bluuebunny/crossref_metadata_2025 huggingface dataset:
Propensity‐matched comparison of antiplatelet versus anticoagulant after left atrial appendage closure with the Watchman
Authors: Liu Xiao‐Xia , Kleinecke Caroline , Busch Sonia , Allakkis Wasim , Mohrez Yamen , Cheikh‐Ibrahim Mohammad , Mahnkopf Christian , Brachmann Johannes , Schnupp Steffen , Gloekler Steffen , Yu Jiangtao , Ma Changsheng
Published: August 2020

Background

Optimal antithrombotic therapy following left atrial appendage closure (LAAC) with the Watchman occluder remains uncertain. This study retrospectively compared clinical outcomes of a 3‐month dual antiplatelet therapy (DAPT group) and a protocol of anticoagulation plus aspirin for 45 days followed by DAPT for 6 months (ACT group) after LAAC with the Watchman device.

Methods

Of two Watchman registries (Coburg and Lichtenfels hospitals, Germany), 220 and 304 consecutive patients with successful LAAC were included. Patients in Coburg hospital received DAPT while they received ACT in Lichtenfels. After a 1:1 propensity score matching, 174 (DAPT) versus 174 (ACT) patients were compared by use of the primary efficacy endpoint of thromboembolic events and cardiovascular/unexplained death, the primary safety endpoint of nonprocedural related major bleeding events at follow‐up, and the combined hazard endpoint, a composite of all above‐mentioned hazards.

Results

The mean age 77.5 ± 7.2 (DAPT) versus 77.3 ± 7.1 (ACT) years, CHA2DS2‐VASc score 4.6 ± 1.5 versus 4.7 ± 1.6, and HAS‐BLED score 3.3 ± 0.8 versus 3.3 ± 0.8 were similar. After 12 months, the clinical efficacy (13/174, 7.4% [DAPT] vs 11/174, 6.3% [ACT]; hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.38‐1.86; P = .66) and safety (6/174, 3.4% vs 8/174, 4.5%; HR, 0.86; 95% CI, 0.29‐2.56; P = .79) as well as the combined hazard endpoint (18/174, 10.3% vs 18/174, 10.3%; HR,1.01; 95% CI, 0.53‐1.95; P = .97) were comparable.

Conclusions

This study suggests comparable efficacy and safety of 3‐month DAPT versus 6 weeks ACT plus aspirin following LAAC with the Watchman.
Effects of E2 binding enzyme UBC9 on porcine oocyte maturation, apoptosis and embryo development
Authors: Xu Da , Sun Fuliang , Bi Jing , Guan Yunfeng , Luo Xiaotong , Chen Xuan , Lv Yanqiu , Jin Yi
Published: August 2020

SUMOylation is a dynamic post‐translational modification process. However, the function of small ubiquitin‐like modifiers (SUMOs) in the maturation of porcine oocytes and embryo growth is not well known. Therefore, the aim of this study was to investigate the effect of E2 binding enzyme UBC9 on the expression of SUMO‐1 protein during the in vitro maturation of porcine oocytes and embryo development after in vitro fertilization. Four groups were used: 0 (Control), 5, 10 and 15 µg/ml UBC9. Western blotting, flow cytometry and RT‐qPCR were used to detect the in vitro maturation of porcine oocytes, SUMO‐1 content, viability and the expression of apoptotic genes. Compared to those in the control treatment, the maturation rate (p < .05) and viability (p < .01) of oocytes in the 5 μg/ml treatment group decreased significantly. SUMO‐1 protein markers appeared at 59 and 71 kDa and the content of SUMO‐1 protein in the 10 µg/ml treatment group decreased significantly (p < .05). In the expression of apoptosis‐related genes, Bcl‐2 gene expression was significantly downregulated in the 10 μg/ml treatment group (p < .05). However, Bax and Caspase‐3 were significantly upregulated in the 5 μg/ml treatment group (p < .05). During embryonic development, the cleavage rate of oocytes in the 10 µg/ml treatment group was significantly reduced (p < .05), whereas blastocyst formation rate in the 5 µg/ml treatment group was significantly reduced. UBC9 regulates SUMO‐1 content in mature pig oocytes in vitro, which affects oocyte maturation rate, viability, apoptotic genes expression and embryo development after fertilization.
Characterization of the novel HLA‐B*53:62 allele by sequencing‐based typing
Authors: Cargou Marine , Elsermans Vincent , Top Isabelle , Guidicelli Gwendaline , Visentin Jonathan
Published: August 2020

HLA‐B*53:62 differs from HLA‐B*53:01:01:01 by seven nucleotide substitutions in six codons in exon 3.
Market Expansion of Domestic Gaming Firms in Shenzhen, China: Dilemma of Globalisation and Regionalisation
Authors: Yang Chun , Chan David Yuen‐Tung
Published: August 2020

