bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial/ethnic variations in weight management among patients with overweight and obesity status who are served by health centres
Authors: Pourat Nadereh , Chen Xiao , Lu Connie , Zhou Weihao , Daniel Marlon , Hoang Hank , Sripipatana Alek
Published: May 2020

This study sought to examine racial/ethnic variations in receipt of provider recommendations on weight loss, patient adherence, perception of weight, attempts at weight loss and actual weight loss among patients with overweight/obesity status at Health Resources and Services Administration‐funded health centres (HC). We used a 2014 nationally representative survey of adult HC patients with overweight/obesity status (PwOW/OB) last year and reported the HC was their usual source of care (n = 3517). We used logistic regression models to assess the interaction of race/ethnicity and having obesity in (1) provider recommendations of diet or (2) exercise, (3) patient adherence to diet or (4) exercise, (5) perceptions of weight and (6) weight loss attempts. We used a multinomial regression model to examine (7) weight loss or gain vs no change and a linear regression model to evaluate (8) percent weight change. We found Black PwOW/OB (OR = 1.65) experienced greater odds of receiving diet recommendations than Whites. We found limited racial/ethnic disparities in adherence. Black (OR = 0.41), Hispanic/Latino (OR = 0.45), and American Indian/Alaska Native (OR = 0.41) PwOW/OB had lower odds of perceiving themselves as overweight. Black (OR = 1.68) and Hispanic (OR = 1.98) PwOW/OB had a greater odds of reporting weight gain, and Asian PwOW/OB (OR = 0.42) had lower odds of reporting weight loss than Whites. Disparities in provider diet recommendations among Blacks and Hispanics indicated the importance of personalized weight management recommendations. Understanding underlying reasons for discordance between self‐perception and observed weight among different groups is needed. Overall increase in weight, despite current interventions, should be addressed through targeted racially/ethnically appropriate approaches.
Cytokines of the IL‐17 family in psoriasis
Authors: Lauffer Felix , Eyerich Kilian , Boehncke Wolf‐Henning , Asadullah Khusru , Beissert Stefan , Ghoreschi Kamran , Schön Michael P.
Published: May 2020

Various immune cells and their messenger substances influence the development of psoriasis. Cytokines of the IL‐17 family are of particular importance. In addition to IL‐17A, which plays a central role in the pathogenesis of psoriasis, other subtypes of the IL‐17 family also have a proinflammatory effect. This review provides an up‐to‐date overview of the immunopathogenesis of psoriasis with regard to the six IL‐17 subtypes, in particular their physiological and pathogenic properties, as well as their significance for psoriasis therapy.
Hippocampal knockdown of α2 nicotinic or M1 muscarinic acetylcholine receptors in C57BL/6J male mice impairs cued fear conditioning
Authors: Mineur Yann S. , Ernstsen Charlotte , Islam Ashraful , Lefoli Maibom Kathrine , Picciotto Marina R.
Published: May 2020

Acetylcholine (ACh) signaling in the hippocampus is important for behaviors related to learning, memory and stress. In this study, we investigated the role of two ACh receptor subtypes previously shown to be involved in fear and anxiety, the M1 mAChR and the α2 nAChR, in mediating the effects of hippocampal ACh on stress‐related behaviors. Adeno‐associated viral vectors containing short‐hairpin RNAs targeting M1 or α2 were infused into the hippocampus of male C57BL/6J mice, and behavior in a number of paradigms related to stress responses and fear learning was evaluated. There were no robust effects of hippocampal M1 mAChR or α2 nAChR knockdown (KD) in the light/dark box, tail suspension, forced swim or novelty‐suppressed feeding tests. However, effects on fear learning were observed in both KD groups. Short term learning was intact immediately after training in all groups of mice, but both the M1 and α2 hippocampal knock down resulted in impaired cued fear conditioning 24 h after training. In addition, there was a trend for a deficit in contextual memory the M1 mAChR KD group 24 h after training. These results suggest that α2 nicotinic and M1 muscarinic ACh receptors in the hippocampus contribute to fear learning and could be relevant targets to modify brain circuits involved in stress‐induced reactivity to associated cues.
Increases in early discharge following acute coronary syndrome hospitalisations and associated clinical outcomes in New Zealand between 2006 and 2015: ANZACS‐QI‐43 study
Authors: Wang Tom Kai Ming , Grey Corina , Jiang Yannan , Bullen Christopher , Jackson Rod , Kerr Andrew
Published: May 2020

Background

International guidelines recommend early discharge for uncomplicated acute coronary syndrome (ACS) patients within 3 days; however, there is a paucity of contemporary literature regarding the safety of this strategy.

Aims

To report the trends in the proportion of ACS hospitalisations discharged within 3 days and their outcomes in New Zealand.

Methods

ACS hospitalisations 2006–2015 using national routinely collected data were categorised by length of stay (LOS) into ≤3, 4–5 and >5 days, excluding deaths during the index admission. Trend analysis of death, cardiovascular and bleeding events and their composites (net adverse clinical events) at 30‐day and 1‐year post‐discharge were performed using generalised linear mixed regression models adjusting for covariates by LOS subgroups.

