bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the Interaction of Disability Status and Childhood Predictors of Physical Activity and Sport Participation: An Exploratory Decision-Tree Analysis
Authors: Ross Samantha M. , Smit Ellen , Yun Joonkoo , Bogart Kathleen R. , Hatfield Bridget E. , Logan Samuel W.
Published: January 2021

A secondary data analysis of 33,093 children and adolescents age 6–17 years (12% with disabilities) from a 2016–2017 National Survey of Children’s Health nonrepresentative sample aimed to identify (a) unique clusters of sociodemographic characteristics and (b) the relative importance of disability status in predicting participation in daily physical activity (PA) and sports. Exploratory classification tree analyses identified hierarchical predictors of daily PA and sport participation separately. Disability status was not a primary predictor of daily PA. Instead, it emerged in the fifth level after age, sex, body mass index, and income, highlighting the dynamic intersection of disability with sociodemographic factors influencing PA levels. In comparison, disability status was a second-level predictor for sport participation, suggesting that unique factors influencing PA level are likely experienced by disabled children and adolescents. The authors employ an intersectionality lens to critically discuss implications for research in adapted PA.
Factors Influencing Blood Alkalosis and Other Physiological Responses, Gastrointestinal Symptoms, and Exercise Performance Following Sodium Citrate Supplementation: A Review
Authors: Urwin Charles S. , Snow Rodney J. , Condo Dominique , Snipe Rhiannon , Wadley Glenn D. , Carr Amelia J.
Published: January 2021

This review aimed to identify factors associated with (a) physiological responses, (b) gastrointestinal (GI) symptoms, and (c) exercise performance following sodium citrate supplementation. A literature search identified 33 articles. Observations of physiological responses and GI symptoms were categorized by dose (< 500, 500, and > 500 mg/kg body mass [BM]) and by timing of postingestion measurements (in minutes). Exercise performance following sodium citrate supplementation was compared with placebo using statistical significance, percentage change, and effect size. Performance observations were categorized by exercise duration (very short < 60 s, short ≥ 60 and ≤ 420 s, and longer > 420 s) and intensity (very high > 100% VO2max and high 90–100% VO2max). Ingestion of 500 mg/kg BM sodium citrate induced blood alkalosis more frequently than < 500 mg/kg BM, and with similar frequency to >500 mg/kg BM. The GI symptoms were minimized when a 500 mg/kg BM dose was ingested in capsules rather than in solution. Significant improvements in performance following sodium citrate supplementation were reported in all observations of short-duration and very high–intensity exercise with a 500 mg/kg BM dose. However, the efficacy of supplementation for short-duration, high-intensity exercise is less clear, given that only 25% of observations reported significant improvements in performance following sodium citrate supplementation. Based on the current literature, the authors recommend ingestion of 500 mg/kg BM sodium citrate in capsules to induce alkalosis and minimize GI symptoms. Supplementation was of most benefit to performance of short-duration exercise of very high intensity; further investigation is required to determine the importance of ingestion duration and timing.
Mock Trial: Transforming Curriculum Through Coopetition
Authors: Lower-Hoppe Leeann M. , Evans James O. , Bailey Richard L. , Brgoch Shea M.
Published: January 2021

Coopetition is a strategic concept that integrates elements of competition and cooperation. This strategy focuses on creating an environment where working together develops additional value for all entities involved, but there is still competition for this newly established value. Mock trial is an experiential learning technique that can serve as a platform to implement coopetitive strategies, providing students the opportunity to cooperatively apply theory to practice in a competitive courtroom simulation. This extended abstract details implementation of coopetition through mock trial for the sport management classroom. Implications for enhancing the coopetitive environment through course format, mentorship, and facilitation are also discussed.
Bringing the light inside the body to perform better surgery
Authors: Fichera Loris
Published: January 2021

Miniaturized robotic laser steering opens new horizons for laser microsurgery.
Collaborating robots sample the primary production in the ocean
Authors: Ludvigsen Martin
Published: January 2021

Sampling of genetic material from phytoplankton in open-ocean eddies becomes more precise and efficient using a heterogeneous network of autonomous marine robots.
A QuICR test to diagnose Parkinson’s disease
Authors: Davis Albert A.
Published: January 2021

Refined conditions permit rapid detection of proteopathic α-synuclein seeds in cerebrospinal fluid from patients with Parkinson’s disease.
Complete Genome Sequence of
Geobacter
sp. Strain FeAm09, a Moderately Acidophilic Soil Bacterium
Authors: Yadav Pooja , Antony-Babu Sanjay , Hayes Erin , Healy Olivia M. , Pan Donald , Yang Wendy H. , Silver Whendee L. , Anderson Christopher L. , Voshall Adam , Fernando Samodha C. , Moriyama Etsuko N. , Herr Joshua R. , Weber Karrie A.
Published: January 2021

A moderately acidophilic
Geobacter
sp. strain, strain FeAm09, was isolated from forest soil. The complete genome sequence is 4,099,068 bp, with an average GC content of 61.1%. No plasmids were detected. The genome contains a total of 3,843 genes and 3,608 protein-coding genes, including genes supporting iron and nitrogen biogeochemical cycling.
Fifteen-minute consultation: how to identify and treat children with acute kidney injury
Authors: Scott Maura , McCall Grace
Published: January 2021

