bluuebunny/crossref_metadata_2025 huggingface dataset:
Draft Genome Sequences of Four Antibiotic-Resistant
Salmonella
Strains Isolated from Australian Red Meat Animal Species
Authors: Sarjit Amreeta , Ravensdale Joshua T. , Coorey Ranil , Fegan Narelle , Dykes Gary A.
Published: August 2019

The genome sequences of four antibiotic-resistant
Salmonella
strains isolated from red meat animals in Australia are presented. Multidrug-resistant
Salmonella enterica
serovar Heidelberg 329 and
Salmonella enterica
serovar Typhimurium 2470 harbored an IncHI2 plasmid similar to the multidrug-resistant
S.
Heidelberg strain N13-01290 plasmid pN13-01290_23 previously isolated in Canada.
Differential effects of primary disease and corneal vascularisation on corneal transplant rejection and survival
Authors: Sibley Daniel , Hopkinson Cathy L , Tuft Stephen J , Kaye Stephen B , Larkin Daniel F P
Published: August 2019

Aims

To investigate the relative risk of pretransplant corneal vascularisation on rate of rejection and graft failure within 5 years of surgery when categorised by indication for transplantation.

We analysed all adults recorded in the UK transplant registry who had a first cornea transplant for keratoconus (KC), pseudophakic bullous keratopathy (PBK) or previous infection (viral/bacterial/fungal/protozoan) between 1999 and 2017. We analysed the number of quadrants of the recipient cornea vascularised before transplant and type of vascularisation, the interval post-transplant to rejection, if any, and the outcome at 5 years post-transplant. Risk factors for rejection and transplant failure were modelled by multivariable risk-adjusted Cox regression.

Results

Corneal vascularisation was recorded in 10%, 25% and 67% of patients with KC, PBK and infection, respectively. Individuals with PBK had an increased hazard of transplant rejection only when there were more than two quadrants of vascularisation (HR 1.5, p=0.004) when either superficial and/or deep vascularisation was present (HR 1.3 and 1.4, respectively, p=0.004). Individuals who had a transplant for previous infection had an increased hazard of rejection with four quadrants of vascularisation (HR 1.6, p=0.003). There was no risk-adjusted increase in transplant failure associated with vascularisation in any group. There was weak evidence of reduction in risk of rejection and/or failure associated with lamellar compared with penetrating transplantation in KC and PBK in vascularised recipient corneas.

Conclusion

Vascularisation is a risk factor for corneal allograft rejection within 5 years. The indication for transplantation has a clinically significant effect on the magnitude of this risk.
HbA1c level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes: Swedish population based cohort study
Authors: Lind Marcus , Pivodic Aldina , Svensson Ann-Marie , Ólafsdóttir Arndis F , Wedel Hans , Ludvigsson Johnny
Published: August 2019

Objective

To evaluate if the lowest target level for glycated haemoglobin (HbA1c) of <6.5% is associated with lower risk for retinopathy and nephropathy than less tight control in children and adults with type 1 diabetes.

Design

Population based cohort study.

Setting

Swedish National Diabetes Registry, 1 January 1998 to 31 December 2017.

Participants

10 398 children and adults with type 1 diabetes followed from diagnosis, or close thereafter, until end of 2017.

Main outcome measures

Relative risk (odds ratios) for retinopathy and nephropathy for different mean levels of HbA1c.

Results

Mean age of participants was 14.7 years (43.4% female), mean duration of diabetes was 1.3 years, and mean HbA1c level was 8.0% (63.4 mmol/mol). After adjustment for age, sex, duration of diabetes, blood pressure, blood lipid levels, body mass index, and smoking, the odds ratio for mean HbA1c <6.5% (<48 mmol/mol) compared with 6.5-6.9% (48-52 mmol/mol) for any retinopathy (simplex or worse) was 0.77 (95% confidence interval 0.56 to 1.05, P=0.10), for preproliferative diabetic retinopathy or worse was 3.29 (0.99 to 10.96, P=0.05), for proliferative diabetic retinopathy was 2.48 (0.71 to 8.62, P=0.15), for microalbuminuria or worse was 0.98 (0.60 to 1.61, P=0.95), and for macroalbuminuria was 2.47 (0.69 to 8.87, P=0.17). Compared with HbA1c levels 6.5-6.9%, HbA1c levels 7.0-7.4% (53-57 mmol/mol) were associated with an increased risk of any retinopathy (1.31, 1.05 to 1.64, P=0.02) and microalbuminuria (1.55, 1.03 to 2.32, P=0.03). The risk for proliferative retinopathy (5.98, 2.10 to 17.06, P<0.001) and macroalbuminuria (3.43, 1.14 to 10.26, P=0.03) increased at HbA1c levels >8.6% (>70 mmol/mol). The risk for severe hypoglycaemia was increased at mean HbA1c <6.5% compared with 6.5-6.9% (relative risk 1.34, 95% confidence interval 1.09 to 1.64, P=0.005).