China's domestic mobile gaming firms, such as Tencent, which has developed into the world's biggest gaming firm by revenues in a short span, have outweighed the leading counterparts in the Western advanced economies. Despite an increasing attention has been paid to the global investment of Chinese gaming firms, this paper argues that their market expansion has focused on the selected Southeast Asian countries. This arguement is developed through the aurthors' extensive field investigation and personal interviews with games developers and publishers in Shenzhen, where Tencent is located, during the early 2017 and late 2019. We showcase that the protective multi‐scalar institutions in which the Chinese gaming firms have dominated in the domestic market, have prevented the overseas market expansion of these firms. Although the government‐designated extra‐local inter‐firm collaboration has helped narrow the technological gaps and articulate China’s firms into the global production networks, the market gaps between the domestic and western economies have not been overcome in the expansion to overseas markets. This study sheds light on that the market expansion of Chinese gaming firms has stucked in a dilemma between globalization and regionalization. While China’s domestic gaming firms, particularly Tencent, have been evolving into lead firms in the global games production networks, their market power has been confined at domestic and regional levels.
Statistical edutainment: Correlation recreation
Authors: Lesser Lawrence M. , Pearl Dennis K.
Published: August 2020

Cartoons, songs, poems, and games can be useful ways to engage students in discussion and learning key concepts about correlation.
Microorganisms associated with incisional infections after gastrointestinal surgery in dogs and cats
Authors: Williams Rachel W. , Cole Stephen , Holt David E.
Published: August 2020

Objective

To determine the rate of incisional infections after gastrointestinal surgery in dogs and cats and describe the aerobic bacteria isolated from these infections.

Study design

Retrospective study.

Animals

Client‐owned dogs (n = 210) and cats (n = 66).

Methods

Records of dogs and cats that underwent gastrointestinal surgery at the Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania were reviewed for surgical procedures, presence of an infection, bacterial species isolated, perioperative antimicrobials administered, and outcome.

Results

The median duration of follow‐up was 14 days (4‐35). Incisional infections were recorded in 7% (20/276) of cases. Among those 20 cases, culture results were available in 12 of 20 cases. The most common bacterial isolate cultured wasEscherichia coli. The most common perioperative antimicrobials administered to treat incisional infection were cefazolin and cefoxitin. Only two of the bacterial isolates were susceptible to these antimicrobials. Bacteria isolated from incisional infections were most often susceptible to chloramphenicol, imipenem, and gentamicin.

Conclusion

Bacterial isolates from incisional infections in this population consisted of native gastrointestinal flora, which was often resistant to the most commonly used perioperative antimicrobials.

Clinical significance

Contamination at time of surgery is the most likely source of incisional infection after gastrointestinal surgery. This rate of infection justifies more rigorous intraoperative hygiene protocols and evaluation of the antimicrobials' susceptibility of causative bacteria to guide antimicrobial treatment.
THE CHINESE PRACTICE‐ORIENTED VIEWS OF SCIENCE AND THEIR POLITICAL GROUNDS
Authors: Guo Yuanlin , Radder Hans
Published: August 2020

In China, practice‐oriented views of science can be traced back to antiquity. In ancient times, the Chinese people independently created and developed application‐oriented sciences, but they ignored basic science. In modern times, China learned and introduced Western science and technology as a practical instrument to protect the nation and make it prosperous and powerful. Through technology and production, science has been playing an immediate and major role in the development of socialism since 1949. Since 1978, the Chinese government has always emphasized that science and technology are the primary productive forces. From ancient times to the present, the practice‐oriented views of science are grounded in politics. Science has been the handmaiden of politics since the Qin Dynasty. However, this state of affairs hinders the development of basic science, a science that is not oriented toward immediate application. It also hinders open‐minded, critical reflection on the downsides or limits of science, which could draw on broader (moral, spiritual, or religious) values.
Application of Generalized Regression Neural Network in Predicting the Thermal Performance of Solar Flat Plate Collector Systems
Authors: Sridharan M. , Shenbagaraj Shribalaji
Published: August 2020

This study presents a smart neural network (NN) model for estimating the thermal performance of a transient nature solar flat plate collector system (SFPCS). For this purpose, a series of experimental studies are conducted through four successive days with three different arrangements of SFPCS (standalone, series, and parallel). Experimental results of such arrangements are then used for designing a generalized regression neural network (GRNN) model. The GRNN architecture proposed in this study consists of four inputs (mass flowrate, solar irradiance, fluid temperature difference, and collector area) and two dependent outputs (power output and efficiency of SFPCS). Such GRNN architecture is trained, tested, and validated with real-time experimental transient datasets for each arrangement individually. The results of the GRNN model are in good agreement with experimental datasets. The overall accuracy of the developed GRNN model in predicting the performance of standalone, series, and parallel connected SFPCS is 98%.
Exclusion of tidal influence on ambient sound measurements
Authors: van Geel Nienke C. F. , Merchant Nathan D. , Culloch Ross M. , Edwards Ewan W. J. , Davies Ian M. , O'Hara Murray Rory B. , Brookes Kate L.
Published: August 2020

Growing concern about the impacts of anthropogenic noise on marine life has led to a global increase in the number of acoustic monitoring programmes aiming to quantify underwater soundscapes. However, low-frequency measurements in coastal sites may be affected by flow noise that is not actually present in the environment, but is caused by tidal flow turbulence around the hydrophone. At present, there is no standard way of removing this contaminating noise. This study presents an approach to exclude tidal influences (flow noise and other tidal-related acoustic self-noise) on ambient sound measurements, using data recorded at ten Scottish coastal sites between 2013 and 2017, and with a focus on the 63 and 125 Hz 1/3-octave bands. The annual ambient sound pressure levels (SPL) of the full and “tidal influence excluded” datasets of the three most tidally affected sites were compared against hypothetical noise thresholds. For the 63 Hz 1/3-octave band, results revealed: Site-specific patterns in the amount of data excluded (28.2%–89.2%), decreases in SPL (0.7–8.5 dB), and differences in the percentage of time that noise thresholds were exceeded. The described approach may serve as a standardised way of excluding tidal influence on soundscape descriptors.
Quasi-Isometric Cycling: A Case Study Investigation of a Novel Method to Augment Peak Power Output in Sprint Cycling
Authors: Kordi Mehdi , Evans Martin , Howatson Glyn
Published: August 2020