Results

Among 130 037 ACS hospitalisations, LOS ≤ 3 days increased from 32% in 2006 to 44% in 2016. This trend was observed for all demographics, ACS subtypes and management strategies. Event rates at 30 days and 1 year were the lowest for the LOS ≤3 days subgroup (all‐cause mortality 1.6% and 9.1% respectively). Thirty‐day and 1‐year all‐cause mortality rates were unchanged over time for this subgroup (adjusted odds ratio (95% confidence interval) of 1.011 (0.985–1.038) and 0.991 (0.979–1.003)), while net adverse clinical event rates significantly decreased (0.962 (0.950–0.973) and 0.972 (0.964–0.980) respectively).

Conclusion

There was a substantial increase in early discharge post‐ACS over 10 years. These patients were associated with reduction in adverse clinical events up to 1 year and no increase in all‐cause mortality. These findings from a comprehensive national register suggest that guideline recommendations on early discharge after uncomplicated ACS are safe and appropriate.
Combination therapy of oxidised regenerated cellulose/collagen/silver dressings with negative pressure wound therapy for coverage of exposed critical structures in complex lower‐extremity wounds
Authors: Loh Mei Ling , Goh Benjamin K. L. , Kong Yuan , Varughese George , Ng Jia Lin , Lo Zhiwen J. , Pek Chong Han
Published: May 2020

Complex wounds with exposed critical structures such as tendon and bone are a conundrum in wound management, especially in the setting where the patient is not a suitable candidate for flap surgery. While the individual use of negative pressure wound therapy (NPWT) and oxidised regenerated cellulose (ORC)/collagen/silver (PROMOGRAN PRISMA) dressing has been described in the literature, there are little data on the efficacy of their combined use. In this study, we describe a novel technique of combining the use of NPWT and ORC/collagen/silver dressings to manage complex wound beds as an alternative management option for patients not suitable for reconstructive flap surgery. This technique was performed in a series of 37 patients with complex lower‐extremity wounds that were not healing with conventional NPWT alone. All patients had open wounds with exposed critical structures that were difficult to manage, such as exposed tendon, bone, deep crevices, and joint. Successful coverage of exposed critical structures was achieved in 89% of patients, and coverage was achieved within 28 days of combination therapy in 82% of these patients, without any complications. The novel technique of combining ORC/collagen/silver dressing and NPWT provides a useful option in the armamentarium of a reconstructive surgeon dealing with difficult complex lower‐extremity wounds.
Characterization, tissue distribution of resistin gene and the effect of fasting and refeeding on resistinmRNA expression in Siberian sturgeon (Acipenser baerii)
Authors: Tang Ni , Liu Yanlin , Tian Zhengzhi , Xu Shaoqi , Wang Mei , Chen Hu , Wang Bin , Li Ya , Wang Yan , Yang Song , Zhao Liulan , Chen Defang , Li Zhiqiong
Published: May 2020

Resistin as an adipokine identified from rodents in 2001 is involved in many biological processes. However, little is known about this gene in fish. We cloned Siberian sturgeon (Acipenser baerii) resistin cDNA of 795 base pairs, encoding 107 amino acids, which showed 38–40% identity to human and rodents. Real‐time quantitative PCR showed that the resistin gene was widely distributed in tissues of Siberian sturgeon, with the highest expression in liver. After fasting for 1, 3, 6 and 10 days, the expression of the resistin gene in the liver of Siberian sturgeon decreased significantly, and after refeeding on the 10 days of fasting the resistin mRNA expression increased rapidly, suggesting that resistin may play an important role in liver in response to starvation. Taken together, these results suggest that resistin may be involved in the regulation of energy homeostasis in liver.
Trophic ecology and ontogenetic diet shift of the blue skate (Dipturus cf. flossada)
Authors: Brown‐Vuillemin Sarah , Barreau Thomas , Caraguel Jean‐Marie , Iglésias Samuel P.
Published: May 2020

Knowledge of skate ecology must be improved to ensure their effective protection. This study represents the first description of diet composition for one of the largest European rajid, the blue skate Dipturus cf. flossada. A total of 346 specimens collected in the Celtic Sea from 2012 to 2015 were analysed for their gut content, with respect to individual total length, maturity stage and sex. Overall, the blue skate diet mainly consisted of shrimps and prawns, crabs and teleost fishes. Nonmetric multidimensional scaling and ANOSIM analyses revealed major ontogenetic shifts in the feeding strategy that were related to size and maturity, but not to sex. Shrimps and prawns, mostly composed of Crangon allmanni, dominated the diet of small and immature individuals, while mod‐size skate primarily preyed on crabs. The prevalence of crustaceans decreased with size and maturity, and was gradually replaced by teleost fishes in large mature individuals. A concomitant increase of the trophic level with size revealed that large blue skate become a top predator within the ecosystem. These results highlight the need to include ontogenetic changes in the diet description. As individuals grow and mature, blue skates can play a fundamental role in the structure of the Celtic Sea food web.
Short‐term captivity drives hypothalamic plasticity and asymmetry in wild‐caught northern red bellied dace (Chrosomus eos)
Authors: Joyce Brendan J. , Brown Grant E.
Published: May 2020