Conclusions

Risk of retinopathy and nephropathy did not differ at HbA1c levels <6.5% but increased for severe hypoglycaemia compared with HbA1c levels 6.5-6.9%. The risk for severe complications mainly occurred at HbA1c levels >8.6%, but for milder complications was increased at HbA1c levels >7.0%.
Patients with heart failure with and without a history of stroke in the Netherlands: a secondary analysis of psychosocial, behavioural and clinical outcomes up to three years from the COACH trial
Authors: Ski Chantal F , van der Wal Martje H L , Le Grande Michael , van Veldhuisen Dirk J. , Lesman-Leegte Ivonne , Thompson David R , Middleton Sandy , Cameron Jan , Jaarsma Tiny
Published: August 2019

Objective

To identify differences in psychosocial, behavioural and clinical outcomes between patients with heart failure (HF) with and without stroke.

Design and participants

A secondary analysis of 1023 patients with heart failure enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure.

Setting

Seventeen hospitals located across the Netherlands.

Outcomes measures

Depressive symptoms (Centre for Epidemiological StudiesDepressionScale), quality of life (Minnesota Living with Heart Failure Questionnaire, Ladder of Life Scale), self-care (European Heart Failure Self-Care Behaviour Scale), adherence to HF management (modified version of the Heart Failure Compliance Questionnaire) and readmission for HF, cardiovascular-cause and all-cause hospitalisations at 18 months, and all-cause mortality at 18 months and 3 years.

Results

Compared with those without stroke, patients with HF with a stroke (10.3%; n=105) had twice the likelihood of severe depressive symptoms (OR 2.83, 95% CI 1.27 to 6.28, p=0.011; OR 2.24, 95% CI 1.03 to 4.88, p=0.043) at 12 and 18 months, poorer disease-specific and generic quality of life (OR 2.80, 95% CI 1.61 to 4.84, p<0.001; OR 2.00, 95% CI 1.09 to 3.50, p=0.019) at 12 months, poorer self-care (OR 1.80, 95% CI 1.05 to 3.11, p=0.034; OR 2.87, 95% CI 1.61 to 5.11, p<0.0011) and HF management adherence (OR 0.39, 95% CI 0.18 to 0.81, p=0.012; OR 0.35, 95% CI 0.17 to 0.72, p=0.004) at 12 and 18 months, higher rates of hospitalisations and mortality at 18 months and higher all-cause mortality (HR 1.43, 95% CI 1.07 to 1.91, p=0.016) at 3 years.

Conclusions

Patients with HF and stroke have worse psychosocial, behavioural and clinical outcomes, notably from 12 months, than those without stroke. To ameliorate these poor outcomes long-term, integrated disease management pathways are warranted.
Clinical characteristics of patients under 40 years old with early-onset hyperuricaemia: a retrospective monocentric study in China
Authors: Zhang Yi , Yang Yong , Xue Leixi , Wen Jian , Bo Lin , Tang Mei , Yang Ru , Yan Dong , Liu Zhichun
Published: August 2019

Objective

To investigate the clinical characteristics of patients with early-onset hyperuricaemia (HUC).

Methods

A retrospective study using data from the Second Affiliated Hospital of Soochow University was conducted. 623 patients with HUC were divided into early-onset group and late-onset group. Another 201 healthy subjects ≤40 years old were regarded as control group. The data of physical measurements and biochemistry test were collected. Clinical data of early-onset group were compared with late-onset group and control group by analysis of variance (ANOVA) and χ2test. Principal component analysis (PCA) was applied. Logistic regression was used to identify the clinical factors correlated with patients with early-onset HUC.

Results

The patients of early-onset group had different body mass index (BMI), serum albumin, alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AKP), gamma-glutamyltransferase (GGT), creatinine (Cr), triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), TG/high density lipoprotein (HDL) ratio, HDL and percentage of males, hypertension (HBP) as well as fatty liver compared with healthy people in the control group. Early-onset group patients had different albumin, ALT, fasting blood glucose, Cr, percentage of males and HBP compared with late-onset group patients. PCA identified four significant patterns including PC1 (labelled ‘TG and HDL’), PC2 (labelled ‘fatty liver and liver enzymes’), PC3 (labelled ‘TC and LDL’) and PC4 (labelled ‘AKP’). The results of univariate and multivariate logistic regression analysis showed that BMI, HBP and albumin were correlative factors for early onset of HUC when the patients with early-onset and late-onset HUC were involved, while gender, BMI, PC1, PC2 and PC4 were correlative factors for early-onset HUC when the early-onset and control groups were involved.

Conclusion

This study described a group of patients with early-onset HUC with distinct clinical features. Gender, BMI, ‘TG and HDL’, ‘fatty liver and liver enzymes’ and ‘AKP’ have higher values than HBP, type 2 diabetes mellitus and ‘TC and LDL’ in patients under 40 years old with early-onset HUC.
Receiving the home care service offered by certified care workers prior to a patients’ death and the probability of a home death: observational research using an instrumental variable method from Japan
Authors: Abe Kazuhiro , Miyawaki Atsushi , Kobayashi Yasuki , Noguchi Haruko , Takahashi Hideto , Tamiya Nanako
Published: August 2019

Objectives

To assess the association between receiving the certified care workers’ home care service, which is provided by non-medical professionals prior to a patients’ death and the probability of a home death.

Design

Observational research using the full-time translated number of certified care workers providing home care service per member of the population aged 65 or above, during the year prior to patient’s death per municipality as an instrumental variable.

