bluuebunny/crossref_metadata_2025 huggingface dataset:
Whole-Transcriptome and -Genome Analysis of Extensively Drug-Resistant Mycobacterium tuberculosis Clinical Isolates Identifies Downregulation of
ethA
as a Mechanism of Ethionamide Resistance
Authors: de Welzen Lynne , Eldholm Vegard , Maharaj Kashmeel , Manson Abigail L. , Earl Ashlee M. , Pym Alexander S.
Published: October 2017

Genetics-based drug susceptibility testing has improved the diagnosis of drug-resistant tuberculosis but is limited by our lack of knowledge of all resistance mechanisms. Next-generation sequencing has assisted in identifying the principal genetic mechanisms of resistance for many drugs, but a significant proportion of phenotypic drug resistance is unexplained genetically. Few studies have formally compared the transcriptomes of susceptible and resistant
Mycobacterium tuberculosis
strains. We carried out comparative whole-genome transcriptomics of extensively drug-resistant (XDR) clinical isolates using RNA sequencing (RNA-seq) to find novel transcription-mediated mechanisms of resistance. We identified a promoter mutation (t to c) at position −11 (t−11c) relative to the start codon of
ethA
that reduces the expression of a monooxygenase (EthA) that activates ethionamide. (In this article, nucleotide changes are lowercase and amino acid substitutions are uppercase.) Using a flow cytometry-based reporter assay, we show that the reduced transcription of
ethA
is not due to transcriptional repression by
ethR
. Clinical strains harboring this mutation were resistant to ethionamide. Other
ethA
promoter mutations were identified in a global genomic survey of resistant
M. tuberculosis
strains. These results demonstrate a new mechanism of ethionamide resistance that can cause high-level resistance when it is combined with other ethionamide resistance-conferring mutations. Our study revealed many other genes which were highly up- or downregulated in XDR strains, including a toxin-antitoxin module (
mazF5 mazE5
) and tRNAs (
leuX
and
thrU
). This suggests that global transcriptional modifications could contribute to resistance or the maintenance of bacterial fitness have also occurred in XDR strains.
Molecular Characterization of Carbapenemase-Producing Pseudomonas aeruginosa of Czech Origin and Evidence for Clonal Spread of Extensively Resistant Sequence Type 357 Expressing IMP-7 Metallo-β-Lactamase
Authors: Papagiannitsis Costas C. , Medvecky Matej , Chudejova Katerina , Skalova Anna , Rotova Veronika , Spanelova Petra , Jakubu Vladislav , Zemlickova Helena , Hrabak Jaroslav
Published: October 2017

The objective of this study was to perform molecular surveillance for assessing the spread of carbapenemase-producing
Pseudomonas aeruginosa
in Czech hospitals. One hundred thirty-six carbapenemase-producing isolates were recovered from 22 hospitals located throughout the country. Sequence type 357 (ST357) dominated (
n
= 120) among carbapenemase producers. One hundred seventeen isolates produced IMP-type (IMP-7 [
n
= 116] and IMP-1 [
n
= 1]) metallo-β-lactamases (MβLs), 15 produced the VIM-2 MβL, and the remaining isolates expressed the GES-5 enzyme. The
bla
IMP
-like genes were located in three main integron types, with In-p110-like being the most prevalent (
n
= 115). The two other IMP-encoding integrons (In1392 and In1393) have not been described previously.
bla
VIM-2
-carrying integrons included In59-like, In56, and a novel element (In1391).
bla
GES-5
was carried by In717. Sequencing data showed that In-p110-like was associated with a Tn
4380
-like transposon inserted in genomic island LESGI-3 in the
P. aeruginosa
chromosome. The other integrons were also integrated into the
P. aeruginosa
chromosome. These findings indicated the clonal spread of ST357
P. aeruginosa
, carrying the IMP-7-encoding integron In-p110, in Czech hospitals. Additionally, the sporadic emergence of
P. aeruginosa
producing different carbapenemase types, associated with divergent or novel integrons, punctuated the ongoing evolution of these bacteria.
Balance versus hearing after cochlear implant in an adult
Authors: Zur Oz , Ben-Rubi Shimron Hadas , Leisman Gerry , Carmeli Eli
Published: October 2017

The effect of vestibular rehabilitation (VR) on anxiety, dizziness and poor balance that developed after cochlear implant (CI) surgery is described. A 54-year-old woman, with profound hearing loss since the age of 2 years, underwent right CI surgery 2 years previously. On implant activation, the patient immediately felt dizziness and imbalance, which affected the ability to perform activities of daily living and increased anxiety to where the patient considered the CI removal. Prior to VR the patient was evaluated with the Dizziness Handicap Inventory and the Visual Vertigo Dizziness Questionnaire and clinically with the Zur Balance Scale and Video Head Impulse Test. The patient underwent 14 VR sessions over 4 months that included compensation, adaptation and habituation exercises. After VR the patient was able to maintain good balance while using the CI. Dizziness and anxiety improved dramatically. This report increases awareness that a CI could compromise balance, which can be overcome with personalised VR.
Colonic gallstone ileus
Authors: Sigmon Lee , Rejeski Jared , Marion Brandon , Fina Michael
Published: October 2017

Gallstone ileus is a rare aetiology of bowel obstruction and very infrequently occurs in the colon. Typically, colonic gallstone ileus carries a high morbidity and mortality and requires surgery. This case report describes a cholecystocolonic fistula in a patient with ulcerative colitis with resulting colonic gallstone ileus, which was successfully intervened on via an endoscopic approach.
Repeatability of vessel density measurements of optical coherence tomography angiography in normal and glaucoma eyes
Authors: Venugopal Jayasree P , Rao Harsha L , Weinreb Robert N , Pradhan Zia S , Dasari Srilakshmi , Riyazuddin Mohammed , Puttiah Narenda K , Rao Dhanraj A S , Devi Sathi , Mansouri Kaweh , Webers Carroll AB
Published: October 2017

Aims

To compare the intrasession repeatability of peripapillary and macular vessel density measurements of optical coherence tomography angiography (OCTA) in normal and glaucoma eyes, and to evaluate the effect of signal strength of OCTA scans on the repeatability.