Acute kidney injury (AKI) is under-recognised in children and neonates. It is associated with increased mortality and morbidity along with an increased incidence of chronic kidney disease in adulthood. It is important that paediatricians are able to recognise AKI quickly, enabling prompt treatment of reversible causes. In this article, we demonstrate an approach to recognising paediatric AKI, cessation of nephrotoxic medication, appropriate investigations and the importance of accurately assessing fluid status. The mainstay of treatment is attempting to mimic the kidneys ability to provide electrolyte and fluid homeostasis; this requires close observation and careful fluid management. We discuss referral to paediatric nephrology and the importance of long-term follow-up. We present an approach to AKI through case-presentation.
Fetal alcohol spectrum disorders: an overview of current evidence and activities in the UK
Authors: Schölin Lisa , Mukherjee Raja A S , Aiton Neil , Blackburn Carolyn , Brown Sarah , Flemming Kate M , Gard Paul R , Howlett Helen , Plant Moira , Price Alan D , Shields Jennifer , Smith Lesley A , Suttie Michael , Zammitt David C , Cook Penny A
Published: January 2021

Estimates for the UK suggest that alcohol consumption during pregnancy and prevalence of fetal alcohol spectrum disorder (FASD)—the most common neurodevelopmental condition—are high. Considering the significant health and social impacts of FASD, there is a public health imperative to prioritise prevention, interventions and support. In this article, we outline the current state of play regarding FASD knowledge and research in the UK, which is characterised by a lack of evidence, a lack of dedicated funding and services, and consequently little policy formulation and strategic direction. We highlight progress made to date, as well as current knowledge and service gaps to propose a way forward for UK research.
Acute on chronic back pain as the presentation of an occult foreign body bowel perforation with resultant epidural abscess, osteomyelitis and sepsis
Authors: Guthrie Jeff A , Fazio Michael , Anderson Todd , Carroll Christine
Published: January 2021

A 29-year-old male paratrooper presented to multiple emergency departments (EDs) and his primary provider multiple times over sequential days. Each time, the patient received the same diagnosis of acute on chronic back pain. The patient was treated conservatively and routine MRI of the lumbar spine was performed 5 days after the last visit. It revealed a lesion occupying nearly all the visualised portion of the spinal canal. The patient was immediately called back for further imaging. The patient was then diagnosed with a foreign body perforating the rectosigmoid colon, an epidural abscess and pelvic osteomyelitis. The patient was immediately taken to the ED where he was found to be septic. The foreign body was surgically removed and determined to be a swallowed toothpick. Urgent surgical decompression of epidural space was also performed. The patient then underwent a prolonged but near complete recovery.
COVID-19 myocarditis and postinfection Bell’s palsy
Authors: Dahl Elin Hoffmann , Mosevoll Knut Anders , Cramariuc Dana , Vedeler Christian Alexander , Blomberg Bjørn
Published: January 2021

Here we present the case of a 37-year-old previously healthy man who developed fever, headache and a unilateral, painful neck swelling while working offshore. He had no known contact with anyone with COVID-19; however, due to the ongoing pandemic, a nasopharyngeal swab was performed, which was positive for the virus. After transfer to hospital for assessment his condition rapidly deteriorated, requiring admission to intensive care for COVID-19 myocarditis. One week after discharge he re-presented with unilateral facial nerve palsy. Our case highlights an atypical presentation of COVID-19 and the multifaceted clinical course of this still poorly understood disease.
Refractive change and incidence of myopia among rural Chinese children: the Handan Offspring Myopia Study
Authors: Lin Zhong , Vasudevan Balamurali , Gao Tieying , Zhou Hongjia , Ciuffreda Kenneth J , Liang Yuanbo
Published: January 2021

Purpose

To assess the refractive change and incidence of myopia, as well as their risk factors, among Chinese rural children aged 6–17 years.

Methods

Children who completed the baseline vision examination of the Handan Offspring Myopia Study were re-examined, including both cycloplegic and non-cyloplegic autorefraction, with a mean follow-up time of 42.4±1.47 months.

Results

A total of 601 children (68.5%) who completed both baseline and the follow-up examinations were enrolled. The cumulative refractive change and axial length change were −0.53±1.03 diopter and 0.39±0.46 mm (−0.15 diopter/year and 0.11 mm/year), respectively. A hundred and five out of the 469 non-myopic children at baseline become myopic at the follow-up, yielding a cumulative myopia incidence of 22.4% (95% CI: 18.6% to 26.2%), or annual myopia incidence of 6.3%. After adjustment, younger age (β=0.08, p<0.001), more myopic baseline refraction (β=0.31, p<0.001), larger difference between cycloplegic and non-cycloplegic refraction (β=−0.20, p=0.007) and more myopic paternal refraction (β=0.09, p=0.007) were found to be associated with more rapid myopic refractive change. More myopic baseline refraction (relative risk (RR), 95% CI: 0.19, 0.13–0.28, p<0.001) and more myopic paternal refraction (RR, 95% CI: 0.92, 0.84–1.00, p=0.039) were also associated with myopia incidence.