Setting

The certified care workers’ home care service covered by the public long-term care insurance (LTCI) system in Japan.

Participants

In total, 1 613 391 LTCI beneficiaries aged 65 or above who passed away, except by an external cause of death, between January 2010 and December 2013 were included in the analysis.

Primary outcome measures

Death at home or death at other places, including hospitals, nursing homes and clinics with beds.

Results

Out of all participants, 173 498 (10.8%) died at home. The number of patients who used the certified care workers’ home care service more than once per each month during 1, 2 or 3 months prior to the month of death numbered 213 848, 176 686 and 155 716, respectively. This was associated with an increased probability of death at home by 9.1% points (95% CI 2.9 to 15.3), 10.5% points (3.3 to 17.6) and 11.4% points (3.6 to 19.2), respectively.

Conclusions

The use of the certified care workers’ home care service prior to death was associated with the increased probability of a home death.
Does Telemedical Support of First Responders Improve Guideline Adherence in an Offshore Emergency Scenario? A Simulator-Based Prospective Study
Authors: Landgraf Philipp , Spies Claudia , Lawatscheck Robert , Luz Maria , Wernecke Klaus-Dieter , Schröder Torsten
Published: August 2019

Objective

To investigate, in a simulator-based prospective study, whether telemedical support improves quality of emergency first response (performance) by medical non-professionals to being non-inferior to medical professionals.

Setting

In a simulated offshore wind power plant, duos (teams) of offshore engineers and teams of paramedics conducted the primary survey of a simulated patient.

Participants

38 offshore engineers and 34 paramedics were recruited by the general email invitation.

Intervention

Teams (randomised by lot) were supported by transmission technology and a remote emergency physician in Berlin.

Outcome measures

From video recordings, performance (17 item checklist) and required time (up to 15 min) were quantified by expert rating for analysis. Differences were analysed using two-sided exact Mann-Whitney U tests for independent measures, non-inferiority was analysed using Schuirmann one-sided test. The significance level of 5 % was Holm-Bonferroni adjusted in each family of pairwise comparisons.

Results

Nine teams of engineers with, nine without, nine teams of paramedics with and eight without support completed the task. Two experts quantified endpoints, insights into rater dependence were gained. Supported engineers outperformed unsupported engineers (p<0.01), insufficient evidence was found for paramedics (p=0.11). Without support, paramedics outperformed engineers (p<0.01). Supported engineers’ performance was non-inferior (at one item margin) to that by unsupported paramedics (p=0.03). Supported groups were slower than unsupported groups (p<0.01).

Conclusions

First response to medical emergencies in offshore wind farms with substantially delayed professional care may be improved by telemedical support. Future work should test our result during additional scenarios and explore interdisciplinary and ecosystem aspects of this support.

Trial registration number

DRKS00014372
Population-based case–control study of the effect of sun glare on pedestrian fatalities in Taiwan
Authors: Ma Hon-Ping , Chen Ping-Ling , Chen Shang-Ku , Chen Liang-Hao , Linkov Vaclav , Pai Chih-Wei
Published: August 2019

Objectives

Sun glare is a serious driving hazard and increases crash risks. Relatively few studies have examined the effects of sun glare on pedestrian fatalities, given that a crash has occurred. The primary objective of this study was to investigate the effect of sun glare on pedestrian fatalities.

Design

A population-based case–control study.

Setting

Taiwan.

Participants

Using the Taiwan National Traffic Crash Data and sunrise and sunset data from the National Oceanic and Atmospheric Administration for the period 2003 to 2016, 100 411 pedestrians involved in crashes were identified. Of these crashes, 13 355 and 87 056 were glare-related (case) and non-glare-related (control) crashes, respectively.

Methods

To account for unobserved heterogeneity, mixed logit models were estimated to identify the determinants of pedestrian fatalities.

Main outcome measures

Pedestrian fatalities.

Results

Pedestrians involved in glare-related crashes were more likely to be fatally injured than those in non-glare-related crashes (β=0.527;t=3.21). Other contributory factors to fatal injuries among pedestrians were older pedestrians (β=0.553;t=2.33), male drivers (β=0.324;t=2.33), older drivers (β=0.218;t=2.14), intoxicated motorists (β=0.606;t=2.85), rural roadways (β=0.985;t=3.92), overtaking manoeuvres (β=0.472;t=3.58), heavy vehicle crash partners (β=0.248;t=2.78) and sunset hours (β=0.274;t=3.08). Walking against traffic appeared beneficial for decreasing injury severity (β=−0.304;t=−2.76).

Conclusions

Sun glare is associated with pedestrian fatalities. Older pedestrians, male drivers, older drivers and intoxicated motorists are prevalent determinants of pedestrian fatalities in glare-related crashes.
Survey on available treatment for acute kidney injury in the Southern African Development Community and Nigeria: are we ready for zero deaths by 2025 in sub-Saharan Africa?
Authors: Jones Erika , Rayner Brian L , Effa Emmanuel E , Okpechi Ikechi G , Schmitz Michael , Heering Peter J
Published: August 2019

Objectives

The International Society of Nephrology (ISN) has called for zero deaths by 2025. This survey aimed to determine the preparedness of Southern African Development Community (SADC) countries and Nigeria to heed this call.