Teleost fish are neuroplastic and are known to alter their brain morphology and behaviour in response to environmental change such as an increase in predation pressure. The hypothalamus plays a key role in regulating behavioural responses to predation risk. In this study, wild‐caught northern red bellied dace (Chrosomus eos) developed smaller and less symmetric hypothalami when held in captivity for 14 days; both measures correlated with boldness in a latency to emerge test. This study's results highlight the potential impact of short‐term holding conditions on brains and behaviour.
Developmental ecomorphology of the epibranchial organ of the silver carp, Hypophthalmichthys molitrix
Authors: Cohen Karly E. , George Amy E. , Chapman Duane C. , Chick John H. , Hernandez L. Patricia
Published: May 2020

Silver carp regularly consume and digest particles of food as small as 5 μm. This ability drives their efficient consumption of phytoplankton and because they feed low on the food chain they have an important place in aquaculture worldwide. In North America, where they are considered invasive, silver carp deplete food resources for native species and in so doing occupy increased niche space. Here, we determine the ontogenetic stage and size at which silver carp are morphologically capable of primarily feeding on particles <10 μm. Ecological studies on this species have shown that there is an ontogenetic shift in diet as predominantly zooplanktivorous juveniles later switch to eating much smaller phytoplankton. The occupation of this new trophic niche presents both a metabolic and a mechanical challenge to these fish, since it is unclear how they can efficiently feed on such small particles. We hypothesize that the epibranchial organ (EBO) in silver carp is essential in aggregating these small particles of food, allowing the species to consume mass quantities of tiny particles, thus mitigating metabolic constraints. In this study, we investigate early ontogeny of the EBO in silver carp to determine when this structure achieves the requisite morphology to become functional. We find that at around 80 mm standard length (SL) the EBOs are consistently filled with food, demonstrating that this accumulating organ has become functional. This size corresponds with previous ecological data documenting important shifts in the type of food consumed. While the basic bauplan of the EBO is established very early in ontogeny (by 15 mm SL), multiple waves of histological maturation of muscle, cartilage, gill rakers and epithelium ultimately form the functional structure.
Effects of biological traits on capture‐induced parturition in a freshwater stingray and perspectives for species management
Authors: de Sousa Rangel Bianca , de Castro Ribeiro Douglas , Chagas Jumma M. A. , Spada Lucas , Moreira Renata G. , da Silva Ribeiro Cristiéle
Published: May 2020

Elasmobranchs are particularly vulnerable to overexploitation and population depletion, especially due to their life‐history traits, such as low reproductive output and slow growth. Given that capture‐induced parturition (abortion or premature birth) is a common consequence of fisheries in elasmobranchs, but still little studied, we investigated how the abortion/premature birth process varies in response to reproductive traits in a freshwater stingray, Potamotrygon amandae. Our results revealed that capture‐induced parturition was affected by reproductive traits, such as litter size (one to seven) and gestation stage. The event occurred faster in pregnant females with high litter size during late pregnancy. Also, as found in other elasmobranchs, litter size was positively correlated with maternal size. These findings indicate that larger pregnant females in late pregnancy are more vulnerable to capture‐induced parturition. This study improves our understanding of the capture‐induced parturition process in stingrays, and provides useful information for management strategies and future recommendations for elasmobranch conservation.
650 usec 1064nm Nd:YAG laser treatment of acne: A double‐blind randomized control study
Authors: Kesty Katarina , Goldberg David J.
Published: May 2020

Background

A variety of energy‐based devices have been used to treat acne. However, all studies have been subjective and have not involved double‐blind and randomized controlled studies.

Aims

We undertook a randomized controlled study evaluating the use of a 650 usec 1064 nm Nd:YAG laser compared with a sham in the treatment of acne.

Patients/Methods

A total of 20 subjects with moderate‐to‐severe acne were randomized to receive either 650 usec 1064nm Nd:YAG laser or sham treatment. All subjects received 3 treatments, two weeks apart, plus an additional session undertaken 4 weeks after the 3rd treatment. Subjects were evaluated for investigator global improvement, improvement in inflammatory lesions, improvement in comedonal lesions, total porphyrin score, and total sebum score.

Results

The laser‐treated group showed an Investigator's Global Assessment Scale (IGA) improvement of 26% compared with 7% for the sham group (a 271% improvement over sham treatment group). The treatment group also showed a decrease in the number of inflammatory lesions of 42% compared with 26% in the sham group (a 62% improvement over sham). The laser‐treated cohort also experienced a reduction in total number of comedones similar to that seen with inflammatory lesions and a decrease in total porphyrin score. There was also an 18% reduction in sebum production in the treated group, compared with 9% in the sham group (a 100% improvement).

Conclusion

This is the first study that has compared laser treatment of acne compared with a sham treatment. A 650 usec 1064nm Nd:YAG laser can effectively treat acne.
Alternative mental health clinical placements: Knowledge transfer and benefits for nursing practice outside mental healthcare settings
Authors: Goman Caitlin , Patterson Christopher , Moxham Lorna , Harada Theresa , Tapsell Amy
Published: May 2020

Aim and objectives

To explore whether nursing student's experiences at Recovery Camp have impacted their current nursing practices.

Background

Recently, there has been a move towards more holistic models of nursing care, which seek to break down barriers of stigmatisation and embrace the tenets of self‐determination, to acknowledge people with lived experiences of mental illness and their ability to manage their recovery. In that regard, future health professionals such as nursing students will need to be educated in a manner that recognises the importance of lived experience. In this paper, we propose that Recovery Camp, an alternative clinical placement setting model, enhances clinical practice in multiple domains and is beneficial for both nursing practitioners and people with lived experiences of mental illness, as well as offering an effective nontraditional alternative to conventional clinical placement opportunities.