Conclusion

Relatively low myopic refractive change and myopia incidence were found in this study cohort. Children’s refraction and paternal refraction were associated with both myopic refractive change and myopia incidence. Such information will be helpful for further comparisons in other rural versus urban areas of China, and other countries.
Trends and factors influencing long-acting contraceptive utilisation among contraceptive users in Ethiopia: repeated cross-sectional study
Authors: Tadele Afework , Berhanu Mahilet
Published: January 2021

Objectives

Although nationally representative data are helpful in designing strategies and policies of programmes in a country, there is paucity of evidence with regard to trends and factors influencing utilisation of long-acting contraceptives (LACs). Thus, this study aimed to assess the trends and factors influencing LAC utilisation among contraceptive users in Ethiopia.

Design

A repeated cross-sectional study.

Setting and participants

The Performance Monitoring and Accountability (PMA2020) national community-based survey data were used, and 2035 contraceptive users participated. To identify trends, proportions of LAC users were analysed using PMA data from round 1 in January 2014 to round 6 in July 2018.

Main outcome measures

Users using LAC methods or otherwise.

Results

There was a difference in trends in LAC utilisation in the last 4.5 years. There was a 7% increase in the proportion of implant users, while there were no significant changes in utilisation of intrauterine device and female sterilisation. Women in the middle wealth quintile were 1.7 times more likely than those in the lowest quintile to use LAC, while contraceptive users who received recommendations from healthcare providers as well as those who made decisions jointly with healthcare providers were more likely to use LAC compared with those who decided on their own. Women with access to their desired method of contraception were less likely to use LAC, while those informed about intrauterine contraceptive device were more likely to use LAC compared with their counterparts. Women served at health posts, private hospitals and others (family planning clinics, pharmacies and non-governmental organisations) were less likely to use LAC compared with women served at public hospitals.

Conclusion

Overall the utilisation of LAC in Ethiopia is low. Therefore, much has to be done in terms of raising awareness about intrauterine device, how healthcare providers can help users in choosing contraceptive methods, and sharing of experiences between public hospitals and other family planning service delivery points.
Singing for people with aphasia (SPA): results of a pilot feasibility randomised controlled trial of a group singing intervention investigating acceptability and feasibility
Authors: Tarrant Mark , Carter Mary , Dean Sarah Gerard , Taylor Rod , Warren Fiona C , Spencer Anne , Adamson Jane , Landa Paolo , Code Chris , Backhouse Amy , Lamont Ruth A , Calitri Raff
Published: January 2021

Objectives

Pilot feasibility randomised controlled trial (RCT) for the singing groups for people with aphasia (SPA) intervention to assess: (1) the acceptability and feasibility of participant recruitment, randomisation and allocation concealment; (2) retention rates; (3) variance of continuous outcome measures; (4) outcome measure completion and participant burden; (5) fidelity of intervention delivery; (6) SPA intervention costs; (7) acceptability and feasibility of trial and intervention to participants and others involved.

Design

A two-group, assessor-blinded, randomised controlled external pilot trial with parallel mixed methods process evaluation and economic evaluation.

Setting

Three community-based cohorts in the South-West of England.

Participants

Eligible participants with post-stroke aphasia were randomised 1:1 to SPA or control.

Intervention

The manualised SPA intervention was delivered over 10 weekly singing group sessions, led by a music facilitator and assisted by an individual with post-stroke aphasia. The intervention was developed using the Information-Motivation-Behavioural skills model of behaviour change and targeted psychosocial outcomes. Control and intervention participants all received an aphasia information resource pack.

Outcome measures

Collected at baseline, 3 and 6 months post-randomisation, candidate primary outcomes were measured (well-being, quality of life and social participation) as well as additional clinical outcomes. Feasibility, acceptability and process outcomes included recruitment and retention rates, and measurement burden; and trial experiences were explored in qualitative interviews.

Results

Of 87 individuals screened, 42 participants were recruited and 41 randomised (SPA=20, control=21); 36 participants (SPA=17, control=19) completed 3-month follow-up, 34 (SPA=18, control=16) completed 6-month follow-up. Recruitment and retention (83%) were acceptable for a definitive RCT, and participants did not find the study requirements burdensome. High fidelity of the intervention delivery was shown by high attendance rates and facilitator adherence to the manual, and participants found SPA acceptable. Sample size estimates for a definitive RCT and primary/secondary outcomes were identified.

Conclusions

The SPA pilot RCT fulfilled its objectives, and demonstrated that a definitive RCT of the intervention would be both feasible and acceptable.

Trial registration number

NCT03076736.
Efficacy of cognitive behavioural therapy-based smartphone app for smoking cessation in China: a study protocol of a randomised controlled trial
Authors: Liao Yanhui , Tang Jinsong
Published: January 2021

Introduction

A number of smartphone apps have been proved to be effective in assisting smoking cessation in many countries, but little is known about the effectiveness of smartphone apps that assist in smoking cessation in China. This study aims to evaluate the efficacy of cognitive behavioural therapy (CBT)-based cigarette smoking cessation smartphone app for treatment-seeking smokers in China.

