bluuebunny/crossref_metadata_2025 huggingface dataset:
Nile tilapia (Oreochromis niloticus) invasions disrupt the functional patterns of fish community in a large subtropical river in China
Authors: Shuai Fangmin , Li Xinhui , Liu Qianfu , Zhu Shuli , Wu Zhi , Zhang Yingqiu
Published: July 2019

Although non‐native species can modify ecosystem function, their effects in southern China have not been investigated, despite their ecological importance. This study assessed how Nile tilapia Oreochromis niloticus (L.) invasions impact the functional patterns of fish communities in the large subtropical Pearl River by analysing the relationships between invasion and body size over a 9‐year period. The relative abundance of Nile tilapia increased significantly over time. In particular, the established Nile tilapia significantly undermined the relative densities and the body size of the native fishes. Importantly, this study provided empirical evidence that functional indices (such as body size) are more sensitive when evaluating the effects of non‐native species on a community than richness. Understanding processes such as those should be the basis of controlling alien fish species and fisheries management in the Pearl River.
Dermatopathological characteristics of dermatofibromas from dermatoscopic clues
Authors: Genc Yeser , Akay Bengu Nisa , Okcu Heper Aylin , Rosendahl Cliff , Erdem Cengizhan
Published: July 2019

Background

Several types of dermatofibroma (DF) have been identified dermatopathologically and with dermatoscopic correlation, the dermatopathology has been predictable in limited studies so far. We identify DFs with specific dermatoscopic structures and determine the respective dermatopathological correlates.

Methods

Dermatoscopic and dermatopathologic correlation of 403 DFs were assessed. A pattern analysis algorithm was used for the dermatoscopic evaluation, each lesion being evaluated according to 10 dermatoscopic patterns with further subdivision of the atypical subtype according and their dermatoscopic similarities to other defined skin lesions.

Results

Dermatoscopic pattern analysis showed typical patterns in 83.4% of DFs with atypical patterns in 16.6%. We classified the atypical DFs according to their dermatoscopic similarity to certain lesions: Melanoma‐like 2.7%, basal cell carcinoma‐like 0.7%, keratoacanthoma‐like 0.5%, seborrheic keratosis‐like 2.7%; nevus‐like 1.5%; nevus sebaceous‐like 0.9%; xanthogranuloma‐like 0.5%; pyogenic granuloma‐like 0.5%; and spitzoid 6.5%. Dermatopathologically 12 subtypes of DFs were identified. It was found that the most common pattern found in fibrocollagenous DFs was the typical pattern with peripheral reticular lines and central white structureless area (32.9%) whereas non‐fibrocollagenous types were more likely to have atypical patterns (65.1%).

Conclusions

Our study resulted in new conclusions while supporting some previous findings. The fact that the pathogenesis of DF involves a reactive inflammatory process with fibrosis is likely to have diverse effects on dermatoscopic morphology. If atypical dermatoscopic patterns are identified in suspected DF, excisional biopsy may be prudent.
Model‐based analysis on systemic availability of co‐administered cannabinoids after controlled vaporised administration
Authors: Liu Zheng , Galettis Peter , Broyd Samantha J. , van Hell Hendrika , Greenwood Lisa‐Marie , de Krey Peter , Steigler Amy , Zhu Xiao , Schneider Jennifer , Solowij Nadia , Martin Jennifer H.
Published: July 2019

Background

The most important two medicinal cannabinoids are Δ9‐tetrahydrocannabinol (THC) and cannabidiol (CBD). Vaporised administration is superior due to its higher systemic availability, lower individual variability and faster drug delivery. Although it is common THC is co‐administered with CBD, the influence of CBD on the pharmacokinetics, especially the systemic availability of THC after vaporised administration, is unknown.

Aims

To investigate the influence of different doses of co‐administered CBD on the systemic availability of THC, and to compare the availability of THC and CBD in a sample of frequent and infrequent cannabis users.

Methods

The study used a randomised, double‐blind, crossover placebo‐controlled design. THC and/or CBD in ethanol was vaporised and inhaled. Plasma concentrations of THC and CBD were analysed. The THC data created in this study were pooled together with published THC pharmacokinetic data in order to cover all the phases of THC disposition. Population pharmacokinetic model of THC was developed based on the pooled data. The model of CBD was developed based on the data created in this study.

Results

Population pharmacokinetic models of THC and CBD were developed. With concomitant inhalation of high‐dose CBD, the systemic availability of THC decreased significantly. Frequent cannabis users appeared to have higher systemic availability of THC and CBD when high‐dose CBD was administered.

Conclusions

The results observed in this study are useful for guiding future pharmacokinetic studies of medicinal cannabinoids, and for development of dosing guidelines for medical use of cannabis in the ‘real‐world’ setting.
Effectiveness on hospital‐acquired pressure ulcers prevention: a systematic review
Authors: Gaspar Susana , Peralta Miguel , Marques Adilson , Budri Aglécia , Gaspar de Matos Margarida
Published: July 2019