Methods

In a cross-sectional study, three optic nerve head scans each of 65 eyes (30 normal, 35 glaucoma eyes) and three macular scans each of 69 eyes (35 normal, 34 glaucoma eyes) acquired in the same session with OCTA were analysed. Repeatability was assessed using within-subject coefficient of repeatability (CRw) and variation (CVw). Effect of signal strength index (SSI) on repeatability was evaluated with repeated-measures mixed-effects models.

Results

CRw (%) and CVw (%) of peripapillary measurements in normal eyes ranged between 3.3 and 7.0, and 2.5 and 4.4 respectively, and that in glaucoma eyes between 3.5 and 7.1, and 2.6 and 6.6. For the macular, these measurements ranged between 4.1 and 6.0, and 3.3 and 4.7 in normal eyes and 4.3 and 6.9, and 3.7 and 5.6 in glaucoma eyes. Repeatability estimates of most measurements were similar in normal and glaucoma eyes. Vessel densities of both peripapillary and macular regions significantly increased with increase in SSI of repeat scans (coefficients ranging from 0.15 to 0.38, p<0.01 for all associations).

Conclusions

Repeatability estimates of OCTA measured peripapillary and macular vessel densities were similar in normal eyes and eyes with glaucoma. SSI values of the scans had a significant effect on the repeatability of OCTA with the vessel density values increasing in scans with higher SSI values.
Change in physical activity from adolescence to early adulthood: a systematic review and meta-analysis of longitudinal cohort studies
Authors: Corder Kirsten , Winpenny Eleanor , Love Rebecca , Brown Helen Elizabeth , White Martin , Sluijs Esther van
Published: October 2017

Objective

To systematically review and meta-analyse how physical activity (PA) changes from adolescence to early adulthood (13–30 years).

Data sources

Seven electronic databases were searched: Medline, Embase, PsycInfo, SCOPUS, ASSIA, SPORTdiscus and Web of Science.

Eligibility criteria for selecting studies

English-language, longitudinal studies (from 01/1980 to 01/2017) assessing PA ≥twice, with the mean age of ≥1 measurement in adolescence (13–19 years) and ≥1 in young adulthood (16–30 years) were included. Where possible, data were converted to moderate-to-vigorous physical activity (MVPA) min/day, and meta-analyses were conducted between weighted mean differences (WMDs) in adolescence and adulthood. Heterogeneity was explored using meta-regression.

Results

Of 67 included studies, 49 were eligible for meta-analysis. PA was lower during adulthood than adolescence WMD (95% CI) −5.2 (−7.3 to –3.1) min/day MVPA over mean (SD) 3.4 (2.6) years; heterogeneity was high (I2>99.0%), and no predictors explained this variation (all p>0.05). When we restricted analysis to studies with data for males (n=29) and females (n=30) separately, there were slightly larger declines in WMD (−6.5 (−10.6 to –2.3) and −5.5 (−8.4 to −2.6) min/day MVPA) (both I2>99.0%). For studies with accelerometer data (n=9), the decline was −7.4 (−11.6 to –3.1) and longer follow-up indicated more of a decline in WMD (95% CI) (−1.9 (−3.6 to –0.2) min/day MVPA), explaining 27.0% of between-study variation. Of 18 studies not eligible for meta-analysis, nine statistically tested change over time: seven showed a decline and two showed no change.

Conclusion

PA declines modestly between adolescence and young adulthood. More objective longitudinal PA data (eg, accelerometry) over this transition would be valuable, as would investigating how PA change is associated with contemporaneous social transitions to better inform PA promotion interventions.

Registration

PROSPERO ref:CRD42015030114.
An internet-supported school physical activity intervention in low socioeconomic status communities: results from the Activity and Motivation in Physical Education (AMPED) cluster randomised controlled trial
Authors: Lonsdale Chris , Lester Aidan , Owen Katherine B , White Rhiannon L , Peralta Louisa , Kirwan Morwenna , Diallo Thierno M O , Maeder Anthony J , Bennie Andrew , MacMillan Freya , Kolt Gregory S , Ntoumanis Nikos , Gore Jennifer M , Cerin Ester , Cliff Dylan P , Lubans David R
Published: October 2017

Objective

Quality physical education (PE) is the cornerstone of comprehensive school physical activity (PA) promotion programmes. We tested the efficacy of a teacher professional learning intervention, delivered partially via the internet, designed to maximise opportunities for students to be active during PE lessons and enhance adolescents’ motivation towards PE and PA.

Methods

A two-arm cluster randomised controlled trial with teachers and Grade 8 students from secondary schools in low socioeconomic areas of Western Sydney, Australia. The Activity and Motivation in Physical Education (AMPED) intervention for secondary school PE teachers included workshops, online learning, implementation tasks and mentoring sessions. The primary outcome was the proportion of PE lesson time that students spent in moderate-to-vigorous physical activity (MVPA), measured by accelerometers at baseline, postintervention (7–8 months after baseline) and maintenance (14–15 months). Secondary outcomes included observed PE teachers’ behaviour during lessons, students’ leisure-time PA and students’ motivation.

