bluuebunny/crossref_metadata_2025 huggingface dataset:
Qualitative evaluation of neuroretinal rim and retinal nerve fibre layer on optical coherence tomography to detect glaucomatous damage
Authors: Wu Zhichao , Vianna Jayme R , Reis Alexandre S C , Zemborain Zane Z , Lee Seung H , Thenappan Abinaya , Weng Denis S D , Tsamis Emmanouil , Joiner Devon B , Ritch Robert , De Moraes Carlos Gustavo V , Hood Donald C
Published: October 2019

Purpose

To understand the added value of Bruch’s membrane opening-minimum rim width (BMO-MRW) measurements to conventional circumpapillary retinal nerve fibre layer (cpRNFL) thickness measurements on optical coherence tomography (OCT) imaging for discriminating between perimetric glaucoma and healthy eyes, evaluated through a qualitative evaluation.

Methods

384 healthy eyes and 188 glaucoma eyes were evaluated, and glaucoma eyes were categorised as perimetric (n=107) based on a history of ≥3 consecutive abnormal 24–2 visual field tests or suspected glaucoma if they did not (n=81). OCT-derived BMO-MRW and cpRNFL reports were qualitatively evaluated by two experienced graders in isolation at first, and then by using both reports combined. The diagnostic performance (sensitivity at 95% specificity, total and partial area under the receiver operating characteristic curve) of detecting perimetric glaucoma with each method were compared.

Results

All diagnostic performance measures for detecting perimetric glaucoma eyes were not significantly different when using either the cpRNFL or BMO-MRW reports alone compared with using both reports combined (p≥0.190), nor when comparing the use of each report in isolation (p≥0.500).

Conclusions

Experienced graders exhibited no difference in discriminating between perimetric glaucoma and healthy eyes when using a cpRNFL report alone, the BMO-MRW report alone or the two reports combined. Therefore, either OCT imaging report of the neuroretinal tissue could be used effectively for detecting perimetric glaucoma, but further studies are needed to determine whether there are specific advantages of each method, or the combination of both, when evaluating eyes that have a greater degree of diagnostic uncertainty.
Quantitative assessment of the effect of fasting on macular microcirculation: an optical coherence tomography angiography study
Authors: Karaküçük Yalçın , Beyoglu Abdullah , Çömez Ayşegül
Published: October 2019

Aim

To analyse the effect of fasting on the retinal vascular plexus and choriocapillaris structures in healthy subjects via Optical Coherence Tomography Angiography (OCTA).

Methods

In this prospective study, OCTA scans of 98 eyes in 49 healthy subjects were compared in fasting and non-fasting period. All cases had a full ophthalmological examination, with OCTA parameters measured, including superficial flow area (SCP) (mm2), deep flow area (DCP) (mm2), choriocapillaris flow area (CC) (mm2), superficial and deep vascular density (SVD and DVD, respectively) (%), superficial foveal avascular zone area (FAZs) (mm2), deep foveal avascular zone area (FAZd) (mm2), subfoveal choroidal thickness (SFCT) (µm) and central macular thickness (CMT) (µm).

Results

The mean SCP, DCP and CC flow area values were induced to be significantly lower in a fasting than a non-fasting period (p<0.001, p<0.001, p=0.049, respectively). The mean VD in a fasting period was statistically significantly lower than in a non-fasting period at the SCP level (p=0.009). No statistically significant difference was found between the two periods in respect to DVD, FAZd and CMT (p=0.068, p=0.653 and p=0.531, respectively); however, FAZs were significantly lower in a non-fasting than fasting period (p=0.038). The SFCT was determined to be statistically significant and thicker during a fasting period (p<0.001).

Conclusion

The current study documented several physiological changes in a fasting period, such as changes in SCP, DCP, CC flow, SVD and DVD, via OCTA.
Prevalence and factors associated with hypertension among adults in rural Sylhet district of Bangladesh: a cross-sectional study
Authors: Khanam Rasheda , Ahmed Salahuddin , Rahman Sayedur , Kibria Gulam Muhammed Al , Syed Jafar Raza Rizvi , Khan Ahad Mahmud , Moin Syed Mamun Ibne , Ram Malathi , Gibson Dustin G , Pariyo George , Baqui Abdullah H.
Published: October 2019

Objectives

Low-income and middle-income countries are undergoing epidemiological transition, however, progression is varied. Bangladesh is simultaneously experiencing continuing burden of communicable diseases and emerging burden of non-communicable diseases (NCDs). For effective use of limited resources, an increased understanding of the shifting burden and better characterisation of risk factors of NCDs, including hypertension is needed. This study provides data on prevalence and factors associated with hypertension among males and females 35 years and older in rural Bangladesh.

Methods

This is a population-based cross-sectional study conducted in Zakiganj and Kanaighat subdistricts of Sylhet district of Bangladesh. Blood pressure was measured and data on risk factors were collected using STEPS instrument from 864 males and 946 females aged 35 years and older between August 2017 and January 2018. Individuals with systolic blood pressure of ≥140 mm Hg or diastolic blood pressure of ≥90 mm Hg or taking antihypertensive drugs were considered hypertensive. Bivariate and multivariate analyses were performed to identify factors associated with hypertension.