Methods

This study employed a phenomenological research design, involving individual semi‐structured telephone interviews. The Standards for Reporting Qualitative Research (SRQR) checklist was adhered to.

Results

Three main themes were identified from the analysis: (a) engagement, (b) understanding mental health and (c) holistic care. “I definitely look at people with mental health conditions in a different light.” At Recovery Camp, participants felt that they had greater opportunities for engagement with people with lived experiences, and through this engagement, their preconceptions of mental illness began to change.

Conclusions

Recovery Camp may have facilitated the transfer of knowledge that is more person‐centred among nursing students, consequently impacting their current nursing practices.

Relevance to clinical practice

Nurses should be equipped with mental health skills regardless of their career trajectory. While Recovery Camp represents a promising approach to facilitate knowledge transfer, further investigation will be required to determine which other factors are instrumental. This approach may have wider implications for nursing education.
Work‐related stress among health professionals in Swiss acute care and rehabilitation hospitals—A cross‐sectional study
Authors: Peter Karin Anne , Hahn Sabine , Schols Jos M. G. A. , Halfens Ruud J. G.
Published: May 2020

Aims and objectives

This study aimed to identify significant work stressors associated with stress symptoms, job satisfaction, intention to leave and health‐related outcomes among health professionals.

Background

The workforce shortage of health professionals is a current concern, and a reduction of work‐related stress is thus essential for retaining health professionals. Studies on the extent of work‐related stress in different health professions are limited.

Methods

The research was conducted with a cross‐sectional study encompassing 26 randomly selected acute care and rehabilitation hospitals. The sample consisted of 3,398 health professionals. The study was undertaken in accordance with the STROBE checklist for observational studies.

Results

Work–private life conflicts were significantly associated with health professionals' stress symptoms, job satisfaction, intention to leave the organisation and profession, their general health status, burnout symptoms and quality of sleep. Also, opportunities for development and the behaviour of the direct line manager (e.g. quality of leadership, unfair behaviour, rewards given) along with various profession‐specific stressors were the important predictors revealed.

Conclusions

This study shows the high relevance of preventing and reducing work–private life conflicts, enhancing leadership qualities as well as opportunities for development among health professionals working in acute care and rehabilitation hospitals. Also, differences between health professions should be taken into consideration in developing strategies for reducing stress at work.

Relevance to clinical practice

The results of this study are particularly relevant for health professional leaders and reveal the urgent need in hospital practice for effective strategies to improve health professionals' work–private life balance, opportunities for development and quality of leadership.
Comparative evaluations of single‐item pain‐intensity measures in cancer patients: Numeric rating scale vs. verbal rating scale
Authors: Kim Hee‐Ju , Jung Sun‐Ok
Published: May 2020

Aims and Objectives

To evaluate the psychometric quality of two single‐item pain‐intensity measures: the Numeric Rating Scale (NRS) and the Verbal Rating Scale (VRS).

Background

Measuring pain intensity is a vital step in initiating symptom management and evaluating the effectiveness of interventions with cancer patients. Single‐item pain‐intensity measures of the NRS and VRS format have been evaluated to be acceptable for use in clinical practice and research; however, evidence to choose one over the other, as a standardised pain‐assessment format, is insufficient.

Design

Descriptive correlational study. The study was guided and reported following the STROBE guideline.

Methods

Data accrued at two time points during cancer treatment with a total of 249 patients treated in a Korean University Hospital. Two single‐item measures were constructed to assess pain intensity over 1 week. The Brief Pain Inventory (BPI; pain intensity subscale and interference subscale) and the functional assessment of chronic illness therapy‐fatigue were the criterion. Convergent and concurrent validity were tested with Pearson's correlations.

Results

In the convergent‐validity evaluation of the cross‐sectional association with the BPI, the NRS showed a much higher level of association than the VRS (0.81 versus 0.61). In convergent validity with a longitudinal association with the BPI, the NRS score change had a much higher level of association (0.61 versus 0.37). In concurrent‐validity evaluation, the NRS and VRS showed similar levels of associations with fatigue (−0.48 versus −0.49). Yet, the NRS showed statistically higher levels of correlation with functional limitations than the VRS (0.55 versus 0.42), comparable to the concurrent validity of the BPI.

Conclusion

The NRS showed higher validity than VRS when assessing overall pain intensity over the past week.

Relevance to Clinical Nursing

Pain assessment is a vital role of nurses in caring for patients with cancer. Current study findings support the use of the single‐item NRS pain measure to assess global pain intensity over the past week.
Brain MRI Diffusion Encoding Direction Number Affects Tract‐Based Spatial Statistics Results in Multiple Sclerosis
Authors: Kincses Bálint , Spisák Tamás , Faragó Péter , Király András , Szabó Nikoletta , Veréb Dániel , Kocsis Krisztián , Bozsik Bence , Tóth Eszter , Vécsei László , Kincses Zsigmond Tamás
Published: May 2020

BACKGROUND AND PURPOSE

Diffusion tensor imaging (DTI) is a promising approach to detect the underlying brain pathology. These alterations can be seen in several diseases such as multiple sclerosis. Tract‐based spatial statistics (TBSS) is an easy to use and robust way for analyzing diffusion data. The effect of acquisition parameters of DTI on TBSS has not been evaluated, especially the number of diffusion encoding directions (NDED), which is directly proportional with scan time.