Purpose: Peak power output (PPO) is a determinant of sprint cycling performance and can be enhanced by resistance exercise that targets maximum strength. Conventional resistance training is not always suitable for elite cyclists because of chronic spinal issues; therefore, alternative methods to improve strength that concurrently reduce injury risk are welcome. In this case study, quasi-isometric cycling (QIC), a novel task-specific resistance-training method designed to improve PPO without the use of transitional resistance training, was investigated. Methods: A highly trained sprint track cyclist (10.401 s for 200 m) completed a 5-week training block followed by a second 5-week block that replaced conventional resistance training with the novel QIC training method. The replacement training method required the cyclist to maximally drive the crank of a modified cycle ergometer for 5 seconds as it passed through a ∼100° range (starting at 45° from top dead center) at a constant angular velocity. Each session consisted of 3 sets of 6 repetitions on each leg. The lab PPO was recorded in the saddle and out of the saddle. Results: Conventional training did not alter sprinting ability; however, the intervention improved the out-of-the-saddle PPO by 100 W (from 1751 to 1851 W), while the in-the-saddle PPO increased by 57 W from 1671 to 1728 W. Conclusion: QIC increased PPO in a highly trained, national-level sprint cyclist, which could be translated to improvements in performance on the track. Furthermore, QIC provides a simple, but nonetheless effective, alternative for sprint track cyclists who have compromised function to perform traditional strength training.
Tibial Acceleration Reliability and Minimal Detectable Difference During Overground and Treadmill Running
Authors: Aubol Kevin G. , Hawkins Jillian L. , Milner Clare E.
Published: August 2020

Measurements of tibial acceleration during running must be reliable to ensure valid results and reduce errors. The purpose of this study was to determine the reliability and minimal detectable difference (MDD) of peak axial and peak resultant tibial acceleration during overground and treadmill running. The authors also compared reliability and MDDs when peak tibial accelerations were determined by averaging 5 or 10 trials. Tibial acceleration was measured during overground and treadmill running of 19 participants using a lightweight accelerometer mounted to the tibia. Peak axial and peak resultant tibial accelerations were determined for each trial. Intraclass correlation coefficients determined within-session reliability, and MDDs were also calculated. Within-session reliability was excellent for all conditions (intraclass correlation coefficients  = .95–.99). The MDDs ranged from 0.6 to 1.4 g for peak axial acceleration and from 1.6 to 2.0 g for peak resultant acceleration and were lowest for peak axial tibial acceleration during overground running. Averaging 10 trials did not improve reliability compared to averaging 5 trials but did result in small reductions in MDDs. For peak axial tibial acceleration only, lower MDDs indicate that overground running may be the better option for detecting small differences.
Oxidative cross-linking of fibronectin confers protease resistance and inhibits cellular migration
Authors: Locy Morgan L. , Rangarajan Sunad , Yang Sufen , Johnson Mark R. , Bernard Karen , Kurundkar Ashish , Bone Nathaniel B. , Zmijewski Jaroslaw W. , Byun Jaeman , Pennathur Subramaniam , Zhou Yong , Thannickal Victor J.
Published: August 2020

Cross-linking of fibronectin occurs under inflammatory and profibrotic conditions and impairs cell migration.
A better workout without PHD3
Authors: Wong Wei
Published: August 2020

PHD3 deficiency increases fatty acid oxidation in skeletal muscle and improves endurance exercise performance.
Implementation of a paediatric early warning system as a complex health technology intervention
Authors: Duncan Heather , Hudson Adrienne P
Published: August 2020

The national implementation groups of early warning systems in the UK and Ireland have identified a need to understand implementation, adoption and maintenance of these complex interventions. The literature on how to implement, scale, spread and sustain these systems is sparse. We describe a successful adoption and maintenance over 10 years of a paediatric early warning system as a sociotechnical intervention using the Nonadoption, Abandonment, Challenges to the Scale-Up, Spread, and Sustainability Framework for Health and Care Technologies. The requirement for iterative processes within environment, culture, policy, human action and the wider system context may explain the possible reasons for improved outcomes in small-scale implementation and meta-analyses that are not reported in multicentre randomised control trials of early warning systems.
Predictive value of indicators for identifying child maltreatment and intimate partner violence in coded electronic health records: a systematic review and meta-analysis
Authors: Syed Shabeer , Ashwick Rachel , Schlosser Marco , Gonzalez-Izquierdo Arturo , Li Leah , Gilbert Ruth
Published: August 2020

Objective

Electronic health records (EHRs) are routinely used to identify family violence, yet reliable evidence of their validity remains limited. We conducted a systematic review and meta-analysis to evaluate the positive predictive values (PPVs) of coded indicators in EHRs for identifying intimate partner violence (IPV) and child maltreatment (CM), including prenatal neglect.