The effective approach on pressure ulcer (PU) prevention regarding patient safety in the hospital context was evaluated. Studies were identified from searches in EBSCO host, PubMed, and WebofScience databases from 2009 up to December 2018. Studies were selected if they were published in English, French, Portuguese, or Spanish; incidence of PUs was the primary outcome; participants were adults (≥18 years) admitted in hospital wards and/or units. The review included 26 studies. Studies related to prophylactic dressings applied in the sacrum, trochanters, and/or heels, education for health care professionals, and preventive skin care and system reminders on‐screen inpatient care plan were effective in decreasing PUs. Most of the studies related to multiple intervention programmes were effective in decreasing PU occurrence. Single interventions, namely support surfaces and repositioning, were not always effective in preventing PUs. Repositioning only was effective when supported by technological pressure‐mapping feedback or by a patient positioning system. Risk‐assessment tools are not effective in preventing PUs. PUs in the hospital context are still a worldwide issue related to patient safety. Multiple intervention programmes were more effective in decreasing PU occurrence than single interventions in isolation. Single interventions (prophylactic dressings, support surfaces, repositioning, preventive skin care, system reminders, and education for health care professionals) were effective in decreasing PUs, which was always in compliance with other preventive measures. These results provide an overview of effective approaches that should be considered when establishing evidence‐based guidelines to hospital health care professionals and administrators for clinical practice effective in preventing PUs.
Epidemiology of cutaneous porphyria in Israel: a nationwide cohort study
Authors: Edel Y. , Mamet R. , Snast I. , Kaftory R. , Mazor S. , Hodak E. , Lapidoth M. , Elis A. , Molad Y. , Levi A.
Published: July 2019

Background

From a dermatologist's perspective, there are four major types of cutaneous porphyrias (CPs): porphyria cutanea tarda (PCT), erythropoietic protoporphyria (EPP), variegate porphyria (VP) and hereditary coproporphyria (HCP). Scarce data are available regarding the epidemiology of CPs.

Objectives

To describe the epidemiology of CPs in Israel, including distribution, incidence and prevalence rates of major types.

Methods

This retrospective study includes all patients who were diagnosed with CPs between the years 1988–2018. It is based on data from Israel's National Service for the Biochemical Diagnoses of Porphyrias, and Israeli patients’ nationwide electronic medical charts. Incidence and prevalence rates were calculated.

Results

Of 173 patients with CPs diagnosed during a 30‐year period, 65 (38%) had VP, 62 (36%) had PCT, 31 (18%) had HCP and 15 (9%) had EPP; with incidence rates of 0.29, 0.30, 0.17, 0.07, and prevalence rates of 6.3, 4.8, 2.9, 1.6, respectively, per million population. Characteristics of patients with PCT differed from those with other CPs with regard to lack of family history, older mean age at diagnosis [51 vs. 36 (VP), 35 (HCP) and 25 (EPP) years] and male predominance (81% vs. similar distribution). All patients with PCT were diagnosed at adulthood, while 20%, 19% and 15% of patients with VP, HCP and EPP, respectively, were diagnosed during childhood or adolescence.

Conclusions

Variegate porphyria and PCT were found to be the most prevalent in Israel; however, CPs might be underdiagnosed, thus dermatologists’ awareness of these rare disorders is highly important.
Bite performance and feeding behaviour of the sand tiger sharkCarcharias taurus
Authors: Moyer Joshua K. , Shannon Stephanie F. , Irschick Duncan J.
Published: July 2019

This study examines the feeding behaviour and kinematics of three sub‐adult sand tiger sharksCarcharias tauruson display at Mystic Aquarium (Mystic, Connecticut, USA). Using high‐speed video data from 52 bites, we identify kinematic variables associated with the expansive and compressive phases of the bite. The mean bite duration from the onset of the expansive phase to the conclusion of the compressive phase is mean (± SE) 0.14 ± 0.01 s and across the 10 fastest bites of each individual, the maximum performance average is 0.13 ± 0.01 s. Values of maximum performance do not vary significantly among individuals. When compared with kinematic bite data from species studied previously, these results indicate that body size is not the only determinant factor of bite duration. This study also provides detailed descriptions of feeding behaviours inC.taurusand presents documentation of tooth loss both prior to and during feeding, suggesting that there are multiple mechanisms of tooth loss and use inC.taurus. Finally, we discuss the behavioural and ecological components of prey capture inC.taurusand suggest points of consideration to facilitate interspecific comparisons of prey capture performance in ram‐feeding, macrophagous elasmobranchs.
Label‐free multiphoton microscopic imaging as a novel real‐time approach for discriminating colorectal lesions: A preliminary study
Authors: He Kexin , Zhao Lili , Chen Yingtong , Huang Xiaoyang , Ding Ying , Hua Hongjin , Liu Li , Wang Xiang , Wang Min , Zhang Yong , Fan Zhining
Published: July 2019

Background and Aim

Although various endoscopic technologies have been developed to increase the visual diagnostic accuracy of colorectal precancerosis and early carcinoma, the biopsy‐dependent pathology still remains the golden standard. During routine endoscopy, real‐time optical histological diagnosis is desired. Without fluorescent label, multiphoton microscopy (MPM) imaging directly reveals live cellular morphology and tissue microenvironment based on intrinsic two‐photon excited fluorescence and second harmonic generation signals. Its high‐imaging resolution and performance are comparable with the histopathology. We thus aimed to initially investigate the original features of colorectal diseases under MPM and evaluate its potential for real‐time diagnosis.

Methods

Experimental and diagnostic cohorts were designed. Multiphoton images of 40 ex vivo fresh tissues confirmed pathologically of colorectal normal tissues, hyperplastic polyps, adenomas, and adenocarcinomas were collected. Features were recorded to establish diagnostic standards with MPM. For the second cohort with 92 fresh tissues, we distinguished the various colorectal diseases with conclusive MPM features.

