bluuebunny/crossref_metadata_2025 huggingface dataset:
Mineral disorders in pediatric pre‐emptive kidney transplantation
Authors: Hasegawa Kei , Motoyama Osamu , Shishido Seiichiro , Aikawa Atsushi
Published: May 2019

Background

Pre‐emptive kidney transplantation (PEKT) is beneficial for patients, improves graft survival and minimizes the complications associated with chronic kidney disease. Reports on pediatric PEKT, however, are limited, and little is known about the parathyroid hormone (PTH) abnormalities and calcium–phosphorus disorders (CPD) in this condition. This study was the first to report on mineral disorders in pediatric PEKT patients during a 1 year period.

Methods

We conducted a comparative examination of the abnormalities in calcium, phosphorus, calcium–phosphorus products and PTH before and 1 year after living donor kidney transplantation in PEKT and non‐PEKT patients.

Results

Thirty‐one patients were included. The patients were divided into two groups: PEKT (n = 11; 5 months in CKD stage 4–5) and non‐PEKT (n = 20; 31.5 months in dialysis). Mean age at transplantation was 9.4 ± 5.0 years. Hypercalcemia and hyperphosphatemia were observed before and after transplantation in the PEKT and non‐PEKT groups, and >15% of patients in each group had bone disorder and ectopic calcification associated with mineral disorder. Mineral disorder was present for approximately 3 months after transplantation in both treatment groups.

Conclusions

No significant differences in PTH or CPD were noted between PEKT and non‐PEKT groups; moreover, normalization of abnormal values did not differ between the PEKT and non‐PEKT groups. Compared with non‐PEKT, PEKT did not improve the course of mineral metabolism disorders. Mineral and bone disorder treatment was likely insufficiently provided to pediatric PEKT patients. To obtain the maximum advantage of PEKT, calcium and phosphorus levels should be strictly controlled before kidney transplantation.
Do Politicians See Eye to Eye? The Relationship between Political Group Characteristics, Perceived Strategic Plan Quality, and Strategic Consensus in Local Governing Majorities
Authors: Meyfroodt Kenn , Desmidt Sebastian , Goeminne Stijn
Published: May 2019

Although strategic consensus is a core concept in strategic management research, empirical evidence is lacking on (1) the degree of strategic consensus in public organizations, (2) how strategic consensus is impacted by group characteristics specific to public strategic decision‐making groups, and (3) how strategic plans impact these relationships. An analysis of multisource data from 1,075 governing majority members nested in 256 Flemish municipalities (Belgium) indicates that within‐group strategic consensus varies among governing majorities and is negatively impacted by political diversity and political power, but these relationships are mediated by perceived strategic plan quality. The results indicate that the idiosyncrasies of public decision‐making groups can impede high levels of strategic consensus, but strategic plans can attenuate this effect by fulfilling a boundary‐spanning role.
Mineral Paragenesis and Ore‐Forming Processes of the Dongping Gold Deposit, Hebei Province, China
Authors: Wang Dazhao , Liu Jiajun , Zhai Degao , Carranza Emmanuel J. M. , Wang Yinhong , Zhen Shimin , Wang Jiang , Wang Jianping , Liu Zhenjiang , Zhang Fangfang
Published: May 2019

The Dongping gold deposit is located near the center of the northern margin of the North China Craton. It is hosted in the Shuiquangou syenite and characterized by large amounts of tellurides. Numerous studies have addressed this deposit; the mineral paragenesis and ore‐forming processes, however, are still poorly studied. In this contribution, a new mineral paragenesis has been evaluated to further understand ore formation, including sulfides (pyrite, chalcopyrite, galena, sphalerite, molybdenite, and bornite), tellurides (altaite, calaverite, hessite, muthmannite, petzite, rucklidgeite, sylvanite, tellurobismuthite, tetradymite, and volynskite), and native elements (tellurium and gold). Molybdenite, muthmannite, rucklidgeite, and volynskite are reported for the first time in this deposit. We consider the Dongping gold deposit mainly formed in the Devonian, and the ore‐forming processes and the physicochemical conditions for ore formation can be reconstructed based on our newly identified ore paragenesis, that is, iron oxides → (CO2 effervescence) → sulfides → (fTe2/fS2 ratio increase) → Pb‐Bi‐tellurides → (condensation of H2Te vapor) → Au‐Ag‐tellurides → (mixing with oxidizing water) → carbonate and microporous gold → secondary minerals → secondary minerals. The logfO2 values increase from the early to late stages, while the fH2S and logfS2 values increase initially and then decrease. CO2 effervescence is the main mechanism of sulfides precipitation; this sulfidation and condensation of H2Te vapor lead to deposition of tellurides. The development of microporous gold indicates that the deposit might experience overprint after mineralization. The Dongping gold deposit has a close genetic relationship with the Shuiquangou syenite, and tellurium likely originated from Shuiquangou alkaline magmatic degassing.
Is oxidative stress an issue in peritoneal dialysis?
Authors: Roumeliotis Stefanos , Eleftheriadis Theodoros , Liakopoulos Vassilios
Published: May 2019

