bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrating spatial data analysis functionalities in a GIS environment: Spatial Analysis using ArcGIS Engine and R (SAAR)
Authors: Koo Hyeongmo , Chun Yongwan , Griffith Daniel A.
Published: August 2018

Spatial data analysis (SDA) tools to efficiently handle and explore spatial data have become readily available. Although these SDA tools have their own strengths and purposes, they suffer from limited support in terms of a development environment offering easy customization and high extensibility, a strength of open source software. This article presents a standalone software package for SDA in a geographic information system (GIS) environment, called Spatial Analysis using ArcGIS Engine and R (SAAR), which provides an integrated GIS and SDA environment. A set of SDA tools in SAAR utilizes functions in R using R.NET, while other tools were developed in .NET independent of R. SAAR provides an efficient working environment for both general and advanced GIS users. For general GIS users with limited programming skills, SAAR furnishes advanced SDA tools in a popular ArcGIS environment with graphical user interfaces. For advanced GIS users, SAAR offers an extensible GIS platform to help them customize and implement SDA functions with relatively little development effort. This article demonstrates some functionalities of SAAR using census data for Texas counties.
A distributed approach for calculating inundation height based on Dijkstra's algorithm
Authors: Grady C. J. , Li Xingong
Published: August 2018

This research proposed a parallelized approach to scaling up the calculation of inundation height, the minimum sea‐level rise required to inundate a cell on a digital elevation model, which is based on Dijkstra's algorithm for shortest‐path calculations on a graph. Our approach is based on the concepts of spatial decomposition, calculate‐and‐correct, and a master/worker parallelization paradigm. The approach was tested using the U.S. Coastal Relief Model (CRM) dataset from the National Geophysical Data Center on a multicore desktop computer and various supercomputing resources through the U.S. Extreme Science and Engineering Discovery Environment (XSEDE) program. Our parallel implementation not only enables computations that were larger than previously possible, but also significantly outperforms serial implementations with respect to running time and memory footprint as the number of processing cores increases. The efficiency of the scalability seemed to be tied to tile size and flattened out at a certain number of workers.
Modeling aggregated expertise of user contributions to assess the credibility of OpenStreetMap features
Authors: Muttaqien Bani Idham , Ostermann Frank O. , Lemmens Rob L. G.
Published: August 2018

The emergence of volunteered geographic information (VGI) during the past decade has fueled a wide range of research and applications. The assessment of VGI quality and fitness‐of‐use is still a challenge because of the non‐standardized and crowdsourced data collection process, as well as the unknown skill and motivation of the contributors. However, the frequent approach of assessing VGI quality against external data sources using ISO quality standard measures is problematic because of a frequent lack of available external (reference) data, and because for certain types of features, VGI might be more up‐to‐date than the reference data. Therefore, a VGI‐intrinsic measure of quality is highly desirable. This study proposes such an intrinsic measure of quality by developing the concept of aggregated expertise based on the characteristics of a feature's contributors. The article further operationalizes this concept and examines its feasibility through a case study using OpenStreetMap (OSM). The comparison of model OSM feature quality with information from a field survey demonstrates the successful implementation of this novel approach.
Cryptococcal infection in lung transplant recipients: A 5‐year retrospective review at an Australian transplant center
Authors: Sohail Asma , Smibert Olivia C. , Snell Greg , Paraskeva Miranda , Jenney Adam
Published: August 2018

Cryptococcosis is a common invasive fungal infection (IFI) in solid organ transplant (SOT) recipients. Little is known about cryptococcosis in lung transplant (LTx) recipients despite having one of the highest risks of infection. The aim of this study was to describe demographic and clinical features of cryptococcal infection in LTx recipients. We performed a retrospective, observational study of cryptococcal infection in LTx recipients at The Alfred Hospital in Melbourne, Australia, from 2012 to 2017. A total of 11 cases were identified. Seven patients (64%) were male and the median age was 54.7 years (range 34‐69 years). Diagnosis occurred at a median of 233 days (range 1‐3650 days) post‐transplant. Nine patients (82%) had isolated pulmonary infection of whom 7 (78%) were asymptomatic. All were treated with oral antifungal therapy and 1 required surgical resection of infected lung. Two patients (18%) had disseminated infection; 1 with pulmonary and central nervous system (CNS) infection and 1 with isolated CNS infection. Both patients presented with headache and brain imaging demonstrated cerebral edema, myelinosis, and leptomeningeal enhancement. One of these patients died. This study highlights the fact that cryptococcal infection should remain a consideration in asymptomatic LTx recipients, especially in the presence of non‐specific nodules on chest imaging, and that the presence of headache in these patients requires urgent investigation for CNS infection.
Donor‐derived infections and infectious risk in xenotransplantation and allotransplantation
Authors: Nellore Anoma , Fishman Jay A.
Published: August 2018