Results

Through the investigation, the colorectal diseases were presented differences in the crypt opening, gland structure, epithelial cells, and collagen fibers. With the typical features, we preliminarily tested the diagnostic efficiency and found that its sensitivity for distinguishing normal, hyperplastic polyps, adenoma and adenocarcinoma was 88.89%, 76.47%, 83.33%, and 97.92%, while the specificity was 99.32%, 94.00%, 94.92%, and 94.12%, respectively.

Conclusion

The real‐time multiphoton microscopic imaging can be effective to identify the colorectal lesions with high resolution. Via integrating with the endoscopes in the future, it could promote precise optical diagnosis in clinics.
Depression‐related disturbances in rat maternal behaviour are associated with altered monoamine levels within mesocorticolimbic structures
Authors: Winokur Sarah B. , Lopes Keianna L. , Moparthi Yashaswani , Pereira Mariana
Published: July 2019

The ability of mothers to sensitively attune their maternal responses to the needs of their developing young is fundamental to a healthy mother‐young relationship. The biological mechanisms that govern how mothers adjust caregiving to the dynamic changes in the demands of the young remain an open question. In the present study, we examined whether changes in monoamine levels, within discrete mesocorticolimbic structures involved in cognitive and motivational processes key to parenting, modulate this flexibility in caregiving across the postpartum period. The present study used a Wistar‐Kyoto (WKY) animal model of depression and control Sprague‐Dawley (SD) rats, which differ dramatically in their cognitive, motivational, and parenting performance. Levels of the monoamine neurotransmitters, dopamine, noradrenaline and serotonin, as well as their major metabolites, were measured within the medial prefrontal cortex, striatum, nucleus accumbens and medial preoptic area of SD and WKY mothers at early (postpartum day [PPD]7‐8), late (PPD15‐16) and weaning (PPD25) postpartum stages using high‐performance liquid chromatography with electrochemical detection. Consistent with our prior work, we find that caregiving of SD mothers declined as the postpartum period progressed. Relative to nulliparous females, early postpartum mothers had lower intracellular concentrations of monoamines, as well as lower noradrenaline turnover, and an elevated serotonin turnover within most structures. Postpartum behavioural trajectories subsequently corresponded to a progressive increase in all three monoamine levels within multiple structures. Compared to SD mothers, WKY mothers were inconsistent and disorganised in caring for their offspring and exhibit profound deficits in maternal behaviour. Additionally, WKY mothers had generally lower levels of all three monoamines, as well as different patterns of change across the postpartum period, compared to SD mothers, suggesting dysfunctional central monoamine pathways in WKY mothers as they transition and experience motherhood. Taken together, the results of the present study suggest a role for monoamines at multiple mesocorticolimbic structures with repect to modulating caregiving behaviours attuned to the changing needs of the young.
Laparoscopic inguinal ligament suspension combined with hysterectomy for the treatment of uterovaginal prolapse
Authors: Li Chunbo , Dai Zhiyuan , Shu Huimin
Published: July 2019

Aim

To demonstrate the efficacy and safety of a modified technique of laparoscopic inguinal ligament suspension (LILS) with hysterectomy for the treatment of uterovaginal prolapse.

Methods

A total of 57 patients were treated by LILS combined with hysterectomy between Jan 2014 and Feb 2016. The perioperative parameters, such as operative time, estimated blood loss, length of stay and intra‐ and postoperative complications were recorded. The Pelvic Organ Prolapse questionnaire classification was applied to evaluate the Pelvic Organ Prolapse stage, and Patient Global Impression of Improvement scale was used to determine the patients' satisfaction. Pelvic Floor Distress Inventory‐20 and Pelvic Floor Impact Questionnaire were used to evaluate the functional improvement. All data were collected preoperatively and then at 12 months postoperatively.

Results

The mean surgical time was 130.4 (82–190) min, the average blood loss was 50.4 (10–300) mL and the mean hospitalization was 5.3 (4–8) days. The rates of intra‐ and postoperative complications were low. After a minimal of 12 months follow‐up, the anatomical success rate was 85.5%, and the subjective satisfaction rate was 92.7%. The functional measures also presented a significant improvement with no recurrence of prolapse.

Conclusion

LILS combined with hysterectomy was a safe and effective technique and might be considered as an alternative treatment for patients with uterovaginal prolapse.
Pathways of Religious Assimilation: Second‐Generation Asian Americans’ Religious Retention and Religiosity
Authors: Chen Carolyn , Park Jerry Z.
Published: July 2019

We explore the religious assimilation of different Asian American second‐generation religious groups by examining their rates of religious retention and levels of religiosity relative to the first generation and the general American population. In general, Asian Americans exhibit a pattern of generational religious decline: the second generation tend to have lower levels of both religious retention and religiosity compared to the immigrant generation. The second generation do not necessarily conform to the religious patterns of the general population. Rather, they follow different trajectories of retention and religiosity depending on the religion. We identify four different pathways of religious change among the second generation, and discuss how racial and religious differences mediate assimilation into American religion.
Religiosity and Aging: Age and Cohort Effects and Their Implications for the Future of Religious Values in High‐Income OECD Countries
Authors: Shulgin Sergey , Zinkina Julia , Korotayev Andrey
Published: July 2019

It has long been
noticed that older people tend to be more religious than younger people. However, it is still disputable whether this fact should be attributed to people generally becoming more religious with age per se (age effect), or to the process of secularization, wherein earlier cohorts (to which the now older people belong) used to be more religious than those that appeared later, younger cohorts (cohort effect). We try to distinguish between these two effects using a multifactor model applied to World Values Survey data (1981–2014) and find that at least in the developed countries the age effect strongly prevails over the cohort effect. This finding has important implications, e.g., that population aging in OECD countries can possibly slow down the transition from religious to secular values. This effect is already visible in some countries, such as Japan.
Exploring the future of the institutional landscape of the oceans beyond national jurisdiction
Authors: Oude Elferink Alex G.
Published: July 2019