During the last two decades, oxidative stress (OS) has emerged as a novel risk factor for a variety of adverse events, including atherosclerosis and mortality in chronic kidney disease (CKD) patients. Increased OS occurs even in early stages of the disease, progresses with deterioration of renal function and is further aggravated by hemodialysis (HD), due to the bioincompatibility of the method. Compared to HD, peritoneal dialysis (PD) is a more biocompatible dialysis modality, characterized by a significantly reduced, but still high, OS status. The culprit for OS in PD is mainly the composition of PD solutions (low pH, lactate buffer, increased osmolarity and high glucose concentration). After heat sterilization of PD solutions, formation of glucose degradation products (GDPs) and advanced glycation end‐products (AGEs) trigger inflammation and enhance OS. Chronic exposure of the peritoneum to this toxic, hyperglycemic environment leads to OS‐derived morphologic damage of peritoneal cells, loss of ultrafiltration capacity and decreased technique survival. Moreover, OS is linked with peritonitis, loss of residual renal function, inflammation, atherosclerosis, cardiovascular (CV) disease, and increased mortality. To ameliorate OS status in PD, a multitargeted approach is necessary that includes use of neutral pH, low GDP, low lactate and iso‐ismolar PD solutions, strict glycemic control, optimal volume management and, probably supplementation with antioxidants, N‐acetylcysteine being the most promising among them.
Grade effects on teacher ratings of ADHD symptoms among primary school students
Authors: Öner Özgür , Vatanartıran Sinem , Karadeniz Şirin
Published: May 2019

Several studies have reported that being younger for grade increases the risk of having attention deficit hyperactivity disorder (ADHD) diagnosis and being on ADHD medication among students. The aim of this study was to investigate this association in a low‐middle income country setting. Sample included 2,627 children from first to fourth grades. We compared students who were older than the 75th and younger than the 25th percentiles in consecutive grades. Teachers completed SNAP‐4 scale. Results indicated that teacher rated ADHD symptoms were 2.5 to 3.6 times more common in students who were younger for their grade, after age, gender, and Fluid IQ scores were controlled. Teacher SNAP‐4 scores were also significantly associated with grade. Our results suggested that the phenomenon of higher rates of teacher rated ADHD symptoms among younger for grade students was not limited to Western countries and that the teacher reported symptom loads were higher in these children.
Implementation of the Adductor Strengthening Programme: Players primed for adoption but reluctant to maintain — A cross‐sectional study
Authors: Harøy Joar , Wiger Espen Guldahl , Bahr Roald , Andersen Thor Einar
Published: May 2019

Groin injuries represent a considerable problem in male football, accounting for 4%‐19% of all time‐loss injuries. The Adductor Strengthening Programme is the first groin‐specific prevention program shown to reduce the risk of groin problems. We aimed to use the RE‐AIM framework to examine the players’ experiences with the implementation of the program and player attitude toward groin injury prevention in football. Of the 632 players involved in the trial examining the effect of the Adductor Strengthening Programme, 501 agreed to participate in a survey at the end of the season. Most players thought that footballers are at moderate to high risk for groin injuries (87%) and that there is a need for preventive measures (96%). They also believed that a preventive program with strengthening exercises would reduce the risk of groin injuries (91%). Majority of the players reported using <5 minutes to complete the program (73%), and only 11% wanted additional exercises. However, only 46% reported to have performed the program as recommended, and an even smaller proportion (31%) planned to continue using it as recommended the next season. Our results suggest that footballers believe that prevention of groin injuries is needed. Attitude toward implementation of the Adductor Strengthening Programme was positive, and the single‐exercise approach was considered an important facilitator. However, in future dissemination of the program, the players’ reluctance to maintain the exercise protocol may be a potential barrier to implementation that should be addressed.
Sedentary behavior in everyday life relates negatively to mood: An ambulatory assessment study
Authors: Giurgiu Marco , Koch Elena D. , Ottenbacher Jörg , Plotnikoff Ronald C. , Ebner‐Priemer Ulrich W. , Reichert Markus
Published: May 2019

Empirical evidence shows that physical behavior positively impacts human health. Recently, researchers have started to differentiate between physical activity and sedentary behavior showing independent effects on somatic health. However, whether this differentiation is also relevant for mood dimensions is largely unknown. For investigating the dynamic relationships between sedentary behavior and mood dimensions in daily life, ambulatory assessment (AA) has become the state‐of‐the‐art methodology. To investigate whether sedentary behaviors influence mood dimensions, we conducted an AA study in the everyday life of 92 university employees over 5 days. We continuously measured sedentary behavior via accelerometers and assessed mood repeatedly 10 times each day on smartphone diaries. To optimize our sampling strategy, we used a sophisticated sedentary‐triggered algorithm. We employed multilevel modeling to analyze the within‐subject effects of sedentary behavior on mood. Sedentary time (15‐minute intervals prior to each e‐diary assessment) and sedentary bouts (30‐minute intervals of uninterrupted sedentary behavior) negatively influenced valence and energetic arousal (all Ps < 0.015). In particular, the more participants were sedentary in their everyday life, the less they felt well and energized. Exploratory analyses of the temporal course of these effects supported our findings. Sedentary behavior can be seen as a general risk factor because it impacts both somatic and mental health. Most importantly, physical activity and sedentary behavior showed independent effects on mood dimensions. Accordingly, future studies should consider the two sides of the physical behavior coin: How should physical activity be promoted? and How can sedentary behavior be reduced?
Effects of pre‐ or post‐exercise whey protein supplementation on oxidative stress and antioxidant enzymes in older women
Authors: Nabuco Hellen C.G. , Tomeleri Crisieli M. , Fernandes Rodrigo R. , Sugihara Junior Paulo , Venturini Danielle , Barbosa Décio S. , Deminice Rafael , Sardinha Luís B. , Cyrino Edilson S.
Published: May 2019

Background

Oxidative stress is an imbalance between antioxidant system and production of free radicals and has been associated with the age‐related deleterious changes. The defense system can be modulated by exercise and nutrition.

