed but not adequately controlled. Hypertension was not independently associated with cognitive function, whereas sociodemographic factors were independently related to cognitive function. J Am Geriatr Soc 68:S29‐S35, 2020.
Pneumonia Lung Ultrasound Score (PLUS): A New Tool for Detecting Pneumonia in the Oldest Patients
Authors: Linsalata Giuseppe , Okoye Chukwuma , Antognoli Rachele , Guarino Daniela , Ravenna Virginia , Orsitto Eugenio , Calsolaro Valeria , Monzani Fabio
Published: August 2020

OBJECTIVES

To compare the diagnostic accuracy of lung ultrasound (LUS) and standard chest X‐ray (CXR) in older patients admitted to an acute‐care geriatric ward for suspected acute pneumonia, and to develop an easy‐to‐use diagnostic tool, now called Pneumonia Lung Ultrasound Score (PLUS), for early risk stratification.

DESIGN

Prospective, single‐center, cohort study.

SETTING

Acute‐care geriatric ward of tertiary care center.

PARTICIPANTS

Individuals, aged 65 years and older, with suspected acute pneumonia.

MEASUREMENTS

Participants were stratified according to the Multidimensional Prognostic Index. All the patients underwent CXR and LUS, whereas chest computed tomography was performed in case of mismatch between LUS and CXR. Using logistic multivariate regression, we assessed the influence of age, sex, multimorbidity, cognitive impairment, and clinical biomarkers in the misdiagnosis of acute pneumonia. Finally, an easy‐to‐perform diagnostic tool based on the combination of biomarkers (brain natriuretic peptide, high‐sensitivity C‐reactive protein, and partial pressure arterial oxygen/fraction of inspired oxygen ratio) and LUS was realized. A receiver operating characteristic curve was used to verify the predictive accuracy of PLUS, CXR, and LUS in pneumonia diagnosis.

RESULTS

A total of 132 subjects (69% women; mean age = 85.3 ± 6.9 years) were enrolled in the study. Acute pneumonia was diagnosed in 94 of 132 cases. LUS showed higher diagnostic accuracy compared with CXR (0.91 (95% confidence interval (CI) = 0.85–0.93) vs 0.67 (95% CI = 0.58–0.75)) in detecting pneumonic consolidations. A higher degree of cognitive impairment was associated with both LUS and CXR pneumonia misdiagnosis (odds ratio = 1.30 (95% CI = 1.04–1.65)). PLUS showed higher predictive accuracy in the diagnosis of acute pneumonia compared with LUS (AUC = 0.92 (95% CI = 0.87–0.98) vs 0.86 (95% CI = 0.80–0.96); P = .029).

CONCLUSIONS

This study confirms the higher diagnostic accuracy of LUS compared with CXR for acute pneumonia in older adults. Nonetheless, the accuracy of PLUS, an easy‐to‐use, biomarker‐derived diagnostic tool, was superior to LUS regardless of patientsʼ degree of frailty.
Sharing the safe operating space: Exploring ethical allocation principles to operationalize the planetary boundaries and assess absolute sustainability at individual and industrial sector levels
Authors: Hjalsted Anjila Wegge , Laurent Alexis , Andersen Martin Marchman , Olsen Karen Holm , Ryberg Morten , Hauschild Michael
Published: August 2020

In the light of increasing human pressures on the Earth system, the issue of sharing in the face of scarcity is more pressing than ever. The planetary boundary framework identifies and quantifies nine environmental boundaries and corresponding human pressures. However, when aiming to make the concept operational for decision support it is unclear how this safe operating space (SOS) within each of the planetary boundaries should be shared. This study proposes a two‐step approach, where the operating space is first downscaled to the individual level using ethical allocation principles and next scaled up to a higher organizational level using different upscaling methods. For the downscaling, three allocation principles are demonstrated: egalitarian (equal per capita); grandfathering (proportional to current share of the total impacts); and ability to pay (proportional to economic activity). For upscaling from the individual level final consumption expenditure is used as a proxy for the priority that the individual gives to the product or sector. In an alternative upscaling approach, an additional upscaling factor is based on the eco‐efficiency (ratio between turnover and environmental impact) of the product or sector. A demonstration of the method's application is given by applying the framework to two of the planetary boundaries, climate change and biogeochemical flows, with the Danish, Indian and global dairy sectors as cases. It is demonstrated how the choices of allocation and upscaling approaches influence the results differently in the three cases. The developed framework is shown to support an informed and transparent selection of allocation principles and upscaling methods and it provides a step toward standardization of distributing the SOS in absolute environmental sustainability assessments.
Cosmetovigilance in a tertiary care hospital: A prospective observational study
Authors: Jyrwa Serika , Sebastian Juny , Shastry Veeranna
Published: August 2020

Background

Cosmetovigilance is a term used for the activities related to the collection, evaluation, and monitoring of reporting of undesirable events observed during or after normal or reasonably foreseeable use of a cosmetic product.