Results

Students (n=1421) from 14 schools completed baseline assessments and were included in linear mixed model analyses. The intervention had positive effects on students’ MVPA during lessons. At postintervention, the adjusted mean difference in the proportion of lesson time spent in MVPA was 5.58% (p<0.001, approximately 4 min/lesson). During the maintenance phase, this effect was 2.64% (p<0.001, approximately 2 min/lesson). The intervention had positive effects on teachers’ behaviour, but did not impact students’ motivation.

Conclusions

AMPED produced modest improvements in MVPA and compares favourably with previous interventions delivered exclusively face-to-face. Online teacher training could help facilitate widespread dissemination of professional learning interventions.

Trial registration number

ACTRN12614000184673.
Understanding and defining sanitation insecurity: women’s gendered experiences of urination, defecation and menstruation in rural Odisha, India
Authors: Caruso Bethany A , Clasen Thomas F , Hadley Craig , Yount Kathryn M , Haardörfer Regine , Rout Manaswini , Dasmohapatra Munmun , Cooper Hannah LF
Published: October 2017

Background

Research suggests that the lived experience of inadequate sanitation may contribute to poor health outcomes above and beyond pathogen exposure, particularly among women. The goal of this research was to understand women’s lived experiences of sanitation by documenting their urination-related, defecation-related and menstruation-related concerns, to use findings to develop a definition ofsanitation insecurityamong women in low-income settings and to develop a conceptual model to explain the factors that contribute to their experiences, including potential behavioural and health consequences.

Methods

We conducted 69 Free-List Interviews and eight focus group discussions in a rural population in Odisha, India to identify women’s sanitation concerns and to build an understanding of sanitation insecurity.

Findings

We found that women at different life stages in rural Odisha, India have a multitude of unaddressed urination, defecation and menstruation concerns. Concerns fell into four domains: the sociocultural context, the physical environment, the social environment and personal constraints. These varied by season, time of day, life stage and toilet ownership, and were linked with an array of adaptations (ie, suppression, withholding food and water) and consequences (ie, scolding, shame, fear). Our derived definition and conceptual model of sanitation insecurity reflect these four domains.

Discussion

To sincerely address women’s sanitation needs, our findings indicate that more is needed than facilities that change the physical environment alone. Efforts to enable urinating, defecating and managing menstruation independently, comfortably, safely, hygienically, privately, healthily, with dignity and as needed require transformative approaches that also address the gendered, sociocultural and social environments that impact women despite facility access. This research lays the groundwork for future sanitation studies to validate or refine the proposed definition and to assess women’s sanitation insecurity, even among those who have latrines, to determine what may be needed to improve women’s sanitation circumstances.
Do attributes of persons with chronic kidney disease differ in low-income and middle-income countries compared with high-income countries? Evidence from population-based data in six countries
Authors: Anand Shuchi , Zheng Yuanchao , Montez-Rath Maria E , Wei Wang Jin , Perico Norberto , Carminati Sergio , Narayan KM Venkat , Tandon Nikhil , Mohan Viswanathan , Jha Vivekanand , Zhang Luxia , Remuzzi Giuseppe , Prabahkaran Dorairaj , Chertow Glenn M
Published: October 2017

Kidney biopsies to elucidate the cause of chronic kidney disease (CKD) are performed in a minority of persons with CKD living in high-income countries, since associated conditions—that is, diabetes mellitus, vascular disease or obesity with pre-diabetes, prehypertension or dyslipidaemia—can inform management targeted at slowing CKD progression in a majority. However, attributes of CKD may differ substantially among persons living in low-income and middle-income countries (LMICs). We used data from population or community-based studies from five LMICs (China, urban India, Moldova, Nepal and Nigeria) to determine what proportion of persons with CKD living in diverse regions fit one of the three major clinical profiles, with data from the US National Health Nutrition and Examination Survey as reference. In the USA, urban India and Moldova, 79.0%–83.9%; in China and Nepal, 62.4%–66.7% and in Nigeria, 51.6% persons with CKD fit one of three established risk profiles. Diabetes was most common in urban India and vascular disease in Moldova (50.7% and 33.2% of persons with CKD in urban India and Moldova, respectively). In Nigeria, 17.8% of persons with CKD without established risk factors had albuminuria ≥300 mg/g, the highest proportion in any country. While the majority of persons with CKD in LMICs fit into one of three established risk profiles, the proportion of persons who have CKD without established risk factors is higher than in the USA. These findings can inform tailored CKD detection and management systems and highlight the importance of studying potential causes and outcomes of CKD without established risk factors in LMICs.
Can coenzyme Q10 supplementation effectively reduce human tumour necrosis factor-α and interleukin-6 levels in chronic diseases? Protocol for a systematic review and meta-analysis of randomised controlled trials
Authors: Farsi Farnaz , Heshmati Javad , Janani Leila , Irandoost Pardis , Mesri Alamdari Naeimeh , Keshtkar Abbasali , Akbari Abolfazl , Vafa Mohammadreza
Published: October 2017

Introduction

Inflammation, as a critical factor, can cause numerous chronic diseases by creating various proinflammatory cytokines. Coenzyme Q10 (CoQ10) can potentially exert an anti-inflammatory agent; in turn, this agent can reduce the systemic inflammatory response. The aims of this study are to conduct a comprehensive systematic review and a meta-analysis for the determination of the CoQ10 efficacy on the changes in serum interleukin-6 (IL-6) and the tumour necrosis factor-α (TNF-α) levels in unhealthy subjects.