Results

The prevalence of hypertension was 18.8% (95% CI 16.3 to 21.5) and 18.7% (95% CI 16.3 to 21.3) in adult males and females, respectively. Among those who were hypertensive, the prevalence of controlled, uncontrolled and unaware/newly identified hypertension was 23.5%, 25.9% and 50.6%, respectively among males and 38.4%, 22.6% and 39.0%, respectively among females. Another 22.7% males and 17.8% females had prehypertension. Increasing age and higher waist circumference (≥90 cm for males and ≥80 cm for females) were positively associated with hypertension both in males (OR 4.0, 95% CI 2.5 to 6.4) and females (OR 2.8, 95% CI 2.0 to 4.1).

Conclusions

In view of the high burden of hypertension and prehypertension, a context-specific scalable public health programme including behaviour change communications, particularly to increase physical activity and consumption of healthy diet, as well as identification and management of hypertension needs to be developed and implemented.
Continuity of care and delivery of diabetes and hypertensive care among regular users of primary care services in Chile: a cross-sectional study
Authors: Leniz Javiera , Gulliford Martin C
Published: October 2019

Objectives

Explore factors related to continuity of care and its association with diabetes and hypertensive care, and disease control.

Design

Cross-sectional study.

Setting

Data from the Chilean Health National Survey 2009–2010.

Participants

Regular users of primary care services aged 15 or older.

Primary and secondary outcome measures

Proportion of hypertensive and diabetic patients with a blood pressure <140/90 mm Hg and HbA1c<7.0% respectively, self-report of diagnosis, treatment and recent foot and ophthalmological exams. Associations between continuity of care, sociodemographic characteristics, and primary and secondary outcomes were explored using logistic regression.

Results

3887 primary care service users were included. 14.7% recognised a usual GP, 82.3% of them knew their name. Continuity of care was positively associated with age >65 years (OR 4.81, 95% CI 3.16 to 7.32), being female (OR 1.66, 95% CI 1.34 to 2.05), retired (OR 2.22, 95% CI 1.75 to 2.83), obese (OR 1.66, 95% CI 1.29 to 2.14), high cardiovascular risk (OR 2.98, 95% CI 2.13 to 4.17) and widowed (OR 1.50, 95% CI 1.13 to 1.99), and negatively associated with educational level (8–12 vs <8 years OR 0.79, 95% CI 0.64 to 0.97), smoking (OR 0.65, 95% CI 0.52 to 0.82) and physical activity (OR 0.76, 95% CI 0.61 to 0.95). Continuity of care was associated with diagnosis awareness (OR 2.83, 95% CI 1.21 to 6.63), pharmacological treatment (OR 2.04, 95% CI 1.15 to 3.63) and a recent foot (OR 3.17, 95% CI 1.84 to 5.45) and ophthalmological exam (OR 3.20, 95% CI 1.66 to 6.18) in diabetic but not in hypertensive patients.

Conclusions

Continuity of care was associated with higher odds of having a recent foot and ophthalmological exam in patients with diabetes, but not with better diseases control. Findings suggest patients with chronic conditions have better continuity of care access.
Public understanding and use of antibiotics in England: findings from a household survey in 2017
Authors: McNulty Cliodna A M , Collin Simon M , Cooper Emily , Lecky Donna M , Butler Chris C
Published: October 2019

Objectives

To describe public understanding and use of antibiotics.

Design

Ipsos MORI Capibus survey of randomly-selected households.

Setting

England, January–April 2017.

Participants

2283 adults (≥15 years) including 777 parents of children <5 years old.

Data collection and analysis

The main survey was undertaken in January 2017 (n=1691); data from an additional sample of parents were collected in April 2017 (n=592). Analyses were weighted to obtain estimates representative of the population.

Main outcome measures

Responses to questions about antibiotics (awareness and perceptions), recent illness (expectations and experience), delayed and leftover antibiotics, and child illness stratified by demographic and socioeconomic characteristics.

Results

Most respondents (83% (1404/1691)) recognised that antibiotics kill bacteria/treat bacterial infections, but a sizeable minority (35% (592/1691)) thought that antibiotics kill viruses/treat viral infections. Overall levels of understanding have not changed substantially since similar surveys in 2003 and 2008/2009. One sixth of respondents who were prescribed antibiotics reported having leftovers (14% (64/498)) and 33% (22/64) kept these for possible future use. 1.3% of all respondents (23/1691) reported taking left-over antibiotics in the past year and 1.6% (26/1691) reported taking antibiotics obtained without a prescription. Higher social grade and educational qualifications were strongly positively associated with antibiotic knowledge; youngest (15–24 years), oldest (65 +years) and black, Asian and minority ethnic adults were less knowledgeable. Among 1319 respondents who had an infection or antibiotics within the past year, 43% (568/1319) said that they had not received any advice or information about antibiotics.

Conclusions

Despite many campaigns, public understanding of antibiotics in England continues to combine correct basic knowledge held by most people with less prevalent but persistent and potentially harmful misunderstandings. These could be addressed through active provision of advice and information during primary and secondary care consultations and more effective public health interventions.
Monitoring young lifestyles (MyLife) - a prospective longitudinal quantitative and qualitative study of youth development and substance use in Norway
Authors: Brunborg Geir Scott , Scheffels Janne , Tokle Rikke , Buvik Kristin , Kvaavik Elisabeth , Burdzovic Andreas Jasmina
Published: October 2019

Purpose

TheMonitoringYoungLifestyles (MyLife) project was initiated as an integrated quantitative and qualitative prospective investigation of correlates, causes, and consequences of adolescent substance use and other addictive behaviours in Norway.