Aim

The study was conducted to assess the adverse cosmetic events from a tertiary care hospital.

Patients/Methods

The patients visiting the study site was reviewed and those who met the study criteria are enrolled in the study after administration of the informed consent. Study participants were followed on regular intervals either telephonically or hospital visits in order to determine the outcome. The causality assessment of the reported event was performed using Colipa and PLM method.

Results

During the study period 22,893 patients visited the dermatology department, in which 87 subjects were enrolled in the study. The incidence of adverse cosmetic event was 0.38%. Hair care products caused more events than body care products. In 73.56% of cases, the suspected cosmetic was withdrawn and all the study population received symptomatic treatment for the adverse events. Causality assessment of Using Colipa method, categorized 49.43% events as likely and using PLM method, 64.37% events were probable. Study couldn't identify any predictors of adverse cosmetic events. Median cost associated with the management of ACRs for hair care products and body care products were 716.62 (IQR: 1011.36–470) and 557.4 (IQR: 711.63–373.8).

Conclusion

The study suggest need for approaches such as awareness programs among the cosmetic sellers, consumers and other stakeholders on cosmetovigilance needs to be developed and implemented.
A systematic review on the skin whitening products and their ingredients for safety, health risk, and the halal status
Authors: Nordin Fatin N. M. , Aziz Atiqah , Zakaria Zalina , Wan Mohamed Radzi Che Wan Jasimah
Published: August 2020

Background

Skin‐whitening products are in the high trend of demand for skin beautifying and lightening. Sources of ingredients for cosmetics could be natural, semi‐synthetic, and synthetic that may affect the halal status of a product. The lack of scientific evidence on the safety and risks of such ingredients is a major concern to many consumers.

Objective

This review paper aimed to shed light on the skin‐whitening ingredients and their issues related to safety, health risk, and halal status.

Methodology

Based on the reviews scientific publications published from January 2015 to July 2020 using Web of Science and Scopus engines.

Findings

Based on the review, most of the common ingredients in the skin‐whitening products are originated from plants, animals, microbes, and heavy metals. Health risk of the ingredients was evaluated based on the usage, chronic or acute adverse effect, frequency of incidence, and the hazardous chemical contents of a halal cosmetics. The halal status of the ingredients was investigated based on the sources of origin, safety evaluation, and associated health risk of the ingredients.

Originality

This review shows that ingredients play a vital role in the halal status decision‐making of a cosmetic product. Therefore, the categories of Halal‐Safe, Haram‐Prohibited, and Critical‐Need further evaluation were suggested to integrate the sources of ingredients with safety.
Inner myometrial laceration: Case report and literature review
Authors: Zakaria Zahar Azuar , Mohammad Razin Nur Syazwani , Abas Sakinah
Published: August 2020

Inner myometrial laceration is a rarely encountered intrapartum uterine trauma, which usually present as post‐partum hemorrhage (PPH). The diagnosis can only be confirmed by direct examination of the uterine cavity but it should be suspected in PPH with good uterine contraction. Discussed here are the characteristics and management of the reported cases including two women managed at our center.
Perineural and lymphovascular invasion in squamous cell carcinoma of the tongue
Authors: Barrett Andrew W. , Pratt Murray K. , Sassoon Isabel , Bisase Brian S. , Newman Laurence , Tighe John V. , Norris Paul M. , Dhanda Jag , Gulati Aakshay
Published: August 2020

Background

Perineural invasion (PNI) and lymphovascular invasion (LVI) may be adverse prognostic indicators in squamous cell carcinoma (SCC) of the tongue.

Methods

The percentages of histological PNI and LVI were determined in 335 patients with tongue SCC. Sixty tumours originally reported as negative for these features were tested to determine how many more were positive with “immunohistochemical enhancement.”