METHODS

We analyzed a large set of DTI data of healthy controls (N = 126) and multiple sclerosis patients (N = 78). The highest NDED (60 directions) was reduced and a tensor calculation was done separately for every subset. We calculated the mean and standard deviation of DTI parameters under the white matter mask. Moreover, the FMRIB Software Library TBSS pipeline was used on DTI images with 15, 30, 45, and 60 directions to compare differences between groups. Mean DTI parameters were compared between groups as a function of NDED.

RESULTS

The mean value of FA and AD decreased with increasing number of directions. This was more pronounced in areas with smaller FA values. RD and MD were constant. The skeleton size reduced with elevating NDED along with the number of significant voxels. The TBSS analysis showed significant differences between groups throughout the majority of the skeleton and the group difference was associated with NDED.

CONCLUSION

Our results suggested that results of TBSS depended on the NDED, which should be considered when comparing DTI data with varying protocols.
Nursing students' perspectives on the inclusion of course content on lesbian, gay, bisexual, and transgender health in the nursing curriculum: A descriptive qualitative study
Authors: Ercan‐Şahin Nilay , Aslan Funda
Published: May 2020

The aim of the study was to examine nursing students' perspectives on why and how course contents on lesbian, gay, bisexual, and transgender health should be included in the nursing curriculum. This was a descriptive qualitative study. A purposive sample was used, and 17 students participated. Thematic analyses revealed four themes: “The need for knowledge and awareness”; “Communication”; “The need for practice‐based learning”; and “Inclusion of course contents on lesbian, gay, bisexual and transgender health in the nursing curriculum”. Almost all the students reported that the proportion of the course content that had been allocated to lesbian, gay, bisexual, and transgender health was inadequate and emphasized that it is necessary to improve both the theoretical and practical components of the nursing curriculum.
Effect of the occupational environment of parents on cryptorchidism
Authors: Mitsui Takahiko , Araki Atsuko , Miyashita Chihiro , Ito Sachiko , Kitta Takeya , Moriya Kimihiko , Shinohara Nobuo , Takeda Masayuki , Kishi Reiko ,   Japan Environment and Children’s Study Group*
Published: May 2020

Background

The early detection and treatment of cryptorchidism are necessary to preserve male fertility. This study aimed to assess the effect of parents’ occupational environment on the incidence of cryptorchidism in their sons.

Methods

The study enrolled 51 316 newborn males, whose mothers were recruited in the Japan Environment and Children’s Study. We analyzed cryptorchidism incidence in male newborns according to 14 categories of occupation of their parents. We also analyzed the effect of the mother’s occupational environment during gestation, including working and night‐shift work, on cryptorchidism incidence. Information on occupations was obtained from self‐administered questionnaires. Cryptorchidism was identified through a survey at birth or 1 month after birth using medical records.

Results

Cryptorchidism was identified in 305 male infants (0.59%) at birth or 1 month after birth. Weight, height, head circumference, and chest circumference at birth were significantly lower in male infants with cryptorchidism than in those without the condition. Gestational age was also shorter in mothers whose infants developed cryptorchidism. Moreover, maternal age at delivery and smoking during gestation also had an effect on cryptorchidism incidence. However, multivariate analysis of the 14 categories of occupation of parents during gestation showed no significant effect on cryptorchidism incidence in their male infants.

Conclusions

This study revealed that the work environment of parents did not significantly affect the incidence of cryptorchidism in their sons. However, this study might have underestimated mild and transient cases of cryptorchidism. Further studies are necessary to investigate the risk factors of cryptorchidism in relation to parents’ occupation.
First pediatric organ donation after circulatory determination of death in Singapore: Facing challenges in the absence of a local practice guideline
Authors: Thong Wen Yi , Chong Poh Heng , Koh Pei Lin , Loh Will Ne‐Hooi , Tay Stacey Kiat‐Hong
Published: May 2020

Pediatric organ donation represents only a low proportion of overall organ donation in many parts of world, unable to match the needs for pediatric organ transplantation. Pediatric organ donation after circulatory determination of death (DCD) is increasingly explored in pediatric transplantation, as it increases the availability of organ grafts. A 6‐year‐old Caucasian boy with a history of arteriovenous malformation presented with a catastrophic intracranial bleed, resulting in severe brainstem dysfunction despite maximal medical and surgical measures. He did not fulfill the criteria for brain death, which must be met for pediatric organ donation in Singapore. Due to parental request, his organs were donated after withdrawal of life support and determination of death by circulatory criteria. Pediatric organ DCD poses many challenges in the pediatric population, especially in the absence of a local practice guideline. We present the first case of a pediatric organ DCD that has occurred in Singapore. Further work is needed, particularly in establishing a national policy for pediatric organ DCD and increasing overall awareness and acceptance toward pediatric organ donations.
A novel null allele, HLA‐DPA1*01:35N in a European American Male from Pennsylvania, USA
Authors: Fisher Carolyn , Casey Heather , Kumer Lorie , Tyler Jennifer , Shike Hiroko
Published: May 2020

A non‐sense mutation in either DPA1*01:03:01:02 or DPA1*01:03:01:05/01:03:01:15 results in the novel allele, HLA‐DPA1*01:35N.
Massive transfusion protocols in paediatric trauma population: A systematic review
Authors: Kinslow Kyle , McKenney Mark , Boneva Dessy , Elkbuli Adel
Published: May 2020

Background

Our main objective was to review the literature to answer the following questions regarding paediatric massive transfusion (PMT) protocols: (a) How is PMT defined?; (b) Which blood product ratios have been investigated, and what is their effect on outcomes?; and (c) What evidence exists regarding PMT outcomes?

