bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic features of placebo effects addressing persistent insomnia disorder: A meta‐analysis of placebo‐controlled randomized clinical trials
Authors: Jiang Binghu , He Dongmei , Guo Zhiwei , Gao Zhanhui
Published: February 2020

It has been accepted knowledge that placebo effects have been significant in insomnia clinical trials. However, the dynamic features of placebo effects have not been clarified. Our aim was therefore to conduct a meta‐analysis of placebo‐controlled randomized clinical trials to characterize the dynamic features of placebo effects addressing persistent insomnia disorder. We performed a comprehensive literature search for randomized, placebo‐controlled, double‐blind clinical trials evaluating the efficacy of therapeutic regimens addressing persistent insomnia disorder. We pooled separate effect size estimates (Hedge's g) of placebo and regimen conditions across trials for outcome measures, and multilevel mixed‐effects models were used to explore potential sources of heterogeneity. The placebo effects were significant and robust to improve the symptoms of insomnia, and subjective measures were significantly smaller than objective measures (p < .001), but placebo response rates were nearly identical between subjective and objective measures. The overall placebo effects were influenced by publication year (p = .015), treatment duration (p = .010), sample size (p < .001) and therapeutic regimen (p < .001). Placebo effects showed a diphasic feature within treatment duration: initially a decrease and subsequently being stable; a sustained decline trend after withdrawals; and a steady‐to‐upward trend for a mixed therapeutic regimens in a large‐scale period over decades. The dynamic features of placebo effects addressing persistent insomnia disorder may lead to the development and validation of dosing strategies that require less medication exposure to maintain clinical effects.
Novel (p)ppGpp0 suppressor mutations reveal an unexpected link between methionine catabolism and GTP synthesis in Bacillus subtilis
Authors: Osaka Natsuki , kanesaki Yu , Watanabe Megumi , Watanabe Satoru , Chibazakura Taku , Takada Hiraku , Yoshikawa Hirofumi , Asai Kei
Published: February 2020

In bacteria, guanosine (penta)tetra‐phosphate ([p]ppGpp) is essential for controlling intracellular metabolism that is needed to adapt to environmental changes, such as amino acid starvation. The (p)ppGpp0 strain of Bacillus subtilis, which lacks (p)ppGpp synthetase, is unable to form colonies on minimal medium. Here, we found suppressor mutations in the (p)ppGpp0 strain, in the purine nucleotide biosynthesis genes, prs, purF and rpoB/C, which encode RNA polymerase core enzymes. In comparing our work with prior studies of ppGpp0 suppressors, we discovered that methionine addition masks the suppression on minimal medium, especially of rpoB/C mutations. Furthermore, methionine addition increases intracellular GTP in rpoB suppressor and this effect is decreased by inhibiting GTP biosynthesis, indicating that methionine addition activated GTP biosynthesis and inhibited growth under amino acid starvation conditions in (p)ppGpp0 backgrounds. Furthermore, we propose that the increase in intracellular GTP levels induced by methionine is due to methionine derivatives that increase the activity of the de novo GTP biosynthesis enzyme, GuaB. Our study sheds light on the potential relationship between GTP homeostasis and methionine metabolism, which may be the key to adapting to environmental changes.
Stepping forward from relevance in mycorrhizal ecology
Authors: Smith Gabriel R. , Peay Kabir G.
Published: February 2020

This article is a Commentary on Fernandez et al., 226: 569–582.
Segmental infantile hemangioma and concomitant hypertension in three African American neonates
Authors: Kullberg Sara A. , Rheault Michelle N. , Haggstrom Anita , Maguiness Sheilagh M.
Published: February 2020

We present three African American infants with segmental, ulcerated infantile hemangiomas and concomitant, persistent hypertension. When treated with beta‐blocker therapy, the hemangiomas decreased in size and the ulcerations resolved, but there was no impact on the elevated blood pressure in one of our patients. We failed to identify any associations between infantile hemangioma and hypertension in the literature.
Real‐time biofeedback integrated into neuromuscular training reduces high‐risk knee biomechanics and increases functional brain connectivity: A preliminary longitudinal investigation
Authors: Diekfuss Jed A. , Grooms Dustin R. , Bonnette Scott , DiCesare Christopher A. , Thomas Staci , MacPherson Ryan P. , Ellis Jonathan D. , Kiefer Adam W. , Riley Michael A. , Schneider Daniel K. , Gadd Brooke , Kitchen Katie , Barber Foss Kim D. , Dudley Jonathan A. , Yuan Weihong , Myer Gregory D.
Published: February 2020

Prospective evidence indicates that functional biomechanics and brain connectivity may predispose an athlete to an anterior cruciate ligament injury, revealing novel neural linkages for targeted neuromuscular training interventions. The purpose of this study was to determine the efficacy of a real‐time biofeedback system for altering knee biomechanics and brain functional connectivity. Seventeen healthy, young, physically active female athletes completed 6 weeks of augmented neuromuscular training (aNMT) utilizing real‐time, interactive visual biofeedback and 13 served as untrained controls. A drop vertical jump and resting state functional magnetic resonance imaging were separately completed at pre‐ and posttest time points to assess sensorimotor adaptation. The aNMT group had a significant reduction in peak knee abduction moment (pKAM) compared to controls (p = .03, d = 0.71). The aNMT group also exhibited a significant increase in functional connectivity between the right supplementary motor area and the left thalamus (p = .0473 after false discovery rate correction). Greater percent change in pKAM was also related to increased connectivity between the right cerebellum and right thalamus for the aNMT group (p = .0292 after false discovery rate correction, r2 = .62). No significant changes were observed for the controls (ps > .05). Our data provide preliminary evidence of potential neural mechanisms for aNMT‐induced motor adaptations that reduce injury risk. Future research is warranted to understand the role of neuromuscular training alone and how each component of aNMT influences biomechanics and functional connectivity.
Linguistic predictability influences auditory stimulus classification within two concurrent speech streams
Authors: Szalárdy Orsolya , Tóth Brigitta , Farkas Dávid , Orosz Gábor , Honbolygó Ferenc , Winkler István
Published: February 2020