Setting

A questionnaire was emailed to facilities, where renal replacement therapy is available; to determine type of services available; quality of care and identify clinicians involved.

Participants

Clinicians and administrators involved in the care of patients with acute kidney injury (AKI) completed the questionnaire.

Results

Completed questionnaires were received from 12 of the 15 SADC countries and Nigeria, covering 48 service providers. The government provided partial funding for dialysis in 41.7% of services. There was no funding for acute dialysis in two countries. Interdisciplinary teams in 72.9% of hospitals covered the intensive care units (ICUs), which included at least one nephrologist in 75%. Only 77% were able to provide dialysis in ICU. Intermittent haemodialysis was the most common modality available (91.7% of facilities), sustained low-efficiency dialysis in 50%, continuous therapies in 35% and peritoneal dialysis in 33.3%. Almost half (47.9%) of the sites were limited to one mode of dialysis and unable to care for severely ill patients. The clinical status was used to initiate and monitor dialysis, with very few sites having clear written standard operating procedures.

Conclusion

In the 16 countries surveyed, the majority had limited ability to provide comprehensive dialysis programmes for patients with AKI due to lack of facilities and government funding. Additionally, nephrologists are scarce; modes of dialysis are limited; as is the care for severely ill patients and lack of standard operating procedures. Resources, training and funding need to be made available to create universal coverage of dialysis for AKI. The ISN goal of providing renal replacement therapy to all by 2025 is unlikely to be achieved in SADC and Nigeria.
Ultra-processed foods and recommended intake levels of nutrients linked to non-communicable diseases in Australia: evidence from a nationally representative cross-sectional study
Authors: Machado Priscila P , Steele Euridice M , Levy Renata B , Sui Zhixian , Rangan Anna , Woods Julie , Gill Tim , Scrinis Gyorgy , Monteiro Carlos A
Published: August 2019

Objective

This study aimed to describe the consumption of ultra-processed foods in Australia and its association with the intake of nutrients linked to non-communicable diseases (NCDs).

Design

Cross-sectional study.

Setting

National Nutrition and Physical Activity Survey (2011-2012).

Participants

12,153 participants aged 2+ years.

Main outcome measures

Average dietary content of nutrients linked to NCDs and the prevalence of intake outside levels recommended for the prevention of NCDs.

Data analysis

Food items were classified according to the NOVA system, a classification based on the nature, extent and purpose of industrial food processing. The contribution of each NOVA food group and their subgroups to total energy intake was calculated. Mean nutrient content of ultra-processed food and non-ultra-processed food fractions of the diet were compared. Across quintiles of the energy contribution of ultra-processed foods, differences in the intake of nutrients linked to NCDs as well as in the prevalence of intakes outside levels recommended for the prevention of NCDs were examined.

Results

Ultra-processed foods had the highest dietary contribution (42.0% of energy intake), followed by unprocessed or minimally processed foods (35.4%), processed foods (15.8%) and processed culinary ingredients (6.8%). A positive and statistically significant linear trend was found between quintiles of ultra-processed food consumption and intake levels of free sugars (standardised β 0.43, p<0.001); total (β 0.08, p<0.001), saturated (β 0.18, p<0.001) and trans fats (β 0.10, p<0.001); sodium (β 0.21, p<0.001) and diet energy density (β 0.41, p<0.001), while an inverse relationship was observed for dietary fibre (β -0.21, p<0.001) and potassium (β -0.27, p<0.001). The prevalence of non-recommended intake levels of all studied nutrients increased linearly across quintiles of ultra-processed food intake, notably from 22% to 82% for free sugars, from 6% to 11% for trans fat and from 2% to 25% for dietary energy density, from the lowest to the highest ultra-processed food quintile.

Conclusion

The high energy contribution of ultra-processed foods impacted negatively on the intake of non-ultra-processed foods and on all nutrients linked to NCDs in Australia. Decreasing the dietary share of ultra-processed foods would substantially improve the diet quality in the country and help the population achieve recommendations on critical nutrients linked to NCDs.
Multicentre, randomised waitlist control trial investigating a parent-assisted social skills group programme for adolescents with brain injuries: protocol for the friends project
Authors: Gilmore Rose , Sakzewski Leanne , Ziviani Jenny , Mcintyre Sarah , Smithers Sheedy Hayley , Hilton Nicola , Williams Tracey , Quinn Kirsten , Sarandrea Anne Marie , Laugeson Elizabeth , Chatfield Mark
Published: August 2019

Introduction

Adolescents with brain injury frequently have difficulties with social competence, which persist into adulthood affecting their participation in daily life. To date, there has been limited research into the efficacy of social competence interventions in this population. Research from the Program for the Education and Enrichment of Relational Skills (PEERS) has demonstrated significant improvements in social competence skills, maintained at 1-year to 5-year follow-up, for adolescents with autism spectrum disorder. PEERS has not yet been tested among adolescents with brain injury. This protocol describes a pragmatic, parallel two-group pre-test post-test randomised waitlist control trial across two sites in Australia, which aims to evaluate the feasibility, acceptability and efficacy of PEERS in adolescents with brain injury compared with usual care.