Objective

The purpose of this investigation was to evaluate the effect of whey protein supplementation pre‐ or post‐resistance training on oxidative stress and antioxidant enzyme activity in pre‐conditioned older women.

Methods

In a randomized, double‐blind, and placebo‐controlled design, 70 older women (≥60 years) were randomly assigned to one of the following three groups: whey protein‐placebo (WP‐PLA, n = 24), placebo‐whey protein (PLA‐WP, n = 23), and placebo‐placebo (PLA‐PLA, n = 23). Each group received 35 g of whey product or placebo pre‐ and post‐training. The RT program was carried out over 12 weeks (3x/week; 3x 8‐12 repetitions maximal). Oxidative stress and blood markers were assessed before and after intervention period. ANOVA for repeated measures was used for data analysis.

Results

There was a significant time effect (P < 0.05), with all groups showing improvements in all oxidative stress markers and antioxidant enzyme activity. A significant (P < 0.001) interaction time vs group was observed for uric acid, with both WP‐PLA and PLA‐WP presenting greater reductions compared with the PLA‐PLA, without differences between the timing of protein intake (WP‐PLA: −8.3%; PLA‐WP: −11.0%; PLA‐PLA:‐2.0%).

Conclusion

In already pre‐conditioned older women, whey protein supplementation reduces plasma uric acid concentration with no further effect on antioxidant enzyme activity and oxidative stress markers. ClinicalTrials.gov: NCT03247192.
An application of fuzzy linear modeling: prediction of uncertainty for beta-glucan content
Authors: Türkşen Özlem , Ertunç Suna
Published: May 2019

Beta-glucan (BG) has positive health effects for the mamalians. However, the BG sources have limited content of it. Besides, the production of the BG has stringent procedures with low productivity. Economical production of the BG needs the improvement of the BG production steps. In this study, it is aimed to improve the BG content during the first step of the BG production, microorganism growth step, by obtaining the optimal values of additive materials (EDTA, CaCl2 and Sorbitol). For this purpose, the experimental data sets with replicated response measures (RRM) are obtained at spesific levels of EDTA, CaCl2 and Sorbitol. Fuzzy modeling, a flexible modeling approach, is applied on the experimental data set because of the small sized data set and diffulty of satisfying probabilistic modeling assumptions. The predicted fuzzy function is obtained according to the fuzzy least squares approach. In order to get the optimal values of EDTA, CaCl2 and Sorbitol, the predicted fuzzy function is maximized based on multi-objective optimization (MOO) approach. By using the optimal values of EDTA, CaCl2 and Sorbitol, the uncertainty for predicted BG content is evaluated from the economic perspective.
Microsecond sensitivity to envelope interaural time differences in rats
Authors: Li Kongyan , Chan Chloe H. K. , Rajendran Vani G. , Meng Qinglin , Rosskothen-Kuhl Nicole , Schnupp Jan W. H.
Published: May 2019

Currently, there is controversy around whether rats can use interaural time differences (ITDs) to localize sound. Here, naturalistic pulse train stimuli were used to evaluate the rat's sensitivity to onset and ongoing ITDs using a two-alternative forced choice sound lateralization task. Pulse rates between 50 Hz and 4.8 kHz with rectangular or Hanning windows were delivered with ITDs between ±175 μs over a near-field acoustic setup. Similar to other mammals, rats performed with 75% accuracy at ∼50 μs ITD, demonstrating that rats are highly sensitive to envelope ITDs.
Ancient jaw gives elusive Denisovans a face
Authors: Gibbons Ann
Published: May 2019

New protein method identifies first Denisovan outside of Siberia, on Tibetan Plateau.
Austerity cuts threaten future of science in Argentina
Authors: Wessel Lindzi
Published: May 2019

Young scientists are left with few career options while labs scramble to pay for equipment, reagents, and cleaning.
Neuron-size probes promise better recordings
Authors: Servick Kelly
Published: May 2019

New electrode designs aim for seamless integration in brain tissue.
Space station finds a calling
Authors: Voosen Paul
Published: May 2019

Carbon observatory joins sensors gaining a lower-cost vantage on Earth from the International Space Station.
In search of blue
Authors: Kupferschmidt Kai
Published: May 2019

New tools are aiding the age-old quest for the rarest of pigments.
Branch-restricted localization of phosphatase Prl-1 specifies axonal synaptogenesis domains
Authors: Urwyler Olivier , Izadifar Azadeh , Vandenbogaerde Sofie , Sachse Sonja , Misbaer Anke , Schmucker Dietmar
Published: May 2019

Compartmentalization of axons

Neurons can spread branches far and wide across the central nervous system. One neuron can simultaneously contact several other neurons, amplifying network complexity. Studying the
Drosophila
brain, Urwyler
et al.
found that not all axon branches are the same, even within one neuron (see the Perspective by Falkner and Scheiffele). A membrane-anchored phosphatase functions within a subset of axon branches to regulate synapse formation. Thus, the pattern of synapses on one neuron is not random but rather is spatially restricted according to subcompartments in the axon.