Acoustic predictability has been shown to affect auditory stream segregation, while linguistic predictability is known to be an important factor in speech comprehension. We tested the effects of linguistic predictability on auditory stream segregation and target detection by assessing the event‐related potentials elicited by targets and distractors in participants presented with two concurrent speech streams. The linguistic cues of predictability varied over four levels. In the three real speech conditions, natural speech was presented with intact phonotactics and sentence prosody: normal speech, word‐salad (randomized word order within each sentence), and pseudo‐words (randomized syllable order within each sentence). The fourth (control) condition delivered a spectrally rotated version of the normal speech condition. Participants were instructed to attend one stream and respond to the natural cough sounds embedded in it. Coughs were present in both streams, serving as targets in the attended and as distractors in the unattended stream. We expected improved target detection with increasing linguistic predictability. The target‐related N2b component's amplitude monotonically increased from the pseudo‐word to the word‐salad and normal speech condition, while no predictability effects were observed for the P3b amplitude or for behavioral responses. The dissociation between the N2b and P3b/behavioral effect suggests that while linguistic predictability enhanced the process of classifying stimuli as potential targets, this did not affect their detection. Furthermore, the observed nonmonotonic distractor N2 (probably MMN) amplitude increase with increasing linguistic predictability is compatible with the notion that linguistic predictability can modulate auditory stream segregation and/or stream selection.
Aurora A inhibition disrupts chromosome condensation and spindle assembly during the first embryonic division in pigs
Authors: Cui Panpan , Abbasi Benazir , Lin Defeng , Rui Rong , Ju Shiqiang
Published: February 2020

As common overexpression of Aurora A in various tumours, much attention has focused on its function in inducing cancer, and its value in cancer therapeutics, considerably less is known regarding its role in the first cleavage division of mammalian embryos. Here, we highlight an indispensable role of Aurora A during the first mitotic division progression of pig embryos just after meiosis. The expression and spatiotemporal localization of Aurora A were initially assessed in pig embryos during the first mitotic division by Western blot analysis and indirect immunofluorescent staining. Then, the potential role of Aurora A was further evaluated using a highly selective Aurora A inhibitor, MLN8054, during this mitotic progression in pig embryos. Aurora A was found to express and exhibit a specific dynamic intracellular localization pattern during the first mitotic division in pig embryos. Aurora A was diffused in the cytoplasm at the prophase stage, and then exhibited a dynamic intracellular localization which was tightly associated with the chromosome and spindle dynamics throughout subsequent mitotic phases. Inhibition of Aurora A by MLN8054 treatment led to the failure of the first cleavage, with the majority of embryos being arrested in prophase of the mitotic division. Further subcellular structure examination showed that Aurora A inhibition not only led to the failure of spindle microtubule assembly, but also resulted in severe defects in chromosome condensation, accompanied by an obvious decrease in p‐TACC3(S558) expression during the prophase of the first mitosis. Together, these results illustrated that Aurora A is crucial for both spindle assembly and chromosome condensation during the first mitotic division in pig embryos, and that the regulation of Aurora A may be associated with its effects on p‐TACC3(S558) expression.
Psychache Predicts Suicide Attempter Status Change in Students Starting University
Authors: Lambert Christine E. , Troister Talia , Ramadan Zeinab , Montemarano Vanessa , Fekken G. Cynthia , Holden Ronald R.
Published: February 2020

Objectives

Unlike many investigations that focus on suicide ideation rather than suicidal behavior, the present research evaluates the merit and relative efficacy of psychache (i.e., unbearable mental pain) for predicting self‐reported suicide attempts among university students who are starting university.

Method

A sample of 516 elevated‐risk undergraduates was assessed during the first three weeks of starting university and, again, 10 weeks later.

Results

Psychache and depression, but not hopelessness, could predict change in suicide attempter status. When measures of psychache, depression, and hopelessness were considered simultaneously, only psychache provided significant, unique predictive power.