Post‐transplantation infections are common in allograft recipients and should be expected in all immunocompromised hosts. Based on the need for immunosuppression in xenotransplantation, procedures developed to enhance safety in allotransplantation can be applied in future xenotransplantation clinical trials. Standardized approaches can be developed to guide the evaluation of common infectious syndromes in xenograft recipients. The opportunity created by screening of swine intended as xenograft donors has equal applicability to allotransplantation—notably broader screening strategies for allograft donors such as use of advanced sequencing modalities including broad‐range molecular probes, microarrays, and high‐throughput pyrosequencing. Considerations in management of allotransplant‐ and xenotransplant‐associated infections are largely the same. Experience in xenotransplantation will continue to inform thinking regarding donor‐derived infections in allotransplantation. We expect that experience in managing complex allotransplant recipients will similarly inform clinical trials in xenotransplantation.
Xenotransplantation panel for the detection of infectious agents in pigs
Authors: Hartline Caroll B. , Conner Ra'Shun L. , James Scott H. , Potter Jennifer , Gray Edward , Estrada Jose , Tector Mathew , Tector A. Joseph , Prichard Mark N.
Published: August 2018

Background

Recent advances in xenotransplantation have produced organs from pigs that are well tolerated in primate models because of genetic changes engineered to delete major antigens from donor animals. To ensure the safety of human transplant recipients, it will be essential to understand both the spectrum of infectious agents in donor pigs and their potential to be transmitted to immunocompromised transplant recipients. Equally important will be the development of new highly sensitive diagnostic methods for use in the detection of these agents in donor animals and for the monitoring of transplant recipients.

Methods

Herein, we report the development of a panel of 30 quantitative polymerase chain reaction (qPCR) assays for infectious agents with the potential to be transmitted to the human host. The reproducibility, sensitivity and specificity of each assay were evaluated and were found to exhibit analytic sensitivity that was similar to that of quantitative assays used to perform viral load testing of human viruses in clinical laboratories.

Results

This analytical approach was used to detect nucleic acids of infectious agents present in specimens from 9 sows and 22 piglets derived by caesarean section. The most commonly detected targets in adult animals were Mycoplasma species and two distinct herpesviruses, porcine lymphotrophic herpesvirus 2 and 3. A total of 14 piglets were derived from three sows infected with either or both herpesviruses, yet none tested positive for the viruses indicating that vertical transmission of these viruses is inefficient.

Conclusions

The data presented demonstrate that procedures in place are highly sensitive and can specifically detect nucleic acids from target organisms in the panel, thus ensuring the safety of organs for transplantation as well as the monitoring of patients potentially receiving them.
Pathogen elimination and prevention within a regulated, Designated Pathogen Free, closed pig herd for long‐term breeding and production of xenotransplantation materials
Authors: Noordergraaf Jeske , Schucker Adrienne , Martin Mike , Schuurman Henk‐jan , Ordway Brianne , Cooley Kevin , Sheffler Marie , Theis Kara , Armstrong Chasa , Klein Laura , Hansen Doug , Olson Megan , Schlechter Lisa , Spizzo Tom
Published: August 2018

Background

We established a Source Animal (barrier) Facility (SAF) for generating designated pathogen‐free (DPF) pigs to serve as donors of viable organs, tissues, or cells for xenotransplantation into clinical patients. This facility was populated with caesarian derived, colostrum deprived (CDCD) piglets, from sows of conventional‐specific (or specified) pathogen‐free (SPF) health status in six cohorts over a 10‐month period. In all cases, CDCD piglets fulfilled DPF status including negativity for porcine circovirus (PCV), a particularly environmentally robust and difficult to inactivate virus which at the time of SAF population was epidemic in the US commercial swine production industry. Two outbreaks of PCV infection were subsequently detected during sentinel testing. The first occurred several weeks after PCV‐negative animals were moved under quarantine from the nursery into an animal holding room. The apparent origin of PCV was newly installed stainless steel penning, which was not sufficiently degreased thereby protecting viral particles from disinfection. The second outbreak was apparently transmitted via employee activities in the Caesarian‐section suite adjacent to the barrier facility. In both cases, PCV was contained in the animal holding room where it was diagnosed making a complete facility depopulation‐repopulation unnecessary.

Method

Infectious PCV was eliminated during both outbreaks by the following: euthanizing infected animals, disposing of all removable items from the affected animal holding room, extensive cleaning with detergents and degreasing agents, sterilization of equipment and rooms with chlorine dioxide, vaporized hydrogen peroxide, and potassium peroxymonosulfate, and for the second outbreak also glutaraldehyde/quaternary ammonium. Impact on other barrier animals throughout the process was monitored by frequent PCV diagnostic testing.

Result

After close monitoring for 6 months indicating PCV absence from all rooms and animals, herd animals were removed from quarantine status.

Conclusion

Ten years after PCV clearance following the second outbreak, due to strict adherence to biosecurity protocols and based on ongoing sentinel diagnostic monitoring (currently monthly), the herd remains DPF including PCV negative.
Comparative gene expression profiling of pig‐derived iPSC‐like cells: Effects of induced pluripotency on expression of porcine endogenous retrovirus (PERV)
Authors: Godehardt Antonia W. , Petkov Stoyan , Gulich Barbara , Fischer Nicole , Niemann Heiner , Tönjes Ralf R.
Published: August 2018

Background

Porcine induced pluripotent stem cells (piPSCs) offer an alternative strategy in xenotransplantation (XTx). As human endogenous retroviruses (HERV), particularly HERV‐K, are highly expressed in natural human stem cells, we compared the expression of porcine endogenous retroviruses (PERV) and retrotransposon LINE‐1 (L1) open reading frames 1 and 2 (pORF1 and pORF2) in different piPSC‐like cell lines with their progenitors (porcine fetal fibroblasts, pFF).