Results

PNI was found in 141 (42.1%) and LVI in 51 (15.2%) patients. 79.4% of the 141 patients who had PNI and 72.6% of the 51 with LVI had a T3 or T4 tumour. Lymph node metastasis was identified in 145 (51.2%) of the 280 patients who had undergone neck dissection; 58.2% of the 141 patients with PNI and 80.4% of the 51 patients with LVI had lymph node metastasis. There was a highly statistically significant correlation between PNI with increasing pT (P < .00001) and pN (P < .0001) stage, and a statistically significant correlation between LVI and pT stage (P < .001), the association of LVI with pN status could not be reliably tested statistically. Immunohistochemistry for S100 identified five further cases of PNI, but review of the original H&E showed the feature was present in four and had been missed at original reporting. CD31 identified three further possible cases of LVI and D2‐40 none. The endothelium of some vascular channels was positive for both CD31 and D2‐40 and cross‐reactivity with other cells compromised interpretation.

Conclusions

Histological identification of PNI and LVI per se remains of uncertain prognostic significance. “Immunohistochemical enhancement” offered little benefit.
Full‐Crown Versus Endocrown Approach: A 3D‐Analysis of Both Restorations and the Effect of Ferrule and Restoration Material
Authors: Tribst João Paulo Mendes , Dal Piva Amanda Maria de Oliveira , de Jager Niek , Bottino Marco Antonio , de Kok Paul , Kleverlaan Cornelis Johannes
Published: August 2020

Purpose

To assess stress distribution in full‐crowns with a composite buildup and endocrowns under axial or oblique loads, both with different ferrules (1 or 2 mm) and ceramic materials (glass ceramic or hybrid ceramic).

Materials and Methods

Sixteen models were analyzed with finite element analysis. No‐separation contacts were considered between restoration/resin cement and resin cement/tooth. The contact between the fixation cylinder and the root was considered perfectly bonded. The axial load was applied to the occlusal surface and the oblique load was applied to the buccal cusp. The resulting tensile stresses were shown for the crown, the cement layer and the tooth.

Results

Almost all factors influenced the stress distribution significantly in the crown and the cement layer, as well as the tooth. The only exception was found under oblique loading by the restoration material and the type of crown that were of no significant influence on the stress distribution in the tooth.

Conclusions

Under axial load, the endocrown showed the least tensile stresses in the tooth, but under oblique loads, the full‐crown showed less tensile stresses than the endocrown. With the hybrid ceramic material, lower stresses were found in the crown, but higher stresses were present in the cement layer. The 2 mm ferrule is beneficial for reducing the resulting tensile stresses in all modalities.
Association between paternal age and offspring's under‐5 mortality: Data from 159 surveys in 67 low‐ to middle‐income countries
Authors: Wu Han , Zhao Min , Liang Yajun , Xi Bo
Published: August 2020

Aim

To investigat the association between paternal age at birth and offspring's under‐5 mortality in low‐ and middle‐income countries (LIMCs).

Methods

Data from 159 population‐based surveys in 67 LIMCs between 2000 and 2018 were obtained from the Demographic and Health Surveys. Cox proportional hazard regression models in consideration of complex survey design were performed to examine the associations.

Results

In the pooled analysis, compared with children born to fathers aged 25–29 years, those born to younger fathers aged 20–24, 16–19 and 12–15 years, respectively, were at increased risk of under‐5 mortality (hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.06–1.13; HR = 1.48, 95% CI = 1.42–1.55; HR = 1.70, 95% CI = 1.56–1.84, respectively). In addition, children born to older fathers aged 40–44 and ≥ 45 years, also had increased risk of under‐5 mortality (HR = 1.08, 95% CI = 1.03–1.15; HR = 1.12, 95% CI = 1.07–1.18, respectively).

Conclusions

Our findings show that children born to both younger and older fathers are at higher risk of offspring's under‐5 mortality in LIMCs.
Bacterial colonisation of the endotracheal tube in ventilated very preterm neonates: A retrospective cohort study
Authors: Antoine Jasmine , Inglis Garry D T , Way Mandy , O'Rourke Peter , Davies Mark W
Published: August 2020

Aim

To determine the rate, type and timing of bacterial endotracheal tube (ETT) colonisation in neonates born <32 weeks gestational age (GA); and if bacterial colonisation is associated with chronic lung disease (CLD), septicaemia, length‐of‐stay or mortality.

Methods

All intubated newborns born <32 weeks GA were included. Endotracheal aspirates were routinely obtained three times‐per‐week. Cohort was divided into three colonisation groups: no growth, normal respiratory flora only, significant bacteria. Logistic regression was performed to identify if ETT bacterial colonisation was associated with CLD, septicaemia or mortality. A general linear model was fitted for length‐of‐stay.