Science
, this issue p.
eaau9952
; see also p.
437
Neural population control via deep image synthesis
Authors: Bashivan Pouya , Kar Kohitij , DiCarlo James J.
Published: May 2019

Predicting behavior of visual neurons

To what extent are predictive deep learning models of neural responses useful for generating experimental hypotheses? Bashivan
et al.
took an artificial neural network built to model the behavior of the target visual system and used it to construct images predicted to either broadly activate large populations of neurons or selectively activate one population while keeping the others unchanged. They then analyzed the effectiveness of these images in producing the desired effects in the macaque visual cortex. The manipulations showed very strong effects and achieved considerable and highly selective influence over the neuronal populations. Using novel and non-naturalistic images, the neural network was shown to reproduce the overall behavior of the animals' neural responses.

Science
, this issue p.
eaav9436
What makes a planet habitable?
Authors: Shahar Anat , Driscoll Peter , Weinberger Alycia , Cody George
Published: May 2019

Efforts to identify habitable planets must look beyond atmospheres to planetary interiors
Snow's storm
The Two Cultures and the Scientific Revolution
C. P. Snow
Cambridge Univ. Press, 1959. 52 pp.
Authors: McCray W. Patrick
Published: May 2019

C. P. Snow's 1959 diagnosis of a divide between British scientists and humanists took on new meaning in America
How a highly driven reaction hits the brakes
Authors: Dempsey Jillian L.
Published: May 2019

Limited access to higher proton vibrational states slows proton-coupled electron transfer
Multiproxy lacustrine records of post-glacial environmental change from the Uinta Mountains, Utah, USA
Authors: Munroe Jeffrey S. , Laabs Benjamin J.C.
Published: May 2019

Twenty-one sediment cores were obtained from 20 lakes in the Uinta Mountains, Utah, USA. Depth-age models were developed using 14C dating, and sediments were analyzed for loss-on-ignition (LOI), carbon-nitrogen ratio (C:N), and grain size distribution. Although some of these cores have been considered individually in previous studies, here the entire set of cores is evaluated collectively to identify consistent patterns, commonalities, and trends in the post-glacial interval. All lakes accumulated substantially greater amounts of submicron-size clastic material before ca. 9.5 ka BP. This pattern is interpreted as a signal of prolonged landscape instability following deglaciation. Values of LOI and C:N exhibit a strong, positive correlation in nearly all lakes, indicating that organic matter accumulation is controlled by the influx of terrestrial material. In the six lakes exhibiting the strongest correlation, and featuring the most robust inflowing streams, median grain size and the abundance of sand increased between 10 and 6 ka BP, simultaneous with increases in LOI and C:N. This correspondence is interpreted as evidence for frequent high-intensity storms during the early Holocene, likely driven by enhanced monsoonal circulation. The early parts of five of the records contain a sharp increase in LOI. Lakes exhibiting this pattern are typically smaller and shallower, and are located in less rugged watersheds. Finally, all six cores from the western Uinta Mountains contain evidence for an environmental perturbation ca. 4.5 ka BP. Although the nature of this event is unclear, these lakes accumulated notably finer-grained sediment with less organic matter at this time. This analysis illuminates the post-glacial history of this strategically located mountain range, and underscores the value inherent in analyzing cores from multiple lakes when reconstructing paleoclimatic history.
Fifteen-minute consultation: Obvious and not-so-obvious mediastinal masses
Authors: Green Katherine , Behjati Sam , Cheng Danny
Published: May 2019

Objectives

To present a structured approach to the management of a child with a mediastinal mass presenting to the emergency department. To raise awareness of presenting features of less-obvious mediastinal masses and to encourage consideration of mediastinal masses in differential diagnoses.

Methods

Review of the relevant literature and review of London Paediatric Cancer Network supportive guidelines and subsequent description of the approach to a child presenting with features suggestive of a mediastinal mass.

Conclusions

A systematic approach to history taking, clinical examination and investigation of a child presenting with a mediastinal mass will assist in the safe and timely management of children presenting when they are critically unwell. Anticipation of potential management complications and early transfer for ongoing management will improve patient outcomes and minimise morbidity.
Preterm birth and risk of chronic kidney disease from childhood into mid-adulthood: national cohort study
Authors: Crump Casey , Sundquist Jan , Winkleby Marilyn A , Sundquist Kristina
Published: May 2019

Objective

To investigate the relation between preterm birth (gestational age <37 weeks) and risk of CKD from childhood into mid-adulthood.

Design

National cohort study.

Setting

Sweden.

Participants

4 186 615 singleton live births in Sweden during 1973-2014.

Exposures

Gestational age at birth, identified from nationwide birth records in the Swedish birth registry.

Main outcome measures

CKD, identified from nationwide inpatient and outpatient diagnoses through 2015 (maximum age 43 years). Cox regression was used to examine gestational age at birth and risk of CKD while adjusting for potential confounders, and co-sibling analyses assessed the influence of unmeasured shared familial (genetic or environmental) factors.