Participants

The MyLife cohort was recruited from middle schools in Norway, which were selected from low, medium and high standard of living areas in both rural and urban regions of the country. A total of 3512 eighth, ninth and tenth graders (55% girls) from 33 schools were enrolled in the quantitative project arm (QT), while a total of 120 eighth graders (52% girls) from six schools were enrolled in the qualitative project arm (QL).

Findings to date

QT baseline was conducted in the fall of 2017, when 2975 adolescents completed an online questionnaire at school during a regular class time. A total of 2857 adolescents participated in the first QT follow-up 1 year later. QL baseline was conducted across the fall semesters of 2014 (one class) and 2015 (five classes), when a total of 118 eighth graders completed face-to-face interviews. QL follow-ups were conducted in the spring of 2015 and fall of 2017 (n=98) for group interviews, and in the spring of 2017 and 2018 (n=95) for individual interviews. In terms of additional data sources, a total of 3035 parents consented to own participation, of which 1899 completed a brief online questionnaire at QT baseline in late 2017. School principals completed brief surveys at the same time.

Future plans

Both QT and QL arms have planned follow-ups through 2021. Consents were obtained for individual-level linkages of adolescent and parental quantitative surveys to each other, as well as to the information available in multiple national registries and databases. These supplemental data sources will provide key information on additional putative exposures as well as on the long-term health, educational, and social outcomes of the MyLife participants.
Effects of a probiotic treatment (Enterococcus faecalis) and open-label placebo on symptoms of allergic rhinitis: study protocol for a randomised controlled trial
Authors: Schaefer Michael , Enck Paul
Published: October 2019

Introduction

Several studies suggest that gut microbiota may play an important role in allergic diseases. The present trial aims to examine effects of the probioticEnterococcus faecalison symptoms of allergic rhinitis in patients. Effects of this probiotic on the immune system have been reported by several studies, but the majority of the previous trials were animal studies. In addition, it is well known that symptoms in allergic rhinitis are prone to exhibit high placebo responses. Moreover, recent studies report that even placebos without deception (open-label placebos) are highly effective in reducing symptoms of allergic rhinitis. Our study design combines both new approaches to assess effects on allergic symptoms in patients. The objective of this study is to compare the effects of a probiotic treatment (E. faecalis) with effects seen by open-label placebo, concealed placebo treatment and no treatment control.

Methods and analysis

A total of 120 patients with allergic rhinitis will be randomly assigned to one of four different groups: a double-blind probiotic/placebo group (groups 1 and 2), an open-label placebo group (group 3) and a no-treatment group (group 4) to control for spontaneous variation of symptoms. The primary outcome is the evaluation of allergic symptoms using the Combined Symptoms Medication Score. Furthermore, health-related quality of life is examined (Rhinitis Quality of Life Questionnaire). Secondary outcomes include a visual analogue scale on allergic burden and a second quality of life questionnaire. This report describes the study design of the randomised controlled trial.

Ethics and dissemination

The study design was approved by the ethical committee of the UKT Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany. The trial is registered at the German Clinical Trials Register (www.drks.de, DRKS00015804). The trial results will be published in peer-reviewed journals and at conferences.

Trial registration number

German Clinical Trials Register (www.drks.de, DRKS00015804); Pre-results.
Lifestyle behaviour change for preventing the progression of chronic kidney disease: a systematic review
Authors: Evangelidis Nicole , Craig Jonathan , Bauman Adrian , Manera Karine , Saglimbene Valeria , Tong Allison
Published: October 2019

Objectives

Modifying lifestyle can prevent the progression of chronic kidney disease (CKD) but the specific elements which lead to favourable behaviour change are not well understood. We aimed to identify and evaluate behaviour change techniques and functions in lifestyle interventions for preventing the progression of CKD.

Design

Systematic review.

Data sources

MEDLINE, EMBASE, CINAHL and PsycINFO.

Eligibility criteria

Trials of lifestyle behaviour change interventions (including diet, physical activity, smoking and/or alcohol) published to September 2018 in adults with CKD stages 1–5.

Data extraction and synthesis

Trial characteristics including population, sample size, study setting, intervention, comparator, outcomes and study duration, were extracted. Study quality was independently assessed by two reviewers using the Cochrane risk of bias tool. The Behaviour Change Technique Taxonomy v1 was used to identify behaviour change techniques (eg, goal setting) and the Health Behaviour Change Wheel was used to identify intervention functions (eg, education). Both were independently assessed by three reviewers.

Results

In total, 26 studies involving 4263 participants were included. Risk of bias was high or unclear in most studies. Interventions involved diet (11), physical activity (8) or general lifestyle (7). Education was the most frequently used function (21 interventions), followed by enablement (18), training (12), persuasion (4), environmental restructuring (4), modelling (2) and incentivisation (2). The most common behaviour change techniques were behavioural instruction (23 interventions), social support (16), behavioural demonstration (13), feedback on behaviour (12) and behavioural practice/rehearsal (12). Eighteen studies (69%) showed a significant improvement in at least one primary outcome, all of which included education, persuasion, modelling and incentivisation.

Conclusion

Lifestyle behaviour change interventions for CKD patients frequently used education, goal setting, feedback, monitoring and social support. The most promising interventions included education and used a variety of intervention functions (persuasion, modelling and incentivisation).

PROSPERO registration number

CRD42019106053.
Expression of MMR system genes is correlated to NF-kB in patients with oral squamous cell carcinoma
Authors: Fonseca Alexandre , Perez Matheus , Veiga Glaucia , Prosdócimi Fábio , Nunes Fabio , Bianco Bianca , Fonseca Fernando , Alves Beatriz
Published: October 2019

Aims

The aim of this study was to evaluate the mismatch repair gene expression and their correlation withNF-kBin patients with oral squamous cell carcinoma (SCC).