Methods and analysis

In this remote control, randomised controlled trial, the participants will be randomised and allocated in 1:1 ratio to smoking cessation app intervention group or to control group. Participants will receive a 12-week intervention (treatment group will receive CBT-based cigarette smoking cessation smartphone app intervention and control group will receive text messaging-based control intervention) with follow-up at week 26. The primary outcome includes biologically verified continuous smoking abstinence at week 26 after the quit date. The main secondary outcomes include 7-hour point prevalence smoking abstinence at weeks 1, 2, 3, 4, 8, 12, 16, 20 and 26, self-reported continuous smoking abstinence at weeks 4, 8, 12, 16, 20 and 26 after the quit date. About 1200 smokers with willingness to make a quit attempt within a month from January 2021 to August 2021 or until the recruitment process is complete will be recruited. The final 26-week follow-up will be completed in August 2022. The trial results will be available by the end of 2022. All analyses will be done on an intention-to-treat basis. Based on the previous studies, we hypothesised that this CBT-based app will be an effective, feasible and accessible smoking cessation app in China.

Ethics and dissemination

Ethical approval was obtained from the ethics committee of Sir Run Run Shaw Hospital, an affiliate of Zhejiang University, Medical College (number: 20200129-33). Study results will be disseminated via research conference presentations and peer-reviewed publications.

Trial registration number

NCT04421170.
Causal effect of children’s secondary education on parental health outcomes: findings from a natural experiment in Botswana
Authors: Ludwig Jan Ole , Davies Neil M , Bor Jacob , De Neve Jan-Walter
Published: January 2021

Objectives

A growing literature highlights the intergenerational transmission of human capital from parents to children. However, far less is known about ‘upward transmission’ from children to parents. In this study, we use a 1996 Botswana education policy reform as a natural experiment to identify the causal effect of children’s secondary schooling on their parents’ health.

Setting

Botswana’s decennial census (2001 and 2011). Data were obtained through the Integrated Public Use Microdata Series and are 10% random samples of the complete population in each of these census years.

Participants

Survey respondents who were citizens born in Botswana, at least 18 years old at the time of the census and born in or after 1975 (n=89 721).

Primary and secondary outcome measures

Parental survival and disability at the time of the census, separately for mothers and fathers.

Results

The 1996 reform caused a large increase in grade 10 enrolment, inducing an additional 0.4 years of schooling for the first cohorts affected (95% CI 0.3 to 0.5, p<0.001). The reform, however, had no effect on parental survival and disability by the time exposed child cohorts reach age 30. Results were robust to a wide array of sensitivity analyses.

Conclusions

This study found little evidence that parents’ survival and disability were affected by their offspring’s educational attainment in Botswana. Parents’ health may not be necessarily affected by increasing their offspring’s educational attainment.
Association of community types and features in a case–control analysis of new onset type 2 diabetes across a diverse geography in Pennsylvania
Authors: Schwartz B S , Pollak Jonathan , Poulsen Melissa N , Bandeen-Roche Karen , Moon Katherine , DeWalle Joseph , Siegel Karen , Mercado Carla , Imperatore Giuseppina , Hirsch Annemarie G
Published: January 2021

Objectives

To evaluate associations of community types and features with new onset type 2 diabetes in diverse communities. Understanding the location and scale of geographic disparities can lead to community-level interventions.

Design

Nested case–control study within the open dynamic cohort of health system patients.

Setting

Large, integrated health system in 37 counties in central and northeastern Pennsylvania, USA.

Participants and analysis

We used electronic health records to identify persons with new-onset type 2 diabetes from 2008 to 2016 (n=15 888). Persons with diabetes were age, sex and year matched (1:5) to persons without diabetes (n=79 435). We used generalised estimating equations to control for individual-level confounding variables, accounting for clustering of persons within communities. Communities were defined as (1) townships, boroughs and city census tracts; (2) urbanised area (large metro), urban cluster (small cities and towns) and rural; (3) combination of the first two; and (4) county. Community socioeconomic deprivation and greenness were evaluated alone and in models stratified by community types.

Results

Borough and city census tract residence (vs townships) were associated (OR (95% CI)) with higher odds of type 2 diabetes (1.10 (1.04 to 1.16) and 1.34 (1.25 to 1.44), respectively). Urbanised areas (vs rural) also had increased odds of type 2 diabetes (1.14 (1.08 to 1.21)). In the combined definition, the strongest associations (vs townships in rural areas) were city census tracts in urban clusters (1.41 (1.22 to 1.62)) and city census tracts in urbanised areas (1.33 (1.22 to 1.45)). Higher community socioeconomic deprivation and lower greenness were each associated with increased odds.

Conclusions

Urban residence was associated with higher odds of type 2 diabetes than for other areas. Higher community socioeconomic deprivation in city census tracts and lower greenness in all community types were also associated with type 2 diabetes.
Characteristics, physiology and mortality of intubated patients in an emergency care population in sub-Saharan Africa: a prospective cohort study from Kigali, Rwanda
Authors: Mbanjumucyo Gabin , Aluisio Adam , Cattermole Giles N
Published: January 2021

Background

Formalised emergency departments (ED) are in early development in sub-Saharan Africa and there are limited data on emergency airway management in those settings. This study evaluates characteristics and outcomes of ED endotracheal intubation, as well as risk factors for mortality, at a teaching hospital in Rwanda.

Methods

This was a prospective observational study of consecutive patients requiring endotracheal intubation at the University Teaching Hospital of Kigali ED conducted between 1 January and 31 December 2017. A standardised data collection tool was used to record patient demographics, preintubation clinical presentation, indication for intubation, vital signs. medications and equipment used, and periintubation complications. The primary outcome was in-hospital mortality. Univariate associations were determined for risks of mortality.