Methods

Cells reprogrammed via Sleeping Beauty‐transposed transcription factors were cultured and analyzed on a custom‐designed microarray representing the reference pig genome. Data were complemented by qRT‐PCR and reverse transcriptase (RT) assay.

Results

The expression profiles revealed that 8515 of 26 967 targets were differentially expressed. A total of 4443 targets showed log2 expression ratio >1, and 4072 targets showed log2 expression ratio less than −1 with 0.05 P‐value threshold. Approximately ten percent of the targets showed highly significant expression ratios with log2 ≥4 or ≤−4. Besides this general switch in cellular gene expression that was accompanied by an altered morphology, expression of both PERV and L1 pORF1/pORF2 was significantly enhanced. piPSC‐like cells revealed a 10‐fold to 100‐fold higher transcription of the viral PERV‐A and PERV‐B envelope genes (env), viral protease/polymerase (prt/pol), and L1 elements. No functional retrovirus could be detected under these conditions.

Conclusion

Epigenetic reprogramming has functional impact on retrotransposons. Thus, the induction of pig‐derived pluripotent cells influences their PERV expression profile. Data emphasize the necessity to focus on animals, which show non‐functional endogenous viral background to ensure virological safety.
Long‐term safety outcome of systemic immunosuppression in pig‐to‐nonhuman primate corneal xenotransplantation
Authors: Choi Se Hyun , Yoon Chang Ho , Lee Hyun Ju , Kim Hong Pyo , Kim Jong Min , Che Jeong‐Hwan , Roh Kyoung Min , Choi Hyuk Jin , Kim Jiyeon , Hwang Eung Soo , Park Chung‐Gyu , Kim Mee Kum
Published: August 2018

Background

Safety concerns exist for corneal recipients under immunosuppression. We report long‐term safety results of porcine corneal xenotransplantation under immunosuppression in nonhuman primates.

Methods

Systemic monitoring data from 49 Chinese rhesus macaques that received pig corneal transplant between 2009 and 2018 were retrospectively reviewed. The recipients were divided into 4 groups depending on the systemic immunosuppressants used: (a) conventional steroid group; costimulation blockade groups ([b] anti‐CD154 antibody, [c] anti‐CD40 antibody); and (d) commercially available immunosuppressants (anti‐CD20 antibody, tacrolimus, basiliximab) group. We compared results of general condition monitoring; hematologic, biochemical, and electrolyte tests; and Rhesus Cytomegalovirus infection monitoring.

Results

All recipients recovered from early weight loss. White blood cell counts significantly decreased at 6 months in the steroid and anti‐CD154 groups. Abnormal liver and kidney function and electrolyte imbalance were not observed in all groups. The mean value of Rhesus Cytomegalovirus DNA copies was consistently lower than 200 copies/mL, and antibody titers did not change over time in all groups. Tacrolimus‐associated thrombotic microangiopathy was developed in one case, which resolved after discontinuation of tacrolimus. In 2017, a simian varicella virus outbreak led to clinical signs in 5 that received immunosuppressive therapies, of which 3 died.

Conclusion

Costimulatory blockade‐based and anti‐CD20 antibody/tacrolimus‐based immunosuppressive therapies seem to be comparably safe with steroid therapy in nonhuman primates receiving corneal xenotransplantation, as they did not reactivate Rhesus Cytomegalovirus and maintained manageable systemic status. Although reactivation is rare, antiviral prophylaxis for simian varicella virus should be considered in immunocompromised hosts.
Porcine endogenous retroviruses: Quantification of the copy number in cell lines, pig breeds, and organs
Authors: Fiebig Uwe , Fischer Konrad , Bähr Andrea , Runge Carolin , Schnieke Angelika , Wolf Eckhard , Denner Joachim
Published: August 2018

Background

Porcine endogenous retroviruses (PERVs) may pose a risk of xenotransplantation using porcine cells, tissues, or organs. PERVs are integrated in the genome of all pigs, and some can infect certain human cells. The copy number of PERVs in different pig breeds has been determined by using different methods, with varying results.

Methods

To determine the PERV copy number in pig cell lines and in animals, a new method, droplet digital polymerase chain reaction (ddPCR) was used. DNA was isolated from pig cell lines (PK15 and PTK75 cells), from Aachen, Göttingen, and Black minipigs, and from genetically modified and non‐modified German landrace pigs. Primers specific for the polymerase gene (pol) were used for the ddPCR.

Results

The median copy number of integrated proviruses was found between 46 and 70 copies in three different PK15 cell lines, 49 copies in PTK75 cells, 64 copies in Göttingen minipigs, 69 copies in Aachen minipigs, 117 copies in Black minipigs, and 59 copies in genetically modified pigs generated for xenotransplantation. PERV copy numbers varied between different organs from a single pig, indicating proviral amplification. The study also revealed that different PK15 cell lines from different laboratories which had been used as virus source for infection experiments carry different PERV copies. Furthermore, different copy numbers of cellular reference genes (GAPDH, ACTB) were detected in different cell lines and pigs.