Conclusions

Findings are interpreted as supporting Shneidman's model whereby psychache is seen as the cause of suicide.
Peer-Assisted Learning: A New Look at the Good Old Monitoring and Its Motivation from the Perspective of Student-Monitor
Authors: Morais Fernando Henrique Dias , André Júlio César , Santos Emerson Roberto dos , Bizotto Thaís Santana Gastardelo , Brienze Sérgio Luís Aparecido , Lima Alba Regina de Abreu , Fucuta Patrícia Da Silva
Published: February 2020

Peer-assisted learning (PAL), good old monitoring, has been used in medical schools and shown good results in professional development and in developing communication skills among students. This method provides mutual benefits for both monitors/near-peer teachers - NPT and monitored students; however, little is still known about the NPT’ perception about peer-assisted learning. To evaluate the real motivation of students to become NPT, and to investigate how NPT qualify their own teaching activities – such as productivity, performance and difficulties faced – seems to be a crucial step for implementing PAL in medical schools. The research instrument, a semi-structured questionnaire with 11 closed questions and 3 questions that allowed the answer “other” and further explanation, was answered by 26 medical students, NPT of basic disciplines. The results showed a positive effect of PAL on the teaching-learning process, and the real reasons of students to become NPT and the positive impacts of PAL on their academic life. The identification of these potential benefits should encourage medical schools to promote training so students can perform their role as NPT since PAL aids in the development of their clinical and pedagogical skills.
Heat treatment improves the exaggerated exercise pressor reflex in rats with femoral artery occlusion via a reduction in the activity of the P2X receptor pathway
Authors: Qin Lu , Li Qin , Li Jianhua
Published: February 2020

Key points

During exercise, the blood pressure (BP) response is exaggerated in peripheral artery disease (PAD).

We examined whether heat treatment (HT) has beneficial effects on the exaggerated exercise pressor reflex in PAD rats.

With HT (increase in basal muscle temperature of ∼1.5°C for 30 min, twice daily for three continuous days), the amplified BP response to muscle contraction is alleviated in PAD.

We demonstrated that HT attenuates the enhancement of the BP response induced by stimulation of P2X in muscle afferent nerves of PAD rats. HT also attenuates the upregulation of the P2X3 and the increase in P2X currents in the muscle afferent neurons of PAD rats.

Previous heat exposure plays a beneficial role in modifying the exaggeration of the exercise pressor reflex in PAD and a reduction in the activity of the P2X receptor pathway is probably a part of the mechanism mediating this improvement.

The current study was performed to examine if heat treatment (HT) has beneficial effects on the exaggerated exercise pressor reflex in rats with peripheral artery disease (PAD). We further determined if the temperature‐sensitive P2X receptor is involved in the effects of HT. The pressor response to static muscle contraction and α,β‐methylene ATP (αβ‐me ATP, a P2X agonist) was examined. Western blot analysis was used to determine the protein levels of P2X3 in the dorsal root ganglion (DRG), and the whole cell patch clamp was used to examine the amplitude of P2X currents in the DRG neurons. The basal muscle temperature (Tm) was lower in PAD rats than in control rats. Tm was increased by ∼1.5°C and this increase was maintained for 30 min. This HT protocol was performed tweice daily for three continuous days. A greater blood pressure (BP) response to contraction was observed in PAD rats. HT attenuated the amplification of the BP response in PAD rats. HT also attenuated the enhancement of the BP response induced by the arterial injection of αβ‐me ATP in PAD rats. In addition, HT attenuated the upregulation of the P2X3 and increased P2X currents in the DRG neurons of PAD rats. In conclusion, previous heat exposure plays an inhibitory role in modifying the exaggeration of the exercise pressor reflex in PAD and a reduction of the activity of the P2X receptor pathway is probably a part of mechanisms leading to the beneficial effects of HT.
Calidad de vida en los niños que viven con Enfermedad Renal Crónica
Authors: Alvarado Herly Ruth , Casallas Vega Alexander , Andrade Fonseca David , Bertolotto Ana María
Published: February 2020

Introducción: La enfermedad renal en los niños causa diferentes cambios que pueden alterar su calidad de vida; por esta razón, es importante que el profesional de salud busque estrategias que contribuyan a disminuir las secuelas y mejorar la calidad de vida del niño. Objetivo: Caracterizar la calidad de vida de los niños de 8 a 18 años, con diagnóstico de enfermedad renal crónica, según el instrumento KIDSCREEN-27 de una institución de salud de la ciudad de Bogotá (Colombia). Método: Estudio descriptivo de corte transversal con una población de estudio de 62 niños con diagnóstico de enfermedad renal crónica con edades entre 8 y 18 años que asistieron a la consulta de nefrología pediátrica. Resultados: Se analizaron cinco dimensiones, donde cada una tuvo un puntaje ponderado mayor a 70, que se relaciona con una buena calidad de vida; la dimensión con menor puntaje, la de actividad física, tuvo un puntaje de 70,1, y la dimensión de estado de ánimo y sentimientos obtuvo el mayor puntaje, 80,8. Conclusiones: La enfermedad renal crónica puede alterar la calidad de vida, sobre todo en la dimensión de actividad física y entorno escolar. Es primordial que se planteen programas que tengan en cuenta las cinco dimensiones, pero especialmente las que obtuvieron menor puntaje, con el fin de mejorar la calidad de vida de los niños con esta enfermedad.
Modeling Actuation of Ionomer Cilia in Salt Solution Under an External Electric Field
Authors: Boldini Alain , Rosen Maxwell , Cha Youngsu , Porfiri Maurizio
Published: February 2020