A comprehensive regime for biodiversity in marine areas beyond national jurisdiction (ABNJ) is currently being negotiated at an intergovernmental conference convened by the United Nations. One of the aspects of the negotiations concerns the institutional arrangements of the treaty that is to be developed. Many activities in ABNJ currently are being regulated at the sectoral and/or regional level, raising the question how the institutional arrangements of the treaty are to interact with these existing frameworks. The article first provides some further information on the background to the current negotiations, then looks at the current status of those negotiations and next attempts to sort out and appraise the options for institutional arrangements. Three main approaches have been tabled: a global approach, a regional approach or a combination of the two. The article concludes that the institutional arrangements of the treaty may be the most critical element in accomplishing an effective regime for the sustainability of ABNJ.
The effect of musicianship, contralateral noise, and ear of presentation on the detection of changes in temporal fine structure
Authors: Tarnowska Emilia , Wicher Andrzej , Moore Brian C. J.
Published: July 2019

Musicians are better than non-musicians at discriminating changes in the fundamental frequency (F0) of harmonic complex tones. Such discrimination may be based on place cues derived from low resolved harmonics, envelope cues derived from high harmonics, and temporal fine structure (TFS) cues derived from both low and high harmonics. The present study compared the ability of highly trained violinists and non-musicians to discriminate changes in complex sounds that differed primarily in their TFS. The task was to discriminate harmonic (H) and frequency-shifted inharmonic (I) tones that were bandpass filtered such that the components were largely or completely unresolved. The effect of contralateral noise and ear of presentation was also investigated. It was hypothesized that contralateral noise would activate the efferent system, helping to preserve the neural representation of envelope fluctuations in the H and I stimuli, thereby improving their discrimination. Violinists were significantly better than non-musicians at discriminating the H and I tones. However, contralateral noise and ear of presentation had no effect. It is concluded that, compared to non-musicians, violinists have a superior ability to discriminate complex sounds based on their TFS, and this ability is unaffected by contralateral stimulation or ear of presentation.
Host mitochondria influence gut microbiome diversity: A role for ROS
Authors: Yardeni Tal , Tanes Ceylan E. , Bittinger Kyle , Mattei Lisa M. , Schaefer Patrick M. , Singh Larry N. , Wu Gary D. , Murdock Deborah G. , Wallace Douglas C.
Published: July 2019

Inherited genetic variations in mitochondrial function shape the gut microbiota species diversity.
Pathogenomics of EmergingCampylobacterSpecies
Authors: Costa Daniela , Iraola Gregorio
Published: July 2019

Campylobacteris among the four main causes of gastroenteritis worldwide and has increased in both developed and developing countries over the last 10 years. The vast majority of reportedCampylobacterinfections are caused byCampylobacter jejuniand, to a lesser extent,C. coli; however, the increasing recognition of other emergingCampylobacterpathogens is urgently demanding a better understanding of how these underestimated species cause disease, transmit, and evolve.
Bacterial and Archaeal Metagenome-Assembled Genome Sequences from Svalbard Permafrost
Authors: Xue Yaxin , Jonassen Inge , Øvreås Lise , Taş Neslihan
Published: July 2019

Permafrost contains one of the least known soil microbiomes, where microbial populations reside in an ice-locked environment. Here, 56 prokaryotic metagenome-assembled genome (MAG) sequences from 13 phyla are reported. These MAGs will provide information on metabolic pathways that could mediate biogeochemical cycles in Svalbard permafrost.
Near-Complete Genome Sequence of a Hepatitis A Subgenotype IB Virus Isolated from Frozen Raspberries
Authors: Chen Haifeng , Wang Weimin , Wang Shiliang , Hu Yuan
Published: July 2019

Hepatitis A virus is one of the most common causes of foodborne viral illness. Here, we report the nearly complete genome sequence of a hepatitis A virus (subgenotype IB) isolated from frozen raspberries using RNA sequencing-based metagenomics.
Collection of Recombinant Rotaviruses Expressing Fluorescent Reporter Proteins
Authors: Philip Asha A. , Herrin Brittany E. , Garcia Maximiliano L. , Abad Andrew T. , Katen Sarah P. , Patton John T.
Published: July 2019

A collection of recombinant rotaviruses that express the fluorescent markers UnaG, mKate, mRuby, TagBFP, CFP, or YFP as separate proteins was generated. Genes for the fluorescent proteins were inserted into genome segment 7 without compromising expression of the protein NSP3. These recombinant rotaviruses are valuable for analyzing rotavirus biology by fluorescence-based live-cell imaging.
Genome Sequences of
Arthrobacter
sp. Phages Inspire2, Ronnie, Hunnie, DeWayne, CGermain, Copper, Azathoth, and Arby
Authors: Harrison Melinda , Mastropaolo Matthew D. , Conboy Andrew ,   Cabrini University SEA-PHAGES Annotators, McKernan Lisa , Schmidt Robert , Delesalle Véronique A.
Published: July 2019