Results

4305 (0.1%) participants had a diagnosis of CKD during 87.0 million person years of follow-up. Preterm birth and extremely preterm birth (<28 weeks) were associated with nearly twofold and threefold risks of CKD, respectively, from birth into mid-adulthood (adjusted hazard ratio 1.94, 95% confidence interval 1.74 to 2.16; P<0.001; 3.01, 1.67 to 5.45; P<0.001). An increased risk was observed even among those born at early term (37-38 weeks) (1.30, 1.20 to 1.40; P<0.001). The association between preterm birth and CKD was strongest at ages 0-9 years (5.09, 4.11 to 6.31; P<0.001), then weakened but remained increased at ages 10-19 years (1.97, 1.57 to 2.49; P<0.001) and 20-43 years (1.34, 1.15 to 1.57; P<0.001). These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families.

Conclusions

Preterm and early term birth are strong risk factors for the development of CKD from childhood into mid-adulthood. People born prematurely need long term follow-up for monitoring and preventive actions to preserve renal function across the life course.
‘Just another vial…’: a qualitative study to explore the acceptability and feasibility of routine blood-borne virus testing in an emergency department setting in the UK
Authors: Cullen Lucy , Grenfell Pippa , Rodger Alison , Orkin Chloe , Mandal Sema , Rhodes Tim
Published: May 2019

Objectives

Increased test uptake for HIV and viral hepatitis is fast becoming a health priority at both national and global levels. Late diagnosis of these infections remains a critical public health concern in the UK. Recommendations have been issued to expand blood-borne virus (BBV) testing in alternative settings. Emergency departments (EDs) offer a potentially important point of testing. This paper presents findings from a qualitative study which aimed to explore the acceptability and feasibility of a routine opt-out combined BBV testing intervention implemented at an inner London ED.

Methods

We conducted 22 semistructured interviews with patients and service providers in the ED over a 4-month period during the intervention pilot. A grounded analytical approach was employed to conduct thematic analysis of qualitative study data.

Results

Core interrelating thematic areas, identified and analytically developed in relation to test intervention implementation and experience, included the following: the remaking of routine test procedure; notions of responsibility in relation to status knowledge and test engagement; the opportunity and constraints of the ED as a site for testing; and the renegotiation of testing cultures within and beyond the clinic space.

Conclusion

Study findings demonstrate how relational and spatial dynamics specific to the ED setting shape test meaning and engagement. We found acceptability of the test practice was articulated through narratives of situated responsibility, with the value of the test offset by perceptions of health need and justification of the test expense. Participant accounts indicate that the nontargeted approach of the test affords a productive disruption to ‘at-risk’ identities, yet they also reveal limits to the test intervention’s ‘normalising’ effect. Evaluation of the intervention must attend to the situated dynamics of the test practice if opportunities of an opt-out BBV test procedure are to be fully realised. Findings also highlight the critical need to further evaluate post-test intervention practices and experiences.
Protocol for a systematic review and meta-analysis of interventions for pathologic perforator veins in chronic venous disease
Authors: de Moraes Silva Melissa Andreia , Flumignan Ronald Luiz Gomes , Miranda Fausto , Cardoso Rodolfo Souza , Silva Seleno Glauber de Jesus , Guedes Henrique Jorge , Nakano Luis Carlos Uta
Published: May 2019

Introduction

Perforator veins (PVs) play an important role in the development of chronic venous insufficiency and ulceration. Procedures to eliminate incompetence and reflux in PV may include open surgery, subfascial endoscopic surgery, intravenous ablation techniques and sclerotherapy. With the aim of filling the evidence gap, this is a protocol for a systematic review that will assess the effects of any form of intervention for the treatment of pathologic PVs of the lower limbs in patients with chronic venous disease.

Methods and analysis

Systematic searches will be carried out in MEDLINE, EMBASE, Cochrane CENTRAL, IBECS and LILACS databases at a minimum without date or language restrictions for relevant randomised controlled trials (RCTs) and quasi-RCTs (trials in which the method of allocation is not truly random). In addition, a search will also be carried out in the WHO International Clinical Trials Registry Platform, in the clinical trial registries of ClinicalTrials.gov and in the grey literature source OpenGrey.eu. The RCT and quasi-RCT comparison techniques isolated or in combination for treating PVs will be considered. Three review authors will independently perform data extraction and quality assessments of data from included studies, and any disagreements will be resolved by discussion. The primary outcomes will be wound healing and pain. Secondary outcomes will include oedema, adverse events, recurrence or recanalisation, quality of life and economic aspects. The Cochrane handbook will be used for guidance. If the results are not appropriate for a meta-analysis in RevManV.5 software (eg, if the data have considerable heterogeneity and are drawn from different comparisons), a descriptive analysis will be performed.

Ethics and dissemination

Ethics committee approval is not necessary. We intend to update the public registry used in this review, report any important protocol amendments and publish the results in a widely accessible journal.

PROSPERO registration number

CRD42018092974
Do pregnant women living in higher well-being populations in the USA experience lower risk of preterm delivery? A cross-sectional study
Authors: Riley Carley , Roy Brita , Herrin Jeph , Spatz Erica , Silvestri Mark T , Arora Anita , Kell Kenneth P , Rula Elizabeth Y , Krumholz Harlan M
Published: May 2019

Objective

To determine if preterm birth, defined as gestational age <37 weeks, is lower for women living in counties with higher well-being, after accounting for known individual risk factors.

Design

Cross-sectional study of all US births in 2011.

Participants

We obtained birth data from the National Center for Health Statistics which included 3 938 985 individuals.