Method and analysis

We will conduct an electronic search for articles published between January 1990 and January 2017 using a prespecified search strategy in MEDLINE, SCOPUS, EMBASE, CENTRAL and Web of Science.

Our search will focus only on randomised controlled clinical trials in unhealthy subjects that employ either a parallel or a crossover design; this search will involve concurrent control groups. The primary outcomes of the literature are to determine the CoQ10 efficacy on the changes in the serum IL-6 and the TNF-α levels in unhealthy subjects. Secondary outcomes such as body mass index, serum adiponectin and high-sensitivity C-reactive protein levels, lipid profile and the heterogeneity assessment of the primary studies will be evaluated. The stages of screen articles, the extracts of relevant data and the assessment of study quality using the Cochrane risk of bias tool will be conducted independently by the two reviewers. Any disagreement will be resolved by discussion with a third person. If the number of eligible studies is sufficient, we will carry out a meta-analysis according to both outcomes.

Ethics and dissemination

This study is the protocol for a systematic review and no ethics approval is needed. The findings from the full systematic review will be published in a peer-reviewed journal, and they will also be exhibited at national/international academic and clinical conferences.

Trial registration number

CRD42016052200.
Implementation outcome assessment instruments used in physical healthcare settings and their measurement properties: a systematic review protocol
Authors: Khadjesari Zarnie , Vitoratou Silia , Sevdalis Nick , Hull Louise
Published: October 2017

Introduction

Over the past 10 years, research into methods that promote the uptake, implementation and sustainability of evidence-based interventions has gathered pace. However, implementation outcomes are defined in different ways and assessed by different measures; the extent to which these measures are valid and reliable is unknown. The aim of this systematic review is to identify and appraise studies that assess the measurement properties of quantitative implementation outcome instruments used in physical healthcare settings, to advance the use of precise and accurate measures.

Methods and analysis

The following databases will be searched from inception to March 2017: MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library. Grey literature will be sought via HMIC, OpenGrey, ProQuest for theses and Web of Science Conference Proceedings Citation Index-Science. Reference lists of included studies and relevant reviews will be hand searched. Three search strings will be combined to identify eligible studies: (1) implementation literature, (2) implementation outcomes and (3) measurement properties. Screening of titles, abstracts and full papers will be assessed for eligibility by two reviewers independently and any discrepancies resolved via consensus with the wider team. The methodological quality of the studies will be assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. A set of bespoke criteria to determine the quality of the instruments will be used, and the relationship between instrument usability and quality will be explored.

Ethics and dissemination

Ethical approval is not necessary for systematic review protocols. Researchers and healthcare professionals can use the findings of this systematic review to guide the selection of implementation outcomes instruments, based on their psychometric quality, to assess the impact of their implementation efforts. The findings will also provide a useful guide for reviewers of papers and grants to determine the psychometric quality of the measures used in implementation research.

Trial registration number

International Prospective Register of Systematic Reviews (PROSPERO):CRD42017065348.
Recurrent wheeze and its relationship with lung function and airway inflammation in preschool children: a cross-sectional study in South Korea
Authors: Soh Ji Eun , Kim Kyung-Moon , Kwon Ji-Won , Kim Hyung Young , Seo Ju-Hee , Kim Hyo-Bin , Lee So-Yeon , Jang Gwang-Cheon , Song Dae-Jin , Kim Woo Kyung , Jung Young-Ho , Hong Soo-Jong , Shim Jung Yeon
Published: October 2017

Background

Relationship between recurrent wheeze and airway function and inflammation in preschool children is not fully known.

Objective

To investigate the relationship between recurrent wheeze and airway inflammation, lung function, airway hyper-reactivity (AHR) and atopy in preschool children.

Design

Observational study, comparing forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and mid-forced expiratory flow (FEF25%–75%), dose–response slope (DRS), exhaled nitric oxide (eNO) and atopic sensitisation between children with recurrent wheeze and those without.

Setting

Population-based, cross-sectional study in Seoul and the Gyeonggi province of Korea conducted as a government-funded programme to perform standardised measurement of the prevalence of allergic diseases, and related factors, in preschool children.

Participants

900 children aged 4–6 years.

Primary and secondary outcome measures

eNO, FEV1/FVC, FEF25%–75%, DRS, atopic sensitisation and allergic diseases.

Methods

Children completed the modified International Study of Asthma and Allergies in Childhood questionnaire and underwent eNO assessments, spirometry, methacholine bronchial provocation tests and skin prick tests. Recurrent wheeze was defined as having a lifetime wheeze of more than three episodes, based on the questionnaire. The frequency of hospitalisation and emergency room visits was also obtained by means of the questionnaire. ‘Current’ wheeze was defined as having symptoms or treatments within the past 12 months.

Results

The prevalence of recurrent wheeze was 13.4%. Children with recurrent wheeze showed a higher prevalence of lifetime or current allergic rhinitis (p=0.01 and p=0.002, respectively) and lifetime atopic dermatitis (p=0.007). Children with recurrent wheeze showed lower FEV1/FVC (p=0.033) and FEF25%–75%(p=0.004), and higher eNO levels (p=0.013) than those without recurrent wheeze. However, the DRS, prevalence of atopic sensitisation and serum IgE levels were not significantly different between the two groups.