Methods

Total RNA was isolated from 28 biopsy samples. A control group was composed of 20 volunteers. Differential expression ofhMSH2,hMSH6andNF-kBgenes was accessed by quantitative PCR.

Results

There is increased expression of all the analysed genes when the patients were smokers and alcoholics. In addition, there is increased expression ofhMSH2when SCC was removed from the base of the tongue. There was a correlation betweenNF-kBandhMSH2andhMSH6as well as between repair geneshMSH2andhMSH6expression levels. There is increased expression of thehMSH2gene in patients with SCC, especially in the alcoholics.

Conclusions

There is a strong indication thatNF-kBgene was expressed along with the studied repair genes, evidencing the possibility that this system can be activated by the inflammatory pathway.
ABO blood group is a determinant of von Willebrand factor protein levels in human pulmonary endothelial cells
Authors: Murray Glenn P , Post Steven R , Post Ginell R
Published: October 2019

ABO blood group antigens are expressed on von Willebrand factor (VWF) and glycosylation patterns influence circulating VWF levels. The aim of this study was to examine the effect of ABO blood type on tissue-associated VWF protein levels. We selected 35 formalin-fixed paraffin-embedded pulmonary tissue blocks obtained at autopsy from decedents who died from pulmonary embolism with known ABO blood groups (O, A, B and AB phenotypes), prepared tissue microarrays (TMAs) and stained TMAs with antibodies to VWF and platelet/endothelial cell adhesion marker-1 (PECAM-1) as a marker of endothelial cells. A pixel count scoring algorithm was used to quantify VWF and PECAM-1 staining intensity in pulmonary arterioles in digitised images. Compared with type O, non-O individuals have a significantly higher amount of endothelial cell-associated VWF protein expression. VWF protein levels associated with pulmonary vascular endothelial cells is influenced by ABO antigenic determinants.
Cultural continuity and Inuit health in Arctic Canada
Authors: Newell Sarah Lynn , Dion Michelle L , Doubleday Nancy C
Published: October 2019

Background

Previous research association increased levels of cultural continuity and decreased rates of youth suicide in First Nations communities. We investigate the relationship between cultural continuity and self-rated health looking specifically at Inuit living in the Canadian Arctic.

Methods

The Arctic Supplements of the Aboriginal Peoples Survey from years 2001 and 2006 were appended to explore the relationship between various measures of cultural continuity and self-rated health. These measures include access to government services in an Aboriginal language, Inuit cultural variables, community involvement and governance. Literature related to Inuit social determinants of health and health-related behaviours were used to build the models.

Results

All measures of cultural continuity were shown to have a positive association with self-rated health for Inuit participants. Background and other control variables influenced the strength of the association but not the direction of the association. Access to services in an Aboriginal language, harvesting activities and government satisfaction were all significantly related to the odds of better health outcomes. Finally, the study contributes a baseline from a known data horizon against which future studies can assess changes and understand future impacts of changes.

Conclusion

The Canadian government and other agencies should address health inequalities between Inuit and non-Inuit people through programmes designed to foster cultural continuity at a community level. Providing access to services in an Aboriginal language is a superficial way of promoting cultural alignment of these services; however, more inclusion of Inuit traditional knowledge is needed to have a positive influence on health.
Community engagement and dementia risk: time-to-event analyses from a national cohort study
Authors: Fancourt Daisy , Steptoe Andrew , Cadar Dorina
Published: October 2019

Background

There is increasing interest in the potential health benefits of referring older adults to engage in community leisure activities (‘social prescribing’) to help promote healthy cognitive ageing. However, it remains unclear whether beneficial effects of community engagement are independent of the well-known protective effects of broader structural, functional and subjective social factors.

Methods

We analysed data from 9550 adults aged 50+ from the English Longitudinal Study of Ageing, with baseline from 2004 to 2005. We assessed associations between different types of community engagement and dementia incidence over a 12-year period. Specifically, we used Cox proportional hazards models, competing risk regressions models, and modified Fine and Gray subdistribution hazards models while controlling for all identified demographic, health-related, and social covariates.

Results

Community cultural engagement (eg, visiting museums, galleries, the theatre) was associated with a lower hazard of developing dementia in older age independent of demographic, health-related and a broad range of social factors, using all three statistical approaches (fully adjusted Cox models: HR 0.58, 95% CI 0.41 to 0.80). Community group engagement (eg, attending clubs or societies) was only associated with dementia prior to adjustment for social factors. Results were robust to sensitivity analyses considering reverse causality, over-adjustment and baseline cognitive function.

Conclusion

It is not just social factors that are associated with reduced risk of dementia onset, but community engagement may also be protective, particularly when relating to cultural activities. These findings are of relevance when considering the current interest in social prescribing to support healthy ageing.
Efficacy and safety of anti-inflammatory agents for the treatment of major depressive disorder: a systematic review and meta-analysis of randomised controlled trials
Authors: Bai Shuang , Guo Wenliang , Feng Yangyang , Deng Hong , Li Gaigai , Nie Hao , Guo Guangyu , Yu Haihan , Ma Yang , Wang Jiahui , Chen Shiling , Jing Jie , Yang Jingfei , Tang Yingxin , Tang Zhouping
Published: October 2019

Objectives

To systematically review the efficacy and safety of anti-inflammatory agents for patients with major depressive disorders.