Results

Of 198 intubations were analysed, 72.7% were male and the median age was 35 years (IQR 23–51). Airway protection was the most common indication for intubation (73.7%). Rapid sequence intubation was performed in 74.2% of cases; sedative-only facilitated intubation in 20.6% and non-drug assisted in 5.2%. The most common agents used were Ketamine for sedation (85.4%) and vecuronium for paralysis (65.7%). All patients were successfully intubated within three attempts, 85.4% on the first attempt. During intubation, 23.1% of patients experienced hypoxia, 6.7% aspiration and 3.6% cardiac arrest. Median ED length of stay was 2 days. Outcome data were available for 164 patients of whom 67.7% died. Bonferroni-corrected univariate analysis demonstrated that mortality was associated with higher postintubation shock index (p=0.0007) and lower postintubation systolic blood pressure (SBP) (p=0.0006).

Conclusion

The first-attempt and overall success rates for intubation in this ED in Rwanda were comparable to those in high-income countries (HIC). Mortality postintubation is associated with lower postintubation SBP and higher postintubation shock index. The high complication and mortality rates suggest the need for better resources and training to address differences in compared with HIC.
Implementation of the ‘TAKE STOCK’ Hot Debrief Tool in the ED: a quality improvement project
Authors: Sugarman Max , Graham Blair , Langston Sarah , Nelmes Pam , Matthews John
Published: January 2021

Hot debriefing (HoD) describes a structured team-based discussion which may be initiated following a significant event. Benefits may include improved teamwork, staff well-being and identification of learning opportunities. Existing literature indicates that while staff value HoD following significant events, it is infrequently undertaken in practice. Internationally, several frameworks for HoD have been developed, although none are widely adopted for use in the ED. A quality improvement project was conducted to introduce HoD into a single UK ED in North West England, between January and March 2019. Following stakeholder consultation, the 9-item ‘TAKE STOCK’ tool was developed. Implementation of the tool increased the number of HoD (0—2.2 HoD episodes/week). Findings from the first plan-do-study-act (PDSA) cycle are presented, which revealed the key strengths and limitations of this model. Staff perceptions of the tool were evaluated using a self-administered short questionnaire designed by the authors. Satisfaction with TAKE STOCK was assessed using 10-point numerical scales. Across respondents (n−15), average satisfaction scores exceeded 9 out of 10 concerning patient care, staff self-care, decision-making, education, teamwork and identification of equipment issues. Implementation of HoD into the ED is feasible and viewed as beneficial by staff. Implementation toolkits for TAKE STOCK have been requested by 42 additional UK hospitals and ambulance trusts, demonstrating significant interest in its use. Research is now required to formally validate HoD frameworks for use in the ED, and assess whether HoD results in sustained improvements to staff and patient outcomes.
Global burden of disease: acute-on-chronic liver failure, a systematic review and meta-analysis
Authors: Mezzano Gabriel , Juanola Adria , Cardenas Andres , Mezey Esteban , Hamilton James P , Pose Elisa , Graupera Isabel , Ginès Pere , Solà Elsa , Hernaez Ruben
Published: January 2021

Background and aims

Acute-on-chronic liver failure (ACLF) is characterised by acute decompensation of cirrhosis associated with organ failures. We systematically evaluated the geographical variations of ACLF across the world in terms of prevalence, mortality, aetiology of chronic liver disease (CLD), triggers and organ failures.

Methods

We searched EMBASE and PubMed from 3/1/2013 to 7/3/2020 using the ACLF-EASL-CLIF (European Association for the Study of the Liver-Chronic Liver Failure) criteria. Two investigators independently conducted the abstract selection/abstraction of the aetiology of CLD, triggers, organ failures and prevalence/mortality by presence/grade of ACLF. We grouped countries into Europe, East/South Asia and North/South America. We calculated the pooled proportions, evaluated the methodological quality using the Newcastle-Ottawa Scale and statistical heterogeneity, and performed sensitivity analyses.

Results

We identified 2369 studies; 30 cohort studies met our inclusion criteria (43 206 patients with ACLF and 140 835 without ACLF). The global prevalence of ACLF among patients admitted with decompensated cirrhosis was 35% (95% CI 33% to 38%), highest in South Asia at 65%. The global 90-day mortality was 58% (95% CI 51% to 64%), highest in South America at 73%. Alcohol was the most frequently reported aetiology of underlying CLD (45%, 95% CI 41 to 50). Infection was the most frequent trigger (35%) and kidney dysfunction the most common organ failure (49%). Sensitivity analyses showed regional estimates grossly unchanged for high-quality studies. Type of design, country health index, underlying CLD and triggers explained the variation in estimates.

Conclusions

The global prevalence and mortality of ACLF are high. Region-specific variations could be explained by the type of triggers/aetiology of CLD or grade. Health systems will need to tailor early recognition and treatment of ACLF based on region-specific data.
Prescription opioid use among drivers in British Columbia, 1997–2016
Authors: Staples John A , Erdelyi Shannon , Moe Jessica , Khan Mayesha , Chan Herbert , Brubacher Jeffrey R
Published: January 2021

Background

Opioids increase the risk of traffic crash by limiting coordination, slowing reflexes, impairing concentration and producing drowsiness. The epidemiology of prescription opioid use among drivers remains uncertain. We aimed to examine population-based trends and geographical variation in drivers’ prescription opioid consumption.