Results

ETT aspirates were sent from 1054 infants: no growth n = 319, only normal respiratory flora n = 357, and significant bacteria n = 378. ETTs became colonised in 70%, most in the first week of life (82%). Most grew normal respiratory flora (642 infants). In those with significant bacteria, 40% grew Gram‐negative species; Klebsiella in 34%. Staphylococcus aureus grew in 104 patients. Adjusted odds ratios for CLD (43% of cohort) compared with no growth were, for normal respiratory flora, 0.58 (95% confidence interval (CI) 0.34–0.99) and, for significant bacteria, 0.48 (95% CI 0.24–0.93). With no overall association between colonisation group and CLD in the adjusted model P = 0.07. The odds of septicaemia (10% of cohort) were 4.50 (95% CI 1.98–10.23, P < 0.001) times greater for significant bacteria compared with no growth. No significant associated was found with mortality or length‐of‐stay.

Conclusions

Bacterial colonisation of ETTs is common. It is associated with more septicaemia. There was no significant association with CLD, longer admission or mortality.
Prevention of occlusion of cEnTral lInes for children with cancer: An implementation study
Authors: Ullman Amanda J , Condon Paula , Edwards Rachel , Gibson Victoria , Takashima Mari , Schults Jessica , Dean Anna , Cattanach Paula , Nicholls Wayne , Osborne Sonya , Rickard Claire M , Cooke Marie , Kleidon Tricia
Published: August 2020

Aim

Central venous access devices (CVADs) are vital medical devices to support the treatment of paediatric cancer; however, device occlusion is common, which disrupts treatment. This study aimed to improve the identification and management of CVAD occlusions in children with cancer, as well as to identify the demographic, clinical and device characteristics associated with increased risk for CVAD occlusion.

Methods

A pre–post‐implementation study was conducted at a metropolitan paediatric oncology facility in Australia, using the Theoretical Domains Framework. Patients with a CVAD for anti‐cancer therapy were prospectively followed for occlusive events pre‐ and post‐ the implementation of clinical resources to support the identification and management of CVAD occlusive events. CVAD occlusion and management data were collected and compared pre‐ and post‐implementation. Risk factors for CVAD occlusion were described by mixed‐effects Poisson regression and incident rate ratios (IRR).

Results

A total of 133 CVADs were inserted into 131 patients for a total of 6784 catheter days. The incidence of CVAD‐related occlusion pre‐implementation was 59.7 (95% confidence interval (CI) 51.4–69.0, per 1000 catheter days); compared to 31.6 (95% CI 26.4–37.6); P < 0.01) post‐implementation of clinical resources. In multivariate models, other than post‐implementation phases (IRR 0.51 (95% CI 0.32–0.81)), only neutropaenia significantly increased the risk of CVAD occlusion (IRR 2.14 (95% CI 1.15–3.97)).

Conclusion

CVAD occlusions in paediatric oncology are common. The development and implementation of CVAD occlusion resources to guide the identification and management of occlusive episodes led to a significant decrease in occlusive events.
When should intensive care be provided for the extremely preterm infants born at the margin of viability? A survey of Australasian parents and clinicians
Authors: Tan Alvin H K , Shand Antonia W , Marsney Renate L , Schindler Timothy , Bolisetty Srinivas , Guaran Robert , Cruz Melinda , Chow Sharon S W , Lui Kei
Published: August 2020

Aim

This study aimed to explore clinician and parent opinions of risk limits on resuscitation and intensive care (IC) for extremely premature infants born at the margin of viability.

Methods

Two anonymous on‐line surveys were conducted from August 2016 to January 2017. Survey participants were: (i) clinicians affiliated with neonatal intensive care units in Australia; and (ii) parents or individuals who expressed interest in premature babies through the Facebook page of Miracle Babies Foundation.

Results

A total of 961 responses were received. Among 204 clinicians, 52% were neonatologists, 22% obstetricians, 20% neonatal intensive care unit nurses and 4% were midwives. Among 757 parents, 98% had a premature baby. Only 75% of clinicians responded to the risk limits questions. Median mortality risk above which they would not recommend resuscitation/IC was 70% (interquartile range (IQR) 50–80%); major disability risk in survivors 60% (IQR 50–75%); and composite risk of mortality and major disability 70% (IQR 50–80%). All parents answered the risk limit questions. The median mortality risk for not planning resuscitation was 90% (IQR 60–90%); major disability risk in survivors 50% (IQR 30–90%); and composite risk 90% (IQR 50–90%). Most clinicians (82%) stated that decisions should be guided by parent opinions if there are uncertainties. Parents had varying perception of previous counselling, and 57% stated that both their viewpoint and doctor's predicted risk influenced their decision‐making.