Eight siphoviral phages isolated from various soil types and locations in southwestern Pennsylvania using
Arthrobacter
sp. strain ATCC 21022 were sequenced. The phages all have relatively small genomes, with each genome containing 15,556 bp. All 8 phages are closely related to previously described cluster AN
Arthrobacter
phages (K. K. Klyczek, J. A. Bonilla, D. Jacobs-Sera, T. L.
mSphere of Influence: Ushering in the CRISPR Revolution to
Toxoplasma
Biology
Authors: Guerra Alfredo J.
Published: July 2019

Alfredo J. Guerra works in the field of molecular parasitology and structural biology. In this mSphere of Influence article, he reflects on how “Efficient Gene Disruption in Diverse Strains of
Toxoplasma gondii
Using CRISPR/CAS9” by Bang Shen et al. (mBio 5:e01114-14, 2014,
https://doi.org/10.1128/mBio.01114-14
) and “Efficient Genome Engineering of
Toxoplasma gondii
using CRISPR/CAS9” by Saima M. Sidik et al. (PLoS One 9:e100450, 2014,
https://doi.org/10.1371/journal.pone.0100450
) made an impact on him by successfully implementing strategies to genetically manipulate
T. gondii
using CRISPR/CAS9 gene editing technology.
Non-invasive Intraocular pressure monitoring with contact lens
Authors: Campigotto Angelica , Leahy Stephane , Zhao Guowei , Campbell Robert J , Lai Yongjun
Published: July 2019

Background

Glaucoma is the second leading cause of blindness in the world and the first leading cause of irreversible vision loss. Currently, the primary methodology of testing for the intraocular pressure (IOP) is during clinical office hours, which only provide a limited amount of information on the trends and fluctuations of the IOP. Therefore, a continuous monitoring system is required to properly determine the peaks of pressure and to negate any false results obtained by sparse, clinic hour testing. The objective of this study is to determine the ability of a newly designed contact lens with an embedded microchannel, to accurately measure the fluctuations in the IOP.

Methods

Experimentation was completed on fresh enucleated porcine eyes. The contact lens was placed on the porcine eye and utilising a camera the fluid movement, within the microchannel in the contact lens, was recorded. A micro-pressure catheter, threaded into the centre of the vitreous chamber, recorded the true IOP and was compared with the displacement of the indicator fluid within the microchannel.

Results

The contact lenses showed a consistent linear responsiveness to changes in IOP and robust to the effects of anatomical differences among eyes. The indicator fluid had an average fluid movement of 28 um/mm Hg between all the trials. Additionally, the devices showed the ability to measure both increases and decreases in IOP during cyclical fluctuations.

Conclusion

The described inexpensive and non-invasive sensor is able to reliably monitor the IOP changes based on porcine eye model.
Dietary fats and mortality among patients with type 2 diabetes: analysis in two population based cohort studies
Authors: Jiao Jingjing , Liu Gang , Shin Hyun Joon , Hu Frank B , Rimm Eric B , Rexrode Kathryn M , Manson JoAnn E , Zong Geng , Sun Qi
Published: July 2019

Objective

To assess the association of dietary fatty acids with cardiovascular disease mortality and total mortality among patients with type 2 diabetes.

Design

Prospective, longitudinal cohort study.

Setting

Health professionals in the United States.

Participants

11 264 participants with type 2 diabetes in the Nurses’ Health Study (1980-2014) and Health Professionals Follow-Up Study (1986-2014).

Exposures

Dietary fat intake assessed using validated food frequency questionnaires and updated every two to four years.

Main outcome measure

Total and cardiovascular disease mortality during follow-up.

Results

During follow-up, 2502 deaths including 646 deaths due to cardiovascular disease were documented. After multivariate adjustment, intake of polyunsaturated fatty acids (PUFAs) was associated with a lower cardiovascular disease mortality, compared with total carbohydrates: hazard ratios comparing the highest with the lowest quarter were 0.76 (95% confidence interval 0.58 to 0.99; P for trend=0.03) for total PUFAs, 0.69 (0.52 to 0.90; P=0.007) for marine n-3 PUFAs, 1.13 (0.85 to 1.51) for α-linolenic acid, and 0.75 (0.56 to 1.01) for linoleic acid. Inverse associations with total mortality were also observed for intakes of total PUFAs, n-3 PUFAs, and linoleic acid, whereas monounsaturated fatty acids of animal, but not plant, origin were associated with a higher total mortality. In models that examined the theoretical effects of substituting PUFAs for other fats, isocalorically replacing 2% of energy from saturated fatty acids with total PUFAs or linoleic acid was associated with 13% (hazard ratio 0.87, 0.77 to 0.99) or 15% (0.85, 0.73 to 0.99) lower cardiovascular disease mortality, respectively. A 2% replacement of energy from saturated fatty acids with total PUFAs was associated with 12% (hazard ratio 0.88, 0.83 to 0.94) lower total mortality.

Conclusions

In patients with type 2 diabetes, higher intake of PUFAs, in comparison with carbohydrates or saturated fatty acids, is associated with lower total mortality and cardiovascular disease mortality. These findings highlight the important role of quality of dietary fat in the prevention of cardiovascular disease and total mortality among adults with type 2 diabetes.
A traditional hip implant is as effective as newer types for people over 65
Authors: Cook Rob , Lamont Tara , Martin Rosie
Published: July 2019

The study

Fawsitt C, Thom H, Hunt L. Choice of prosthetic implant combinations in total hip replacement: cost-effectiveness analysis using UK and Swedish hip joint registries data.
Value Health
2019;22:303-12.

This study was funded by the NIHR Research for Patient Benefit Programme (project number PB-PG-0613-31032).