Methods

We linked 20 years of province-wide driving records to comprehensive population-based prescription data for all drivers in British Columbia (Canada). We calculated age- and sex-standardised rates of prescription opioid consumption. We assessed temporal trends using segmented linear regression and examined regional variation in prescription opioid use using maps and graphical techniques.

Results

A total of 46 million opioid prescriptions were filled by 3.0 million licensed drivers between 1997 and 2016. In 2016 alone, 14.7% of all drivers filled at least one opioid prescription. Prescription opioid use increased from 238 morphine milligram equivalents per driver year (MMEs/DY) in 1997 to a peak of 834 MMEs/DY in 2011. Increases in MMEs/DY were greatest for higher potency and long-acting prescription opioids. The interquartile range of prescription opioid dispensation by geographical region increased from 97 (Q1=220, Q3=317) to 416 (Q1=591, Q3=1007) MMEs/DY over the study interval.

Implications

Patterns of prescription opioid consumption among drivers demonstrate substantial temporal and geographical variation, suggesting they may be modified by clinical and policy interventions. Interventions to curtail use of potentially impairing prescription medications might prevent impaired driving.
Chromosome 10q-linked FSHD identifies DUX4 as principal disease gene
Authors: Lemmers Richard J L F , van der Vliet Patrick J , Blatnik Ana , Balog Judit , Zidar Janez , Henderson Don , Goselink Rianne , Tapscott Stephen J , Voermans Nicol C , Tawil Rabi , Padberg George W A M , van Engelen Baziel GM , van der Maarel Silvère M
Published: January 2021

Background

Facioscapulohumeral dystrophy (FSHD) is an inherited muscular dystrophy clinically characterised by muscle weakness starting with the facial and upper extremity muscles. A disease model has been developed that postulates that failure in somatic repression of the transcription factor DUX4 embedded in the D4Z4 repeat on chromosome 4q causes FSHD. However, due to the position of the D4Z4 repeat close to the telomere and the complex genetic and epigenetic aetiology of FSHD, there is ongoing debate about the transcriptional deregulation of closely linked genes and their involvement in FSHD.

Method

Detailed genetic characterisation and gene expression analysis of patients with clinically confirmed FSHD and control individuals.

Results

Identification of two FSHD families in which the disease is caused by repeat contraction and DUX4 expression from chromosome 10 due to a de novo D4Z4 repeat exchange between chromosomes 4 and 10. We show that the genetic lesion causal to FSHD in these families is physically separated from other candidate genes on chromosome 4. We demonstrate that muscle cell cultures from affected family members exhibit the characteristic molecular features of FSHD, including DUX4 and DUX4 target gene expression, without showing evidence for transcriptional deregulation of other chromosome 4-specific candidate genes.

Conclusion

This study shows that in rare situations, FSHD can occur on chromosome 10 due to an interchromosomal rearrangement with the FSHD locus on chromosome 4q. These findings provide further evidence that DUX4 derepression is the dominant disease pathway for FSHD. Hence, therapeutic strategies should focus on DUX4 as the primary target.
Predictors of survival in frontotemporal lobar degeneration syndromes
Authors: El-Wahsh Shadi , Finger Elizabeth C , Piguet Olivier , Mok Vincent , Rohrer Jonathan D , Kiernan Matthew C , Ahmed Rebekah M
Published: January 2021

After decades of research, large-scale clinical trials in patients diagnosed with frontotemporal lobar degeneration (FTLD) are now underway across multiple centres worldwide. As such, refining the determinants of survival in FTLD represents a timely and important challenge. Specifically, disease outcome measures need greater clarity of definition to enable accurate tracking of therapeutic interventions in both clinical and research settings. Multiple factors potentially determine survival, including the clinical phenotype at presentation; radiological patterns of atrophy including markers on both structural and functional imaging; metabolic factors including eating behaviour and lipid metabolism; biomarkers including both serum and cerebrospinal fluid markers of underlying pathology; as well as genetic factors, including both dominantly inherited genes, but also genetic modifiers. The present review synthesises the effect of these factors on disease survival across the syndromes of frontotemporal dementia, with comparison to amyotrophic lateral sclerosis, progressive supranuclear palsy and corticobasal syndrome. A pathway is presented that outlines the utility of these varied survival factors for future clinical trials and drug development. Given the complexity of the FTLD spectrum, it seems unlikely that any single factor may predict overall survival in individual patients, further suggesting that a precision medicine approach will need to be developed in predicting disease survival in FTLD, to enhance drug target development and future clinical trial methodologies.
Three pitfalls of accountable healthcare rationing
Authors: Eijkholt Marleen , Broekman Marike , Balak Naci , Mathiesen Tiit
Published: January 2021