Methods

We searched 18 electronic databases between January 1980 and May 2020 for studies comparing any coded indicator of IPV or CM including prenatal neglect defined as neonatal abstinence syndrome (NAS) or fetal alcohol syndrome (FAS), against an independent reference standard. We pooled PPVs for each indicator using random effects meta-analyses.

Results

We included 88 studies (3 875 183 individuals) involving 15 indicators for identifying CM in the prenatal period and childhood (0–18 years) and five indicators for IPV among women of reproductive age (12–50 years). Based on the International Classification of Disease system, the pooled PPV was over 80% for NAS (16 studies) but lower for FAS (<40%; seven studies). For young children, primary diagnoses of CM, specific injury presentations (eg, rib fractures and retinal haemorrhages) and assaults showed a high PPV for CM (pooled PPVs: 55.9%–87.8%). Indicators of IPV in women had a high PPV, with primary diagnoses correctly identifying IPV in >85% of cases.

Conclusions

Coded indicators in EHRs have a high likelihood of correctly classifying types of CM and IPV across the life course, providing a useful tool for assessment, support and monitoring of high-risk groups in health services and research.
Acute transverse myelitis in COVID-19 infection
Authors: Chow Chian Chiang Nicholas , Magnussen John , Ip Jerome , Su Yuen
Published: August 2020

A 60-year-old man presented to hospital with bilateral lower limb weakness, urinary retention and constipation. He had been diagnosed with COVID-19 10 days prior. Clinical examination revealed global weakness, increased tone, hyperreflexia and patchy paresthesia in his lower limbs bilaterally. Preliminary blood tests performed revealed a mildly elevated C reactive protein and erythrocyte sedimentation rate but was otherwise unremarkable. MRI scan of his whole spine demonstrated hyperintense T2 signal centrally from T7 to T10, suggestive of acute transverse myelitis. A lumbar puncture showed elevated protein count but normal glucose and white blood cell count. Serological testing for other viruses was negative. His neurological symptoms improved significantly after treatment with intravenous methylprednisone. This case highlights a potential neurological complication of COVID-19 infection.
Peripheral facial paralysis as presenting symptom of COVID-19 in a pregnant woman
Authors: Figueiredo Rita , Falcão Vera , Pinto Maria João , Ramalho Carla
Published: August 2020

Acute facial nerve disease leading to peripheral facial paralysis is commonly associated with viral infections. COVID-19 may be a potential cause of peripheral facial paralysis and neurological symptoms could be the first and only manifestation of the disease. We report a case of a term pregnancy diagnosed with COVID-19 after presenting with isolated peripheral facial palsy.
Rare encounter: hydrocoele of canal of Nuck in a Scottish rural hospital during the COVID-19 pandemic
Authors: Scott Michael , Helmy Ahmed Hazem
Published: August 2020

We report the case of a 32-year-old woman who presented with reducible indirect inguinal hernia and a challenging constellation of symptoms, signs and radiographic findings. Surgical approach superseded conservative management when the patient’s abdomen became acute, with a rising lactate and haemodynamic instability. Specifically, the presence of a fluid collection was concerning for sinister acute pathology. Our patient was rediagnosed intraoperatively with hydrocoele of canal of Nuck. This so-called ‘female hydrocoele’ is an eponymous anatomical rarity in general surgery, presenting as an inguinolabial swelling with variable clinical profile. Hydrocoele of canal of Nuck takes origin from failure of transitory reproductive anlagen to regress and is thus analogous to patent processus vaginalis. Its true incidence is speculative, with just several hundred cases globally. We aim to provide insights into surgical patient management for a rare entity during the COVID-19 outbreak, from the unique perspective of a small rural hospital in Scotland.
Corneal graft failure: an update
Authors: Alio Jorge L , Montesel Andrea , El Sayyad Fouad , Barraquer Rafael Ignacio , Arnalich-Montiel Francisco , Alio Del Barrio Jorge Luis
Published: August 2020

Corneal graft surgery is one of the most successful forms of human solid-tissue transplantation, and nowadays, there is a worldwide expansion of the surgical volume of corneal grafts. This surgery is continuously evolving, with new surgical techniques and postoperative treatments that have considerably increased the chance of survival for the grafts. Despite the high rate of success, corneal transplantation is still complicated by a relevant risk of graft failure. This study investigates the causes that lead to the failure of the different corneal graft surgical techniques and provides an updated synthesis on this topic. A comprehensive review of the main pathological pathways that determine the failure of corneal grafts is provided, analysing the main risk factors and disclosing the survival rates of the principal form of corneal grafts. Our results revealed that penetrating keratoplasty has higher failure rates than lamellar keratoplasty, with immunological rejection being the leading cause of graft failure, followed by late endothelial failure (LEF) and ocular surface disorders. Postoperative glaucoma and dehiscence of the surgical wound represent other important causes of failure. Endothelial keratoplasty showed the lowest rates of failure in the mid-term, with LEF, detachment of the graft and primary graft failure representing the most common pathological reasons for failure.
Performance of the Eversense versus the Free Style Libre Flash glucose monitor during exercise and normal daily activities in subjects with type 1 diabetes mellitus
Authors: Fokkert Marion , van Dijk Peter R , Edens Mireille A , Díez Hernández Alberto , Slingerland Robbert , Gans Rijk , Delgado Álvarez Elías , Bilo Henk
Published: August 2020

Introduction

Accurate blood glucose measurements are important in persons with diabetes during normal daily activities (NDA), even more so during exercise. We aimed to investigate the performance of fluorescence sensor-based and glucose oxidase-based interstitial glucose measurement during (intensive) exercise and NDA.