Conclusion

The determination of the PERV copy number using ddPCR extended previous data showing differences between the pig breeds and between different organs of a single animal. The determination of PERV copy numbers can be used to select animals less likely to transmit PERVs during xenotransplantation. In addition, this method will be of special value when PERV proviruses are to be inactivated by CRISPR/Cas9.
Early weaning completely eliminates porcine cytomegalovirus from a newly established pig donor facility for xenotransplantation
Authors: Egerer Stefanie , Fiebig Uwe , Kessler Barbara , Zakhartchenko Valeri , Kurome Mayuko , Reichart Bruno , Kupatt Christian , Klymiuk Nikolai , Wolf Eckhard , Denner Joachim , Bähr Andrea
Published: August 2018

For clinical xenotransplantation, transplants must be free of porcine cytomegalovirus (PCMV). Piglets become infected primarily in the perinatal period by the mother sow. While individual donor animals can be protected from infection by isolation husbandry, success is not guaranteed and this strategy poses the risk of undetected infections and raises animal welfare questions. Here, we present the establishment of a completely PCMV‐negative pig herd for breeding donor animals for xenotransplantation. Eleven pregnant DanAvl Basic hybrid sows were purchased from a designated pathogen‐free (DPF), PCMV‐positive colony and transferred to a new pig facility at the Centre for Innovative Medical Models (CiMM) 4 weeks prior to farrowing. At the age of 24 hours, piglets were early‐weaned and transferred to a commercially available Rescue Deck system dedicated to motherless rearing of piglets. Sows were removed from the facility. The PCMV status of F1‐generation animals was determined at regular intervals over a period of 14 months by a sensitive real‐time PCR‐based detection method testing blood, nasal swabs and cultured peripheral blood mononuclear cells (PBMCs). F1 sows were used as recipients of genetically modified embryos to generate a xenotransplant donor herd. Offspring were tested for PCMV accordingly. All offspring have remained PCMV negative over the whole observation period of 14 months. A completely PCMV‐negative pig herd for xenotransplantation has thus been successfully established.
Possible risks posed by single‐stranded DNA viruses of pigs associated with xenotransplantation
Authors: Karuppannan Anbu K. , Opriessnig Tanja
Published: August 2018

Routine large‐scale xenotransplantation from pigs to humans is getting closer to clinical reality owing to several state‐of‐the‐art technologies, especially the ability to rapidly engineer genetically defined pigs. However, using pig organs in humans poses risks including unwanted cross‐species transfer of viruses and adaption of these pig viruses to the human organ recipient. Recent developments in the field of virology, including the advent of metagenomic techniques to characterize entire viromes, have led to the identification of a plethora of viruses in many niches. Single‐stranded DNA (ssDNA) viruses are the largest group prevalent in virome studies in mammals. Specifically, the ssDNA viral genomes are characterized by a high rate of nucleotide substitution, which confers a proclivity to adapt to new hosts and cross‐species barriers. Pig‐associated ssDNA viruses include torque teno sus viruses (TTSuV) in the Anelloviridae family, porcine parvoviruses (PPV), and porcine bocaviruses (PBoV) both in the family of Parvoviridae, and porcine circoviruses (PCV) in the Circoviridae family, some of which have been confirmed to be pathogenic to pigs. The risks of these viruses for the human recipient during xenotransplantation procedures are relatively unknown. Based on the scant knowledge available on the prevalence, predilection, and pathogenicity of pig‐associated ssDNA viruses, careful screening and monitoring are required. In the case of positive identification, risk assessments and strategies to eliminate these viruses in xenotransplantation pig stock may be needed.
Active Students Are Healthier and Happier Than Their Inactive Peers: The Results of a Large Representative Cross-Sectional Study of University Students in Ireland
Authors: Murphy Marie H. , Carlin Angela , Woods Catherine , Nevill Alan , MacDonncha Ciaran , Ferguson Kyle , Murphy Niamh
Published: August 2018

Background:Time spent in university represents a period of transition and may be an appropriate time to promote physical activity among young adults. The aim of this study was to assess participation of university students in sport and physical activity in Ireland and to explore the association between physical activity and perceptions of overall health, mental health, and happiness.Methods: The Student Activity and Sport Study Ireland was a cross-sectional online survey among a representative sample (n = 8122) of university students in Ireland. Binary logistic regressions were performed to examine associations between self-reported physical activity and gender (predictor variables) and individual perceptions of overall health, mental health, and happiness (binary outcomes).Results: Only 64.3% of respondents met the recommended level of 150 minutes of moderate to vigorous physical activity per week with males significantly more active than females (72.1% vs 57.8% meeting guidelines). Those meeting physical activity guidelines were more likely to report greater overall health and higher mental health and happiness scores compared with their inactive peers.Conclusions: Active students enjoy better health (overall and mental) and are happier than their inactive peers. This provides a clear rationale for providing students with opportunities to be active at university. The data provide a baseline to monitor changes in physical activity patterns.
The Role of PETE in Developing and Sustaining Physical Literacy Informed Practitioners
Authors: Flemons Michelle , Diffey Fiona , Cunliffe Dominic
Published: August 2018