Methods

We searched the literature to identify potentially relevant randomised controlled trials (RCTs) up to 1 January 2019. The primary outcome was efficacy, measured by mean changes in depression score from baseline to endpoint. Secondary outcomes included response and remission rates and quality of life (QoL). Safety was evaluated by incidence of classified adverse events. Heterogeneity was examined using the I2 and Q statistic. Pooled standard mean differences (SMDs) and risk ratios (RRs) were calculated. Subgroup meta-analyses were conducted based on type of treatment, type of anti-inflammatory agents, sex, sponsor type and quality of studies.

Results

Thirty RCTs with 1610 participants were included in the quantitative analysis. The overall analysis pooling from 26 of the RCTs suggested that anti-inflammatory agents reduced depressive symptoms (SMD −0.55, 95% CI −0.75 to −0.35, I2=71%) compared with placebo. Higher response (RR 1.52, 95% CI 1.30 to 1.79, I2=29%) and remission rates (RR 1.79, 95% CI 1.29 to 2.49, I2=41%) were seen in the group receiving anti-inflammatory agents than in those receiving placebo. Subgroup analysis showed a greater reduction in symptom severity in both the monotherapy and adjunctive treatment groups. Subgroup analysis of non-steroidal anti-inflammatory drugs, omega-3 fatty acids, statins and minocyclines, respectively, disclosed significant antidepressant effects for major depressive disorder (MDD). For women-only trials, no difference in changes of depression severity was found between groups. Subanalysis stratified by sponsor type and study quality led to the same outcomes in favour of anti-inflammatory agents in both subgroups. Changes of QoL showed no difference between the groups. Gastrointestinal events were the only significant differences between groups in the treatment periods.

Conclusions

Results of this systematic review suggest that anti-inflammatory agents play an antidepressant role in patients with MDD and are reasonably safe.
Arrogance of ‘but all you need is a good index finger’: A narrative ethics exploration of lack of universal funding of PSA screening in Canada
Authors: Nisker Jeff
Published: October 2019

This narrative ethics exploration stems from my happy prostate-specific antigen (PSA) story, though it should not have been, as I annually refuse my family physician’s recommendation to purchase PSA screening. The reason for my refusal is I teach ethics to medical students and of course must walk the talk, and PSA screening is not publicly funded in the province of Ontario, Canada. In addition, I might have taken false comfort in ‘but all you need is a good index finger’ to detect prostate cancer, expounded by a senior physician at a national medical conference in 2010, and applauded by the large audience of physicians. I was compelled to begin this exploration out of survivor guilt, although I will not be a survivor for long, and as a mea culpa to the men similarly situated to me in having late diagnosis of prostate cancer, aggressive tumours and multiple metastases, but who unlike me are dead because they did not experience the physician–educator-based exceptionisms and coincidences that permit me to still be alive. Although my PSA story will always be a happy story, even when my life ends in a few years, the initiation of public funding of PSA screening for all men over 50 would make my PSA story an even happier story.
Artificial wombs, birth and ‘birth’: a response to Romanis
Authors: Colgrove Nick
Published: October 2019

Recently, I argued that human subjects in artificial wombs (AWs) ‘share the same moral status as newborns’ and so, deserve the same treatment and protections as newborns. This thesis rests on two claims: (A) subjects of partial ectogenesis—those that develop in utero for at time before being transferred to AWs—are newborns and (B) subjects of complete ectogenesis—those who develop in AWs entirely—share the same moral status as newborns. In response, Elizabeth Chloe Romanis argued that the subject in an AW is ‘a unique human entity…rather than a fetus or a newborn’. She provides four lines of response to my essay. First, she argues that I have ‘misconstrued’ what birth is. Once we correct that error, it becomes clear that subjects of partial ectogenesis have not been born. Second, she argues that my claims imply that non-implanted embryos (existing in vivo) ‘would also be “born”’. But that is absurd. Third, she claims I fail to ‘meaningfully respond’ to distinctions she draws between subjects of ectogenesis and neonates. Finally, she criticises my essay for focusing on subjects of AWs rather than focusing on pregnant persons (who should be at the ‘centre’ of debates over AWs). I respond to each of these charges. In doing so, I reaffirm that (contra Romanis) some subjects of ectogenesis are newborns and all subjects of ectogenesis—even those that have not been born—share the same moral status as newborns.
Taking one for the team: a reiteration on the role of self-blame after medical error
Authors: Tigard Daniel W
Published: October 2019

In a critique of my work on ‘taking the blame’ as a response to medical errors, my position on the potential goods of individual responsibility and blame is challenged. It is suggested that medicine is a ‘team sport’ and several rich examples are provided to support the possible harms of practitioner self-blame. Yet, it appears that my critics have misunderstood my demands and to whom they are directed. With this response, I offer several clarifications of my account, as well as a reiteration on the role of self-blame after medical error.
Mortality reduction after thrombectomy for acute intracranial large vessel occlusion: meta-analysis of randomized trials
Authors: Yaeger Kurt A , Martini Michael L , Hardigan Trevor , Ladner Travis , Hao Qing , Singh I Paul , Mocco J
Published: October 2019

Background

Thrombectomy for patients with emergent large vessel occlusion (ELVO) is currently recognized as the standard of care for appropriately selected patients. As proven in several randomized clinical trials and meta-analyses, treatment with thrombectomy lowers rates of poor functional outcomes after ELVO, compared with standard medical management. However, combined mortality rates of the most recent, high-quality clinical trials have not been collectively assessed.