Conclusions

Recurrent wheeze in preschool children may be associated with airway inflammation and diminished airway function, but not with AHR or atopy.
A genetic roadmap of pancreatic cancer: still evolving
Authors: Notta Faiyaz , Hahn Stephan A , Real Francisco X
Published: October 2017

A diagnosis of pancreatic ductal adenocarcinoma (PDA) is often fatal. PDA is widely recognised as one of the ‘incurable cancers’ because therapies against this tumour type are generally ineffective. The fatal nature of this tumour is due to its aggressive clinical course. Pancreatic cancer commonly presents at the metastatic stage; even in cases where tumours are localised to the pancreas at diagnosis, metastatic seeds have often been invariably been spawned off, frustrating surgical attempts to cure the cancer. The key principles of pancreatic cancer mutational development were outlined nearly two decades ago using the genetics of precursor lesions to position the various stages of tumour progression. Since then, there has been a cavalcade of new data. How these recent studies impact the classical perceptions of pancreatic cancer development is a work in progress. Given that significant improvements in patient outcomes are not in sight for this disease, it is likely that broadening the current perspectives and acquiring deeper biological insights into the morphogenetic route of tumour development will be needed to foster new strategies for more effective cancer control.
Changes in marital quality over 6 years and its association with cardiovascular disease risk factors in men: findings from the ALSPAC prospective cohort study
Authors: Bennett-Britton Ian , Teyhan Alison , Macleod John , Sattar Naveed , Davey Smith George , Ben-Shlomo Yoav
Published: October 2017

Background

Marital relationship quality has been suggested to have independent effects on cardiovascular health outcomes. This study investigates the association between changes in marital relationship quality and cardiovascular disease (CVD) risk factors in men.

Methods

We used data from The Avon Longitudinal Study of Parents and Children, a prospective birth cohort study (Bristol, UK). Our baseline sample was restricted to married study fathers with baseline relationship and covariate data (n=2496). We restricted final analysis (n=620) to those with complete outcome, exposure and covariate data, who were married and confirmed the study child’s father at 6.4 years and 18.8 years after baseline. Relationship quality was measured at baseline and 6.4 years and operationalised as consistently good, improving, deteriorating or consistently poor relationship. We measured CVD risk factors of blood pressure, resting heart rate, body mass index, lipid profile and fasting glucose at 18.8 years after baseline.

Results

Improving relationships were associated with lower levels of low-density lipoprotein (−0.25 mmol/L, 95% CI −0.46 to −0.03) and relative reduction of body mass index (−1.07 kg/m2, 95% CI −1.73 to −0.42) compared with consistently good relationships, adjusting for confounders. Weaker associations were found between improving relationships and total cholesterol (−0.24 mmol/L, 95% CI −0.48 to 0.00) and diastolic blood pressure (−2.24 mm Hg, 95% CI −4.59 to +0.11). Deteriorating relationships were associated with worsening diastolic blood pressure (+2.74 mm Hg, 95% CI 0.50 to 4.98).

Conclusions

Improvement and deterioration of longitudinal relationship quality appears associated with respectively positive and negative associations with a range of CVD risk factors.
Explaining time changes in oral health-related quality of life in England: a decomposition analysis
Authors: Tsakos Georgios , Guarnizo-Herreño Carol C , O’Connor Rhiannon , Wildman John , Steele Jimmy G , Allen Patrick Finbarr
Published: October 2017

Background

Oral diseases are highly prevalent and impact on oral health-related quality of life (OHRQoL). However, time changes in OHRQoL have been scarcely investigated in the current context of general improvement in clinical oral health. This study aims to examine changes in OHRQoL between 1998 and 2009 among adults in England, and to analyse the contribution of demographics, socioeconomic characteristics and clinical oral health measures.

Methods

Using data from two nationally representative surveys in England, we assessed changes in the Oral Health Impact Profile-14 (OHIP-14), in both the sample overall (n=12 027) and by quasi-cohorts. We calculated the prevalence and extent of oral impacts and summary OHIP-14 scores. An Oaxaca-Blinder type decomposition analysis was used to assess the contribution of demographics (age, gender, marital status), socioeconomic position (education, occupation) and clinical measures (presence of decay, number of missing teeth, having advanced periodontitis).

Results

There were significant improvements in OHRQoL, predominantly among those that experienced oral impacts occasionally, but no difference in the proportion with frequent oral impacts. The decomposition model showed that 43% (–4.07/–9.47) of the decrease in prevalence of oral impacts reported occasionally or more often was accounted by the model explanatory variables. Improvements in clinical oral health and the effect of ageing itself accounted for most of the explained change in OHRQoL, but the effect of these factors varied substantially across the lifecourse and quasi-cohorts.

Conclusions

These decomposition findings indicate that broader determinants could be primarily targeted to influence OHRQoL in different age groups or across different adult cohorts.
Inherited mutations in BRCA1 and BRCA2 in an unselected multiethnic cohort of Asian patients with breast cancer and healthy controls from Malaysia
Authors: Wen Wei Xiong , Allen Jamie , Lai Kah Nyin , Mariapun Shivaani , Hasan Siti Norhidayu , Ng Pei Sze , Lee Daphne Shin-Chi , Lee Sheau Yee , Yoon Sook-Yee , Lim Joanna , Lau Shao Yan , Decker Brennan , Pooley Karen , Dorling Leila , Luccarini Craig , Baynes Caroline , Conroy Don M , Harrington Patricia , Simard Jacques , Yip Cheng Har , Mohd Taib Nur Aishah , Ho Weang Kee , Antoniou Antonis C , Dunning Alison M , Easton Douglas F , Teo Soo Hwang
Published: October 2017

Background

Genetic testing for BRCA1 and BRCA2 is offered typically to selected women based on age of onset and family history of cancer. However, current internationally accepted genetic testing referral guidelines are built mostly on data from cancer genetics clinics in women of European descent. To evaluate the appropriateness of such guidelines in Asians, we have determined the prevalence of germ line variants in an unselected cohort of Asian patients with breast cancer and healthy controls.