Conclusions

Clinicians and parents had different views on mortality and major disability risks when deciding on resuscitation/neonatal IC treatment. When there was uncertainty, both agreed on working together.
The relationship between portable school‐based oral health prevention services and subsequent oral health treatment
Authors: Pourat Nadereh , Chen Xiao , Spetz Joanne
Published: August 2020

Objectives

This study examines whether a portable, school‐based, preventive oral health program was associated with reduced use of treatment services over time.

Methods

We obtained encounter data from Community Health Center, Inc. (CHC) in Connecticut that operates such a program. We followed cohorts of children for 4 years, examining change in ratio of treatment to total services in the fourth year, following receipt of portable preventive care in the prior 3 years. The sample included 3,006 children 4.5 to 15 years old on their first visit during 2005–2015. We used structural equation path models to assess change in the dependent variable, controlling for available demographics and service use patterns. We conducted additional sensitivity analyses to assess robustness of our findings.

Results

We found a reduction in ratio of treatment (particularly restorative) to total services in the fourth year, given receipt of portable preventive care in the third year (direct impact) and receipt of portable preventive care in prior years (indirect impact). Older children and those covered by Medicaid (versus privately insured) had a higher ratio of treatment to total services in the fourth year.

Conclusions

Our retrospective analysis showed CHC portable dental program may reduce the use of treatment services over time among underserved children. This program is an example of a viable approach that could be emulated elsewhere if regulations allow remote supervision of hygienists and reimbursement levels are adequate.
Medicinal plants used against various inflammatory biomarkers for the management of rheumatoid arthritis
Authors: Singh Shareen , Singh Thakur Gurjeet , Mahajan Kriti , Dhiman Sonia
Published: August 2020

Objectives

Rheumatoid arthritis is a chronic autoimmune disease manifested clinically by polyarthralgia associated with joint dysfunction triggering the antibodies targeting against the self-neoepitopes determined by autoimmune responses associated with chronic arthritic attacks. The activation of macrophages and other defence cells in response to self-epitopes as biomarkers in RA provides a better understanding of pathogenesis of disease and has led to the development of novel therapeutic approaches acting as potent inhibitors of these cells.

Key findings

The current review retrieved the various medicinal plants possessing an active phytoconstituents with anti-inflammatory and antioxidant properties, which tends to be effective alternative approach over the synthetic drugs concerned with high toxic effects. The current available literature provided an evident data concluding that the active constituents like fatty acids, flavonoids, terpenes and sesquiterpene lactones attenuate the RA symptoms by targeting the inflammatory biomarkers involved in the pathogenesis of RA.

Despite the various synthetic treatment approaches targeting immune cells, cytokines improved the quality of life but still the drug management is challenging due to toxic and chronic teratogenic effects with anti-arthritic drugs. The current review has elaborated the selected traditionally used herbal medicinal plants with phytoconstituents possessing anti-inflammatory activity by suppressing the inflammatory biomarkers with lesser side effects and providing the future exploration of natural drug therapy for rheumatoid arthritis.
Therapeutic effects of açaí seed extract on hepatic steatosis in high-fat diet-induced obesity in male mice: a comparative effect with rosuvastatin
Authors: Tavares Thamires Barros , Santos Izabelle Barcellos , de Bem Graziele Freitas , Ognibene Dayane Teixeira , da Rocha Ana Paula Machado , de Moura Roberto Soares , Resende Angela de Castro , Daleprane Julio Beltrame , da Costa Cristiane Aguiar
Published: August 2020

Objectives

Obesity is considered a risk factor for the development of non-alcoholic fatty liver disease (NAFLD). The hydroalcoholic extract obtained from the açai seed (ASE), rich in proanthocyanidins, has been shown a potential body weight regulator with antioxidant properties. This study aimed to investigate the therapeutic effect of ASE in obesity-associated NAFLD and compare it with Rosuvastatin.

Methods

Male C57BL/6 mice received a high-fat diet or standard diet for 12 weeks. The treatments with ASE (300 mg/kg per day) or rosuvastatin (20 mg/kg per day) began in the eighth week until the 12th week.

