bluuebunny/crossref_metadata_2025 huggingface dataset:
Synergistic Efficacy of β-Lactam Combinations against
Mycobacterium abscessus
Pulmonary Infection in Mice
Authors: Story-Roller Elizabeth , Maggioncalda Emily C. , Lamichhane Gyanu
Published: May 2019

Mycobacterium abscessus
is an emerging pathogen capable of causing invasive pulmonary infections in patients with chronic lung diseases. These infections are difficult to treat, necessitating prolonged multidrug therapy, which is further complicated by extensive intrinsic and acquired resistance exhibited by clinical
M. abscessus
isolates.
Essential Role for the Phosphatidylinositol 3,5-Bisphosphate Synthesis Complex in Caspofungin Tolerance and Virulence in
Candida glabrata
Authors: Choudhary Deepak Kumar , Bhakt Priyanka , Kaur Rupinder
Published: May 2019

Increasing resistance of the human opportunistic fungal pathogen
Candida glabrata
toward the echinocandin antifungals, which target the cell wall, is a matter of grave clinical concern. Echinocandin resistance in
C. glabrata
has primarily been associated with mutations in the β-glucan synthase-encoding genes
C. glabrata
FKS1
(
CgFKS1
) and
CgFKS2
. This notwithstanding, the role of the phosphoinositide signaling in antifungal resistance is just beginning to be deciphered.
Coordination of the Cell Wall Integrity and High-Osmolarity Glycerol Pathways in Response to Ethanol Stress in Saccharomyces cerevisiae
Authors: Udom Nisarut , Chansongkrow Pakkanan , Charoensawan Varodom , Auesukaree Choowong
Published: May 2019

The budding yeast
Saccharomyces cerevisiae
has been widely used in industrial fermentations, including the production of alcoholic beverages and bioethanol. During fermentation, an increased ethanol concentration is the main stress that affects yeast metabolism and inhibits ethanol production. This work presents evidence that in response to ethanol stress, both CWI and HOG pathways cooperate to control the expression of cell wall-remodeling genes in order to build the adaptive strength of the cell wall. These findings will contribute to a better understanding of the molecular mechanisms underlying adaptive responses and tolerance of yeast to ethanol stress, which is essential for successful engineering of yeast strains for improved ethanol tolerance.
Fluorescence Tools Adapted for Real-Time Monitoring of the Behaviors of
Streptococcus
Species
Authors: Shields R. C. , Kaspar J. R. , Lee K. , Underhill S. A. M. , Burne R. A.
Published: May 2019

Oral streptococci are the most abundant bacteria in the mouth and have a major influence on oral health and disease. In this study, we designed and optimized the expression of fluorescent proteins in
Streptococcus mutans
and other oral streptococci. We monitored the levels of expression and noise (the variability in fluorescence across the population). We then created several fluorescent protein delivery systems (green, yellow, and red) for use in oral streptococci. The data show that we can monitor bacterial growth and interactions
in situ
, differentiating between different bacteria growing in biofilms, the natural state of the organisms in the human mouth. These new tools will allow researchers to study these bacteria in novel ways to create more effective diagnostic and therapeutic tools for ubiquitous infectious diseases.
The Microbial Lipopeptide Paenibacterin Disrupts Desiccation Resistance in Salmonella enterica Serovars Tennessee and Eimsbuettel
Authors: Abdelhamid Ahmed G. , Yousef Ahmed E.
Published: May 2019

Salmonella enterica
adapts effectively and persists for a long time in low-a
w
foods or environments through resistance mechanisms to desiccation stress. Desiccation-resistant cells compromise food safety and constitute a serious health hazard. Strategies to combat desiccation resistance in
S. enterica
are needed to sensitize the pathogen to lethal processes used in food preservation. The study proved that the membrane-active lipopeptide paenibacterin disrupts the resistance in desiccation-adapted
S. enterica
, as measured by phenotypic, biochemical, and genetic analyses. This study highlighted the role of the lipopeptide paenibacterin in disrupting mechanisms employed by
S. enterica
to resist desiccation. This knowledge may lead to the design of novel control measures to improve the safety of low-a
w
foods.
Extended Dosing Regimens for Fungal Prophylaxis
Authors: Lehrnbecher Thomas , Bochennek Konrad , Klingebiel Thomas , Gastine Silke , Hempel Georg , Groll Andreas H.
Published: May 2019