Main outcomes measures

Primary outcome measure was maternal risk of preterm delivery by county; primary independent variable was county-level well-being as measured by the Gallup-Sharecare Well-Being Index (WBI).

Results

Women living in counties with higher population well-being had a lower rate of preterm delivery. The rate of preterm birth in counties in the lowest WBI quintile was 13.1%, while the rate of preterm birth in counties in the highest WBI quintile was 10.9%. In the model adjusted for maternal risk factors (age, race, Hispanic ethnicity, smoking status, timing of initiation of prenatal visits, multiparity, maternal insurance payer), the association was slightly attenuated with an absolute difference of 1.9% (95% CI 1.7% to 2.1%; p<0.001).

Conclusions

Pregnant women who live in areas with higher population well-being have lower risk of preterm birth, even after accounting for individual risk factors.
Salt content of instant noodles in Malaysia: a cross-sectional study
Authors: Tan Chun Han , Chow Zhen Yee , Ching Siew Mooi , Devaraj Navin Kumar , He Feng J , MacGregor Graham A , Chia Yook Chin
Published: May 2019

Objective

To determine the salt content in instant noodles sold in Malaysia.

Study design

A cross-sectional survey was done involving 707 different flavours and packaging of instant noodles sold in six hypermarkets and retailer chains in Malaysia and the corresponding brand’s official websites in 2017.

Methods

The salt content (gram per serving and per 100 g) was collected from the product packaging and corresponding brand’s official website.

Results

Of the 707 different packaging and flavours of instant noodles, only 62.1% (n=439) provided the salt content in their food label.

The mean (±SD) salt per 100 g of instant noodles was 4.3±1.5 g and is nearly four times higher than the salt content of food classified in Malaysia as a high salt content (>1.2 g salt per 100 g). The salt content for instant noodle per packaging ranged from 0.7 to 8.5 g. 61.7% of the instant noodles exceeded the Pacific Salt Reduction Target, 11.8% exceeded the WHO recommended daily salt intake of <5.0 per day and 5.50% exceeded Malaysia Salt Action Target. 98% of instant noodles will be considered as high salt food according to the Malaysia Guidelines.

The probability of the instant noodles without mixed flavour (n=324) exceeding the Pacific Salt Reduction Target was tested on univariate and multivariate analysis. Instant noodles with soup, Tom Yam flavour, pork flavour and other flavours were found to be predictors of instant noodles with the tendency to exceed Pacific Salt Reduction Target when compared with instant noodles without mixed flavours (p<0.05).

Conclusion

Only 62% of instant noodles displayed the salt content on their food label. Salt content in instant noodles is very high, with 90% exceeding the daily salt intake recommended by WHO. Prompt action from regulatory and health authorities is needed to reduce the salt content in instant noodles.
Australian children undergoing selective dorsal rhizotomy: protocol for a national registry of multidimensional outcomes
Authors: Lewis Jennifer , Bear Natasha , Baker Felicity , Fowler Adam , Lee Olivia , McLennan Kim , Richardson Emma , Scheinberg Adam , Smith Nadine , Thomason Pam , Tidemann Andrew , Wynter Meredith , Paget Simon
Published: May 2019

Introduction

Selective dorsal rhizotomy (SDR) is a neurosurgical intervention intended to permanently reduce spasticity in the lower limbs and improve mobility in selected children with cerebral palsy (CP). Despite SDR having been performed worldwide for the past 30 years, there is moderate quality of evidence that SDR is effective in reducing spasticity with low to very low evidence of its effectiveness in improving gait, function and participation, using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. Published studies have described outcomes for groups that differ in selection, surgical technique and postoperative rehabilitation making it difficult for clinicians to use this information to advise families on best management. There is substantial community interest in SDR. A small number of children with CP undergo SDR in Australia each year and some families seek the intervention at international sites. Capturing clinical outcomes and adverse event (AE) data for Australian children undergoing SDR will provide clinicians with information to help guide families considering SDR.

Methods and analysis

The Australian SDR Research Registry is a national registry of multidimensional outcomes for Australian children undergoing SDR in an Australian or overseas centre. Data will be collected for up to 10 years following the surgery, to include surgery and admission details, surgical and long-term AEs, and outcome measures across the body structure and functions, activity and participation domains of the International Classification of Functioning, Disability and Health. Data will be collected at baseline, during inpatient admission and at 1, 2, 5 and 10 years post. The aim of collecting these data is to improve understanding of short-, medium- and long-term outcomes and adverse effects of the intervention.

Ethics and dissemination

This study was approved by the individual Human Research and Ethics committees at the five Australian tertiary hospitals involved. Results will be disseminated via peer-reviewed publications and conference presentations.

Trial registration number

ACTRN12618000985280; Pre-results.
Diabetes & Women’s Health (DWH) Study: an observational study of long-term health consequences of gestational diabetes, their determinants and underlying mechanisms in the USA and Denmark
Authors: Zhang Cuilin , Olsen Sjurdur F , Hinkle Stefanie N , Gore-Langton Robert E , Vaag Allan , Grunnet Louise Groth , Yeung Edwina H , Bao Wei , Bowers Katherine , Liu Aiyi , Mills James L , Sherman Seth , Gaskins Audrey J , Ley Sylvia H , Madsen Camilla M , Chavarro Jorge E , Hu Frank B
Published: May 2019

Purpose

Women who experience gestational diabetes mellitus (GDM) are at exceptionally high-risk of developing type 2 diabetes (T2DM) later in life. However, limited information is available about genetic and environmental factors that are implicated in the progression from GDM to T2DM.