A recent experiment by Kim’s group from the University of Nevada, Las Vegas, has shown the possibility of actuating ionomer cilia in salt solution. When these actuators are placed between two external electrodes, across which a small voltage is applied, they move toward the cathode. This is in stark contrast with ionic polymer metal composites, where the same ionomers are plated by metal electrodes but bending occurs toward the anode. Here, we seek to unravel the factors underlying the motion of ionomer cilia in salt solution through a physically based model of actuation. In our model, electrochemistry is described through the Poisson–Nernst–Planck system in terms of concentrations of cations and anions and voltage. Through finite element analysis, we establish that Maxwell stress is the main driving force for the motion of the cilia. This study constitutes a first effort toward understanding the motion of ionomer cilia in salt solution, which, in turn, may help elucidate the physical underpinnings of actuation in ionic polymer metal composites.
JAK inhibition increases bone mass in steady-state conditions and ameliorates pathological bone loss by stimulating osteoblast function
Authors: Adam Susanne , Simon Nils , Steffen Ulrike , Andes Fabian T. , Scholtysek Carina , Müller Dorothea I. H. , Weidner Daniela , Andreev Darja , Kleyer Arnd , Culemann Stephan , Hahn Madelaine , Schett Georg , Krönke Gerhard , Frey Silke , Hueber Axel J.
Published: February 2020

JAK inhibition enhances the function of bone-forming osteoblasts, increases bone mass, and induces repair of arthritic bone erosions.
A spring-like renewal in the lungs
Authors: Naxerova Kamila
Published: February 2020

Epithelial cells with a low mutation burden expand after smoking cessation.
The tick tock of toxicity
Authors: Hurley Jennifer M.
Published: February 2020

A cell-intrinsic circadian program diminishes neutrophil toxicity to protect organs from excessive inflammation.
Role of Arginine 214 in the Substrate Specificity of OXA-48
Authors: Oueslati Saoussen , Retailleau Pascal , Marchini Ludovic , Berthault Camille , Dortet Laurent , Bonnin Rémy A. , Iorga Bogdan I. , Naas Thierry
Published: February 2020

Increasing numbers of variants of the carbapenem-hydrolyzing class D β-lactamase OXA-48 are identified in
Enterobacterales
worldwide. Among them, OXA-181 and OXA-232 are of particular interest, as they differ from each other by a single amino acid substitution at position 214 (R in OXA-181 and S in OXA-232) that results in reduced carbapenem-hydrolyzing activity for OXA-232. To investigate the role of amino acid position 214 (AA214), the X-ray structure of OXA-232 was determined and AA214 of OXA-48 and of OXA-232 was replaced by G, L, D, E, S, R, and K using site-directed mutagenesis.
B Cells Inhibit CD4+T Cell-Mediated Immunity toBrucellaInfection in a Major Histocompatibility Complex Class II-Dependent Manner
Authors: Dadelahi Alexis S. , Lacey Carolyn A. , Chambers Catherine A. , Ponzilacqua-Silva Bárbara , Skyberg Jerod A.
Published: February 2020

Brucellaspp. are facultative intracellular bacteria notorious for their ability to induce a chronic, and often lifelong, infection known as brucellosis. To date, no licensed vaccine exists for prevention of human disease, and mechanisms underlying chronic illness and immune evasion remain elusive. We and others have observed that B cell-deficient mice challenged withBrucelladisplay reduced bacterial burden following infection, but the underlying mechanism has not been clearly defined.
Intracellular Accumulation of Staphylopine Can Sensitize Staphylococcus aureus to Host-Imposed Zinc Starvation by Chelation-Independent Toxicity
Authors: Grim Kyle P. , Radin Jana N. , Solórzano Paola K. Párraga , Morey Jacqueline R. , Frye Katie A. , Ganio Katherine , Neville Stephanie L. , McDevitt Christopher A. , Kehl-Fie Thomas E.
Published: February 2020

Staphylococcus aureus
and many other bacterial pathogens rely on metal-binding small molecules to obtain the essential metal zinc during infection. In this study, we reveal that export of these small molecules is critical for overcoming host-imposed metal starvation during infection and prevents toxicity due to accumulation of the metal-binding molecule within the cell. Surprisingly, we found that intracellular toxicity of the molecule is not due to chelation of cellular metals.
Human Cytomegalovirus Glycoprotein B Nucleoside-Modified mRNA Vaccine Elicits Antibody Responses with Greater Durability and Breadth than MF59-Adjuvanted gB Protein Immunization
Authors: Nelson Cody S. , Jenks Jennifer A. , Pardi Norbert , Goodwin Matthew , Roark Hunter , Edwards Whitney , McLellan Jason S. , Pollara Justin , Weissman Drew , Permar Sallie R.
Published: February 2020

Human cytomegalovirus (HCMV) is the most common infectious cause of infant birth defects, resulting in permanent neurological disability for one newborn child every hour in the United States. After more than a half century of research and development, we remain without a clinically licensed vaccine or immunotherapeutic to reduce the burden of HCMV-associated disease. In this study, we sought to improve upon the glycoprotein B protein vaccine (gB/MF59), the most efficacious HCMV vaccine evaluated in a clinical trial, via targeted modifications to either the protein structure or vaccine formulation. Utilization of a novel vaccine platform, nucleoside-modified mRNA formulated in lipid nanoparticles, increased the durability and breadth of vaccine-elicited antibody responses. We propose that an mRNA-based gB vaccine may ultimately prove more efficacious than the gB/MF59 vaccine and should be further evaluated for its ability to elicit antiviral immune factors that can prevent HCMV-associated disease.
Reverse Genetics Reveals a Role of Rotavirus VP3 Phosphodiesterase Activity in Inhibiting RNase L Signaling and Contributing to Intestinal Viral Replication
In Vivo
Authors: Song Yanhua , Feng Ningguo , Sanchez-Tacuba Liliana , Yasukawa Linda L. , Ren Lili , Silverman Robert H. , Ding Siyuan , Greenberg Harry B.
Published: February 2020