Methods

The PRISMA guidelines were used. We searched PubMed, Google Scholar, Cochrane Library, EMBASE, Wiley Online Library and Ovid. Articles were screened for inclusion based on relevance to PMT. Articles were assessed for study design, presence of established/tested PMT, PMT definition, PMT activation criteria and Transfusion Ratios for the final determination of article inclusion.

Results

Our search produced 3213 articles, with 33 included for final review. Existing definitions of PMT are based on volume administered/kg but vary in timeframe criteria (over 4 hours vs 24 hours). Some studies have investigated “high” balanced transfusion ratios as seen in adults (1:1 FFP:pRBC), with a few showing statistically significant improvement in paediatric mortality vs lower ratios. PMT protocol implementation has not been shown to consistently reduce paediatric trauma mortality across multiple centres. However, other operational aspects, such as reduced time to first transfusion, are apparent benefits.

Conclusions

There is poor consensus over the definition of PMT. Definitions that involve early recognition have the most promise for practice and future studies. Evidence supporting an optimal blood product ratio in PMT is also lacking but trends towards supporting balanced approaches. Implementation of PMT protocols has been limited in showing significant improvement of overall paediatric trauma mortality but may reduce associated morbidity.
Association of vitamin B12deficiency in people with type 2 diabetes on metformin and without metformin: a multicenter study, Karachi, Pakistan
Authors: Miyan Zahid , Waris Nazish
Published: May 2020

Objective

To assess the prevalence of vitamin B12deficiency in people with type 2 diabetes mellitus (T2DM) on metformin and without metformin.

Methodology

Between May 2018 and January 2019, this prospective multicenter observational study recruited participants from seven centers in four provinces of Pakistan (Sindh, Punjab, Baluchistan and Khyber Pakhtunkhwa). Participants with T2DM treated with metformin for >2 years and those not on metformin underwent assessment of hemoglobin, vitamin B12, homocysteine and diabetic neuropathy (vibration perception threshold (VPT) >15V) and painful diabetic neuropathy (Douleur Neuropathique 4 (DN4) ≥4) and Diabetic Neuropathy Symptom (DNS) score ≥1.

Results

Of 932 subjects, 645 (69.2%) were treated with metformin, while 287 (30.8%) were not on metformin. Overall, B12deficiency (<200 pg/mL) was significantly higher in metformin users of 25 (3.9%), compared with non-metformin users of 6 (2.1%), while B12insufficiency (200–300 pg/mL) was significantly lower in metformin users of 117 (18.4%) compared with non-metformin users of 80 (27.9%). Subjects with B12deficiency and insufficiency with hyperhomocysteinemia (≥15) were found in 19 (76%) µmol/L and 69 (60.5%) µmol/L in metformin users compared with 6 (100%) µmol/L and 57 (73.1%) μmol/L in non-metformin users, respectively. VPT>25 and DN4 score ≥4 were significantly higher in B12-deficient metformin users compared with non-metformin users. Similarly, DNS score ≥1 was non-significantly higher in B12-deficient metformin users compared with non-metformin users.

Conclusion

This study shows that vitamin B12insufficiency was frequently found in our population and may progress into B12deficiency. It is also associated with neuropathy in subjects on metformin. Further interventional studies to assess the benefit of B12treatment on painful neuropathy in patients on metformin may be warranted. B12levels may be checked in people with T2DM using metformin for >2 years.
Risk factors for genital infections in people initiating SGLT2 inhibitors and their impact on discontinuation
Authors: McGovern Andrew P , Hogg Michael , Shields Beverley M , Sattar Naveed A , Holman Rury R , Pearson Ewan R , Hattersley Andrew T , Jones Angus G , Dennis John M
Published: May 2020

Introduction

To identify risk factors, absolute risk, and impact on treatment discontinuation of genital infections with sodium-glucose co-transporter-2 inhibitors (SGLT2i).

Research design and methods

We assessed the relationship between baseline characteristics and genital infection in 21 004 people with type 2 diabetes initiating SGLT2i and 55 471 controls initiating dipeptidyl peptidase-4 inhibitors (DPP4i) in a UK primary care database. We assessed absolute risk of infection in those with key risk factors and the association between early genital infection and treatment discontinuation.