Participants

The Diabetes & Women’s Health (DWH) Study applied a hybrid design, which combined new prospective data collection with existing data in two prospective cohorts, the Danish National Birth Cohort (DNBC) and the Nurses’ Health Study II (NHS II). In total, the DWH Study identified 7759 women with a GDM diagnosis from both cohorts; 4457 women participated in the DWH Study data collection, which included two cycles of follow-up from 2012 to 2014 and 2014 to 2016.

Findings to date

Progression from GDM to T2DM was high. In the NHS II group, by 2013, 23.1% (n=846/3667) developed T2DM. In the DNBC group, at cycle 1 (2012–2014), the progression rate was even higher: 27.2% (n=215/790) had developed T2DM. Furthermore, we have shown that women who had GDM experienced a significantly greater risk of hypertension and cardiovascular diseases, as well as early stages of glomerular hyperfiltration and renal damage. Moreover, the DWH Study findings have shown that healthful diet and lifestyle factors and weight control were related to a lower risk of T2DM, hypertension and cardiovascular diseases.

Future plans

Primary data collection for the DWH Study is complete and investigators are currently investigating interactions of the abovementioned modifiable factors with T2DM genetic susceptibility in determining the risk of progression from GDM to T2DM. Findings from ongoing work will provide further insights for identifying more precise prevention strategies for T2DM and comorbidities in this high-risk population. Future work will examine novel biomarkers of health and disease in this cohort.
Effects of tolvaptan add-on therapy in patients with acute heart failure: meta-analysis on randomised controlled trials
Authors: Ma Guang , Ma Xixi , Wang Guoliang , Teng Wei , Hui Xuezhi
Published: May 2019

Objectives

Treating acute decompensated heartfailure (ADHF) for improving congestion with diuretics may cause worsening renal function (WRF), but the clinical efficacy of tolvaptan add-on therapy on reducing WRF in ADHF patients is inconsistent. This analysis is to evaluate the effects of tolvaptan add-on therapy on reducing WRF in ADHF patients.

Methods

Meta-analysis of randomised trials of tolvaptan add-on therapy on reducing WRF in ADHF patients. The MEDLINE, Embase and Cochrane Central Register of Controlled Trials databases were searched for relevant articles from their inception to 31 October, 2017. Two reviewers filtrated the documents on WRF, short-term all-cause mortality, body weight decreased, elevated sodium level for calculating pooled relatives risks, weighted mean difference and associated 95% CIs. We used fixed-effects or random-effects models according to I2statistics.

Achievements

Seven random controlled trials with 937 patients were included for analysis. Compared with the control, tolvaptan add-on therapy did not improve incidence of worsening renal function (RR 0.78, 95% CI 0.48 to 1.26, p=0.31, I2=66%) and short-term all-cause mortality (RR 0.85, 95% CI 0.47 to 1.56, p=0.61, I2=0%). On subgroup analyses, there was a suggestion of possible effect modification by dose of tolvaptan, in which benefit was observed in low-dose (≤15 mg/day) group (RR 0.48, 95% CI 0.23 to 1.02, p=0.05, I2=54%), but not with high-dose (30 mg) group (RR 1.33, 95% CI 0.99 to 1.78, p=0.05, I2=0%). However, tolvaptan add-on therapy reduced body weight in 2 days (standardised mean difference −0.49, 95% CI −0.64 to −0.34, p<0.00001, I2=0%), increased sodium level (mean difference 1.56, 95% CI 0.04 to 3.07, p=0.04, I2=0%).

Conclusion

The result suggests that comparing with the standard diuretic therapy, tolvaptan add-on therapy did not reduce the incidence of WRF and short-term mortality, however, it can decrease body weight and increase the sodium level in patients who are with ADHF. Further researches are still required for confirmation.
Attitudes and beliefs of Spanish families regarding their family members aged 75 years and over who live alone: a qualitative study
Authors: Molina-Mula Jesús , Gallo-Estrada Julia , Miquel-Novajra Alexandre
Published: May 2019

Objective

This study aimed to assess the attitudes and beliefs of Spanish families regarding their elderly family members aged 75 years and over who live alone, with consideration of gender and educational differences among the family members.

Methods

This qualitative study was based on the critical social paradigm, the theory of constructivist structuralism and Bourdieu’s theory of sociology of action. Four discussion groups were created with the following distribution of family members based on their gender and educational level: women with higher education, women with basic or secondary education, men with higher education and men with basic or secondary education. Participants were selected using purposive and snowball sampling. Announcements inviting voluntary participation were posted at primary health care facilities, social centres and neighbourhood associations in Mallorca, Spain.

Results

Analyses of the group discussions and a field journal revealed that families believe that elderly individuals prefer to live alone to retain their freedom and individual identities.

Conclusions

Families held two main views regarding elderly individuals living alone: a more traditional one in which elderly care is considered a moral duty associated with women, and a more modern view in which elderly care is considered a personal option that can be delegated. Sociomedical resources were considered insufficient and not easily accessible.
Importance of personal and professional experience for hospital staff in person-centred dementia care: a cross-sectional interview study using freelisting in a UK hospital ward
Authors: Petty Stephanie , Dening Tom , Griffiths Amanda , Coleston Donna Maria
Published: May 2019

Objective

To detail how hospital staff with differing personal and professional caregiving experiences approach the care of patients with dementia, in order to make practical recommendations for practice.