Rotaviruses are significant human pathogens that result in diarrhea, dehydration, and deaths in many children around the world. Rotavirus vaccines have suboptimal efficacy in low- to middle-income countries, where the burden of the diseases is the most severe. With the ultimate goal of improving current vaccines, we aim to better understand how rotavirus interacts with the host innate immune system in the small intestine. Here, we demonstrate that interferon-activated RNase L signaling blocks rotavirus replication in a strain-specific manner. In addition, virus-encoded VP3 antagonizes RNase L activity both
in vitro
and
in vivo
. These studies highlight an ever-evolving arms race between antiviral factors and viral pathogens and provide a new means of targeted attenuation for next-generation rotavirus vaccine design.
Assessment of correlates of hand hygiene compliance among final year medical students: a cross-sectional study in the Netherlands
Authors: Erasmus Vicki , Otto Suzie , De Roos Emmely , van Eijsden Rianne , Vos Margreet C , Burdorf Alex , van Beeck Ed
Published: February 2020

Objectives

To identify the factors that influence the hand hygiene compliance of final year medical students, using a theoretical behavioural framework.

Design

Cross-sectional survey assessing self-reported compliance and its behavioural correlates.

Setting

Internships of medical students in the Netherlands.

Participants

322 medical students of the Erasmus Medical Center were recruited over a period of 12 months during the Public Health internship, which is the final compulsory internship after an 18-month rotation schedule in all major specialities.

Primary and secondary outcome measures

Behavioural factors influencing compliance to hand hygiene guidelines were measured by means of a questionnaire based on the Theory of Planned Behaviour and Social Ecological Models. Multiple linear regression analysis was used to identify the effect of including attitudes, social norms, self-efficacy, knowledge, risk perception and habit on hand hygiene compliance.

Results

We included 313 students in the analysis (response rate 97%). The behavioural model explained 40% of the variance in self-reported compliance (adjusted R2=0.40). Hand hygiene compliance was strongly influenced by attitudes (perceived outcomes of preventive actions), self-efficacy (perception of the ability to perform hand hygiene at the clinical ward) and habit, but was not associated with knowledge and risk perception.

Conclusions

Targeting medical students’ behaviour should focus on the empowerment of these juniors and provide them with evidence on the health benefits of prevention, rather than increasing their factual knowledge of procedures. Clinical teaching environments could help them form good patient safety habits during this vital phase of their career.
Cross-sectional study on tobacco advertising, promotion and sponsorship (TAPS) and violations of tobacco sale regulations in Myanmar: do these factors affect current tobacco use among Myanmar high school students?
Authors: Cho Su Myat , Saw Yu Mon , Latt Nyi Nyi , Saw Thu Nandar , Htet Hein , Khaing Moe , Than Thet Mon , Win Ei Mon , Aung Zaw Zaw , Kariya Tetsuyoshi , Yamamoto Eiko , Hamajima Nobuyuki
Published: February 2020

Objectives

To examine the associations of current tobacco use with tobacco advertising, promotion and sponsorship (TAPS), and illicit tobacco sales exposures among Myanmar high school students.

Design

A quantitative, cross-sectional study.

Setting

Seven high schools from both urban and rural areas of four states and regions in Myanmar.

Participants

In total, 1174 high school students (482 males and 692 females) were interviewed using a self-administered questionnaire.

Main outcome measure

Current tobacco use of participants, defined as using any kind of smoked or smokeless tobacco product at least one occasion within the past 30 days.

Results

The prevalence of TAPS exposure was 90.9% among high school students in Myanmar. Current tobacco use was positively associated with being over 14 years old (adjusted OR (AOR) 9.81; 95% CI 4.54 to 21.19), being male (AOR 28.06; 95% CI 13.29 to 59.25), exposure to any kind of TAPS (AOR 6.59; 95% CI 2.33 to 18.64), having seen any smoked tobacco product for sale inside or within 100 feet of the school premises (AOR 4.17; 95% CI 1.65 to 10.58), having seen the sale or gifting of any smoked tobacco product to minors (AOR 6.46; 95% CI 2.18 to 19.12) and having seen the sale or distribution of any smoked tobacco product by minors (AOR 2.42; 95% CI 1.42 to 4.10). Having ever received health education about tobacco use (AOR 0.45; 95% CI 0.27 to 0.78), or having a higher perception score of tobacco use (AOR 0.17; 95% CI 0.10 to 0.30) were negatively associated with current tobacco use.

Conclusions

There was an alarming prevalence of TAPS exposure among Myanmar high school students. TAPS exposure and violations of tobacco sale regulations were strong risk factors for current tobacco use among Myanmar high school students, while health education about tobacco products was reported as an effective protective factor. Specific smokeless tobacco sale regulations for minors are needed immediately in Myanmar.
Rethinking rehabilitation after percutaneous coronary intervention: a protocol of a multicentre cohort study on continuity of care, health literacy, adherence and costs at all care levels (the CONCARDPCI)
Authors: Norekvål Tone M , Allore Heather G , Bendz Bjørn , Bjorvatn Cathrine , Borregaard Britt , Brørs Gunhild , Deaton Christi , Fålun Nina , Hadjistavropoulos Heather , Hansen Tina Birgitte , Igland Stig , Larsen Alf Inge , Palm Pernille , Pettersen Trond Røed , Rasmussen Trine Bernholdt , Schjøtt Jan , Søgaard Rikke , Valaker Irene , Zwisler Ann Dorthe , Rotevatn Svein
Published: February 2020