Results

Genital infection was substantially more common in those treated with SGLT2i (8.1% within 1 year) than DPP4i (1.8%). Key predictors of infection with SGLT2i were female sex (HR 3.64; 95% CI 3.23 to 4.11) and history of genital infection; <1 year before initiation (HR 4.38; 3.73 to 5.13), 1–5 years (HR 3.04; 2.64 to 3.51), and >5 years (HR 1.79; 1.55 to 2.07). Baseline HbA1c was not associated with infection risk for SGLT2i, in contrast to DPP4i where risk increased with higher HbA1c. One-year absolute risk of genital infection with SGLT2i was highest for those with a history of prior infection (females 23.7%, males 12.1%), compared with those without (females 10.8%, males 2.7%). Early genital infection was associated with a similar discontinuation risk for SGLT2i (HR 1.48; 1.21–1.80) and DPP4i (HR 1.58; 1.21–2.07).

Conclusions

Female sex and history of prior infection are simple features that can identify subgroups at greatly increased risk of genital infections with SGLT2i therapy. These data can be used to risk-stratify patients. High HbA1c is not a risk factor for genital infections with SGLT2i.
10-Valent pneumococcal non-typeable H. influenzae protein D conjugate vaccine (PHiD-CV10) versus 13-valent pneumococcal conjugate vaccine (PCV13) as a booster dose to broaden and strengthen protection from otitis media (PREVIX_BOOST) in Australian Aboriginal children: study protocol for a randomised controlled trial
Authors: Oguoma Victor M , Wilson Nicole , Mulholland Kim , Santosham Mathuram , Torzillo Paul , McIntyre Peter , Smith-Vaughan Heidi , Balloch Anne , Chatfield Mark , Lehmann Deborah , Binks Michael J , Chang Anne , Carapetis Jonathan , Krause Vicki , Andrews Ross , Snelling Tom , Licciardi Paul , Morris Peter , Leach Amanda Jane
Published: May 2020

Introduction

Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) are major otitis media pathogens that densely co-colonise the nasopharynx and infect the middle ear of Australian Aboriginal infants from very early in life. Our co-primary hypotheses are that at 18 months of age infants receiving 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) compared with those receiving 13-valent pneumococcal conjugate vaccine (PCV13) as a booster at 12 months of age will have higher antibody levels to Haemophilus influenzae protein D and that infants receiving PCV13 will have higher antibody levels to PCV13-only serotypes 3, 6A and 19A.

Methods and analyses

Our randomised controlled trial will enrol 270 Aboriginal children at 12 months of age to a booster dose of either PHiD-CV10 or PCV13. Children who completed the three-dose primary course schedules of PHiD-CV10 at 2, 4, 6 months of age; PCV13 at 2, 4, 6 months of age; or a combination schedule of PHiD-CV10 at 1, 2, 4 months of age plus PCV13 at 6 months of age are eligible. The co-primary assessor-blinded outcomes when the infants are 18 months of age are as follows: (a) IgG geometric mean concentration (GMC) and proportion with IgG ≥100 EU/mL for protein D, and (b) IgG GMC and the proportion with IgG ≥0.35 µg/mL for pneumococcal serotypes 3, 6A and 19A. Secondary immunogenicity comparisons of six primary and booster dose schedules of 10 shared serotypes at 18 months of age, nasopharyngeal carriage, all forms of otitis media, hearing loss and developmental milestones at 18, 24, 30 and 36 months of age will be reported.

Ethics and dissemination

Ethics committees of NT Department of Health, Menzies, WA Department of Health and WA Aboriginal Health approved the study. Results will be presented to communities, at conferences and published in peer-reviewed journals.

Trial registration number

NCT01735084.
The Copenhagen Primary Care Laboratory Pregnancy (CopPreg) database
Authors: Janbek Janet , Kriegbaum Margit , Grand Mia Klinten , Specht Ina Olmer , Lind Bent Struer , Andersen Christen Lykkegaard , Heitmann Berit Lilienthal
Published: May 2020

Purpose

The Copenhagen Primary Care Laboratory Pregnancy (CopPreg) database was established based on data from The Danish Medical Birth Register and the Copenhagen Primary Care Laboratory (CopLab) database. The aim was to provide a biomedical and epidemiological data resource for research in early disease programming (eg, parental clinical biomarker levels and pregnancy/ birth outcomes or long-term health in the offspring).

Participants

The cohort consisted in total of 203 608 women (with 340 891 pregnancies) who gave birth to 348 248 children and with 200 590 related fathers. In this paper, we focused on women and fathers who had clinical test requisitions prior to and during pregnancy, and on all children. Thus, the cohort in focus consisted of 203 054 pregnancies with requisitions on 147 045 pregnant women, 39 815 fathers with requisitions during periconception and 65 315 children with requisitions.

Findings to date

In addition to information on pregnancy and birth health status and general socio-demographic data, over 2.2 million clinically relevant test results were available for pregnancies with requisitions, over 1.5 million for children and over 600 000 test results were available for the fathers with requisitions during periconception. These were ordered by general practitioners in the primary care setting only and included general blood tests, nutritional biomarkers (macronutrients and micronutrients) and hormone tests. Information on tests related to infections, allergies, heart and lung function and sperm analyses (fathers) were also available.