Research design and methods

Prospective, observational study in 23 persons with type 1 diabetes when mountain biking for 6 days, followed by 6 days of NDA. Readings of the Eversense (fluorescence-based continuous glucose monitoring (CGM); subcutaneously implanted) and of the Free Style Libre (FSL; glucose oxidase-based flash glucose monitoring (FGM); transcutaneously placed) were compared with capillary glucose levels (Free Style Libre Precision NeoPro strip (FSLCstrip)).

Results

Mean average differences (MAD) and mean average relative differences (MARD) were significantly different when comparing exercise with NDA (reference FSLCstrip); Eversense MAD 25±19 vs 17±6 mg/dL (p<0.001); MARD 17±6 vs 13%±6% (p<0.01) and FSL MAD 32±17 vs 18±8 mg/dL (p<0.01); MARD 20±7 vs 12%±5% (p<0.001).

When analyzing the data according to the Integrated Continuous Glucose Monitoring Approvals (class II–510(K) guidelines), the overall performance of interstitial glucose readings within 20% of the FSLCstrip during exercise compared with NDA was 69% vs 81% for the Eversense and 59% vs 83% for the FSL, respectively. Within 15% of the FSLCstrip was 59% vs 70% for the Eversense and 46% vs 71% for the FSL.

Conclusions

During exercise, both fluorescence and glucose oxidase-based interstitial glucose measurements (using Eversense and FSL sensors) were less accurate compared with measurements during NDA. Even when acknowledging the beneficial effects of CGM or FGM, users should be aware of the risk of diminished accuracy of interstitial glucose readings during (intensive) exercise.
Mapping evidence of food safety at transport stations in Africa: a scoping review protocol
Authors: Ncama Busisiwe Purity , Kuupiel Desmond , Duma Sinegugu E , Mchunu Gugu , Guga Phindile , Slotow Rob
Published: August 2020

Introduction

In Africa, travels, urbanisation and changing consumer habits are increasing the number of people buying and eating food prepared/sold at public spaces including transport stations, particularly in the urban and periurban areas. Although food trading in such public spaces serves as a source of livelihood for many people, unsafe food can have a negative impact on health. We, therefore, aim to systematically explore and examine the literature, and describe the evidence on food safety (food handling, storage, preparation and sale, packaging of food when sold, hygiene of sale venue and quality (nutrition) of food sold/purchased/eaten) at transport stations to inform policy, as well as identify research gaps for future studies in Africa.

Methods and analysis

We will employ the Arksey & O’Malley framework, Levac et al recommendations and the Joanna Briggs Institute guidelines to guide this study. We will conduct a comprehensive search in PubMed, SCOPUS, Web of Science, Google Scholar and EBSCOhost (Academic search complete, CINAHL with Full-text and Health Source) from inception to December 2019 for relevant peer-review articles using a combination of keywords/search terms with no limitations. We will also search for relevant literature from the reference list of all included articles. Two investigators will independently screen the articles in parallel at the abstract and full-text phases using the eligibility criteria as a guide. Data extraction will be done using a piloted data extraction form designed in a Microsoft Word tabular format. Afterward, the extracted data will be collated into themes and subthemes, summarised, and the results reported using a narrative approach. We will the Preferred Reporting Items for Systematic Reviews and Meta-analyses: Extension for scoping reviews checklist to report this study results.

Ethics and dissemination

Ethics approval is not required. All sources of data will be adequately cited and added to the reference list. We will present the final scoping review results at the appropriate workshops, meetings, conferences, as well as submit for peer-review and publication in a scientific journal.
Effect of regulating gut microbiota using probiotics on functional changes in the brain: protocol for a systematic review
Authors: Liu Lu , Ni Xixiu , Tian Tian , Li Xiao , Li Fengmei , Sun Mingsheng , Chen Jiao , Zhou SiYuan , Zhao Ling
Published: August 2020

Introduction

There is a growing number of randomised controlled trials (RCTs) that focus on functional changes in the brain detected by functional MRI (fMRI) and gut microbiota composition changes after using probiotics.

However, the effect of probiotics on functional changes in the brain through gut microbiota remains controversial in existing RCTs. Furthermore, to our knowledge, there is no systematic review to evaluate the effect of probiotics on functional changes in the brain through gut microbiota. Therefore, we aim to summarise literatures evaluating the potential association between probiotics, gut microbiota and functional changes in the brain to elucidate whether probiotics influence gut microbiota and affect functional changes in the brain through gut microbiota.