Key findings

Our data show that the treatments with ASE and rosuvastatin reduced body weight and hyperglycaemia, improved lipid profile and attenuated hepatic steatosis in HFD mice. ASE and Rosuvastatin reduced HMGCoA-Reductase and SREBP-1C and increased ABGC8 and pAMPK expressions in the liver. Additionally, ASE, but not Rosuvastatin, reduced NPC1L1 and increased ABCG5 and PPAR-α expressions. ASE and rosuvastatin increased SIRT-1 expression and antioxidant defence, although only ASE was able to decrease the oxidative damage in hepatic tissue.

Conclusions

The therapeutic effect of ASE was similar to that of rosuvastatin in reducing dyslipidemia and hepatic steatosis but was better in reducing oxidative damage and hyperglycaemia.
Effects of metronidazole on the fecal microbiome and metabolome in healthy dogs
Authors: Pilla Rachel , Gaschen Frederic P. , Barr James W. , Olson Erin , Honneffer Julia , Guard Blake C. , Blake Amanda B. , Villanueva Dean , Khattab Mohammad R. , AlShawaqfeh Mustafa K. , Lidbury Jonathan A. , Steiner Jörg M. , Suchodolski Jan S.
Published: August 2020

Background

Metronidazole has a substantial impact on the gut microbiome. However, the recovery of the microbiome after discontinuation of administration, and the metabolic consequences of such alterations have not been investigated to date.

Objectives

To describe the impact of 14‐day metronidazole administration, alone or in combination with a hydrolyzed protein diet, on fecal microbiome, metabolome, bile acids (BAs), and lactate production, and on serum metabolome in healthy dogs.

Animals

Twenty‐four healthy pet dogs.

Methods

Prospective, nonrandomized controlled study. Dogs fed various commercial diets were divided in 3 groups: control group (no intervention, G1); group receiving hydrolyzed protein diet, followed by metronidazole administration (G2); and group receiving metronidazole only (G3). Microbiome composition was evaluated with sequencing of 16S rRNA genes and quantitative polymerase chain reaction (qPCR)‐based dysbiosis index. Untargeted metabolomics analysis of fecal and serum samples was performed, followed by targeted assays for fecal BAs and lactate.

Results

No changes were observed in G1, or G2 during diet change. Metronidazole significantly changed microbiome composition in G2 and G3, including decreases in richness (P < .001) and in key bacteria such as Fusobacteria (q < 0.001) that did not fully resolve 4 weeks after metronidazole discontinuation. Fecal dysbiosis index was significantly increased (P < .001). Those changes were accompanied by increased fecal total lactate (P < .001), and decreased secondary BAs deoxycholic acid and lithocholic acid (P < .001).

Conclusion and Clinical Importance

Our results indicate a minimum 4‐week effect of metronidazole on fecal microbiome and metabolome, supporting a cautious approach to prescription of metronidazole in dogs.
Unravelling associations among chemosensory system components in Liolaemus lizards
Authors: Ruiz–Monachesi M. R. , Cruz F. B. , Valdecantos S. , Labra A.
Published: August 2020

Morphology can be associated with different aspects of an organisms' life and the size of sensorial organs may allow inferences on the relevance of sensorial systems employed by them. There are organs implied in signal detection (sensory organs) and production (emitting organs) that are linked frequently to behaviour. Lizards are mostly dependent on the chemosensory system, where the vomeronasal organ (VNO) detects chemical scents delivered by the tongue from glands. The VNO, tongue flicks and glands, should be associated under a morpho‐functional paradigm, and our main aim is to explore whether there is an association among these three chemosensory components in Liolaemus lizards. Additionally, tongue flicks have been used to evaluate the interaction between the chemical and visual sensory systems, showing a positive association. Hence, considering the close association between morphology and behaviour, our second aim is to explore whether the morphological (VNO, glands) and behavioural (tongue flicks) chemosensory components are correlated with eye size. We studied the rate of tongue flicks exhibited under two conditions, own scents and control, in 13 Liolaemus species and measured their head length, snout volume (VNO proxy), eye surface, and counted their number of precloacal glands. The rate of tongue flicks correlated positively with the residuals to head of snout volume and negatively with the number of precloacal glands, suggesting that they are associated and that this behaviour links both structures. In addition, residuals of snout volume and the rate of tongue flicks were positively associated with the residuals of eye surface, suggesting that chemical and visual sensory modalities would have co‐evolved in these Liolaemus species. Our results show the importance of morphology and behaviour to infer the relevance of animals' sensory systems.
Ornamental fish: a potential source of pathogenic and multidrug-resistant motile Aeromonas spp.
Authors: Hossain S. , Heo G.-J.
Published: August 2020