To read the full NIHR Signal, go to
https://discover.dc.nihr.ac.uk/content/signal-000771/a-traditional-hip-implant-is-as-effective-as-more-expensive-newer-types-for-older-people
Methodological quality and redundancy of systematic reviews that compare endarterectomy versus stenting for carotid stenosis
Authors: Mendoza Juan Fulgencio Welko , Latorraca Carolina de Oliveira Cruz , Oliveira Ricardo de Ávila , Pachito Daniela Vianna , Martimbianco Ana Luiza Cabrera , Pacheco Rafael Leite , Riera Rachel
Published: July 2019

A review of systematic reviews (SRs) and a critical appraisal study was conducted at Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp). The objectives of this review are (1) to identify all published SRs comparing the effectiveness and safety of carotid endarterectomy (CEA) versus carotid artery stenting (CAS) for carotid artery stenosis, (2) to assess their methodological quality and (3) to compare the primary studies contained in each SR. We included 17 SRs published between 2005 and 2017. None of the SRs fulfilled all items of AMSTAR-2. The overall confidence in the results was graded as critically low for 16 SRs (94%) and low for 1 SR (6%). Five items were judged inadequate in all SRs: reference to a published protocol, explanation to the selection of study design, comprehensive search of the literature, methods for statistical combination of findings and consideration of the risk of bias on the results of meta-analysis. In total, 15 randomised clinical trials (RCTs) were included at least in one SR. The number of included RCTs in each SR was inconsistent (4 to 15) and was not related to the year of publication of the SR. Our study found redundant and low methodological quality SR comparing CAS versus CEA for carotid stenosis.
Low fasting glucose and future risks of major adverse outcomes in people without baseline diabetes or cardiovascular disease: a systematic review and meta-analysis
Authors: Liao Hung-Wei , Saver Jeffrey , Yeh Hsin-Chieh , Chen Chi-Hsin Sally , Wu Yi-Ling , Lee Meng , Ovbiagele Bruce
Published: July 2019

Objective

To investigate the link between low fasting blood glucose levels and all-cause mortality and cardiovascular outcomes among people without baseline diabetes or cardiovascular disease.

Design

Systematic review and meta-analysis.

Data sources

PubMed and Embase (1966–February 2019).

Selection criteria

Prospective cohort studies were included for meta-analysis if they reported adjusted HRs with 95% CIs for associations between risk of all-cause mortality, stroke, major cardiovascular events, coronary heart disease and low fasting glucose levels (<4.6 mmol/L and/or 4.0 mmol/L, respectively) versus normal fasting glucose levels.

Data extraction and statistical analysis

Two independent reviewers extracted data from eligible studies. Heterogeneity was assessed by p value of χ2tests and I2. We assessed four characteristics for each included study based on items developed by the US Preventive Task Force, as well as the modified checklist used in previous studies.

Results

Eleven articles (consisting of 129 prospective cohort studies) with 2 674 882 participants without diabetes and cardiovascular disease at baseline were included in this meta-analysis. Pooled results from the random effects model showed increased risks of all-cause mortality (HR: 1.56; 95% CI 1.09 to 2.23), total stroke (HR: 1.08, 95% CI 1.03 to 1.13) and ischaemic stroke (HR: 1.06, 95% CI 1.01 to 1.10), and major cardiovascular events (HR: 1.05, 95% CI 1.03 to 1.07) among people with a fasting glucose <4.0 mmol/L, as compared with people with normal fasting glucose. The less stringent low fasting glucose level, <4.6 mmol/L, was not associated with increased risk of any endpoints.

Discussion and conclusions

Among people without baseline diabetes or cardiovascular disease, a fasting blood glucose level of <4.0 mmol/L is associated with increased risk of all-cause mortality, major cardiovascular events and stroke.
Intersectoral and integrated approaches in achieving the right to health for refugees on resettlement: a scoping review
Authors: Ho Shirley , Javadi Dena , Causevic Sara , Langlois Etienne V , Friberg Peter , Tomson Göran
Published: July 2019

Background

Better understanding, documentation and evaluation of different refugee health interventions and their means of health system integration and intersectoral collaboration are needed.

Objectives

Explore the barriers and facilitators to the integration of health services for refugees; the processes involved and the different stakeholders engaged in levaraging intersectoral approaches to protect refugees’ right to health on resettlement.

Design

Scoping review.

Methods

A search of articles from 2000 onward was done in MEDLINE, Web of Science, Global Health and PsycINFO, Embase. Two frameworks were applied in our analysis, the ‘framework for analysing integration of targeted health interventions in systems’ and ‘Health in All Policies’ framework for country action. A comprehensive description of the methods is included in our published protocol.

Results

6117 papers were identified, only 18 studies met the inclusion criteria. Facilitators in implementation included: training for providers, colocation of services, transportation services to enhance access, clear role definitions and appropriate budget allocation and financing. Barriers included: lack of a participatory approach, insufficient resources for providers, absence of financing, unclear roles and insufficient coordination of interprofessional teams; low availability and use of data, and turf wars across governance stakeholders. Successful strategies to address refugee health included: networks of service delivery combining existing public and private services; system navigators; host community engagement to reduce stigma; translation services; legislative support and alternative models of care for women and children.