Methods and analysis

Forty adolescents with an acquired brain injury or cerebral palsy will be randomly assigned to either the 14-week PEERS group or waitlist care as usual group. The waitlist group will then receive PEERS following the 26-week retention time point. Outcomes will be assessed at baseline, 14 weeks (immediately postintervention) and 26 weeks follow-up (retention). The primary outcomes are self-report and parent report on the Social Skills Improvement System Rating Scales immediately post PEERS at 14 weeks. Secondary outcomes include increased frequency of get-togethers with peers with reduced conflict and increased adolescent self-reported knowledge of social skills. Acceptability and feasibility will be examined through qualitative analysis of focus group data collected after the completion of each group.

Ethics and dissemination

Ethics approval has been granted by the Medical Research Ethics Committee Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/17/QRCH/87), The University of Queensland (2017000864) and the Cerebral Palsy Alliance Ethics Committee (20170802/HREC:EC00402). The findings will be disseminated in peer-reviewed journals, by conference presentation and newsletters to consumers.

Trial registration number

ACTRN12617000723381.
Time to care: why the humanities and the social sciences belong in the science of health
Authors: Clarke Brendan , Ghiara Virginia , Russo Federica
Published: August 2019

Health is
more
than the absence of disease. It is also more than a biological phenomenon. It is inherently social, psychological, cultural and historical. While this has been recognised by major health actors for decades, open questions remain as to how to build systems that reflect the complexity of health, disease and sickness, and in a context that is increasingly technologised. We argue that an urgent change of approach is necessary. Methods and concepts from the humanities and social science must be embedded in the concepts and methods of the health sciences if we are to promote sustainable interventions capable of engaging with the recognised complexity of health, disease and sickness. Our vision is one of radical interdisciplinarity, integrating aspects of biological, psychological, social and humanities approaches across areas of urgent health need. Radical interdisciplinarity, we argue, entails the practical, methodological and conceptual integration of these approaches to health.
Association between psychosocial factors at work and health outcomes after retirement: a protocol for a systematic review and meta-analysis
Authors: Imamura Kotaro , Tsutsumi Akizumi , Asai Yumi , Arima Hideaki , Ando Emiko , Inoue Akiomi , Inoue Reiko , Iwanaga Mai , Eguchi Hisashi , Otsuka Yasumasa , Kobayashi Yuka , Sakuraya Asuka , Sasaki Natsu , Tsuno Kanami , Hino Ayako , Watanabe Kazuhiro , Shimazu Akihito , Kawakami Norito
Published: August 2019

Introduction

The world’s population is rapidly ageing, and health among older people is thus an important issue. Several previous studies have reported an association between adverse psychosocial factors at work before retirement and postretirement health. The objective of this systematic review and meta-analysis is to examine the association between psychosocial factors at work and health outcomes after retirement, based on a synthesis of well-designed prospective studies.

Methods and analysis

The participants, exposures, comparisons and outcomes of the studies in this systematic review and meta-analysis are defined as follows: (P) people who have retired from their job, (E) presence of adverse psychosocial factors at work before retirement, (C) absence of adverse psychosocial factors at work before retirement and (O) any physical and mental health outcomes after retirement. Published studies were searched using the following electronic databases: MEDLINE, EMBASE, PsycINFO, PsycARTICLES and Japan Medical Abstracts Society. The included studies will be statistically synthesised in a meta-analysis to estimate pooled coefficients and 95% CIs. The quality of each included study will be assessed using the Risk Of Bias In Non-randomised Studies-of Interventions. For the assessment of meta-bias, publication bias will be assessed by using Egger’s test, as well as visually on a funnel plot. Heterogeneity will be assessed using the χ² test with Cochran’s Q statistic and I2.

Ethics and dissemination

Results and findings will be submitted and published in a scientific peer-reviewed journal and will be disseminated broadly to researchers and policy-makers interested in the translatability of scientific evidence into good practices.

PROSPERO registration number

CRD42018099043.
Automated virtual reality (VR) cognitive therapy for patients with psychosis: study protocol for a single-blind parallel group randomised controlled trial (gameChange)
Authors: Freeman Daniel , Yu Ly-Mee , Kabir Thomas , Martin Jen , Craven Michael , Leal José , Lambe Sinéad , Brown Susan , Morrison Anthony , Chapman Kate , Dudley Robert , O'Regan Eileen , Rovira Aitor , Goodsell Andrew , Rosebrock Laina , Bergin Aislinn , Cryer Tillie L , Robotham Dan , Andleeb Humma , Geddes John R , Hollis Chris , Clark David M , Waite Felicity
Published: August 2019

Introduction

Many patients with psychosis experience everyday social situations as anxiety-provoking. The fears can arise, for example, from paranoia, hallucinations, social anxiety or negative-self beliefs. The fears lead patients to withdraw from activities, and this isolation leads to a cycle of worsening physical and mental health. Breaking this cycle requires highly active treatment directly in the troubling situations so that patients learn that they can safely and confidently enter them. However patients with psychosis seldom receive such life-changing interventions. To solve this problem we have developed an automated psychological treatment delivered in virtual reality (VR). It allows patients to experience computer simulations of the situations that they find anxiety-provoking. A virtual coach guides patients, using cognitive techniques, in how to overcome their fears. Patients are willing to enter VR simulations of anxiety-provoking situations because they know the simulations are not real, but the learning made transfers to the real world.