Aeromonas spp. are ubiquitous bacteria that cause diseases in fish and other aquatic animals. They are the natural inhabitants of different aquatic environments, such as freshwater, brackishwater and marinewater. Extrinsic stressors, such as crowding, unhygienic handling, poor water quality, polluted feeding and inadequate nutrition, can predispose fish to Aeromonas infection. In ornamental fish, motile Aeromonas spp. are known as aetiological agents of motile aeromonad infections, which cause significant mortality in fish and economic loss in the ornamental fish industry. The existence of different virulence factors leads to the virulence potential of motile Aeromonas spp. There are several antimicrobials used to treat bacterial infections in ornamental fish. However, the extensive use of antimicrobials in the ornamental fish industry causes multidrug resistance. This article reviewed a multitude of virulence factors that are related to the ornamental fish-borne Aeromonas pathogenicity and the antimicrobial resistance determinants related to the multidrug resistance phenotypes of motile Aeromonas spp. in ornamental fish.
Currency's reversed marginal role in children's literature: Loans, debts, Mum Bucks and their subversion inDiary of a Wimpy Kid
Authors: Hui Haifeng
Published: August 2020

Monetary issues abound in the best‐seller graphic novelDiary of a Wimpy Kid, where Heffley, his little brother Manny, and his friend Rowley often try to borrow or use others' money, the failure of which often develops into stealth or abuse of money, not to mention Heffley's mom's failed effort of disciplining him by introducing Mum Bucks. Money plays the role of currency and is one of the regulating and most fundamental principles in the adult society. Those who disregard the commonly accepted way of the use of money are often marginalized or even become criminals. On the contrary, in the children's world, money is often marginalized and destabilized—it is not respected with reference to its proper function in the adult world and it is often abused, counterfeited, or denied, the degree of which often indicates the degree of maturity of the character. This article analyzes different characters' regards and uses of money inDiary of a Wimpy Kidin an attempt to reveal the marginalized or even destabilizing role money plays in the children's world. It argues that the least mature character holds the most careless attitude toward money and this behavior often upsets the more mature character, who to a certain extent has partly internalized the central role of money in the adult world. It is, therefore, not surprising that Heffley's mom's introduction of Mom Bucks fail to work in the end because it symbolizes adults' futile enforcement of the disciplinary power of money in the children's world where it is not recognized as such.
Classifying rodent diets for comparative research
Authors: Verde Arregoitia Luis D. , D’Elía Guillermo
Published: August 2020

The foods consumed by animals reflect their adaptations and ecological roles, which makes diet an important trait for ecological, evolutionary, and paleobiological research. Rodents are the most species‐rich order of mammals and are also ecologically diverse, consuming a wide range of foods.

To relate form with function, and to study diversification in the context of diet and feeding, researchers should follow classification schemes that capture diet composition.

We evaluated existing diet datasets for mammals as well as previous classification schemes developed for rodents. To propose a suitable categorical scheme, we defined splits within plant‐eating and animal‐eating rodents, aiming to capture the intrinsic differences in diet composition in terms of the accessibility, nutrient content, and digestibility of various food items.

Our proposal includes eight categories (Carnivore, Folivore, Frugivore, Granivore, Omnivore, Specialist Herbivore, Unknown, and Vermivore) in which species can be assigned with information from species accounts and field guides. To avoid ambiguity, we provide examples and detailed criteria for each diet category.

For biologically tractable comparative research, we ask researchers to use our diet categories for rodent species. The categories can also be applied at other taxonomic levels or to different populations, sexes, or ontogenetic stages. We call for further study of the natural history of small mammals and the uptake of primary data into open databases.
Endogenous vertical structure with network externalities
Authors: Lee DongJoon , Choi Kangsik , Nariu Tatsuhiko
Published: August 2020