A pandemic may cause a sudden imbalance between available medical resources and medical needs where fundamental care to a patient cannot be delivered. Inability to fulfil a professional commitment to deliver care as needed can lead to distress among caregivers and patients. This distress is sometimes alleviated through mechanisms that hide the facts that care is rationed and not all medical needs are met. We have identified three mechanisms that jeopardise accountable and optimal allocation of resources: (1) hidden value judgements that allow rationing under the disguise of triage or prioritisation, (2) disguised conflict of interest between societal and individual patient’s needs and (3) concealed biases in the application of medical tools. Under these three pitfalls decisions of resource allocation and who gets treated are handled as medical decisions: normative decisions are concealed and perceived as falling with the realm of medical judgement. Value judgements and moral agency are hidden to offer a ‘false sense of medical judgement’, while in fact there are several ethical judgements and biases at stake. The three pitfalls entail hidden normative deliberation and are inappropriate for sustainable healthcare delivery and resource allocation. We believe it is necessary to maintain transparency in decision making under conditions of insufficient resources to maintain trust in professional care givers and secure fair treatment allocation. Recognition of the pitfalls, by applying our recommendations, may help to ensure transparent and accountable distribution of care and contribute to public acceptance of the ethics behind rationing.
Rapid response team integration at a quaternary care academic centre: new paradigm for critical care organistions
Authors: Gupta Rohit R , Gonzalez Cristhian , Wang Jennifer , Martillo Miguel , Kohli-Seth Roopa
Published: January 2021

Background

Decompensating patients require expeditious and focused care at the bedside. This can be particularly challenging when there are multiple layers of providers, each with differing specialisation, experience and autonomy. We examined the impact of our intensivist-driven hospital-wide rapid response team (RRT) at our 1171-bed quaternary care centre.

Design

Single-centre retrospective cohort study.

Methods

RRT service was implemented to assess, manage and triage acutely ill patients outside the intensive care unit (ICU). Criteria for consultation and workflow were established. The 24/7 team was led by an intensivist and included nurse practitioners and respiratory therapists. Over 3 years, we reviewed the impact of the RRT on patient outcomes and critical care support beyond the ICU.

Results

Over 3 years, the RRT received 31 392 consults for 12 122 individual patients averaging 30 consults over 24 hours. 58.9% of the calls received were for sepsis alerts/risk of decompensation and 41.1% of the consults were for reasons of acute decompensation. Among patients that were seen by the RRT, over the course of their hospital stay, 14% were upgraded to a step-down unit, 18% were upgraded to the ICU and 68% completed care without requiring any escalation. The average mortality rate for patients seen by the RRT service during their hospital stay was 11.3% with an average 30-day readmission rate of 16.5% and average hospital length of stay 16 days without significant variation between the 3 years.

Conclusions

Intensivist-led RRT ensured consistent high value care. Early intervention and consistent supervision enabled timely and efficient delivery of critical care services.
Guidelines for mono, double and triple antithrombotic therapy
Authors: van Uden Renate C A E , Houtenbos Ilse , Griffioen-Keijzer Anita , Odekerken Diego A M , van den Bemt Patricia M L A , Becker Matthijs L
Published: January 2021

Guidelines for antithrombotic therapy are complex, especially if a patient has several indications that require antithrombotic therapy. In general, no patient should receive lifelong double or triple antithrombotic therapy. In this overview, we outline the most common indications for mono, double and triple antithrombotic therapy; the preferred antithrombotic therapy and the recommended duration of therapy. Both antiplatelet therapy and therapeutic anticoagulation therapy with vitamin K antagonists or direct oral anticoagulants were included. European guidelines were used or, if no European guidelines were available, the Dutch guidelines were used.
Determinants associated with viable genital or rectalChlamydia trachomatisbacterial load (FemCure)
Authors: Janssen Kevin J H , Wolffs Petra F G , Hoebe Christian J P A , Heijman Titia , Götz Hannelore M , Bruisten Sylvia M , Schim van der Loeff Maarten , de Vries Henry J , Dukers-Muijrers Nicole H T M
Published: January 2021

Background

Chlamydia trachomatis(CT) is routinely diagnosed by nucleic acid amplification tests (NAATs), which are unable to distinguish between nucleic acids from viable and non-viable CT organisms.

Objectives

We applied our recently developed sensitive PCR (viability PCR) technique to measure viable bacterial CT load and explore associated determinants in 524 women attending Dutch sexual health centres (STI clinics), and who had genital or rectal CT.

Methods

We included women participating in the FemCure study (Netherlands, 2016–2017). At the enrolment visit (pre-treatment), 524 were NAAT positive (n=411 had genital and rectal CT, n=88 had genital CT only and n=25 had rectal CT only). We assessed viable rectal and viable genital load using V-PCR. We presented mean load (range 0 (non-viable) to 6.5 log10CT/mL) and explored potential associations with urogenital symptoms (coital lower abdominal pain, coital blood loss, intermenstrual bleeding, altered vaginal discharge, painful or frequent micturition), rectal symptoms (discharge, pain, blood loss), other anatomical site infection and sociodemographics using multivariable regression analyses.

Results

In genital (n=499) CT NAAT-positive women, the mean viable load was 3.5 log10CT/mL (SD 1.6). Genital viable load was independently associated with urogenital symptoms—especially altered vaginal discharge (Beta=0.35, p=0.012) and with concurrent rectal CT (aBeta=1.79; p<0.001). Urogenital symptoms were reported by 50.3% of women; their mean genital viable load was 3.6 log10CT/mL (vs 3.3 in women without symptoms). Of 436 rectal CT NAAT-positive women, the mean rectal viable load was 2.2 log10CT/mL (SD 2.0); rectal symptoms were reported by 2.5% (n=11) and not associated with rectal viable load.