Invasive fungal diseases carry high morbidity and mortality in patients undergoing chemotherapy for hematological malignancies or allogeneic hematopoietic stem cell transplantation. In order to prevent these life-threatening infections, antifungal chemoprophylaxis plays an important role in daily clinical practice.
CD40 in Endothelial Cells Restricts Neural Tissue Invasion by Toxoplasma gondii
Authors: Portillo Jose-Andres C. , Van Grol Jennifer , Saffo Saad , Lopez Corcino Yalitza , Rodriguez Myriam , Fox Barbara A. , Bzik David J. , Ward Nicole L. , Dubyak George R. , Rojas Roxana E. , Toosi Zahra , Subauste Carlos S.
Published: May 2019

Little is known about whether pathogen invasion of neural tissue is affected by immune-based mechanisms in endothelial cells. We examined the effects of endothelial cell CD40 on
Toxoplasma gondii
invasion of the retina and brain, organs seeded hematogenously.
T. gondii
circulates in the bloodstream within infected leukocytes (including monocytes and dendritic cells) and as extracellular tachyzoites.
Stenotrophomonas maltophilia
Differential Gene Expression in Synthetic Cystic Fibrosis Sputum Reveals Shared and Cystic Fibrosis Strain-Specific Responses to the Sputum Environment
Authors: Willsey Graham G. , Eckstrom Korin , LaBauve Annette E. , Hinkel Lauren A. , Schutz Kristin , Meagher Robert J. , LiPuma John J. , Wargo Matthew J.
Published: May 2019

Stenotrophomonas maltophilia
is an important infecting bacterium in the airways of people with cystic fibrosis (CF). However, compared to the other CF pathogens,
S. maltophilia
has been relatively understudied. The significance of our research is to provide insight into the global transcriptomic changes of
S. maltophilia
in response to a medium that was designed to mimic important aspects of the CF lung. This study elucidates the overall metabolic changes that occur when
S. maltophilia
encounters the CF lung and generates a road map of candidate genes to test using
in vitro
and
in vivo
models of CF.
Carbapenem-Nonsusceptible
Pseudomonas aeruginosa
Isolates from Intensive Care Units in the United States: a Potential Role for New β-Lactam Combination Agents
Authors: Asempa Tomefa E. , Nicolau David P. , Kuti Joseph L.
Published: May 2019

Pseudomonas aeruginosa
, a frequent pathogen in the intensive care unit (ICU), has the propensity to develop antibiotic resistance. In particular, carbapenem-nonsusceptible (NS)
P. aeruginosa
poses tremendous challenges, and new antibiotics will be needed to treat this phenotype. Here we determine carbapenem nonsusceptibility rates for contemporary
P. aeruginosa
isolates from U.S. ICUs and
in vitro
activities of new β-lactam combination agents.
GII.13/21 Noroviruses Recognize Glycans with a Terminal β-Galactose via an Unconventional Glycan Binding Site
Authors: Cong Xin , Sun Xiao-man , Qi Jian-xun , Li Han-bo , Chai Wen-gang , Zhang Qing , Wang Hong , Kong Xiang-yu , Song Jiao , Pang Li-li , Jin Miao , Li Dan-di , Tan Ming , Duan Zhao-jun
Published: May 2019