Conclusion

Limited evidence was found overall. Further research on intersectoral approaches is needed. Key policy insights gained from barriers and facilitators reported in available studies include: improving coordination between existing programmes; supporting colocation of services; establishing formal system navigator roles that connect relevant programmes; establishing formal translation services to improve access and establishing training and resources for providers.
Understanding the influence of the MomConnect programme on antenatal and postnatal care service utilisation in two South African provinces: a realist evaluation protocol
Authors: Kabongo Eveline M , Mukumbang Ferdinand C , Delobelle Peter , Nicol Edward
Published: July 2019

Introduction

Timely antenatal care (ANC) and postnatal care (PNC) attendance decrease maternal and child mortality by improving maternal and child health (MCH) outcomes. Mobile health or mHealth has been identified as an effective way of improving the uptake of MCH services. The MomConnect programme is an mHealth initiative launched by the National Department of Health of South Africa in August 2014 to support MCH. Although widely used, there is a limited understanding of how, why, for whom and under which health system conditions, the implementation of MomConnect improves the health-seeking behaviour of pregnant women and mothers of infants in ANC and PNC facilities. This paper describes the protocol for a realist evaluation of the MomConnect programme, to provide a theory-based understanding of how, why and under what healthcare conditions the MomConnect programme works or not.

Method and analysis

We will use the realist evaluation approach through its research cycle conducted in three phases. In phase I, a multimethod elicitation study design will be used, including a document review, key informant interviews and a scoping review to formulate an initial programme theory of the MomConnect intervention. Content and thematic analytic approaches will be used to analyse the data that will be fitted into a realist framework to formulate the initial programme theory. In phase II, a multi-case study design will be applied using a multimethod approach in two South African provinces. In each case, a theory-testing approach underpinned by the hypothetico-deduction analytic model will be used to test the initial programme theory. Surveys, interviews and focus group discussions will be conducted with various programme actors and analysed using appropriate methods. Phase III will entail refining the tested/modified programme theory through cross-case analysis.

Expected outcomes

An improved understanding of how and why the MomConnect intervention improves the health-seeking behaviour of pregnant women and mothers of infants, and the health system conditions that influence its implementation.

Ethics and dissemination

Ethics approval was granted by the Stellenbosch University Ethics Committee (S18/09/189). The protocol has been designed and the study will be conducted in line with the principles of the Declaration of Helsinki (1964).
Loneliness as a risk factor for metabolic syndrome: results from the HUNT study
Authors: Henriksen Roger Ekeberg , Nilsen Roy M , Strandberg Ragnhild Bjarkøy
Published: July 2019

Objective

Metabolic syndrome (MetS) includes hyperglycaemia, hypertension, central adiposity, elevated triglyceride levels and low levels of high-density lipoprotein cholesterol. All factors are identified as risk factors for cardiovascular disease and mortality. This longitudinal study examined whether loneliness, which has been shown to predict a range of negative health outcomes, increases the risk for MetS.

Methods

We used data from ‘the Nord-Trøndelag Health Study’ (HUNT) which is a large longitudinal health study based on a Mid-Norway county population (n=26 990). Self-reports, physical examinations and blood samples were analysed to evaluate the associations between loneliness and incidents of MetS after 10 years (follow-up survey conducted during 2006–2008). We also investigated the role of depression as a potential mediating factor.

Results

Individuals who reported higher levels of loneliness had a higher odds for MetS (adjusted OR 1.09 (95% CI 1.02 to 1.16); p=0.007). This effect was mediated through depression.

Conclusions

Findings suggest that loneliness may be an important factor that increases the risk for MetS. The effect of loneliness on MetS is mediated through depressive symptoms. Reducing loneliness may help prevent the incidence of MetS and related diseases.
Onset to reperfusion time as a determinant of outcomes across a wide range of ASPECTS in endovascular thrombectomy: pooled analysis of the SWIFT, SWIFT PRIME, and STAR studies
Authors: Kim Joon-Tae , Goyal Mayank , Levy Elad I , Liebeskind David , Jahan Reza , Pereira Vitor M , Gralla Jan , Bonafe Alain , Saver Jeffrey L
Published: July 2019

Background

The time–benefit relationship of endovascular thrombectomy (EVT) according to the size of the core infarct has been incompletely explored in prior studies. We investigated whether established infarct core size on baseline imaging modifies the relationship between onset-to-reperfusion time (OTR) and functional outcomes in patients with acute ischemic stroke treated with EVT.

Methods

We analyzed a database containing individual patient data pooled from three prospective Solitaire stent retriever studies. The inclusion criteria were treatment with a Solitaire device and achievement of substantial reperfusion (modified Thrombolysis in Cerebral Infarction 2b–3). Main analyses were performed in patients with baseline Alberta Stroke Program Early CT Scores (ASPECTSs) of 7–10.

Results

Among the 305 patients (mean age 67±13 years, 58% women), the proportions of patients in different categories of pretreatment infarct extent were: small (ASPECTS 9–10) 52.0%, moderate (ASPECTS 7–8) 37.1%, and large (ASPECTS 0–6) 7.6%. The mean OTR was 297±95 min. At 3 months, 60.1% of the patients achieved a good outcome. For OTRs of 2–8 hours, the rates of good outcomes at all time points were higher with higher baseline ASPECTS but declined with similar steepness. Both baseline ASPECTS (OR 1.23 (95% CI 1.04 to 1.45)) and OTR (every 30 min delay, OR 0.80 (95% CI 0.73 to 0.88)) were independently associated with a good 3-month outcome. No interaction between OTR and baseline ASPECTS was observed.