Future plans

The CopPreg database provides ready to use and valid data from already collected, objectively measured and analysed clinical tests. With several research projects planned, we further invite national and international researchers to use this vast data resource. In a coming paper, we will explore and discuss the indication bias in our cohort.
Hypothetical interventions and risk of myocardial infarction in a general population: application of the parametric g-formula in a longitudinal cohort study—the Tromsø Study
Authors: Wilsgaard Tom , Vangen-Lønne Anne Merete , Mathiesen Ellisiv , Løchen Maja-Lisa , Njølstad Inger , Heiss Gerardo , Danaei Goodarz
Published: May 2020

Objectives

The aim of this study was to use the parametric g-formula to estimate the 19-year risk of myocardial infarction (MI) under hypothetical interventions on six cardiovascular risk factors.

Design and setting

A populations-based cohort study with repeated measurements, the Tromsø Study.

Primary outcome measure

Myocardial infarction.

Participants

We estimated the relative and absolute risk reduction under feasible and intensive risk reduction strategies for smoking, physical activity, alcohol drinking, body mass index, total serum cholesterol and systolic blood pressure in 14 965 men and women with 19 years of follow-up (1994–2013).

Results

The estimated 19-year risk of MI under no intervention was 7.5% in individuals with baseline mean age 49.3 years (range 25–69). This risk was reduced by 30% (95% CI 19% to 39%) under joint feasible interventions on all risk factors, and 70% (60%, 78%) under a set of more intensive interventions. The most effective interventions were lowering of total cholesterol to 5.18 mmol/L and lowering of systolic blood pressure to 120 mm Hg (33% and 37% lower MI risk, respectively). The absolute risk reductions were significantly larger in men, in older participants, in smokers and in those with low education.

Conclusion

Modification of population levels of cardiovascular risk factors could have prevented close to one-third of the cases of MI in the municipality of Tromsø during 19 years of follow-up.
Study protocol for the antidepressant advisor (ADeSS): a decision support system for antidepressant treatment for depression in UK primary care: a feasibility study
Authors: Harrison Phillippa , Carr Ewan , Goldsmith Kimberley , Young Allan H , Ashworth Mark , Fennema Diede , Barrett Barbara , Zahn Roland
Published: May 2020

Introduction

The Antidepressant Advisor Study is a feasibility trial of a computerised decision-support tool which uses an algorithm to provide antidepressant treatment guidance for general practitioners (GPs) in the UK primary care service. The tool is the first in the UK to implement national guidelines on antidepressant treatment guidance into a computerised decision-support tool.

Methods and analysis

The study is a parallel group, cluster-randomised controlled feasibility trial where participants are blind to treatment allocation. GPs were assigned to two treatment arms: (1) treatment-as-usual (TAU) and (2) computerised decision-support tool to assist with antidepressant choices. The study will assess recruitment and lost to follow-up rates, GP satisfaction with the tool and impact on health service use. A meaningful long-term roll-out unit cost will be calculated for the tool, and service use data will be collected at baseline and follow-up to inform a full economic evaluation of a future trial.

Ethics and dissemination

The study has received National Health Service ethical approval from the London—Camberwell St Giles Research Ethics Committee (ref: 17/LO/2074). The trial was pre-registered in the Clinical Trials.gov registry. The results of the study will be published in a pre-publication archive within 1 year of completion of the last follow-up assessment.

Trial registration number

NCT03628027.
Canadian clinical practice guidelines for the use of plant-based cannabis and cannabinoid-based products in the management of chronic non-cancer pain and co-occurring conditions: protocol for a systematic literature review
Authors: Wright Patrick , Walsh Zach , Margolese Shari , Sanchez Tatiana , Arlt Stephanie , Belle-Isle Lynne , St.Pierre Michelle , Bell Alan , Daeninck Paul , Gagnon Marilou , Lacasse Gary , MacCallum Caroline , Mandarino Enrico , Yale Janet , O'Hara James , Costiniuk Cecilia
Published: May 2020

Introduction

Chronic pain and co-occurring disorders, such as sleep disorders, anxiety, depression, post-traumatic stress disorder and substance use disorders, are among the most common conditions for which cannabis and cannabinoid-based products derived from the cannabis plant (CBP) are used for therapeutic purposes. However, healthcare providers report that they lack sufficient information on the risks, benefits and appropriate use of cannabis and CBP derived from the cannabis plant for therapeutic purposes.

Methods and analysis

We will conduct a systematic review of studies investigating the use of cannabis and CBP derived from the cannabis plant for the treatment of chronic pain and co-occurring conditions. Randomised controlled trials, meta-analyses and observational studies will be prioritised. We will exclude reviews of cannabinoid mechanisms of actions, commentary articles and narrative reviews. The primary outcome of interest will be efficacy in relieving chronic pain. Secondary outcomes will be efficacy in ameliorating conditions such as sleep disorders, anxiety, depression, post-traumatic stress disorder and substance use disorders. We will search electronic bibliographic databases including Academic Search Complete, Cochrane Database of Systematic Reviews, Evidence based Medicine Reviewes, OVID Medline, PsychINFO, PubMed, CINAHL and Web of Science. Two reviewers will conduct screening and data collection independently. Study level of bias will be assessed using the Cochrane Risk of Bias Assessment Tool for randomised controlled trials and non-randomised studies. Narrative analysis will be utilised to interpret the data.

Ethics and dissemination

The results of this systematic review will inform guideline development for the use of cannabis and CBP derived from the cannabis plant in the management of chronic pain and co-occurring conditions. Areas requiring further study will also be highlighted.

PROSPERO registration number

CRD42020135886.