Evidence from both phenotypic binding assay and structural study support the observed interactions of human noroviruses (huNoVs) with histo-blood group antigens (HBGAs) as receptors or attachment factors, affecting their host susceptibility. GII.13 and GII.21 genotypes form a unique genetic lineage that differs from the mainstream GII huNoVs in their unconventional glycan binding site. Unlike the previous findings that GII.13/21 genotypes recognize only Le
a
antigen, we found in this study that they can interact with a group of glycans with a common terminal β-Gal, including Lec, lactose, and mucin core 2. However, this wide glycan binding spectrum in a unique binding mode of the GII.13/21 huNoVs appears not to increase their prevalence, probably due to the existence of decoy glycan receptors in human gastrointestinal tract limiting their infection. Our findings shed light on the host interaction and epidemiology of huNoVs, which would impact the strategy of huNoV control and prevention.
Complete Genome Sequence of the Aerobic Facultative Methanotroph Methylocella tundrae Strain T4
Authors: Kox Martine A. R. , Farhan Ul Haque Muhammad , van Alen Theo A. , Crombie Andrew T. , Jetten Mike S. M. , Op den Camp Huub J. M. , Dedysh Svetlana N. , van Kessel Maartje A. H. J. , Murrell J. Colin
Published: May 2019

Methylocella tundrae
T4
T
is a facultative aerobic methanotroph which was isolated from an acidic tundra wetland and possesses only a soluble methane monooxygenase. The complete genome, which includes two megaplasmids, was sequenced using a combination of Illumina and Nanopore technologies.
Fungiculture in Termites Is Associated with a Mycolytic Gut Bacterial Community
Authors: Hu Haofu , da Costa Rafael Rodrigues , Pilgaard Bo , Schiøtt Morten , Lange Lene , Poulsen Michael
Published: May 2019

Understanding functional capacities of gut microbiomes is important to improve our understanding of symbiotic associations. Here, we use peptide-based functional annotation to show that the gut microbiomes of fungus-farming termites code for a wealth of enzymes that likely target the fungal diet the termites eat. Comparisons to other termites showed that fungus-growing termite guts have relatively more fungal cell wall-degrading enzyme genes, whereas wood-feeding termite gut communities have relatively more plant cell wall-degrading enzyme genes. Across termites with different diets, the dominant biomass-degrading enzymes are predominantly coded for by the most abundant bacterial taxa, suggesting tight links between diet and gut community compositions.
Quality of life of children with tuberous sclerosis complex
Authors: Fong Choong Yi , Ng Kexin , Kong Ann Nie , Ong Lai Choo , Rithauddin Mohamed Ahmad , Thong Meow Keong , Ganesan Vigneswari , Heng Hock Sin , Teh Chee Ming , Yahya Norazni
Published: May 2019

Aim

Evaluation of impaired quality of life (QOL) of Malaysian children with tuberous sclerosis complex (TSC) and its possible risk factors.

Method

Cross-sectional study on 68 parents of Malaysian children aged 2–18 years with TSC. QOL was assessed using proxy-report Paediatric Quality of Life Inventory (PedsQL) V.4.0, and scores compared with those from a previous cohort of healthy children. Parents also completed questionnaires on child behaviour (child behaviour checklist (CBCL)) and parenting stress (parenting stress index-short form). Multiple regression analysis was used to determine sociodemographic, medical, parenting stress and behavioural factors that impacted on QOL.

Results

The mean proxy-report PedsQL V.4.0 total scale score, physical health summary score and psychosocial health summary score of the patients were 60.6 (SD 20.11), 65.9 (SD 28.05) and 57.8 (SD 19.48), respectively. Compared with healthy children, TSC patients had significantly lower mean PedsQL V.4.0 total scale, physical health and psychosocial health summary scores (mean difference (95% CI): 24 (18–29), 20 (12–27) and 26 (21–31) respectively). Lower total scale scores were associated with clinically significant CBCL internalising behaviour scores, age 8–18 years and Chinese ethnicity. Lower psychosocial health summary scale scores were associated with clinically significant CBCL internalising behaviour scores, Chinese ethnicity or >1 antiepileptic drug (AED).