Methods

Germ line DNA from a hospital-based study of 2575 unselected patients with breast cancer and 2809 healthy controls were subjected to amplicon-based targeted sequencing of exonic and proximal splice site junction regions of BRCA1 and BRCA2 using the Fluidigm Access Array system, with sequencing conducted on a Illumina HiSeq2500 platform. Variant calling was performed with GATK UnifiedGenotyper and were validated by Sanger sequencing.

Results

Fifty-five (2.1%) BRCA1 and 66 (2.6%) BRCA2 deleterious mutations were identified among patients with breast cancer and five (0.18%) BRCA1 and six (0.21%) BRCA2 mutations among controls. One thousand one hundred and eighty-six (46%) patients and 97 (80%) carriers fulfilled the National Comprehensive Cancer Network guidelines for genetic testing.

Conclusion

Five per cent of unselected Asian patients with breast cancer carry deleterious variants in BRCA1 or BRCA2. While current referral guidelines identified the majority of carriers, one in two patients would be referred for genetic services. Given that such services are largely unavailable in majority of low-resource settings in Asia, our study highlights the need for more efficient guidelines to identify at-risk individuals in Asia.
Contribution of dietary intake to relapse rate in early paediatric multiple sclerosis
Authors: Azary Saeedeh , Schreiner Teri , Graves Jennifer , Waldman Amy , Belman Anita , Guttman Bianca Weinstock , Aaen Gregory , Tillema Jan-Mendelt , Mar Soe , Hart Janace , Ness Jayne , Harris Yolanda , Krupp Lauren , Gorman Mark , Benson Leslie , Rodriguez Moses , Chitnis Tanuja , Rose John , Barcellos Lisa F , Lotze Tim , Carmichael Suzan L , Roalstad Shelly , Casper Charles T , Waubant Emmanuelle
Published: October 2017

Objective

The role of diet in multiple sclerosis (MS) course remains largely unknown. Children with MS have a higher relapse rate compared with MS in adults. Thus, studying the effect of diet on relapse rate in this age group is likely to provide more robust answers.

Methods

This is a multicentre study done at 11 paediatric MS centres in the USA. Patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome (CIS) with disease onset before 18 years of age and duration of less than 4 years were included in this study. Dietary intake during the week before enrolment was assessed with the validated Block Kids Food Screener. The outcome of the study was time from enrolment to the next relapse. 219 patients with paediatric RRMS or CIS were enrolled. Each 10% increase in energy intake from fat increased the hazard of relapse by 56% (adjusted HR 1.56, 95% CI 1.05 to 2.31, p=0.027), and in particular each 10% increase in saturated fat tripled this hazard (adjusted HR: 3.37, 95% CI 1.34 to 8.43, p=0.009). In contrast, each additional one cup equivalent of vegetable decreased the hazard of relapse by 50% (adjusted HR: 0.50, 95% CI 0.27 to 0.91, p=0.024). These associations remained with mutual adjustment and persisted when adjusting for baseline 25(OH) vitamin D serum level. Other studied nutrients were not associated with relapse.

Conclusions

This study suggests that in children with MS, high energy intake from fat, especially saturated fat, may increase the hazard to relapse, while vegetable intake may be independently protective.
Fate and the clinic: a multidisciplinary consideration of fatalism in health behaviour
Authors: Perfetti Ross Harrison
Published: October 2017

The role of fatalism in health behaviour has stirred significant controversy in literature across several disciplines. Some researchers have demonstrated a negative correlation between fatalistic beliefs and healthy behaviours such as cancer screening, arguing that fatalism is a barrier to health-seeking behaviours. Other studies have painted a more complicated picture of fatalistic beliefs and health behaviours that ultimately questions fatalism’s causality as a distinct factor. Unpacking this debate raises thought-provoking questions about how epistemological and methodological frameworks present particular pictures about the connections between belief, race, class and behaviour. The discussion surrounding fatalism illuminates larger tensions between structural and cultural determinants of health behaviour. This article argues for a more rigorous delineation of culture and structure and suggests that future theory-informed and ethnographic research may more precisely parse the role of fatalism in health attitudes, beliefs and behaviours.
In-room assessment of intravascular velocity from time-resolved rotational angiography in patients with arteriovenous malformation: a pilot study
Authors: Lin Chung Jung , Yang Huai Che , Chien Ai Chi , Guo Wan Yuo , Wu Chih Chun , Hung Sheng Che , Chen Ko Kung , Wu Hsiu Mei , Luo Chao Bao , Chu Wei Fa , Hong Jia Sheng , Wu Chun Shien Frank
Published: October 2017

Background

Time-resolved rotational angiography (t-RA) enables interventionists to better comprehend complex arteriovenous malformations (AVMs), thereby facilitating endovascular treatment. However, its use in evaluating hemodynamic changes has rarely been explored.

Objective

This study uses t-RA to estimate intravascular flow in patients with AVM to compare this with flow in the normal population.