This study discusses teacher preparation in relation to encouraging and empowering future teachers to appreciate the potential and value of adopting physical literacy as the goal of physical education (PE). The study addresses the issue of the role of schools and teacher training programs in developing the next generation of PE teachers entering PE teacher education with respect to thoughts, feelings, perceptions, and beliefs that underpin the concept of physical literacy, and providing high-quality learning experiences that are crucial to continuing physical activity throughout the life course for all children, not just those who have a natural aptitude in this area. Many advocates for radical change in PE have repeatedly argued that PE curricula around the world are too focused on a traditional, one size fits all, sport technique based, multiactivity form. Others have argued that the traditional curricula have a primary focus on physical competence in running, jumping, and balls skills rather than providing experience in a wide range of physical activities including, inter alia, those with a focus on aesthetic awareness and those related to outdoor adventure.
What is the effect of aerobic exercise intensity on cardiorespiratory fitness in those undergoing cardiac rehabilitation? A systematic review with meta-analysis
Authors: Mitchell Braden L , Lock Merilyn J , Davison Kade , Parfitt Gaynor , Buckley John P , Eston Roger G
Published: August 2018

Objective

Assess the role of exercise intensity on changes in cardiorespiratory fitness (CRF) in patients with cardiac conditions attending exercise-based cardiac rehabilitation.

Design

Systematic review with meta-analysis.

Data sources

MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO and Web of Science.

Eligibility criteria for selection

Studies assessing change in CRF (reported as peak oxygen uptake; V̇O2peak) in patients post myocardial infarction and revascularisation, following exercise-based cardiac rehabilitation. Studies establishing V̇O2peakvia symptom-limited exercise test with ventilatory gas analysis and reported intensity of exercise during rehabilitation were included. Studies with mean ejection fraction <40% were excluded.

Results

128 studies including 13 220 patients were included. Interventions were classified as moderate, moderate-to-vigorous or vigorous intensity based on published recommendations. Moderate and moderate-to-vigorous-intensity interventions were associated with a moderate increase inrelativeV̇O2peak(standardised mean difference±95% CI=0.94±0.30 and 0.93±0.17, respectively), and vigorous-intensity exercise with a large increase (1.10±0.25). Moderate and vigorous-intensity interventions were associated with moderate improvements inabsoluteV̇O2peak(0.63±0.34 and 0.93±0.20, respectively), whereas moderate-to-vigorous-intensity interventions elicited a large effect (1.27±0.75). Large heterogeneity among studies was observed for all analyses. Subgroup analyses yielded statistically significant, but inconsistent, improvements in CRF.

Conclusion

Engagement in exercise-based cardiac rehabilitation was associated with significant improvements in both absolute and relative V̇O2peak. Although exercise of vigorous intensity produced the greatest pooled effect for change in relative V̇O2peak, differences in pooled effects between intensities could not be considered clinically meaningful.

Registration

Prospero CRD42016035638.
Comparison of hospital admission rates for psychiatric patients cared for by multidisciplinary outreach teams with and without peer specialist: a retrospective cohort study of Japanese Outreach Model Project 2011–2014
Authors: Kido Yoshifumi , Kawakami Norito , Kayama Mami
Published: August 2018

Objective

This study examined whether having peer specialists (PS) in psychiatric multidisciplinary outreach teams was associated with a lower risk of hospitalisation, improved social functioning and decreased problem behaviours.

Design and setting

This study was a retrospective cohort study based on medical records. This study was conducted as a part of the Japanese Outreach Model Project 2011–2014, which provides services for persons diagnosed mainly as ICD-10 F0, F2 and F3, who have a high possibility of hospital admission/readmission with regular Japanese outpatient care.

Participants

A total of 292 participants (clients) from 31 multidisciplinary outreach teams with and without PS (n=108 and 184, respectively) fulfilled the inclusion criteria and were included in the analysis.

Outcome measures

The primary outcome measure was hospitalisation during follow-up. The difference in hospitalisation during the follow-up between teams with and without PS was analysed by Kaplan-Meier survival curves and a Cox proportional hazards model. The secondary outcome measures were social functioning (Global Assessment of Functioning, GAF) and problem behaviours (Social Behaviour Schedule, SBS) of clients, and were assessed at baseline and at 6-month follow-up. Changes in social functioning and problem behaviours were compared between clients cared for by the two team types. Amount and content of the service were also compared.

Results

The clients cared by teams with PS had a significantly decreased probability of hospitalisation in Cox proportional hazards models adjusting for baseline characteristics (HR=0.53, 95% CI 0.31 to 0.89). The 6-month change in GAF or SBS was not significantly different between the two groups.

Conclusion

This is an observational study in which the presence of a PS appeared to be associated with a reduced rate of hospitalisation. A randomised study would be required to demonstrate a causal relationship.
Providing routine chronic disease preventive care in community substance use services: a pilot study of a multistrategic clinical practice change intervention
Authors: Tremain Danika , Freund Megan , Wye Paula , Bowman Jenny , Wolfenden Luke , Dunlop Adrian , Bartlem Kate , Lecathelinais Christophe , Wiggers John
Published: August 2018

Objectives

To evaluate the potential effectiveness of a practice change intervention in increasing preventive care provision in community-based substance use treatment services. In addition, client and clinician acceptability of care were examined.