Conclusion

Parents of children with TSC reported lower PedsQL V.4.0 QOL scores in all domains, with psychosocial health most affected. Older children, those with internalising behaviour problems, of Chinese ethnicity or on >1 AED was at higher risk of lower QOL. Clinicians need to be vigilant of QOL needs among children with TSC particularly with these additional risk factors.
Outcome of vein of Galen malformation presenting in the neonatal period
Authors: Malarbi Stephanie , Gunn-Charlton Julia K , Burnett Alice C , Prentice Trisha M , Williams Amy , Mitchell Peter , Wray Alison , Hunt Rod W
Published: May 2019

Objective

Vein of Galenaneurysmal malformation (VGAM) is a rare but important congenital malformation presenting to neonatal intensive care units (NICUs), and with a change from surgical to endovascular management, survival for this condition has improved. However, there is little reported about the medical management decisions of infants with this condition and the associated long-term neurodevelopmental outcomes. We aim to report a single centre experience of both acute treatment and long-term outcomes of VGAM for those infants admitted to our NICU soon after birth.

Design

Retrospective cohort study over a 15-year period from 2001 to 2015 inclusive.

Setting

A quaternary NICU at The Royal Children’s Hospital, Melbourne, Australia.

Participants

24 newborn infants referred for management of VGAM. There were no eligibility criteria set for this study; all presenting infants were included.

Interventions

None.

Main outcomes measures

Clinical neuroimaging data were gathered. Surviving children were formally assessed with a battery of tests administered by a neuropsychologist and occupational therapist/physiotherapist at various ages across early to middle childhood.

Results

Fifteen neonates with VGAM did not survive beyond their NICU admission. 10 of these were not offered endovascular intervention. Of the nine surviving infants, only one had a normal neurodevelopmental outcome.

Conclusions

The mortality of VGAM presenting in the neonatal period was high, and rates of normal neurodevelopmental outcome for survivors were low. These findings contribute to our understanding of which neonates should be treated and highlights the importance of providing clinical neurodevelopmental follow-up to survivors beyond their infant years.
Tear of long head of biceps following cardiopulmonary resuscitation: a rare complication
Authors: Bhattacharya Deepanjan , Patra Pratap , Pilania Rakesh Kumar , Jindal Ankur Kumar
Published: May 2019

Cardiopulmonary resuscitation (CPR) is uncommon in routine practice of a paediatrician and injuries arising out of CPR are extremely rare especially in those involving children. A 41-year-old senior resident of paediatrics performed CPR on a young boy, following which he complained of pain in the left shoulder with restriction of all movements and flexion of the left elbow. MRI of the left shoulder revealed tear of the long head of biceps brachii, soft tissue oedema in left deltoid muscle and mild effusion in left glenohumeral joint with extension into subcapsularis bursa. He was treated conservatively with analgesics, following which there was significant improvement and full recovery of shoulder movements. Injuries to the resuscitator have been rarely reported in literature and mostly limited to adult CPR. We report this case to highlight an unusual complication to resuscitator transpiring from paediatric resuscitation.
Creation of a national infection prevention and control programme in Sierra Leone, 2015
Authors: Kanu Hossinatu , Wilson Kathryn , Sesay-Kamara Nanah , Bennett Sarah , Mehtar Shaheen , Storr Julie , Allegranzi Benedetta , Benya Hassan , Park Benjamin , Kolwaite Amy
Published: May 2019

Prior to the 2014–2016 Ebola epidemic, Sierra Leone’s Ministry of Health and Sanitation had no infection prevention and control programme. High rates of Ebola virus disease transmission in healthcare facilities underscored the need for infection prevention and control in the healthcare system. The Ministry of Health and Sanitation led an effort among international partners to rapidly stand up a national infection prevention and control programme to decrease Ebola transmission in healthcare facilities and strengthen healthcare safety and quality. Leadership and ownership by the Ministry of Health and Sanitation was the catalyst for development of the programme, including the presence of an infection prevention and control champion within the ministry. A national policy and guidelines were drafted and approved to outline organisation and standards for the programme. Infection prevention and control focal persons were identified and embedded at public hospitals to manage implementation. The Ministry of Health and Sanitation and international partners initiated training for new infection prevention and control focal persons and committees. Monitoring systems to track infection prevention and control implementation were also established. This is a novel example of rapid development of a national infection prevention and control programme under challenging conditions. The approach to rapidly develop a national infection prevention and control programme in Sierra Leone may provide useful lessons for other programmes in countries or contexts starting from a low baseline for infection prevention and control.
A methodological survey on reporting of pilot and feasibility trials for physiotherapy interventions: a study protocol
Authors: Scola Luiz Felicio Cadete , Moseley Anne M , Thabane Lehana , Almeida Matheus , Costa Lucíola da Cunha Menezes
Published: May 2019