Objective

The goal of this study was to assess the combined mortality rates of patients with ELVO following thrombectomy using data from the most recent, high-quality clinical trials.

Methods

Meta-analysis was performed in clinical trials comparing thrombectomy and medical management for patients with anterior circulation ELVO. Cumulative rates of mortality (mRS 6) as well as mortality or severe disability (mRS 5-6) were calculated.

Results

Ten clinical trials fit the inclusion criteria, including PISTE, REVASCAT, DAWN, THRACE, SWIFT PRIME, ESCAPE, DEFUSE 3, THERAPY, EXTEND-IA, and MR CLEAN, with 2233 patients assessed for mortality alone and 2229 for mortality or severe disability. There was a significantly reduced risk of death with thrombectomy compared with standard medical care (14.9% vs 18.3%, P=0.03; RR 0.81, 95% CI 0.67 to 0.98), as well as a reduced risk of mortality or severe disability (mRS 5–6) in ELVO patients treated with thrombectomy (21.1% vs 30.5%, P<0.0001; RR 0.69, 95% CI 0.60 to 0.80).

Conclusions

Overall, these results suggest a lower risk of death, as well as death or severe disability, in patients with ELVO treated with thrombectomy compared with medical management alone.
Perceived and content-related emotional demands at work and risk of long-term sickness absence in the Danish workforce: a cohort study of 26 410 Danish employees
Authors: Framke Elisabeth , Sørensen Jeppe Karl , Nordentoft Mads , Johnsen Nina Føns , Garde Anne Helene , Pedersen Jacob , Madsen Ida E H , Rugulies Reiner
Published: October 2019

Objectives

This study aimed to examine whether high emotional demands at work predict long-term sickness absence (LTSA) in the Danish workforce and whether associations differ by perceived and content-related emotional demands.

Methods

We included 26 410 individuals from the Work Environment and Health in Denmark Study, a nationwide sample of the Danish workforce. Emotional demands at work were measured with two items: one assessing perceived emotional demands (asking how often respondents were emotionally affected by work) and one assessing content-related emotional demands (frequency of contact with individuals in difficult situations). LTSA was register based and defined as spells of ≥6 weeks. Respondents with LTSA during 2 years before baseline were excluded. Follow-up was 52 weeks. Using Cox regression, we estimated risk of LTSA per one-unit increase in emotional demands rated on a five-point scale.

Results

During 22 466 person-years, we identified 1002 LTSA cases. Both perceived (HR 1.20, 95% CI 1.12 to 1.28) and content-related emotional demands (HR 1.07, 95% CI 1.01 to 1.13) predicted risk of LTSA after adjustment for confounders. Further adjustment for baseline depressive symptoms substantially attenuated associations for perceived (HR 1.08, 95% CI 1.01 to 1.16) but not content-related emotional demands (HR 1.05, 95% CI 1.00 to 1.11). Individuals working in occupations with above-average values of both exposures had an increased risk of LTSA (HR 1.32, 95% CI 1.14 to 1.52) compared with individuals in all other job groups.

Conclusions

Perceived and content-related emotional demands at work predicted LTSA, also after adjustment for baseline depressive symptoms, supporting the interpretation that high emotional demands may be hazardous to employee’s health.
Long QT syndrome is associated with an increased burden of diabetes, psychiatric and neurological comorbidities: a nationwide cohort study
Authors: Marstrand Peter , Theilade Juliane , Andersson Charlotte , Bundgaard Henning , Weeke Peter E , Tfelt-Hansen Jacob , Jespersen Camilla , Gislason Gunnar , Torp-Pedersen Christian , Kanters Jørgen K , Jørgensen Mads E
Published: October 2019

Objective

Studies have suggested a shared genetic aetiology between congenital long QT syndrome (LQTS) and diabetes, epilepsy and mental disorders. We investigated the prevalence of metabolic, neurological and psychiatric comorbidities in LQTS patients.

Methods

This retrospective cohort study was based on data from nationwide Danish registries, 2003–2017. LQTS patients were matched 1:5 with controls on sex and age.

Results

We matched 463 LQTS patients with 2315 controls from the background population. Mean age was 35.7 (SD 21.0) years, and 38% were males in both groups. LQTS patients had a higher prevalence of atrial fibrillation (6.5% vs 2.3%, p<0.001), diabetes (3.7% vs 1.8 %, p=0.011) and hearing loss (3.2% vs 1.7%, p=0.027). LQTS patients had a higher prevalence of psychiatric disorders overall (13.0% vs 9.1%, p=0.01) but the difference could not be attributed to a specific psychiatric disease subgroup. LQTS patients had a higher prevalence of neurological disorders (22.0% vs 13.2%, p<0.001), largely driven by epilepsy (6.7% vs 1.6%, p<0.001). In 20/27 (74%) of the LQTS patients, the epilepsy diagnosis did not reappear in the registries after the LQTS diagnosis was established.

Conclusions

In this nationwide cohort, patients with LQTS had a significantly increased burden of diabetes, neurological and psychiatric comorbidities, compared with the background population. The higher prevalence of neurological comorbidities was largely driven by epilepsy, despite a high rate of potentially misdiagnosed patients prior to LQTS diagnosis. Our data support that LQTS may be considered a multiorgan disease and suggest that patient management should be adjusted accordingly.
Ethnically diverse urban transmission networks ofNeisseria gonorrhoeaewithout evidence of HIV serosorting
Authors: Dave Jayshree , Paul John , Pasvol Thomas Joshua , Williams Andy , Warburton Fiona , Cole Kevin , Miari Victoria Fotini , Stabler Richard , Eyre David W
Published: October 2019

Objective

We aimed to characterise gonorrhoea transmission patterns in a diverse urban population by linking genomic, epidemiological and antimicrobial susceptibility data.