Design

A pre-post trial conducted from May 2012 to May 2014.

Setting

Public community-based substance use treatment services (n=15) in one health district in New South Wales (NSW), Australia.

Participants

Surveys were completed by 226 clients and 54 clinicians at baseline and 189 clients and 46 clinicians at follow-up.

Interventions

A 12-month multistrategic clinician practice change intervention that aimed to increase the provision of preventive care for smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity.

Primary and secondary outcome measures

Client and clinician reported provision of assessment, brief advice and referral for three modifiable health risk behaviours: smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity. Clinician-reported optimal care was defined as providing care to 80% of clients or more. Client acceptability and clinician attitudes towards preventive care were assessed at follow-up.

Results

Increases in client reported care were observed for insufficient fruit and/or vegetable consumption including: assessment (24% vs 54%, p<0.001), brief advice (26% vs 46%, p<0.001), and clinicians speaking about (10% vs 31%, p<0.001) and arranging a referral (1% vs 8%, p=0.006) to telephone helplines. Clinician reported optimal care delivery increased for: assessment of insufficient fruit and/or vegetable consumption (22% vs 63%, p<0.001) and speaking about telephone helplines for each of the three health risk behaviours. Overall, clients and clinicians held favourable views regarding preventive care.

Conclusion

This study reported increases in preventive care for insufficient fruit and/or vegetable consumption; however, minimal increases were observed for smoking or insufficient physical activity. Further investigation of the barriers to preventive care delivery in community substance use settings is needed.

Trialregistrationnumber

ACTRN12614000469617.
Development of a population pharmacokinetic model of olanzapine for Chinese health volunteers and patients with schizophrenia
Authors: Li Anning , Ji Shuangmin , Yue Weihua , Yan Hao , Dong Fang , Ruan Canjun , Li Wenbiao , Lu Wei , Zhang Dai , Wang Chuanyue
Published: August 2018

Objective

Olanzapine is an atypical antipsychotic drug commonly used for the treatment of schizophrenia. However, there are still many complications associated with the use of olanzapine, and researchers continually strive to improve the handling of data from regular therapeutic drug monitoring (TDM). The objective of this study is to optimise the individualised treatment of olanzapine by establishing a population pharmacokinetics (PopPK) model in Chinese patients with schizophrenia.

Methods

This study integrates an extensive collection of concentration data from healthy volunteers after a single dose and a less extensive collection of samples from patients undergoing TDM. A PopPK model was developed using non-linear mixed-effects modelling. Potential covariates, including the olanzapine manufacturer and patient gender and age, were assessed during model development. A total of 616 plasma concentration levels from 22 healthy male individuals in China and 458 concentration levels from 112 male and 122 female patients with schizophrenia undergoing TDM at 12 hospitals in China were included in the analysis. The concentration profile could be best described using a two-compartment model with first-order absorption and elimination.

Results

The absorption rate (Ka) of olanzapine ranged from 2.85 h–1to 5.39 h–1for the different formulations. The typical absorption time delay was 0.877 hour. Body weight had a considerable effect on the apparent volume of the centre compartment and showed a power relationship.

Conclusions

A PopPK model of olanzapine in Chinese patients with schizophrenia was developed in this study. After determining the PK parameters of olanzapine, the results suggested that body weight exhibited a considerable impact effect on VC/F. The impact of subjects and formulations requires further study. The PopPK model established in this study is likely to provide some information for the individualised therapy of olanzapine.

Trial registration number

ChiCTR-TRC-10000934; Results.
Maternal seafood intake and the risk of small for gestational age newborns: a case–control study in Spanish women
Authors: Amezcua-Prieto Carmen , Martínez-Galiano Juan Miguel , Salcedo-Bellido Inmaculada , Olmedo-Requena Rocío , Bueno-Cavanillas Aurora , Delgado-Rodríguez Miguel
Published: August 2018

Objective

To investigate the relationship between seafood consumption during pregnancy and the risk of delivering a small for gestational age (SGA) newborn.

Design

This case–control study included women with SGA newborns and controls matched 1:1 for maternal age (±2 years) and hospital.

Setting

Five hospitals in Eastern Andalusia, Spain.

Participants

518 pairs of pregnant Spanish women. The SGA group included women who delivered SGA newborns: SGA was defined as a birth weight below the 10th percentile of infants at a given gestational age. Controls were women who delivered newborns with adequate birth weights.

Interventions

We collected data on demographic characteristics, socioeconomic status, toxic habits and diet. Midwives administered a 137-item Food Frequency Questionnaire.

Outcome measures

We calculated quintiles of seafood intake and applied conditional logistic regression to estimate ORs and 95% CIs.