Conclusions

Although patients with higher baseline ASPECTS are more likely to have good clinical outcomes at all OTR intervals after 2 hours, this benefit consistently declines with time, even in patients with a small infarct core, reinforcing the need to treat all patients as quickly as possible.
Long-term implementation of a prehospital severity scale for EMS triage of acute stroke: a real-world experience
Authors: Jumaa Mouhammad A , Castonguay Alicia C , Salahuddin Hisham , Shawver Julie , Saju Linda , Burgess Richard , Kung Vieh , Slawski Diana E , Tietjen Gretchen , Lindstrom David , Parquette Brent , Korsnack Andrea , Cole Kimberly , Afreen Ehad , Bafna Kunaal , Zaidi Syed F
Published: July 2019

Background

Data on the implementation of prehospital large vessel occlusion (LVO) scales to identify and triage patients with acute ischemic stroke (AIS) in the field are limited, with the majority of studies occurring outside the USA.

Objective

To report our long-term experience of a US countywide emergency medical services (EMS) acute stroke triage protocol using the Rapid Arterial oCclusion Evaluation (RACE) score.

Methods

Our prospective database was used to identify all consecutive patients triaged within Lucas County, Ohio by the EMS with (1) a RACE score ≥5, taken directly to an endovascular capable center (ECC) as RACE-alerts (RA) and (2) a RACE score <5, taken to the nearest hospital as stroke-alerts (SA). Baseline demographics, RACE score, time metrics, final diagnosis, treatments, and clinical and angiographic outcomes were captured. The sensitivity and specificity for patients with a RACE score ≥5 with LVO, eligible for mechanical thrombectomy (MT), were calculated.

Results

Between July 2015 and June 2018, 492 RA and 1147 SA were triaged within our five-hospital network. Of the RA, 37% had AIS secondary to LVOs. Of the 492 RA and 1147 SA, 125 (25.4%) and 38 (3.3%), respectively, underwent MT (OR=9.9; 95% CI 6.8 to 14.6; p<0.0001). Median times from onset-to-ECC arrival (74 vs 167 min, p=0.03) and dispatch-to-ECC arrival (31 vs 46 min, p=0.0002) were shorter in the RA-MT than in the SA-MT cohort. A RACE cut-off point ≥5 showed a sensitivity and specificity of 0.77 and 0.75 for detection of patients with LVO eligible for MT, respectively.

Conclusions

We have demonstrated the long-term feasibility of a countywide EMS-based prehospital triage protocol using the RACE Scale within our hospital network.
Sustained virological response and drug resistance among female sex workers living with HIV on antiretroviral therapy in Kampala, Uganda: a cross-sectional study
Authors: Namale Gertrude , Kamacooko Onesmus , Bagiire Daniel , Mayanja Yunia , Abaasa Andrew , Kilembe William , Price Matt , Ssemwanga Deogratius , Lunkuse Sandra , Nanyonjo Maria , Ssenyonga William , Mayaud Philippe , Newton Rob , Kaleebu Pontiano , Seeley Janet
Published: July 2019

Objectives

We assessed the prevalence and risk factors associated with virological failure among female sex workers living with HIV on antiretroviral therapy (ART) in Kampala, Uganda.

Methods

We conducted a cross-sectional study between January 2015 and December 2016 using routinely collected data at a research clinic providing services to women at high risk of STIs including HIV. Plasma samples were tested for viral load from HIV-seropositive women aged ≥18 years who had been on ART for at least 6 months and had received adherence counselling. Samples from women with virological failure (≥1000 copies/mL) were tested for HIV drug resistance by population-based sequencing. We used logistic regression to identify factors associated with virological failure.

Results

Of 584 women, 432 (74%) with a mean age of 32 (SD 6.5) were assessed, and 38 (9%) were found to have virological failure. HIV resistance testing was available for 78% (28/38), of whom 82.1% (23/28) had at least one major drug resistance mutation (DRM), most frequently M184V (70%, 16/23) and K103N (65%, 15/23). In multivariable analysis, virological failure was associated with participant age 18–24 (adjusted OR (aOR)=5.3, 95% CI 1.6 to 17.9), self-reported ART non-adherence (aOR=2.6, 95% CI 1.2 to 5.8) and baseline CD4+ T-cell count ≤350 cells/mm3(aOR=3.1, 95% CI 1.4 to 7.0).

Conclusions

A relatively low prevalence of virological failure but high rate of DRM was found in this population at high risk of transmission. Younger age, self-reported ART non-adherence and low CD4+ T-cell count on ART initiation were associated with increased risk of virological failure.
Accelerated frames and galactic rotation curves
Authors: Ulhoa S. C. , Carneiro F. L.
Published: July 2019

In this paper, the galactic rotation curve is analyzed as an effect of an accelerated reference frame. Such a rotation curve was the first evidence for the so-called dark matter. We show another possibility for this experimental data: non-inertial reference frame can fit the experimental curve. We also show that general relativity is not enough to completely explain that which encouraged alternatives paths such as the MOND approach. The accelerated reference frames hypothesis is well-suited to deal with the rotation curve of galaxies and perhaps has some role to play concerning other evidences for dark matter.
A Froggatt–Nielsen flavor model for neutrino physics
Authors: Berger Micheal S. , Dawid Maria
Published: July 2019

Superheavy neutrinos can, via the seesaw model, provide a mechanism for lepton number violation. If they are combined with flavor violation as characterized by the Froggatt–Nielsen mechanism, then the phenomenology for the neutrinos in oscillation experiments, neutrinoless double beta decay, and other experiments can be described by a relatively few number of parameters. We describe the low-energy neutrino mass matrix and show that the results are consistent with currently available data.