Methods

Neisseria gonorrhoeaeisolates from patients attending sexual health clinics at Barts Health NHS Trust, London, UK, during an 11-month period underwent whole-genome sequencing and antimicrobial susceptibility testing. We combined laboratory and patient data to investigate the transmission network structure.

Results

One hundred and fifty-eight isolates from 158 patients were available with associated descriptive data. One hundred and twenty-nine (82%) patients identified as male and 25 (16%) as female; four (3%) records lacked gender information. Self-described ethnicities were: 51 (32%) English/Welsh/Scottish; 33 (21%) white, other; 23 (15%) black British/black African/black, other; 12 (8%) Caribbean; 9 (6%) South Asian; 6 (4%) mixed ethnicity; and 10 (6%) other; data were missing for 14 (9%). Self-reported sexual orientations were 82 (52%) men who have sex with men (MSM); 49 (31%) heterosexual; 2 (1%) bisexual; data were missing for 25 individuals. Twenty-two (14%) patients were HIV positive. Whole-genome sequence data were generated for 151 isolates, which linked 75 (50%) patients to at least one other case. Using sequencing data, we found no evidence of transmission networks related to specific ethnic groups (p=0.64) or of HIV serosorting (p=0.35). Of 82 MSM/bisexual patients with sequencing data, 45 (55%) belonged to clusters of ≥2 cases, compared with 16/44 (36%) heterosexuals with sequencing data (p=0.06).

Conclusion

We demonstrate links between 50% of patients in transmission networks using a relatively small sample in a large cosmopolitan city. We found no evidence of HIV serosorting. Our results do not support assortative selectivity as an explanation for differences in gonorrhoea incidence between ethnic groups.
Prognostic markers and assessment of a previously published clinical severity index in 109 hospitalised dogs with acute presentation of pancreatitis
Authors: Kuzi Sharon , Mazor Reut , Segev Gilad , Nivy Ran , Mazaki‐Tovi Michal , Chen Hilla , Rimer Dar , Duneyevitz Asia , Yas Einat , Lavy Eran , Aroch Itamar
Published: October 2019

Background

Acute pancreatitis (AP) is common in dogs. Nevertheless, validated clinical severity index (CSI) scoring systems to assess severity and guide treatment in current, large‐scale studies are unavailable.

Methods

This is a retrospective study including 109 dogs. Pancreatitis was diagnosed based on clinical signs, abdominal sonographic evidence, positive pancreatic lipase assays and experts’ assessment consensus.

Results

The survival rate was 75 per cent (82 dogs). Azotaemia and presence of local complications (ie, ascites) and secondary complications (ie, acute kidney injury and acute respiratory distress syndrome) were significantly associated with death. In agreement with the previously published CSI, respiratory anomalies were significantly associated with death. However, in disagreement with that study, high scores in the kidney and local abdominal complication categories and the sum of scores of all nine categories, but not high gastrointestinal category score, were also significantly associated with death. A final CSI score of at least 4 was associated with death.

Conclusions

This study has validated a nine‐category CSI, proven a useful assessment tool in dogs with AP. Several previously reported and novel prognostic markers were assessed.
Congenital sensorineural deafness in English setters in the United Kingdom: prevalence and association with phenotype and sex
Authors: Marsh Oliver James Richard , Freeman Julia , Van Dijk Jan , De Risio Luisa
Published: October 2019

Background

The English setter (ES) is predisposed to congenital sensorineural deafness (CSD). CSD prevalence and association with phenotype in the UK ES population are previously unreported.

Methods

The database of the authors’ institution was searched for ES puppies undergoing brainstem auditory evoked response (BAER) testing for CSD screening (2000–2018). Inclusion criteria were BAER performed at 5–10 weeks of age, testing of complete litters and available phenotypic data. The age, sex, presence of patches at birth, coat colour, iris colour, hearing status and BAER‐determined parental hearing status of each puppy were recorded. Multivariable binary logistic regression was performed to determine the significance of these variables as predictors for the likelihood of puppies being unilaterally or bilaterally deaf.

Results

Inclusion criteria were met for 447 puppies. Hearing was bilaterally normal in 427 (95.5 per cent) puppies. The prevalence of unilateral and bilateral CSD was 3.6 per cent and 0.9 per cent, respectively. Females were 3.3 times more likely to be deaf than males, and puppies with both parents of unknown hearing status were 4.6 times more likely to be deaf than those with at least one normal parent.