Results

Shellfish intake more than once/week yielded a significant protective effect against an SGA newborn (OR 0.25, 95% CI 0.08 to 0.76, after adjusting for energy, educational level, smoking, prepregnancy body mass index, weight and a history of preterm or low birthweight newborn). The risk of an SGA newborn was lower among women who consumed >29 g/day fish compared with women who consumed ≤8 g (adjusted OR 0.63, 95% CI 0.41 to 0.98; p=0.025 for a trend). Similarly, the risk of an SGA newborn was lower among women who consumed >1 g/day of marine n-3 polyunsaturated fatty acids compared with those who consumed ≤0.4 g/day (adjusted OR 0.58, 95% CI 0.38 to 0.90; p=0.025 for a trend).

Conclusion

An average seafood intake of at least 29 g/day during pregnancy, equivalent to 2–3 servings/week, reduced the risk of an SGA newborn, compared with an average seafood intake of less than 8 g/day.
Age-related differences in glycaemic control, cardiovascular disease risk factors and treatment in patients with type 2 diabetes: a cross-sectional study from the Australian National Diabetes Audit
Authors: Nanayakkara Natalie , Ranasinha Sanjeeva , Gadowski Adelle M , Davis Wendy A , Flack Jeffrey Ronald , Wischer Natalie , Andrikopoulos Sof , Zoungas Sophia
Published: August 2018

Objective

To compare the glycaemic control and cardiovascular risk factor profiles of younger and older patients with type 2 diabetes. Cross-sectional analysis of data from the 2015 Australian National Diabetes Audit was undertaken.

Methods

Data were obtained from adults with type 2 diabetes presenting to Australian secondary/tertiary diabetes centres. Logistic regression examined associations with glycated haemoglobin A1c (HbA1c) >7% (53 mmol/mol) and cardiovascular risk factors.

Results

Data from 3492 patients were analysed. Mean (±SD) age was 62.9±12.5 years, mean diabetes duration 13.5±9.4 years and mean HbA1c 8.2%±1.8%. Mean HbA1c was 8.6%±2.1% and 8.0%±1.6% for the younger (<60 years) and older subgroups (≥60 years), respectively (p<0.001). The adjusted OR (aOR) of HbA1c above >7.0% was 1.5 times higher (95% CI 1.22 to 1.84) for younger patients compared with older patients after adjustment for gender, smoking, diabetes duration, renal function and body mass index. Younger patients were also more likely to have dyslipidaemia (aOR 2.02, 95% CI 1.53 to 2.68; p<0.001), be obese (aOR 1.25, 95% CI 1.05 to 1.49; p<0.001) and be current smokers (aOR 2.13 95% CI 1.64 to 2.77; p<0.001) than older patients.

Conclusions

Younger age was associated with poorer glycaemic control and adverse cardiovascular risk factor profiles. It is imperative to optimise and monitor treatment in order to improve long-term outcomes.
Representation of social determinants of health in German medical education: protocol of a content analysis study
Authors: Hommes Franziska , Drees Simon , Geffert Karin , von Philipsborn Peter , Stratil Jan M
Published: August 2018

Introduction

Action on the social determinants of health has been key for improving health and prolonging life in the past, and remains so today. Against this background, WHO’s Commission on Social Determinants of Health has called for increased efforts to create health workforces trained in recognising, understanding and acting on the social determinants of health. However, little is known about the extent to which current medical education systems prepare graduates for this challenge. We, therefore, aim to analyse the extent to which the medical curriculum in Germany incorporates content on the social determinants of health.

Methods and analysis

We will conduct a qualitative and quantitative content analysis of four key document groups which influence medical education in Germany: the national medical catalogue of learning objectives; examination content outlines provided by the German Institute for Medical and Pharmaceutical Examination Questions; the online textbook most widely used for final examination preparation and the full set of questions from two national medical licensing examinations. We will analyse these documents based on a coding system, which we derived deductively from the report of WHO’s Commission on Social Determinants of Health as well as other key publications of WHO. We will report quantitative indicators, such as the percentage of text related to social determinants of health for each document type. Moreover, we will conduct a semiqualitative analysis of relevant content.

Ethics and dissemination

This study is based on the analysis of existing documents which do not contain personal or otherwise sensitive information. Results from the study will be published in a scientific peer-reviewed journal.
Protocol for a scoping review about ethics in transition programmes for adolescents and young adults with neurodisabilities
Authors: Bogossian Aline , Gorter Jan Willem , Racine Eric
Published: August 2018

Introduction

As adolescents with neurodisabilities near adulthood, they and their caregivers will face the challenge of transferring from paediatric to adult healthcare systems. Despite the growing number of programmes designed to support healthcare transitions, little is known about practices that result in positive outcomes or how ethical issues are addressed. The objective of this review is to identify and document the ethical principles that may be embedded in the vision of transitional care programmes and to map ethical issues encountered in transitional care as well as the strategies employed to recognise and address these ethical issues.

Method and analysis

We will document hidden and explicit ethical principles and issues from empirical studies on transition programmes for youth with neurodisabilities. An initial framework developed through a content extraction strategy will serve as a point of departure for data analysis and will be iteratively refined through our analytic process and with feedback from our stakeholders, including youth with neurodisabilities and their families. Findings will then be shared in different formats with health and social services professionals, healthcare decision and policymakers.