Methods and analysis

China National Knowledge Infrastructure, Wanfang Data, VIP Databases (the Chongqing VIP Chinese Science and Technology Periodical Database), SinoMed, PubMed, Web of Science, MEDLINE (The National Library of Medicine), EMBASE (Excerpt Medica Database), Scopus, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov will be searched until July 2019. The Grey Literature in Europe (OpenSIGLE) database and Google search engine will also be used. The reference lists of each included study will be reviewed to determine whether there are any further relevant studies. RCTs using probiotics compared with a placebo/control will be included. We will use risk of bias assessment and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the quality of evidence. The results of the systematic review will be synthesised narratively in the domains of the three primary outcome measures: (1) Increased/decreased activity in brain regions or altered functional connectivity (FC) of brain detected by fMRI and their association with changes in behaviour, gastrointestinal/emotional symptoms after using probiotics. (2) Changes in composition and diversity of the gut microbiota and their association with changes in behaviour, gastrointestinal/emotional symptoms after using probiotics. (3) Increased/decreased activity in brain regions or altered FC of brain detected by fMRI and the changes in composition or diversity of the gut microbiota after administration of probiotics.

Ethics and dissemination

The results will be disseminated through a peer-reviewed publication. As no private and confidential patient data will be included in the reporting, there are no ethical considerations associated with this protocol.

PROSPERO registration number

CRD42019145114.
Racial and ethnic disparities in SARS-CoV-2 pandemic: analysis of a COVID-19 observational registry for a diverse US metropolitan population
Authors: Vahidy Farhaan S , Nicolas Juan Carlos , Meeks Jennifer R , Khan Osman , Pan Alan , Jones Stephen L , Masud Faisal , Sostman H Dirk , Phillips Robert , Andrieni Julia D , Kash Bita A , Nasir Khurram
Published: August 2020

Introduction

Data on race and ethnic disparities for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited. We analysed sociodemographic factors associated with higher likelihood of SARS-CoV-2 infection and explore mediating pathways for race and ethnic disparities in the SARS-CoV-2 pandemic.

Methods

This is a cross-sectional analysis of the COVID-19 Surveillance and Outcomes Registry, which captures data for a large healthcare system, comprising one central tertiary care hospital, seven large community hospitals and an expansive ambulatory/emergency care network in the Greater Houston area. Nasopharyngeal samples for individuals inclusive of all ages, races, ethnicities and sex were tested for SARS-CoV-2. We analysed sociodemographic (age, sex, race, ethnicity, household income, residence population density) and comorbidity (Charlson Comorbidity Index, hypertension, diabetes, obesity) factors. Multivariable logistic regression models were fitted to provide adjusted OR (aOR) and 95% CI for likelihood of a positive SARS-CoV-2 test. Structural equation modelling (SEM) framework was used to explore three mediation pathways (low income, high population density, high comorbidity burden) for the association between non-Hispanic black (NHB) race, Hispanic ethnicity and SARS-CoV-2 infection.

Results

Among 20 228 tested individuals, 1551 (7.7%) tested positive. The overall mean (SD) age was 51.1 (19.0) years, 62% were females, 22% were black and 18% were Hispanic. NHB and Hispanic ethnicity were associated with lower socioeconomic status and higher population density residence. In the fully adjusted model, NHB (vs non-Hispanic white; aOR, 2.23, CI 1.90 to 2.60) and Hispanic ethnicity (vs non-Hispanic; aOR, 1.95, CI 1.72 to 2.20) had a higher likelihood of infection. Older individuals and males were also at higher risk of infection. The SEM framework demonstrated a significant indirect effect of NHB and Hispanic ethnicity on SARS-CoV-2 infection mediated via a pathway including residence in densely populated zip code.

Conclusions

There is strong evidence of race and ethnic disparities in the SARS-CoV-2 pandemic that are potentially mediated through unique social determinants of health.
Complementary medicine visits by palliative care patients: a cross-sectional survey
Authors: Steel Amie , Schloss Janet , Diezel Helene , Palmgren Per J , Maret Jean Baptiste , Filbet Marilène
Published: August 2020

Background

The paucity of empirical research examining complementary medicine (CM) use in palliative care in France compared with other countries results in a gap in scientific knowledge. This study aims to describe the frequency and the cause of palliative care patients consulting with a CM clinician along with the conventional physicians.

Methods

This study is an observational cross-sectional survey conducted in three palliative care centres in Lyon, France, between July 2017 and May 2018: two tertiary hospitals and one palliative care unit in a private hospital. Inpatients and outpatients visiting the palliative care clinics with a primary diagnosis of cancer were invited to participate in the study. Using a 19-item paper-based survey instrument, we collected data on the participants’ personal characteristics, health service utilisation and attitudes towards CM.

Results

From the 138 participants meeting the inclusion criteria, 100 (72.4%) were included in the study. On average, they were 62.9 years old (SD 12.4) and the majority were women (60%). The primary cancer site was mostly colorectal (29.0%), breast (15.0%) and gynaecological (11.0%). The most commonly visited CM clinician was the aromatherapist (72.7%), recording more than six consultations (78.1%) for symptom management (21.9%). Visits to an osteopath were reported by 28.6% of patients, and 45.8% of osteopathy users reported visiting an osteopath more than six times for symptom management (62.5%). Participants visiting a naturopath (15.3%) reported less than four visits and indicated symptom management as the most common reason (76.9%).

Conclusions

Our findings show a substantial proportion of palliative care patients visit CM clinicians and primarily seek symptom management from CM clinical care.
Symptom reduction in palliative care from single session mindful breathing: a randomised controlled trial
Authors: Look Mei Ling , Tan Seng Beng , Hong Li Li , Ng Chong Guan , Yee Hway Ann , Lim Liang Yik , Ng Diana Leh Ching , Chai Chee Shee , Loh Ee Chin , Lam Chee Loong
Published: August 2020

Context

There has been increasing evidence of the role of mindfulness-based interventions in improving various health conditions. However, the evidence for the use of mindfulness in the palliative care setting is still lacking.