Methods and analysis

432 patients with psychosis and anxious avoidance of social situations will be recruited from National Health Service (NHS) secondary care services. In the gameChange trial, they will be randomised (1:1) to the six-session VR cognitive treatment added to treatment as usual or treatment as usual alone. Assessments will be conducted at 0, 6 (post-treatment) and 26 weeks by a researcher blind to allocation. The primary outcome is avoidance and distress in real-life situations, using a behavioural assessment task, at 6 weeks. The secondary outcomes are psychiatric symptoms, activity levels and quality of life. All main analyses will be intention-to-treat. Moderation and mediation will be tested. An economic evaluation will be conducted.

Ethics and dissemination

The trial has received ethical approval from the NHS South Central - Oxford B Research Ethics Committee (19/SC/0075). A key output will be a high-quality automated VR treatment for patients to overcome anxious avoidance of social situations.

Trial registration number

ISRCTN17308399.
Identification of processes that mediate the impact of workplace violence on emergency department healthcare workers in the USA: results from a qualitative study
Authors: Vrablik Marie C , Chipman Anne K , Rosenman Elizabeth D , Simcox Nancy J , Huynh Ly , Moore Megan , Fernandez Rosemarie
Published: August 2019

Objectives

Violence towards emergency department healthcare workers is pervasive and directly linked to provider wellness, productivity and job satisfaction. This qualitative study aimed to identify the cognitive and behavioural processes impacted by workplace violence to further understand why workplace violence has a variable impact on individual healthcare workers.

Design

Qualitative interview study using a phenomenological approach to initial content analysis and secondary thematic analysis.

Setting

Three different emergency departments.

Participants

We recruited 23 emergency department healthcare workers who experienced a workplace violence event to participate in an interview conducted within 24 hours of the event. Participants included nurses (n=9; 39%), medical assistants (n=5; 22%), security guards (n=5; 22%), attending physicians (n=2; 9%), advanced practitioners (n=1; 4%) and social workers (n=1; 4%).

Results

Five themes emerged from the data. The first two supported existing reports that workplace violence in healthcare is pervasive and contributes to burn-out in healthcare. Three novel themes emerged from the data related to the objectives of this study: (1) variability in primary cognitive appraisals of workplace violence, (2) variability in secondary cognitive appraisals of workplace violence and (3) reported use of both avoidant and approach coping mechanisms.

Conclusion

Healthcare workers identified workplace violence as pervasive. Variability in reported cognitive appraisal and coping strategies may partially explain why workplace violence negatively impacts some healthcare workers more than others. These cognitive and behavioural processes could serve as targets for decreasing the negative effect of workplace violence, thereby improving healthcare worker well-being. Further research is needed to develop interventions that mitigate the negative impact of workplace violence.
Simulation to improve medical student confidence and preparedness to care for the dying: a feasibility study
Authors: Wells Geoffrey , Montgomery Julia , Hiersche Andreas
Published: August 2019

Background

Undergraduate teaching currently fails to adequately prepare doctors to deliver ‘end-of-life’ care. Despite much evidence supporting simulation-based teaching, its use in medical undergraduate palliative and ‘end-of-life’ care curricula remain low.

Aim

This study assesses whether simulation can improve the confidence and preparedness of medical students to provide holistic care to dying patients and their families, from clinical assessment to symptom management, communication and care after death.

Methods

Six fourth-year medical students undertook individual simulations involving a dying patient (high-fidelity simulator) and family member (actor). Intentional patient death occurred in four of the six scenarios (although unexpected by students). Pre-simulation/post-simulation thanatophobia questionnaires measured student attitudes towards providing care to dying patients. Thematic analysis of post-simulation focus group transcripts generated qualitative data regarding student preparedness, confidence and value of the simulations.

Results

Thematic analysis revealed that students felt the simulations were realistic, and left them better prepared to care for dying patients. Students coveted the ‘safe’ exposure to dying patient scenarios afforded by the simulations. Observed post-simulation reduction in mean thanatophobia scores was not found to be statistically significant (p=0.07).

Conclusions

Results suggest a feasible potential for simulations to influence undergraduate medical student teaching on the care of a dying patient and their family. We believe that this study adds to the limited body of literature exploring the value of simulation in improving the confidence and preparedness of medical students to provide ‘end-of-life’ care. Further research into the cost-effectiveness of simulation is required to further support its application in this setting.
Comparison of risk engagement and protection survey (REPS) among mothers and fathers of children aged 6-12 years
Authors: Olsen Lise L , Lin Yingyi , Ishikawa Takuro , Mâsse Louise C , Brussoni Mariana
Published: August 2019

Background

Parental attitudes regarding child safety and risk engagement play important roles in child injury prevention and health promotion efforts. Few studies have compared mothers’ and fathers’ attitudes on these topics. This study used the risk engagement and protection survey (REPS) previously validated with fathers to compare with data collected from mothers.