Introduction

Pilot and feasibility trials aim to test whether a full trial can be conducted or if any procedures must be changed for the full trial. Pilot trials must be reported in a transparent, accurate and complete way. In this report, we present a protocol for a methodological survey with the following aims: (1) to determine the percentage of physiotherapy trial reports which claim to be pilot or feasibility trials that evaluate feasibility, (2) to determine the aspect of feasibility evaluated in the primary objectives of the pilot or feasibility trials, (3) to describe the completeness of reporting of abstracts and full articles of pilot or feasibility trials using the Consolidated Standards of Reporting Trials (CONSORT) extension to randomised pilot and feasibility trials and (4) to investigate factors associated with completeness of reporting of pilot or feasibility trials.

Methods and analysis

Reports of randomised controlled trials indexed in the Physiotherapy Evidence Database (PEDro) that claim to be pilot or feasibility trials and published in 2011–2017 will be included. Two independent reviewers will confirm eligibility and classify the aspect of feasibility being evaluated in the objectives of the included pilot or feasibility trials. Completeness of reporting of both the abstract and the full article will be evaluated using the CONSORT extension to randomised pilot and feasibility trials. The primary analysis will be a descriptive analysis about the reporting quality of abstracts and full texts of pilot and feasibility trials. We will use generalised estimating equation analysis to explore factors associated with completeness of reporting.

Ethics and dissemination

The results of this study will be disseminated by presentation at conferences and will be submitted for publication in a peer-reviewed journal. Ethical approval is not necessary for this study.
Association between homocysteine, vitamin B12, folic acid and erectile dysfunction: a cross-sectional study in China
Authors: Chen Yang , Li Jie , Li Tianyu , Long Jianxiong , Liao Jinling , Wei Gong-Hong , Mo Zengnan , Cheng Jiwen
Published: May 2019

Objectives

Erectile dysfunction (ED) affects up to 53.4% of men aged 30–80 years. In this study, we aimed to examine the association between homocysteine (HCY), vitamin B12(B12), folic acid (FA) and ED.

Design

Cross-sectional study.

Setting

Guangxi, China.

Participants

A total of 1381 participants who completed questionnaires were included, between September 2009 and December 2009.

Measures

ED was evaluated by the International Index of Erectile Function scores. Also, the values of HCY, B12 and FA were acquired. Then, regression and between-group analyses were performed.

Results

No association between FA and ED was found. Significant correlations between HCY and ED were found—the relationships between these two parameters were most notable in men aged over 60 years and in men living alone (bachelors or bachelorhood). B12 levels were higher in men with ED (718.53±234.37 pg/mL vs 688.74±229.68, p=0.015). Using multinomial logistic regression analyses, B12 levels were related to mild ED (multivariate adjusted analysis: OR 1.620, 95% CI 1.141 to 2.300, p=0.007), especially among men aged 40–49 years (OR 2.907, 95% CI 1.402 to 6.026, p=0.004).

Conclusions

We report, for the first time, a relationship between B12 levels and ED. We also found specific cohorts of men for whom the relationship between HCY levels and ED is most prominent. Further studies are required to elucidate the mechanisms underlying these relationships—these may ultimately result in new therapies for ED.
Prevalence of type 2 diabetes mellitus in women of childbearing age in Africa during 2000–2016: a systematic review and meta-analysis
Authors: Chivese Tawanda , Werfalli Mahmoud M , Magodoro Itai , Chinhoyi Rekai Lionel , Kengne A P , Norris Shane A , Levitt Naomi S
Published: May 2019

Objectives

The aim of this research was to estimate the prevalence of type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), in African women of childbearing age.