Introduction

Percutaneous coronary intervention (PCI) aims to provide instant relief of symptoms, and improve functional capacity and prognosis in patients with coronary artery disease. Although patients may experience a quick recovery, continuity of care from hospital to home can be challenging. Within a short time span, patients must adjust their lifestyle, incorporate medications and acquire new support. Thus, CONCARDPCIwill identify bottlenecks in the patient journey from a patient perspective to lay the groundwork for integrated, coherent pathways with innovative modes of healthcare delivery. The main objective of the CONCARDPCIis to investigate (1) continuity of care, (2) health literacy and self-management, (3) adherence to treatment, and (4) healthcare utilisation and costs, and to determine associations with future short and long-term health outcomes in patients after PCI.

Methods and analysis

This prospective multicentre cohort study organised in four thematic projects plans to include 3000 patients. All patients undergoing PCI at seven large PCI centres based in two Nordic countries are prospectively screened for eligibility and included in a cohort with a 1-year follow-up period including data collection of patient-reported outcomes (PRO) and a further 10-year follow-up for adverse events. In addition to PROs, data are collected from patient medical records and national compulsory registries.

Ethics and dissemination

Approval has been granted by the Norwegian Regional Committee for Ethics in Medical Research in Western Norway (REK 2015/57), and the Data Protection Agency in the Zealand region (REG-145-2017). Findings will be disseminated widely through peer-reviewed publications and to patients through patient organisations.

Trial registration number

NCT03810612.
Knowledge, attitude and current practices of pregnant women towards group B streptococcus screening: cross-sectional study, Al-Madinah, Saudi Arabia
Authors: Alshengeti Amer , Alharbi Amjad , Alraddadi Shahad , Alawfi Abdulsalam , Aljohani Bushra
Published: February 2020

Aims

Group B streptococcus (GBS) is one of the most frequent bacterial pathogens causing invasive infections in neonates. It can be transmitted from colonised mother to neonates around delivery. Screening strategies for GBS during pregnancy include either universal culture-based or risk-based screening. The present study aimed to assess the knowledge, attitude and current practices of pregnant women towards GBS screening in Al-Madinah City, Saudi Arabia.

Methods

A hospital-based cross-sectional study was conducted at Madinah Maternity and Children Hospital, Al-Madinah, Saudi Arabia, from May to July 2018. Participants were recruited from postnatal wards. Participants were interviewed using a previously published validated survey that was divided into the following domains: demographic data, knowledge, experience and attitude towards different GBS screening strategies.

Results

A total of 377 out of 450 women (response rate 83.7%) were enrolled. The results showed that the overall mean knowledge score of the pregnant women towards GBS screening was 59.8%. Majority of the women (66.8%) were not aware of the GBS bacterium, while 86.5% of them had never been informed of GBS risk assessment during their pregnancies. The mean knowledge score among women who were aware of GBS (62.8%) was significantly higher than that among women who were not (58.4%) (p=0.015). However, majority of the pregnant women (61.8%) showed preference for universal culture-based GBS screening strategy over risk-based strategy.

Conclusion

The study results have concluded that the level of awareness and knowledge about GBS among pregnant women were relatively poor; however, majority of the pregnant women prefer universal culture-based screening.
‘Unpacking’ pathways to lymphoma and myeloma diagnosis: Do experiences align with the Model of Pathways to Treatment? Findings from a UK qualitative study with patients and relatives
Authors: Howell Debra , Hart Ruth , Smith Alexandra , Macleod Una , Patmore Russell , Roman Eve
Published: February 2020

Objectives

To explore alignment of experiences before lymphoma and myeloma diagnosis with the appraisal, help seeking and diagnostic intervals in the Model of Pathways to Treatment (MPT).

Design

A qualitative study using in-depth semistructured interviews with patients and relatives. Interviews were transcribed verbatim, anonymised and analysed using qualitative description.

Setting

A UK population-based haematological malignancy patient cohort.

Participants

Fifty-five patients (35 lymphoma, 20 myeloma: diagnosed 2014–2016) and 28 relatives participated, within around a year of the patient’s diagnosis. Patients were selected from those in the cohort who had returned a questionnaire about their symptoms and help seeking, and consented to contact for further research. Sampling was purposive, to achieve maximum variation in age, sex and time to diagnosis.

Results

Participants described time from symptom onset to diagnosis as ranging from several weeks to years. Pathways largely aligned with MPT components and help seeking could lead to the rapid investigations and identification of abnormalities. However, symptoms could be vague and/or inadvertently interpreted as other conditions, which if perpetuated, could cause diagnostic delay. The latter was associated with chaotic pathways, with activities rarely occurring only once or in a linear sequence. Rather, intermittent or ongoing processes were described, moving forward and backwards through intervals. This is ‘unpacked’ within five themes: (1) appraisal and reappraisal; (2) patient-initiated self-management/treatment; (3) initial help seeking; (4) re-presentation; and (5) patient-initiated actions, decisions and emotions during re-presentation. Within these themes, various healthcare professionals were consulted, often many times, as symptoms persisted/progressed. Input from family/friends was described as substantial, as was the extent to which information seeking occurred.