Methods

Patients with available t-RA scans were prospectively categorized into one of three groups: hemorrhagic AVM, non-hemorrhagic AVM and control. Pulsatile time–density curves (TDCs) for C1, C6 and VOIMCAwere used for amplitude and velocity estimation. C1 was at the cervical internal carotid artery (ICA), 2–3 cm below the carotid canal, C6 was at the paraclinoid segment of the ICA, and VOIMCAwas at the junction of the first and second segment of the middle cerebral artery (MCA). A waveform amplitude ratio was defined as (peak − trough)/trough contrast intensity. VICAwas defined as the distance between C6 and C1 divided by the time required for the wave to pass, and correspondingly, the average velocity of MCA (VMCA) was defined as the distance between C6 and VOIMCAdivided by the duration for the same peak to travel from C6 and VOIMCA, AVM volume was estimated by MR angiography.

Results

Amplitude ratios AC1and AC6, and average flow velocities VICAand VMCAwere significantly larger in the non-hemorrhagic group than in the control group, while the hemorrhagic AVM group was not significantly different from the controls. VICAand VMCAshowed moderate to good correlations with AVM volume (r=0.51 and 0.73, respectively). VMCA(33.0±9.1) was significantly lower than VICA(41.3±13.2) in the control group, but not in the two AVM groups.

Conclusion

TDC waveform propagation derived from t-RA can quantify hemodynamic differences between AVM and the control group. t-RA provides both real-time anatomic and hemodynamic evaluation, and can thus potentially improve the interventional workflow.
Tobacco industry strategies undermine government tax policy: evidence from commercial data
Authors: Hiscock Rosemary , Branston J Robert , McNeill Ann , Hitchman Sara C , Partos Timea R , Gilmore Anna B
Published: October 2017

Objective

Taxation equitably reduces smoking, the leading cause of health inequalities. The tobacco industry (TI) can, however, undermine the public health gains realised from tobacco taxation through its pricing strategies. This study aims to examine contemporary TI pricing strategies in the UK and implications for tobacco tax policy.

Design

Review of commercial literature and longitudinal analysis of tobacco sales and price data.

Setting

A high-income country with comprehensive tobacco control policies and high tobacco taxes (UK).

Participants

2009 to 2015 Nielsen Scantrak electronic point of sale systems data.

Main outcome measures

Tobacco segmentation; monthly prices, sales volumes of and net revenue from roll-your-own (RYO) and factory-made (FM) cigarettes by segment; use of price-marking and pack sizes.

Results

The literature review and sales data concurred that both RYO and FM cigarettes were segmented by price. Despite regular tax increases, average real prices for the cheapest FM and RYO segments remained steady from 2013 while volumes grew. Low prices were maintained through reductions in the size of packs and price-marking. Each year, at the point the budget is implemented, the TI drops its revenue by up to 18 pence per pack, absorbing the tax increases (undershifting). Undershifting is most marked for the cheapest segments.

Conclusions

The TI currently uses a variety of strategies to keep tobacco cheap. The implementation of standardised packaging will prevent small pack sizes and price-marking but further changes in tax policy are needed to minimise the TI’s attempts to prevent sudden price increases.
Participation in moderate-to-vigorous leisure time physical activity is related to decreased visceral adipose tissue in adults with spinal cord injury
Authors: Pelletier Chelsea A. , Omidvar Maryam , Miyatani Masae , Giangregorio Lora , Craven B. Catharine
Published: October 2017

Increased visceral adiposity places individuals with chronic spinal cord injury (SCI) at increased risk of cardiometabolic disease. The purpose of this study was to identify if people with chronic SCI who participate in any moderate- to vigorous-intensity leisure time physical activity (LTPA) have lower visceral adipose tissue (VAT) area compared with those who report none. Participants included 136 adult men (n = 100) and women (n = 36) with chronic (mean (±SD) 15.6 ± 11.3 years post-injury) tetraplegia (n = 66) or paraplegia (n = 70) recruited from a tertiary rehabilitation hospital. VAT area was assessed via whole-body dual-energy X-ray absorptiometry using a Hologic densitometer and the manufacturer’s body composition software. Moderate-to-vigorous LTPA was assessed using the Leisure Time Physical Activity Questionnaire for People with SCI (LTPAQ-SCI) or the Physical Activity Recall Assessment for People with SCI (PARA-SCI). Summary scores were dichotomized into any or no participation in moderate-to-vigorous LTPA to best represent the intensity described in current population-specific physical-activity guidelines. Data were analyzed using univariate and multiple regression analyses to identify the determinants of VAT. Overall, the model explained 67% of the variance in VAT area and included time post-injury, age-at-injury, android/gynoid ratio, waist circumference, and moderate-to-vigorous LTPA. Participation in any moderate-to-vigorous LTPA was significantly (95% confidence interval: –34.71 to –2.61, p = 0.02) associated with VAT after controlling for injury-related and body-composition correlates. Moderate-to-vigorous LTPA appears to be related to lower VAT area, suggesting potential for LTPA to reduce cardiometabolic disease risk among individuals with chronic SCI.
The effect of resistance training set configuration on strength, power, and hormonal adaptation in female volleyball players
Authors: Arazi Hamid , Khanmohammadi Aida , Asadi Abbas , Haff G. Gregory
Published: October 2017