Methods

Multi-group confirmatory factor analysis was used with a sample of 234 mothers and 282 fathers. Eligible parents had a child 6–12 years attending a paediatric hospital for an injury-related or other reason. We tested the factor structure of the survey by examining configural, metric and scalar invariance. Following this, mothers’ and fathers’ mean scores on the two identified factors of child injury protection and risk engagement were compared.

Results

Comparing mothers’ and fathers’ data showed the two-factor structure of the REPS held for the mothers’ data. Comparing mean scores for the two factors suggested that fathers and mothers held equivalent attitudes. For the combined sample, parent injury protection attitude scores were significantly higher for daughters versus sons. In addition, attitude scores were significantly lower for injury protection and higher for risk engagement among parents born in Canada compared with those who were not.

Conclusions

The REPS allows for valid assessment of injury protection and risk engagement factors for fathers and mothers. Mothers conceptualised the two factors as distinct concepts, similar to fathers. The REPS can be used to inform parenting programme development, implementation and evaluation.
Cell block processing is optimal for assessing endoscopic ultrasound fine needle aspiration specimens of pancreatic mucinous cysts
Authors: Wong Newton A C S , Gwiti Paida , Murigu Timothy , Melegh Zsombor , Beavers Sophie , Gordon Fiona , Alexandridis Efstratios , Norton Sally
Published: August 2019

Aims

The cell block technique for assessing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) specimens from pancreatic mucinous cystic lesions (MCLs) was systematically evaluated for the first time, including comparisons with three traditional methods of assessing such specimens.

Methods

The prospective arm comprised EUS-FNA specimens from EUS-suspected pancreatic MCLs. The retrospective arm comprised EUS-FNA specimens from pancreatic MCLs surgically resected before the study start. For each specimen, these data points were collected: macroscopic likelihood of mucin, cyst fluid carcinoembryonic antigen (CEA) level and presence of mucin in air-dried, direct smears and in cell block preparations.

Results

The prospective and retrospective arms of the study comprised 80 and 30 EUS-FNA specimens, respectively. Seven prospective cases led to surgical resections during the study, and therefore, 37 EUS-FNA specimens were confirmed to have originated from MCLs. In the prospective arm, macroscopic mucin was suspected, cyst fluid CEA level exceeded 192 ng/mL, mucin was detected in direct smears and cell block preparations in 78%, 30%, 39% and 73% of cases, respectively. Of the 37 specimens confirmed to originate from MCLs, macroscopic mucin assessment, cyst fluid CEA level, direct smear mucin assessment and cell block mucin assessment had sensitivities for diagnosing MCL of 87%, 45%, 45% and 81%, respectively.

Conclusions

Cell block preparations are as likely to identify mucin from pancreatic MCLs as macroscopic assessment but are twice as likely to diagnose MCL than direct smears and fluid CEA biochemistry. The cell block technique is easy for sample collection and processing especially because these are identical for solid and cystic pancreatic lesions.
Importance of being persistent. Should transgender children be allowed to transition socially?
Authors: Giordano Simona
Published: August 2019

Studies suggest that the majority of gender diverse children (up to 84%) revert to the gender congruent with the sex assigned at birth when they reach puberty. These children are now known in the literature as ‘desisters’. Those who continue in the path of gender transition are known as ‘persisters’. Based on the high desistence rates, some advise being cautious in allowing young children to present in their affirmed gender. The worry is that social transition may make it difficult for children to de-transition and thus increase the odds of later unnecessary medical transition. If this is true, allowing social transition may result in an outright violation of one of the most fundamental moral imperatives that doctors have: first do no harm. This paper suggests that this is not the case. Studies on desistence should inform clinical decisions but not in the way summarised here. There is no evidence that social transition per se leads to unnecessary medical transition; so should a child persist, those who have enabled social transition should not be held responsible for unnecessary bodily harm. Social transition should be viewed as a tool to find out what is the right trajectory for the particular child. Desistence is one possible outcome. A clinician or parent who has supported social transition for a child who later desists will have not violated, but acted in respect of the moral principle of non-maleficence, if the choice made appeared likely to minimise the child’s overall suffering and to maximise overall the child’s welfare at the time it was made.
A microstructure-based elastoplastic model to describe the behaviour of a compacted clayey silt in isotropic and triaxial compression
Authors: Musso Guido , Azizi Arash , Jommi Cristina
Published: August 2019

The paper focuses on the hydromechanical behaviour of an unsaturated compacted clayey silt, accounting for fabric changes induced by drying–wetting cycles occurring at low stress levels. The response along isotropic compression and triaxial compression (shear) at constant water content was investigated by laboratory tests on both as-compacted and dried–wetted samples. Compaction induces a microstructural porosity pertinent to clay peds and a macrostructural porosity external to the peds. Drying–wetting cycles decrease the microporosity and increase the macroporosity, which reduces the water retention capacity, increases the compressibility, and promotes higher peak strengths with more brittle behaviour during triaxial compression. A coupled double-porosity elastic–plastic model was formulated to simulate the experimental results. A nonassociated flow rule was defined for the macrostructure, modifying a stress–dilatancy relationship for saturated granular soils to account for the increase in dilatancy with suction observed in the experiments. The average skeleton stress and suction were adopted as stress variables. As correctly predicted by the model, the shear strength at critical state is not significantly influenced by the degree of saturation or by the hydraulic history. On the contrary, the higher peak strength, brittleness, and dilatancy of the dried–wetted samples are mostly explained by their reduced water-retention capacity.
Termination of Action Potential Due to Site Selective Ion Channel Blockers
Authors: Pal Krishnendu , Gangopadhyay Gautam
Published: August 2019