Objectives

The objective of our study was to determine the efficacy of a single session of 20 min mindful breathing in alleviating multiple symptoms in palliative care.

Methods

Adult palliative care in patients with at least one symptom scoring ≥5/10 based on the Edmonton Symptom Assessment Scale (ESAS) were recruited from September 2018 to December 2018. Recruited patients were randomly assigned to either 20 min mindful breathing and standard care or standard care alone.

Results

Forty patients were randomly assigned to standard care plus a 20 min mindful breathing session (n=20) or standard care alone (n=20). There was statistically significant reduction of total ESAS score in the mindful breathing group compared with the control group at minute 20 (U=98, n1= n2= 20, mean rank1= 15.4, mean rank2= 25.6, median reduction1= 6.5, median reduction2= 1.5, z=−2.763, r=0.3, p=0.005).

Conclusion

Our results provided evidence that a single session of 20 min mindful breathing was effective in reducing multiple symptoms rapidly for palliative care patients.
Depression treatment research in people with cancer does not reflect cancer prevalence: findings from a systematic review
Authors: Bravery Benjamin , Loughnan Siobhan , Murphy Michael
Published: August 2020

Background

One in six people with cancer will develop depression at some point in their care. Untreated depression affects quality of life, cancer care satisfaction and healthcare expenditure. Treatments for this vulnerable heterogenous population should be evidence based and specific. A common sentiment is that psychiatric research does not reflect the prevalence of patients with cancer and comorbid depression and is biased towards certain cancers, but this has not been empirically shown.

Study selection and analysis

A systematic review of studies on psychological and pharmacological treatments for depression in people with cancer was conducted. Of 4621 papers identified from a search of PubMed and PsycINFO up to 27 June 2020, 84 met inclusion criteria (eg, adults with cancer; depression diagnosis; treatment study) and comprised 6048 participants with depression with cancer.

Findings

Cancer types are not proportionally represented in depression research in accordance with their incidence. Breast cancer is over-represented (relative frequency in research 49.3%, but 11.7% of global cancer). Cancers of the head and neck and bone and soft tissue were close to parity. All other cancers are under-represented. Representativeness varied 40-fold across different cancers.

Conclusions

The evidence base for depression treatments is dominated by a single cancer. Given heterogeneity in cancer populations (eg, stage of illness; psychological impact; cancer treatments), it is possible that depression treatments may not have the same benefits and harms across all cancers, impeding the ability to offer people with different cancers the best depression treatment. While the dominant opinion within this research field is that a cancer bias exists, this is the first study to demonstrate as such.
Incidence and characteristics of paediatric abusive head trauma in Taiwan, 2006–2015: a nationwide population-based study
Authors: Chang Yi-Ting , Chang Hsin-Yi , Chen Li-Wen , Lu Tsung-Hsueh , Tsai Hui-Ju , Chen Yi-Wen , Chang Yu-Chun , Feng Jui-Ying
Published: August 2020

Objectives

To examine the incidence rate and characteristics of paediatric abusive head trauma (PAHT) among children under age 5 years in Taiwan.

Methods

The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) was used to identify broad and narrow definitions of children aged under 5 years with PAHT from 2006 to 2015 in Taiwan using a representative national insurance research database. Medical resource utilisation was also analysed. Incidence rates per 100 000 person-years were calculated and presented with 95% CI. Joinpoint regression analysis was used to detect the changes in trends and calculate the annual percentage change in PAHT incidence over time.

Results

From 2006 to 2015, 479 (narrow definition) and 538 (broad definition) PAHT cases were identified. Incidence rates of PAHT by narrow and broad definitions among children under 1 year of age (18.7/100 000 and 20.0/100 000) were nearly 10-fold or 20-fold higher than for children aged 1–2 (1.7/100 000 and 2.1/100 000) and 3–5 (0.9/100 000 and 1.2/100 000) years. The PAHT incidence significantly increased since 2012, with trends varying by age and gender. Our results suggest that over 40% of the children with PAHT experienced serious injury and nearly 13% were fatal cases. For 87% (n=57) of fatal cases, this was their first ever hospitalisation. The number of fatal cases among infants was fourfold higher than that of children aged 1–5 years.

Conclusions

This study provides a robust national estimate of PAHT and identifies infants as the most vulnerable group for PAHT in Taiwan. Education to enhance healthcare profession’s sensitivity and competence for the early identification and diagnosis of PAHT is critical.
Global systematic review of the effects of suicide prevention interventions in Indigenous peoples
Authors: Leske Stuart , Paul Elise , Gibson Mandy , Little Brock , Wenitong Mark , Kolves Kairi
Published: August 2020

Objective

Suicide rates are often higher in Indigenous than in non-Indigenous peoples. This systematic review assessed the effects of suicide prevention interventions on suicide-related outcomes in Indigenous populations worldwide.