The primary purpose of this investigation was to determine the impact of altering the set structure during an 8-week resistance training program on anthropometric, hormonal, and strength power characteristics. Thirty female volleyball players were recruited for participation and then randomly assigned to 1 of 3 resistance training groups: (i) cluster sets (CRT; n = 10), (ii) traditional sets (TRT; n = 10), or (iii) control (CON; n = 10). All athletes were evaluated for thigh and arm circumference, vertical jump, 20-m sprint, 4 × 9-m shuttle-run, 1-repetition maximum (1RM) back squat, bench press, military press, and deadlift prior to and after an 8-week periodized training intervention. Blood samples were taken before and after the 8-week training period to evaluate resting testosterone, cortisol, and insulin-like growth factor 1 responses to the training period. After 8 weeks of training the CRT group displayed a small but significant improvement in vertical jump (CRT: effect size (ES) = 038, 7.1%) performance when compared with the TRT group (ES = 0.34, 5.6%). Both the CRT and TRT training interventions resulted in very large increases in the 1RM squat (CRT: 8.4% ± 1.2%; TRT: 7.3% ± 0.6%), bench press (CRT: 8.3% ± 2.0%; TRT: 8.7% ± 1.9%), military press (CRT: 5.7% ± 1.2%; TRT: 5.5% ± 1.6%), and deadlift (CRT: 8.2% ± 1.6%; TRT: 8.3% ± 2.2%). There were no significant differences in 20-m sprint or 4 × 9-m shuttle run times between the CRT, TRT, and CON groups. These results suggest that cluster sets allow for greater improvements in vertical jump performance and equal improvements in strength gains to those seen with traditional sets.
Maternal iron nutriture as a critical modulator of fetal alcohol spectrum disorder risk in alcohol-exposed pregnancies
Authors: Helfrich Kaylee K. , Saini Nipun , Kling Pamela J. , Smith Susan M.
Published: October 2017

Alcohol consumption during pregnancy places the fetus at risk for permanent physical, cognitive, and behavioral impairments, collectively termed fetal alcohol spectrum disorder (FASD). However, prenatal alcohol exposure (PAE) outcomes vary widely, and growing evidence suggests that maternal nutrition is a modifying factor. Certain nutrients, such as iron, may modulate FASD outcomes. Untreated gestational iron deficiency (ID) causes persistent neurodevelopmental deficits in the offspring that affect many of the same domains damaged by PAE. Although chronic alcohol consumption enhances iron uptake and elevates liver iron stores in adult alcoholics, alcohol-abusing premenopausal women often have low iron reserves due to menstruation, childbirth, and poor diet. Recent investigations show that low iron reserves during pregnancy are strongly associated with a worsening of several hallmark features in FASD including reduced growth and impaired associative learning. This review discusses recent clinical and animal model findings that maternal ID worsens fetal outcomes in response to PAE. It also discusses underlying mechanisms by which PAE disrupts maternal and fetal iron homeostasis. We suggest that alcohol-exposed ID pregnancies contribute to the severe end of the FASD spectrum.
Thermo-hydro-mechanical coupling analysis of a thermo-active diaphragm wall
Authors: Rui Yi , Yin Mei
Published: October 2017

Thermo-active diaphragm walls that combine load bearing ability with a ground source heat pump (GSHP) are considered to be one of the new technologies in geotechnical engineering. Despite the vast range of potential applications, current thermo-active diaphragm wall designs have very limited use from a geotechnical aspect. This paper investigates the wall–soil interaction behaviour of a thermo-active diaphragm wall by conducting a thermo-hydro-mechanical finite element analysis. The GSHP operates by circulating cold coolant into the thermo-active diaphragm wall during winter. Soil contraction and small changes in the earth pressures acting on the wall are observed. The strain reversal effect makes the soil stiffness increase when the wall moves in the unexcavated side direction, and hence gives different trends for long-term wall movements compared to the linear elastic model. The GSHP operation makes the wall move in a cyclic manner, and the seasonal variation is approximately 0.5–1 mm, caused by two factors: the thermal effects on the deformation of the diaphragm wall itself and the thermally induced volume change of the soil and pore water. In addition, it is found that the change in bending moment of the wall due to the seasonal GSHP cycle is caused mainly by the thermal differential across the wall during the winter, because the seasonal changes in earth pressures acting on the diaphragm wall are very limited.
The effect of the cosmological constant on a quadrupole signal in the linearized approximation
Authors: Somlai László Ábel , Vasúth Mátyás
Published: October 2017

In this study the effects of a nonzero cosmological constant [Formula: see text] on a quadrupole gravitational wave (GW) signal are analyzed. The linearized approximation of general relativity was used, so the perturbed metric can be written as the sum of [Formula: see text] GWs and [Formula: see text] background term, originated from [Formula: see text]. The [Formula: see text] term was also included in this study. To derive physically relevant consequences of [Formula: see text] comoving coordinates are used. In these coordinates, the equations of motion (EoMs) are not self-consistent so the result of the linearized theory has to be transformed to the FRW frame. The luminosity distance and the same order of the magnitude of frequency in accordance with the detected GWs were used to demonstrate the effects of the cosmological constant.
A pointwise finite-dimensional reduction method for a fully coupled system of Einstein–Lichnerowicz type
Authors: Premoselli Bruno
Published: October 2017

We construct non-compactness examples for the fully coupled Einstein–Lichnerowicz constraint system in the focusing case. The construction is obtained by combining pointwise a priori asymptotic analysis techniques, finite-dimensional reductions and a fixed-point argument. More precisely, we perform a fixed-point procedure on the remainders of the expected blow-up decomposition. The argument consists of an involved finite-dimensional reduction coupled with a ping-pong method. To overcome the non-variational structure of the system, we work with remainders which belong to strong function spaces and not merely to energy spaces. Performing both the ping-pong argument and the finite-dimensional reduction therefore heavily relies on the a priori pointwise asymptotic techniques of the [Formula: see text] theory.