This study examines the endogenous vertical structure in which each manufacturer sells its product to its exclusive retailer who sells network goods to consumers (i.e. a duopoly in the upstream market) under Bertrand competition and Cournot competition with network externalities. We show that with strong (weak) network externalities under Bertrand competition, (a) it is a dominant strategy for each manufacturer to integrate (separate) its retailer; (b) with strong network externalities, the manufacturers’ profits, consumers’ surplus and social welfare are higher under vertical integration than under vertical separation. Under Cournot competition, (a) vertical separation is a unique subgame perfect Nash equilibrium; (b) with strong network externalities, the manufacturers’ profits, consumers’ surplus and social welfare are higher under vertical separation than under vertical integration.
Differential effects of a school‐based obesity prevention program: A cluster randomized trial
Authors: Nickel Nathan C. , Doupe Malcolm , Enns Jennifer E. , Brownell Marni , Sarkar Joykrishna , Chateau Dan , Burland Elaine , Chartier Mariette , Katz Alan , Crockett Leah , Azad Meghan B. , McGavock Jon M. , Santos Robert
Published: August 2020

School‐based healthy living interventions are widely promoted as strategies for preventing obesity. The peer‐led Healthy Buddies™ curriculum has been shown to improve obesity‐related outcomes in school‐aged children. We examined whether these improvements existed among subgroups of children stratified by sex, income level and urban/rural geography. In a cluster‐randomized controlled trial, elementary schools in Manitoba, Canada, were randomly allocated to Healthy Buddies™ (10 schools, 340 students) or standard curriculum (10 schools, 347 students). Healthy Buddies™ participants had 21weekly lessons on healthy eating, physical activity and self‐efficacy, delivered by children age 9–12 to children age 6–8. We assessed pre‐ and post‐intervention body mass index (BMI) z‐scores, waist circumference, healthy living knowledge, dietary intake and self‐efficacy among the younger children. Compared to standard curriculum (n = 154), Healthy Buddies™ participants (n = 157) experienced a greater reduction in waist circumference (−1.7 cm; 95% confidence interval [CI][−2.8, −0.5 cm]) and improved dietary intake (4.6; 95% CI [0.9, 8.3]), healthy living knowledge (5.9; 95% CI [2.3, 9.5]) and self‐efficacy (5.3; 95% CI [1.0, 9.5]) scores. In subgroup analyses, effects for waist circumference (−2.0 cm; 95% CI [−3.6, −0.5]), healthy living knowledge (9.1; 95% CI [4.4, 13.8]) and self‐efficacy (8.3; 95% CI [3.3, 13.3]) were significant among boys. Dietary intake (10.5; 95% CI [5.5, 15.4]), healthy living knowledge (9.8; 95% CI [4.5, 15.0]) and self‐efficacy (6.7; 95% CI [0.7, 12.7]) improved among urban‐dwelling but not rural‐dwelling children. Healthy Buddies™ was effective for boys and children living in urban settings. Enhanced curricula may be needed to improve program effectiveness for select subgroups of school‐aged children.
Overweight in childhood of exclusively breastfed infants with a high weight at 5 months
Authors: Morgen Camilla S. , Larsson Melanie W. , Ängquist Lars , Sørensen Thorkild I. A. , Michaelsen Kim F.
Published: August 2020

High infant weight increases the risk of childhood overweight, while breastfeeding may reduce the risk. However, some infants have a very high weight gain even though they are exclusively breastfed. We examined the risk of a high body mass index (BMI) and overweight in childhood for infants ≥2.5 SD above the median weight‐for‐age (WAZ) at age 5 months according to duration of exclusive breastfeeding (≤2, >2 to <4 or ≥4 months). The study is based on 13,401 7‐year‐old and 9,819 11‐year‐old children enrolled into the Danish National Birth Cohort (born 1997–2003). Linear and logistic regression analyses were used to examine the associations while adjusting for presumed confounders including birth weight. The results showed that infants ≥2.5 SD at 5 months, breastfed exclusively ≤2, >2 to <4 or ≥4 months had adjusted odds ratios (ORs) for overweight at age 7 at 3.67 (95% confidence interval [CI] [2.10, 6.43]), 3.42 (95% CI [2.32, 5.04]) and 3.19 (95% CI [1.90, 5.36]) respectively, when compared with infants <2.5 SD WAZ exclusively breastfed ≥4 months. The corresponding results for BMIz‐scores were 0.82 (95% CI [0.60, 1.04]), 0.63 (95% CI [0.48, 0.78]) and 0.57 (95% CI [0.38, 0.77]). For the ≥2.5 SD infants, the differences in risk of overweight and BMI according to duration of exclusive breastfeeding were neither significantly different among the 7‐year nor among the 11‐year‐old children. A high infant weight increases the odds of overweight and is associated with a higher BMI in childhood. Whereas the odds and BMIz‐scores tended to be lower for those exclusively breastfed longer, the differences were not statistically significant.