Conclusion

Lymphoma and myeloma pathways align with the MPT, but do not fully capture the repetition and complexity described by participants. Time to diagnosis was often prolonged, despite the best efforts of patients, relatives and healthcare professionals. The impact of National Health Service England’s Multi-diagnostic Disciplinary Centres on time to haematological cancer diagnosis remains to be seen.
The extent to which family physicians record their patients’ exercise in medical records: a scoping review
Authors: Lindeman Cliff , McCurdy Ashley , Lamboglia Carminda G , Wohlers Brendan , Pham Anh N Q , Sivak Allison , Spence John C
Published: February 2020

Objective

Exercise is an effective modality for the prevention and treatment of chronic conditions and family physicians are the healthcare providers tasked to manage patients’ chronic disease status. However, little is known about the exercise documentation in family-physician records. Therefore, a scoping review was conducted to describe family-physician-recorded exercise-related advice to patients in electronic medical records.

Design

Scoping review.

Setting

Primary care clinics.

Search strategy

PubMed, Medline, SPORTDiscus, Google, Dissertations & Theses Global, OCLC PapersFirst (via First Search) and included references were searched between 1 January 1990 and 10 June 2018. Extracted information included year, geographic origin, data input structure, input frequency and content of exercise inputs in family physicians’ electronic medical records. The primary outcomes are the structure, purpose and frequency of inputs.

Results

Of a possible 1758 documents, 83 remained after a title and abstract scan and 22 after a full-text review. These documents included 32 findings of physical activity/exercise medical record documentation: counselling/advising patients (50.0%), status (12.5%), embedded questionnaires (12.5%), status as a risk factor (12.5%), health promotion documentation (6.3%), inactivity status (3.1%) and grading (3.1%). The frequency of exercise inputs in primary care records vary from as low as 0.4% of patients with documentation of physical activity health promotion inputs to as high as 87.8% of patients with exercise or physical activity status recorded. The majority of included documents (63.6%) were focused on patients with identified chronic conditions.

Conclusion

The findings suggest that the structure and purpose of exercise documentation is often unclear or unspecified. Studies that present exercise information from family-physician medical records tend to focus on patients with specific chronic conditions and present little detail about the field from which information was extracted. The review found that the proportion of patients with physical activity or exercise information is often less than half.
Adrenal lesions found incidentally: how to improve clinical and cost-effectiveness
Authors: Hanna Fahmy W F , Issa Basil G , Lea Simon C , George Cherian , Golash Anurag , Firn Mike , Ogunmekan Seyi , Maddock Elloise , Sim Julius , Xydopoulos Georgios , Fordham Richard , Fryer Anthony A
Published: February 2020

Introduction

Adrenal incidentalomas are lesions that are incidentally identified while scanning for other conditions. While most are benign and hormonally non-functional, around 20% are malignant and/or hormonally active, requiring prompt intervention. Malignant lesions can be aggressive and life-threatening, while hormonally active tumours cause various endocrine disorders, with significant morbidity and mortality. Despite this, management of patients with adrenal incidentalomas is variable, with no robust evidence base. This project aimed to establish more effective and timely management of these patients.

Methods

We developed a web-based, electronic Adrenal Incidentaloma Management System (eAIMS), which incorporated the evidence-based and National Health Service–aligned 2016 European guidelines. The system captures key clinical, biochemical and radiological information necessary for adrenal incidentaloma patient management and generates a pre-populated outcome letter, saving clinical and administrative time while ensuring timely management plans with enhanced safety. Furthermore, we developed a prioritisation strategy, with members of the multidisciplinary team, which prioritised high-risk individuals for detailed discussion and management. Patient focus groups informed process-mapping and multidisciplinary team process re-design and patient information leaflet development. The project was partnered by University Hospital of South Manchester to maximise generalisability.

Results

Implementation of eAIMS, along with improvements in the prioritisation strategy, resulted in a 49% reduction in staff hands-on time, as well as a 78% reduction in the time from adrenal incidentaloma identification to multidisciplinary team decision. A health economic analysis identified a 28% reduction in costs.

Conclusions

The system’s in-built data validation and the automatic generation of the multidisciplinary team outcome letter improved patient safety through a reduction in transcription errors. We are currently developing the next stage of the programme to proactively identify all new adrenal incidentaloma cases.
ePTFE/FEP stents for malignant biliary obstruction
Authors: Hui Andrew , Krokidis Miltiadis
Published: February 2020

Background

Biliary obstruction due to malignant disease causes debilitating symptoms and palliation of the disease involves placement of biliary stents. Covered self-expanding metal biliary stents may provide a longer patency and a lower risk of complications and dysfunction compared to uncovered stents, making them better for patients’ quality of life and cost effectiveness. This study aims to evaluate the indications and outcomes for a group of cases where expanded polytetrafluoroethylene/fluorinated ethylene propylene (ePTFE/FEP) covered metal stents were used to palliate malignant biliary obstruction.

Methods

All cases of ePTFE/FEP-covered Viabil stent implantation in a 4-year period in a single hospital were identified and details of indications and outcomes for stent placement were recorded. Kaplan-Meier estimator analysis was used to create plots for stent patency and survival time.

Results

The median stent patency was 173 days (standard error of the mean, SE = 54) and the median survival time was 247 days (SE = 88). No complications of stent implantation were recorded and in seven cases no dysfunction was noted. In one case, tumour ingrowth was observed, and in one other case the stent was no longer found in situ on subsequent imaging.