Methods

We searched CINAHL, Embase, PubMed, PsycINFO, ProQuest Dissertations & Theses and Web of Science from database inception to April 2020. Eligible were English language, empirical and peer-reviewed studies presenting original data assessing the primary outcomes of suicides and suicide attempts and secondary outcomes of suicidal ideation, intentional self-harm, suicide or intentional self-harm risk, composite measures of suicidality or reasons for life in experimental and quasi-experimental interventions with Indigenous populations worldwide. We assessed the risk of bias with the Cochrane Risk of Bias Tool and the Risk of Bias Assessment for Non-randomised Studies.

Findings

We included 24 studies from Australia, Canada, New Zealand and the USA, comprising 14 before–after studies, 4 randomised controlled trials (RCTs), 3 non-randomised controlled trials, 2 interrupted time-series designs and 1 cohort study. Suicides decreased in four and suicide attempts in six before–after studies. No studies had a low risk of bias. There was insufficient evidence to confirm the effectiveness of any one suicide prevention intervention due to shortage of studies, risk of bias, and population and intervention heterogeneity. Review limitations include language bias, no grey literature search and data availability bias.

Conclusion

For the primary outcomes of suicides and suicide attempts, the limited available evidence supports multilevel, multicomponent interventions. However, there are limited RCTs and controlled studies.
Multilevel regression and poststratification for estimating population quantities from large health studies: a simulation study based on US population structure
Authors: Downes Marnie , Carlin John
Published: August 2020

Introduction

Recruiting a representative sample of participants is becoming increasingly difficult in large-scale health surveys. Multilevel regression and poststratification (MRP) has been shown to be effective in estimating population descriptive quantities in non-representative samples. We performed a simulation study, previously applied to an Australian population, this time to a US population, to assess MRP performance.

Methods

Data were extracted from the 2017 Current Population Survey representing a population of US adult males aged 18–55 years. Simulated datasets of non-representative samples were generated. State-level prevalence estimates for a dichotomous outcome using MRP were compared with the use of sampling weights (with and without raking adjustment). We also investigated the impact on MRP performance of sample size, model misspecification, interactions and the addition of a geographic-level covariate.

Results

MRP was found to achieve generally superior performance, with large gains in precision vastly outweighing the increased accuracy observed for sampling weights with raking adjustment. MRP estimates were generally robust to model misspecification. We found a tendency of MRP to over-pool between-state variation in the outcome, particularly for the least populous states and small sample sizes. The inclusion of a state-level covariate appeared to mitigate this and further improve MRP performance.

Discussion

MRP has been shown to be effective in estimating population descriptive quantities in two different populations. This provides promising evidence for the general applicability of MRP to populations with different geographic structures. MRP appears to be a valuable analytic strategy for addressing potential participation bias from large-scale health surveys.
Progression of coal workers’ pneumoconiosis absent further exposure
Authors: Almberg Kirsten S , Friedman Lee S , Rose Cecile S , Go Leonard H T , Cohen Robert A
Published: August 2020

Objectives

The natural history of coal workers’ pneumoconiosis (CWP) after cessation of exposure remains poorly understood.

Methods

We characterised the development of and progression to radiographic progressive massive fibrosis (PMF) among former US coal miners who applied for US federal benefits at least two times between 1 January 2000 and 31 December 2013. International Labour Office classifications of chest radiographs (CXRs) were used to determine initial and subsequent disease severity. Multivariable logistic regression models were used to identify major predictors of disease progression.

Results

A total of 3351 former miners applying for benefits without evidence of PMF at the time of their initial evaluation had subsequent CXRs. On average, these miners were 59.7 years of age and had 22 years of coal mine employment. At the time of their first CXR, 46.7% of miners had evidence of simple CWP. At the time of their last CXR, 111 miners (3.3%) had radiographic evidence of PMF. Nearly half of all miners who progressed to PMF did so in 5 years or less. Main predictors of progression included younger age and severity of simple CWP at the time of initial CXR.

Conclusions

This study provides further evidence that radiographic CWP may develop and/or progress absent further exposure, even among miners with no evidence of radiographic pneumoconiosis after leaving the industry. Former miners should undergo regular medical surveillance because of the risk for disease progression.
Paediatric reproducibility limits for the forced expiratory volume in 1 s
Authors: Stanojevic Sanja , Filipow Nicole , Ratjen Felix
Published: August 2020

Background

Current reproducibility standards for spirometry were derived using a small adult dataset and may not be optimal for interpretation of repeated measurements of lung function in children.

Objective

To define reproducibility limits for forced expiratory volume in 1 s (FEV1) change that represent the normal within-subject between-visit variability in healthy children and evaluate these limits as a tool to monitor children with cystic fibrosis (CF).

Methods

Repeated FEV1 measurements (3 months to 5 years apart) from healthy children from the Global Lung Function Initiative data repository were used to derive a conditional change score. Spirometry and clinical data from a CF clinical database was used to verify utility in clinical practice.

Results

A reproducibility change score was derived from 47 938 FEV1 measures from 7885 healthy children 6–18 years of age. The simple algorithm, which is conditional on the initial measurement, also accounts for age and time interval between measurements. The change score limits of reproducibility were much narrower than currently used cut-offs. Specifically, changes, considered as improvements using either a 12% or 10% relative change from baseline, are too wide for children. In CF, there was overall agreement between different approaches, with the distinct advantage that the change score was not biased by regression to the mean.

Conclusions

Compared with current approaches to interpretation of repeated lung function measurements, the proposed change score was less biased and provides a simple alternative to reduce misinterpretation.