Here, we have provided a qualitative theoretical description about how the action potential generation and its associated intrinsic properties such as ionic current, spiking frequency, action potential duration, gating dynamics, etc. are affected due to site selective ion channel blockers, by suitably adapting Gillespie’s stochastic simulation technique to an extended Hodgkin–Huxley Markov model, representing a very basic type of neuron. Considering different types and degrees of blocking potency of channel blockers to channel proteins, we have found that the nature of action potential termination process and corresponding ionic current profiles are very distinct from each other. With the increasing blocking affinity, the frequency of action potential spiking falls off exponentially in presence of sodium channel only blockers and dual type blockers having more sodium binding potency than potassium blockers, whereas in contrast, for potassium channel only blockers, dual type blockers having equal or higher potassium blocking affinity with respect to sodium blocking, the spiking frequency initially is enhanced followed by a gradual decrease due to the competition between channel number fluctuation and overall sodium and potassium conductances. Sodium channel blockers tend to shorten the action potential duration while the potassium channel blockers broaden it. The channel gating dynamics are also found to be changed drastically for different types of blockers. The final quiescent state arrival time and the quiescent state membrane voltage profiles show distinct features for different types of channel blockers with different applied external stimulus. Finally, we showed how consistent our results are with the existing literature of experimentally observed channel blocking effects in diverse systems and compared the similarities, dissimilarities and advantages of our model with an existing theoretical drug binding model with Langevin description. Our approach provides a qualitative pathway to investigate the effects of many other types of blocking mechanisms such as closed state, inactivated state blocking with desired level of structural and functional details.
Compact Einstein multiply warped product space with nonpositive scalar curvature
Authors: Pal Buddhadev , Kumar Pankaj
Published: August 2019

In this paper, we characterize the Einstein multiply warped product space with nonpositive scalar curvature. As a result, it is shown that, if [Formula: see text] is Einstein multiple-warped product spaces with compact base and nonpositive scalar curvature, then [Formula: see text] is simply a Riemannian manifold. Next, we apply our result on Generalized Robertson–Walker space-time and Generalized Friedmann–Robertson–Walker space-time.
Investigation of fractional harmonic oscillator canonical ensemble in the q-deformed super-statistic
Authors: Sobhani Hadi , Hassanabadi Hassan , Chung Won Sang
Published: August 2019

In this paper, a canonical ensemble of fractional harmonic oscillator has been considered. Then by using the [Formula: see text]-deformed formalism of super-statistic, thermodynamical properties of such an ensemble have been evaluated. The important point in this paper is that because of the existence of the fractional parameter, the partition functions, consequently and the other thermodynamical properties, can be analytically derived. Therefore, these quantities have been evaluated numerically. These quantities have been plotted in terms of temperature when the deformation and the fractional parameter vary. Effects of these parameters on the thermodynamical properties of the canonical ensemble have been discussed in detail.
Observational constraints of emergent universe in brane-world with Gauss–Bonnet term and dissipative effect
Authors: Debnath Partha Sarathi
Published: August 2019

Cosmological solutions in the Randall–Sundrum (RS) type II brane-world model including Gauss–Bonnet (GB) term, in the presence of a bulk viscous cosmological fluid are discussed. Transport equations described by Eckart and Israel Stewart are implemented here. Cosmological models admitting emergent universe (EU) of the early universe is explored here in the presence of imperfect fluid described by Eckart theory and Truncated Israel Stewart (TIS) theory and Full Israel Stewart (FIS) theory. We also study the permitted values of the EU model parameters by considering cosmological observational dataset. The stability analysis of the equilibrium points of the dynamical system associated with the evolution in the RS brane including GB term are studied in Eckart theory, TIS theory and FIS theory.
Complexity factor for dynamical spherically symmetric fluid distributions in f(R) gravity
Authors: Nazar H. , Abbas G.
Published: August 2019

In this study, we analyze the complexity factor that is extended up to the dynamical spherically symmetric non-static case with anisotropic dissipative self-gravitating fluid distribution in context of [Formula: see text] theory of gravity. For this evaluation we choose the particular [Formula: see text] model that signifies the physical nature of the self-gravitating system. The proposed work discusses not only the complexity factor of the structure of the fluid distribution, but also defines the minimization rate of complexity of the pattern of evolution. Here, first we have applied similar approach for obtaining the structure scalar [Formula: see text] of the complexity factor as used for in the static case, and next we have described explicitly the dissipative and non-dissipative cases by assuming the simplest pattern of evolution (homologous condition). It has been found that the system configuration fulfills the vanishing condition of complexity factor and emerging homologously, corresponds to a energy density homogeneity, shearfree and geodesic, isotropic in pressure. Moreover, we define the stability results for the vanishing complexity factor condition. Finally, we would like to mention that these results are satisfying the prior investigation about complexity factor in General Relativity (GR) by setting [Formula: see text].