Conclusion

The prevalence of CSD was 4.5 per cent, with female puppies and those with two parents of unknown hearing status at greatest risk.
Towards integrated knowledge of climate change in Arctic marine systems: a systematic literature review of multidisciplinary research
Authors: Falardeau Marianne , Bennett Elena M.
Published: October 2019

Climate change affects Arctic marine ecosystems, the ecosystem services they provide, and the human well-being that relies on these services. The impacts of climate change in the Arctic and elsewhere involve cascading effects and feedbacks that flow across social-ecological systems (SES), such as when sea ice loss alters food security through changes in the distribution of marine animals. These cascades and feedbacks across social and ecological systems can exacerbate the effects of climate change or lead to surprising outcomes. Identifying where cascades and feedbacks may occur in SES can help anticipate, or even prevent unexpected outcomes of climate change, and lead to improved policy responses. Here, we perform a systematic literature review of multidisciplinary Arctic research to determine the state of knowledge of the impacts of climate change on marine ecosystems. Then, in a case study corresponding to Inuit regions, we use network analysis to integrate research into a SES perspective and identify which linkages have been most versus least studied, and whether some potential cascades and feedbacks have been overlooked. Finally, we propose ways forward to advance knowledge of changing Arctic marine SES, including transdisciplinary approaches involving multiple disciplines and the collaboration of Indigenous and local knowledge holders.
Management strategies for spasmodic stocks: a Canadian Atlantic redfish fishery case study
Authors: Licandeo Roberto , Duplisea Daniel E. , Senay Caroline , Marentette Julie R. , McAllister Murdoch K.
Published: October 2019

There exist few recommendations for managing stocks with spasmodic recruitment, despite such stocks being not uncommon. Management procedures (MPs), developed for two species of redfish (Sebastes mentella and Sebastes fasciatus) in eastern Canada, are recommended for setting catch limits during periods of high and low abundance. A well-designed fishery-independent trawl survey is essential to provide advance warning of strong recruitment events and project future recruitment. Under an “inventory management” strategy, a more appropriate aim in spasmodic stocks may be to maximize the number of years with “good catches,” instead of maximizing total catches, as is traditionally considered in management strategy evaluation (MSE). Following a spasmodic recruitment event, an empirical harvest control rule based on larger fish delays the harvest of large cohorts by a few years, targets more commercially valuable fish sizes, and reduces the risk of growth overfishing. Capped MPs produced longer periods of large catches than uncapped MPs. MPs allowed for low harvests during periods of low abundance, thus avoiding unnecessary hardship in the industry. MPs evaluated here could be good candidates for other stocks with similar or less extreme recruitment variability.
Whole genome sequencing to study the phylogenetic structure of serotype a Haemophilus influenzae recovered from patients in Canada
Authors: Tsang Raymond S.W. , Shuel Michelle , Ahmad Tauqeer , Hayden Kristy , Knox Natalie , Van Domselaar Gary , Hoang Linda , Tyrrell Gregory J. , Minion Jessica , Van Caeseele Paul , Kus Julianne V. , Ulanova Marina , Lefebvre Brigitte , Haldane David , Garceau Richard , German Greg , Zahariadis George , Hanley Brendan , Kandola Kami , Patterson Michael
Published: October 2019

This study examined the phylogenetic structure of serotype a Haemophilus influenzae (Hia) isolates recovered from patients in Canada. Hia isolates from 490 separate patients and an American Type Culture Collection (ATCC) strain were analyzed by multilocus sequence typing (MLST), with 18 different sequence types (STs) identified. Most (85.7%) Hia patient isolates were typed as ST-23 and another 12.7% belonged to 14 different STs with 6, 5, or 4 MLST gene loci related to ST-23 (ST-23 complex). Core genome single-nucleotide variation phylogeny (SNVPhyl) on whole genome sequence (WGS) data of 121 Hia patient isolates representing all identified STs and the ATCC strain revealed 2 phylogenetic populations, with all the ST-23 complex isolates within 1 population. The other phylogenetic population contained only the ATCC strain and 3 patient isolates. Concatenated hitABC sequences retrieved from WGS data and analyzed by MEGA (Molecular Evolutionary Genetic Analysis) alignment confirmed the phylogeny obtained by SNVPhyl. The sodC gene was found only in isolates in the minor phylogenetic population. The 2 phylogenetic populations of the Canadian Hia isolates are similar to the 2 clonal divisions described for serotype b H. influenzae. Combining MLST, core SNVPhyl, and hitABC gene sequence alignment showed that most (99.4%) Canadian Hia patient isolates belonged to 1 major phylogenetic population.
Rotational spectrum of isotopic methyl mercaptan, 13CH3SH, in the laboratory and towards Sagittarius B2(N2)
Authors: Ilyushin Vadim V. , Zakharenko Olena , Lewen Frank , Schlemmer Stephan , Alekseev Eugene A. , Pogrebnyak Mykola , Lees Ronald M. , Xu Li-Hong , Belloche Arnaud , Menten Karl M. , Garrod Robin T. , Müller Holger S.P.
Published: October 2019

Methyl mercaptan (CH3SH) is a known interstellar molecule with abundances high enough that the detection of some of its minor isotopologues is promising. The present study aims to provide accurate spectroscopic parameters for the 13CH3SH isotopologue to facilitate its identification in the interstellar medium at millimetre and submillimetre wavelengths. Through careful analysis of recent CH3SH spectra from 49–510 GHz and 1.1–1.5 THz recorded at natural isotopic composition, extensive assignments were possible not only for the ground torsional state of 13CH3SH, but also in the first and second excited states. The torsion–rotation spectrum displays complex structure due to the large-amplitude internal rotation of the 13CH3 group, similar to the main and other minor isotopic species of methyl mercaptan. The assigned transition frequencies have been fitted to within experimental error with a 52-parameter model employing the RAM36 programme. With predictions based on this fit, 13CH3SH was searched for in spectra from the Atacama Large Millimetre/sub-millimetre Array (ALMA) towards the Galactic centre source Sgr B2(N2). Several transitions were expected to be observable, but all of them turned out to be severely blended with emission from other species, which prevents us from identifying 13CH3SH in this source.