Conclusion

Among women diagnosed with CT in an outpatient clinical setting, viable genital CT load was higher in those reporting urogenital symptoms, but the difference was small. Viable genital load was substantially higher when women also had a concurrent rectal CT.

Trial registration number

ClinicalTrials.govNCT02694497.
Diagnostic role of CXCL13 and CSF serology in patients with neurosyphilis
Authors: Li Dongdong , Huang Xiyue , Shi Mingqiao , Luo Lan , Tao Chuanmin
Published: January 2021

Background

Considering the unknown prevalence of neurosyphilis in West China, and the confusing diagnosis of neurosyphilis, the role of CSF_CXCL13 and syphilis serology was studied to provide a more accurate reference for the clinical detection and diagnosis of neurosyphilis.

Methods

A retrospective data set I was used to investigate the prevalence of neurosyphilis, as well as the laboratory characteristics of 244 patients. Besides, to explore the diagnostic value of CSF_CXCL13 and syphilis serology for neurosyphilis, another 116 CSF_serum paired samples (data set II) were collected from 44 neurosyphilis and 72 non-neurosyphilis/syphilis patients.

Results

About 6.25% (156 out of 2494) syphilis was neurosyphilis. WhenTreponema palliduminfection occurs, syphilis serology (sero_TRUST ≥1:16 and sero_TPPA titre ≥1:10240) can be good predictors of neurosyphilis, as well as syphilis CSF serology (CSF_TPPA ≥1:320, CSF_TRUST and venereal disease research laboratory). The sensitivity of serology in neurosyphilis can be complemented by CSF_CXCL13, which could be the therapy monitor of neurosyphilis.

Conclusion

Due to the lack of ideal biomarkers for neurosyphilis, the importance of syphilis serology cannot be ignored, and their combination with CSF_CXCL13 or other biomarkers should be further investigated.
Impact of cigarette package warnings on attitudes towards sharing and gifting cigarettes in China: a nationwide study of smokers and non-smokers
Authors: Liao Yanhui , Tang Jinsong , McNeill Ann , Kelly Brian C , Cohen Joanna E
Published: January 2021

Background

Sharing and gifting cigarettes are common in China. These social practices promote cigarette consumption, and consequently may reduce quit rates in China. This study investigated sharing and gifting cigarettes, and the relationship of observing pictorial health warnings to attitudes towards sharing and gifting cigarettes in China.

Methods

We conducted an online nationwide cross-sectional study of 9818 adults in China. Experiences of sharing and gifting cigarettes, and attitudes towards sharing and gifting cigarettes before and after viewing text and pictorial health warnings on the packages were assessed, and compared between smokers and non-smokers.

Results

Most current smokers reported experiences of sharing (97%) and gifting (around 90%) cigarettes. Less than half of non-smokers reported sharing cigarettes and receiving gifted cigarettes, but over half (61.4%) gave cigarettes as a gift to others. More than half of non-smokers but less than 10% of smokers disagreed with sharing and gifting cigarettes. After observing both text and pictorial health warnings on the packages, disagreement with sharing and gifting cigarettes increased by more than 10 percentage points among both smokers and non-smokers.

Conclusion

Having pictorial health warnings on cigarette packages may reduce sharing and gifting cigarettes in China.
Automated Adult Epilepsy Diagnostic Tool Based on Interictal Scalp Electroencephalogram Characteristics: A Six-Center Study
Authors: Thomas John , Thangavel Prasanth , Peh Wei Yan , Jing Jin , Yuvaraj Rajamanickam , Cash Sydney S. , Chaudhari Rima , Karia Sagar , Rathakrishnan Rahul , Saini Vinay , Shah Nilesh , Srivastava Rohit , Tan Yee-Leng , Westover Brandon , Dauwels Justin
Published: January 2021

The diagnosis of epilepsy often relies on a reading of routine scalp electroencephalograms (EEGs). Since seizures are highly unlikely to be detected in a routine scalp EEG, the primary diagnosis depends heavily on the visual evaluation of Interictal Epileptiform Discharges (IEDs). This process is tedious, expert-centered, and delays the treatment plan. Consequently, the development of an automated, fast, and reliable epileptic EEG diagnostic system is essential. In this study, we propose a system to classify EEG as epileptic or normal based on multiple modalities extracted from the interictal EEG. The ensemble system consists of three components: a Convolutional Neural Network (CNN)-based IED detector, a Template Matching (TM)-based IED detector, and a spectral feature-based classifier. We evaluate the system on datasets from six centers from the USA, Singapore, and India. The system yields a mean Leave-One-Institution-Out (LOIO) cross-validation (CV) area under curve (AUC) of 0.826 (balanced accuracy (BAC) of 76.1%) and Leave-One-Subject-Out (LOSO) CV AUC of 0.812 (BAC of 74.8%). The LOIO results are found to be similar to the interrater agreement (IRA) reported in the literature for epileptic EEG classification. Moreover, as the proposed system can process routine EEGs in a few seconds, it may aid the clinicians in diagnosing epilepsy efficiently.