Conclusion

The use of the ePTFE/FEP-covered Viabil stent in the palliation of malignant obstruction where indicated is promising, providing a low rate of stent dysfunction and complications. More data need to be collected to conclusively ascertain whether covered stents have a longer patency and lower complication rate compared to uncovered stents.
Secondary mitral regurgitation: pathophysiology, proportionality and prognosis
Authors: Chehab Omar , Roberts-Thomson Ross , Ng Yin Ling Clarissa , Marber Michael , Prendergast Bernard D , Rajani Ronak , Redwood Simon R
Published: February 2020

Secondary mitral regurgitation (SMR) occurs as a result of multifactorial left atrioventricular dysfunction and maleficent remodelling. It is the most common and undertreated form of mitral regurgitation (MR) and is associated with a very poor prognosis. Whether SMR is a bystander reflecting the severity of the cardiomyopathy disease process has long been the subject of debate. Studies suggest that SMR is an independent driver of prognosis in patients with an intermediate heart failure (HF) phenotype and not those with advanced HF. There is also no universal agreement regarding the quantitative thresholds defining severe SMR and indeed there are challenges with echocardiographic quantification. Until recently, no surgical or transcatheter intervention for SMR had demonstrated prognostic benefit, in contrast with HF medical therapy and cardiac resynchronisation therapy. In 2018, the first two randomised controlled trials (RCTs) of edge-to-edge transcatheter mitral valve repair versus guideline-directed medical therapy in HF (Percutaneous Repair with the MitraClip Device for Severe (MITRA-FR), Transcather mitral valve repair in patients with heart failure (COAPT)) reported contrasting yet complimentary results. Unlike in MITRA-FR, COAPT demonstrated significant prognostic benefit, largely attributed to the selection of patients with disproportionately severe MR relative to their HF phenotype. Consequently, quantifying the degree of SMR in relation to left ventricular volume may be a useful discriminator in predicting the success of transcatheter intervention. The challenge going forward is the identification and validation of such parameters while in parallel maintaining a heart-team guided holistic approach.
Phenotype of genetically confirmed Silver-Russell syndrome beyond childhood
Authors: Lokulo-Sodipe Oluwakemi , Ballard Lisa , Child Jenny , Inskip Hazel M , Byrne Christopher D , Ishida Miho , Moore Gudrun E , Wakeling Emma L , Fenwick Angela , Mackay Deborah J G , Davies Justin Huw , Temple I Karen
Published: February 2020

Background

Silver-Russell syndrome is an imprinting disorder that restricts growth, resulting in short adult stature that may be ameliorated by treatment. Approximately 50% of patients have loss of methylation of the imprinting control region (H19/IGF2:IG-DMR) on 11p15.5 and 5%–10% have maternal uniparental disomy of chromosome 7. Most published research focuses on the childhood phenotype. Our aim was to describe the phenotypic characteristics of older patients with SRS.

Methods

A retrospective cohort of 33 individuals with a confirmed molecular diagnosis of SRS aged 13 years or above were carefully phenotyped.

Results

The median age of the cohort was 29.6 years; 60.6% had a height SD score (SDS) ≤−2 SDS despite 70% having received growth hormone treatment. Relative macrocephaly, feeding difficulties and a facial appearance typical of children with SRS were no longer discriminatory diagnostic features. In those aged ≥18 years, impaired glucose tolerance in 25%, hypertension in 33% and hypercholesterolaemia in 52% were noted. While 9/33 accessed special education support, university degrees were completed in 40.0% (>21 years). There was no significant correlation between quality of life and height SDS. 9/25 were parents and none of the 17 offsprings had SRS.

Conclusion

Historical treatment regimens for SRS were not sufficient for normal adult growth and further research to optimise treatment is justified. Clinical childhood diagnostic scoring systems are not applicable to patients presenting in adulthood and SRS diagnosis requires molecular confirmation. Metabolic ill-health warrants further investigation but SRS is compatible with a normal quality of life including normal fertility in many cases.
Withdrawing treatment from patients with prolonged disorders of consciousness: the wrong answer is what the wrong question begets
Authors: Wang Daniel Wei Liang
Published: February 2020

In a recent paper, Charles Foster argued that the epistemic uncertainties surrounding prolonged disorders of consciousness (PDOC) make it impossible to prove that the withdrawal of life-sustaining treatment can be in a patient’s best interests and, therefore, the presumption in favour of the maintenance of life cannot be rebutted. In the present response, I argue that, from a legal perspective, Foster has reached the wrong conclusion because he is asking the wrong question. According to the reasoning in two leading cases—BlandandJames—the principle of respect for autonomy creates apersuasive presumptionagainst treatment without consent. Therefore, it is the continuation of treatment that requires justification, rather than its withdrawal. This presumption also works as the tiebreaker determining that treatment should stop if there is no persuasive evidence that its continuation is in the best interests of the patient. The presumption in favour of the maintenance of life, on the other hand, should be understood as anevidential presumptionon a factual issue that is assumed to be true if unchallenged. However, the uncertainties regarding PDOC actually give reasons for displacing this evidential presumption. Consequently, decision-makers will have to weigh up the pros and cons of treatment having the presumption against treatment without consent as the tiebreaker if the evidence is inconclusive. In conclusion, when the right question is asked, Foster’s argument can be turned on its head and uncertainties surrounding PDOC weigh in to justify the interruption of treatment in the absence of compelling contrary evidence.