Dissemination

Scoping review results will be shared at key conferences and disseminated in peer-reviewed publications as well as plain language summaries with stakeholders and the general public. Opportunities will be sought to discuss this project and its preliminary findings with partners in the paediatric, adult healthcare and rehabilitation communities comprising young people with neurodisabilities, their families, clinicians, programme managers and researchers.
Effectiveness of a peer-mediated educational intervention in improving general practitioner diagnostic assessment and management of dementia: a cluster randomised controlled trial
Authors: Pond Dimity , Mate Karen , Stocks Nigel , Gunn Jane , Disler Peter , Magin Parker , Marley John , Paterson Nerida , Horton Graeme , Goode Susan , Weaver Natasha , Brodaty Henry
Published: August 2018

Objective

Test effectiveness of an educational intervention for general practitioners (GPs) on quality of life and depression outcomes for patients.

Design

Double-blind, cluster randomised controlled trial.

Setting

General practices in Australia between 2007 and 2010.

Participants

General practices were randomly allocated to the waitlist (n=37) or intervention (n=66) group, in a ratio of 1:2. A total of 2030 (1478 intervention; 552 waitlist) community-dwelling participants aged 75 years or older were recruited via 168 GPs (113 intervention; 55 waitlist).

Interventions

A practice-based academic detailing intervention led by a peer educator that included: (1) training in use of the GP assessment of cognition dementia screening instrument; (2) training in diagnosis and management based on Royal Australian College of General Practitioners Dementia Guidelines; (3) addressing GPs’ barriers to dementia diagnosis; and (4) a business case outlining a cost-effective dementia assessment approach.

Outcome measures

Primary outcome measures were patient quality of life and depression; secondary outcome measures were: (1) sensitivity and specificity of GP identification of dementia; (2) referral to medical specialists and/or support services; (3) patient satisfaction with care; and (4) carer quality of life, depression and satisfaction with care.

Results

The educational intervention had no significant effect on patient quality of life or depression scores after 12 months. There were however improvements in secondary outcome measures including sensitivity of GP judgement of dementia (p=0.002; OR 6.0, 95% CI 1.92 to 18.73), satisfaction with GP communication for all patients (p=0.024; mean difference 2.1, 95% CI 0.27 to 3.93) and for patients with dementia (p=0.007; mean difference 7.44, 95% CI 2.02 to 12.86) and enablement of carers (p=0.0185; mean difference 24.77, 95% CI 4.15 to 45.40).

Conclusion

Practice-based academic detailing did not improve patient quality of life or depression scores but did improve detection of dementia in primary care and patient satisfaction with GP communication.

Trial registration number

ACTRN12607000117415; Pre-results.
Housing, neighbourhood and sociodemographic associations with adult levels of physical activity and adiposity: baseline findings from the ENABLE London study
Authors: Nightingale Claire M , Rudnicka Alicja R , Ram Bina , Shankar Aparna , Limb Elizabeth S , Procter Duncan , Cooper Ashley R , Page Angie S , Ellaway Anne , Giles-Corti Billie , Clary Christelle , Lewis Daniel , Cummins Steven , Whincup Peter H , Cook Derek G , Owen Christopher G
Published: August 2018

Objectives

The neighbourhood environment is increasingly shown to be an important correlate of health. We assessed associations between housing tenure, neighbourhood perceptions, sociodemographic factors and levels of physical activity (PA) and adiposity among adults seeking housing in East Village (formerly London 2012 Olympic/Paralympic Games Athletes’ Village).

Setting

Cross-sectional analysis of adults seeking social, intermediate and market-rent housing in East Village.

Participants

1278 participants took part in the study (58% female). Complete data on adiposity (body mass index (BMI) and fat mass %) were available for 1240 participants (97%); of these, a subset of 1107 participants (89%) met the inclusion criteria for analyses of accelerometer-based measurements of PA. We examined associations between housing sector sought, neighbourhood perceptions (covariates) and PA and adiposity (dependent variables) adjusted for household clustering, sex, age group, ethnic group and limiting long-standing illness.

Results

Participants seeking social housing had the fewest daily steps (8304, 95% CI 7959 to 8648) and highest BMI (26.0 kg/m2, 95% CI 25.5kg/m2to 26.5 kg/m2) compared with those seeking intermediate (daily steps 9417, 95% CI 9106 to 9731; BMI 24.8 kg/m2, 95% CI 24.4 kg/m2to 25.2 kg/m2) or market-rent housing (daily steps 9313, 95% CI 8858 to 9768; BMI 24.6 kg/m2, 95% CI 24.0 kg/m2to 25.2 kg/m2). Those seeking social housing had lower levels of PA (by 19%–42%) at weekends versus weekdays, compared with other housing groups. Positive perceptions of neighbourhood quality were associated with higher steps and lower BMI, with differences between social and intermediate groups reduced by ~10% following adjustment, equivalent to a reduction of 111 for steps and 0.5 kg/m2for BMI.

Conclusions

The social housing group undertook less PA than other housing sectors, with weekend PA offering the greatest scope for increasing PA and tackling adiposity in this group. Perceptions of neighbourhood quality were associated with PA and adiposity and reduced differences in steps and BMI between housing sectors. Interventions to encourage PA at weekends and improve neighbourhood quality, especially among the most disadvantaged, may provide scope to reduce inequalities in health behaviour.