Design

Cross-sectional qualitative interviews.

Setting

A UK hospital ward providing dementia care.

Participants

A complete hospital ward staff team, constituting 47 hospital staff from 10 professions.

Methods

Hospital staff were asked to list their approaches to emotion-focused care in individual, ethnographic freelisting interviews. Cultural consensus analysis was used to detail variations in approaches to dementia care between staff subgroups.

Main outcome measures

The most salient listed descriptions of care emphasised by staff members with personal experience of dementia caregiving when compared with staff members without such experience, and descriptions from staff newer to the profession compared with staff with more years of professional dementia caregiving experience.

Results

Subgroups of hospital staff showed different patterns of responses both in how they noticed the emotional distress of patients with dementia, and in prioritised responses that they deemed to work. Hospital staff with professional experience of dementia caregiving and staff with fewer years of professional experience prioritised mutual communication and getting to know each patient.

Conclusions

Subgroups of hospital staff with personal caregiving experiences and fewer years of professional care experience were more likely to describe person-centred care as their routine ways of working with patients with dementia. It is recommended that personal experience and the novice curiosity of hospital staff be considered as valuable resources that exist within multidisciplinary staff teams that could enhance staff training to improve the hospital care for patients with dementia.
Effect of preoperative bicarbonate infusion on maternal and perinatal outcomes of obstructed labour in Mbale Regional Referral Hospital: a study protocol for a randomised controlled trial
Authors: Musaba Milton W , Barageine Justus K , Ndeezi Grace , Wandabwa Julius N , Weeks Andrew
Published: May 2019

Introduction

To improve maternal and fetal outcomes among patients with obstructed labour (OL) in low-resource settings, the associated electrolyte and metabolic derangements must be adequately corrected. Oral fluid intake during labour and preoperative intravenous fluid replacement following OL corrects the associated dehydration and electrolyte changes, but it does not completely reverse the metabolic acidosis, that is, a cause of intrapartum birth asphyxia and a risk factor for primary postpartum haemorrhage due to uterine atony. Sodium bicarbonate is a safe, effective, cheap and readily available acid buffer, that is widely used by sportspeople to improve performance. It also appears to improve fetal and maternal outcomes in abnormally progressing labour. However, its effects on maternal and fetal outcomes among patients with OL is unknown. We aim at establishing the effect of a single-dose preoperative infusion of sodium bicarbonate on maternal and fetal lactate levels and clinical outcomes among patients with OL.

Methods and analysis

This will be a double blind, randomised controlled clinical phase IIb trial. We will randomise 478 patients with OL to receive either 50 mL of placebo with standard preoperative infusion of normal saline (1.5 L) or 4.2 g of sodium bicarbonate solution (50 mL of 50 mmol/L) with the preoperative infusion of normal saline (1.5 L). The primary outcome will be mean lactate levels in maternal capillary blood at 1 hour after study drug administration and in the arterial cord blood at birth. We will use the intention-to-treat analysis approach. Secondary outcomes will include safety, maternal and fetal morbidity and mortality up to 14 days postpartum.

Ethics and dissemination

Makerere University School of Medicine Research and Ethics Committee and Uganda National Council for Science and Technology have approved the protocol. Each participant will give informed consent at enrollment.

Trial registration number

PACTR201805003364421
Propensity-matched study of enhanced primary care on contact with the criminal justice system among individuals recently released from prison to New Haven
Authors: Wang Emily A , Lin Hsiu-ju , Aminawung Jenerius A , Busch Susan H , Gallagher Colleen , Maurer Kathleen , Puglisi Lisa , Shavit Shira , Frisman Linda
Published: May 2019

Background

Health systems can be integral to addressing population health, including persons with incarceration exposure. Few studies have comprehensively integrated state-wide data to assess how the primary care system can impact criminal justice outcomes. We examined whether enhanced primary care can decrease future contact with the criminal justice system among individuals just released from prison.

Methods

We linked administrative data (2013–2016) of Connecticut Department of Correction, Department of Mental Health and Addiction Services, Department of Social Service, Court Support Services Division, and Department of Public Health to conduct a quasi-experimental study using propensity score matching of 94 participants who received enhanced primary care in Transitions Clinic to 94 controls not exposed to the programme. The propensity score included 23 variables, which encompassed participants’ medical and incarceration history and service utilisation. The main outcomes were reincarceration rates and days incarcerated in the first year from the index date, which was either enrolment in the Transitions Clinic programme or release from prison in the control group.

Results

The odds of reincarceration, including arrests and new convictions, were similar for the two groups, but Transitions Clinic participants had lower odds of returning to prison for a parole or probation technical violation (adjusted OR: 0.38; 95% CI 0.16 to 0.93) compared with the control group. Further, Transitions Clinic participants had fewer incarceration days (incidence rate ratio: 0.55; 95% CI 0.35 to 0.84) compared with the control group.

Conclusions

Enhanced primary care for individuals just released from prison can reduce reincarceration for technical violations and shorten time spent within correctional facilities. This study shows how community health systems may play a role in current strategies to reduce prison populations.