Study design

Systematic review and meta-analysis of relevant African studies published from January 2000 to December 2016.

Data sources

We searched several databases, including EMBASE, MEDLINE, CINAHL, grey literature and references of included studies.

Setting

Studies carried out in African communities or any population-based studies were included.

Participants

We included studies, carried out in Africa, with non-pregnant women of childbearing age. Studies must have been published between the years 2000 and 2016.

Outcomes

The primary outcome was prevalent T2DM. The secondary outcomes were IFG and IGT.

Data extraction and synthesis

Two reviewers independently extracted data and, using the adapted Hoy risk of bias tool, independently assessed for risk of bias. We used random-effects meta-analysis models to pool prevalence estimates across studies. We used Cochran’s Q statistic and the I2statistic to assess heterogeneity.

Results

A total of 39 studies from 27 countries were included, totaling 52 075 participants, of which 3813 had T2DM. The pooled prevalence of T2DM was 7.2% (95% CI 5.6% to 8.9%) overall and increased with age. The pooled prevalence was 6.0% (95% CI 4.2% to 8.2%) for impaired fasting glycemia while the prevalence of IGT ranged from 0.9% to 37.0% in women aged 15–24 and 45–54 years, respectively. Substantial heterogeneity across studies was not explained by major studies characteristics such as period of publication, rural/urban setting or whether a study was nationally representative or not.

Conclusion

This review highlights the need for interventions to prevent and control diabetes in African women of childbearing age, in view of the significant prevalence of T2DM and prediabetes.

PROSPERO registration number

CRD42015027635
Engaging high-risk groups in early lung cancer diagnosis: a qualitative study of symptom presentation and intervention preferences among the UK’s most deprived communities
Authors: McCutchan Grace , Hiscock Julia , Hood Kerenza , Murchie Peter , Neal Richard D , Newton Gareth , Thomas Sara , Thomas Ann Maria , Brain Kate
Published: May 2019

Objectives

People at high-risk for lung cancer—current/former smokers, aged 40+ years, with serious lung comorbidity (ie, chronic obstructive pulmonary disease) and living in highly deprived areas—are more likely to delay symptom presentation. This qualitative study aimed to understand the influences on early presentation with lung cancer symptoms in high-risk individuals and intervention preferences.

Methods

Semi-structured qualitative interviews with 37 high-risk individuals (without a cancer diagnosis), identified through seven GP practices in socioeconomically deprived areas of England, Scotland and Wales (most deprived 20%). A symptom attribution task was used to explore lung symptom perception and help seeking, developed using Leventhal’s Common Sense Model. Four focus groups with 16 high-risk individuals and 12 local stakeholders (healthcare professionals and community partners) were conducted to explore preferences for an intervention to promote early lung cancer symptom presentation. Data were synthesised using Framework analysis.

Results

Individual and area level indicators of deprivation confirmed that interview participants were highly deprived.Interviews.Preoccupation with managing ‘treatable’ short-term conditions (chest infections), led to avoidance of acting on ‘inevitable and incurable’ long-term conditions (lung cancer). Feeling judged and unworthy of medical help because of their perceived social standing or lifestyle deterred medical help seeking, particularly when difficult life circumstances and traumatic events led to tobacco and alcohol addiction.Focus groups. Participants recommended multifaceted interventions in community venues, with information about lung cancer symptoms and the benefits of early diagnosis, led by a trained and non-judgemental facilitator.

Conclusions

This study was novel in engaging a high-risk population to gain an in-depth understanding of the broader contextual influences on lung cancer symptom presentation. Perceived lack of health service entitlement and complex lives facilitated avoidance of recognising and presenting with lung cancer symptoms. Community-based interventions have the potential to empower disadvantaged populations to seek medical help for lung symptoms.
Designing and psychometric evaluation of Stretching Exercise Influencing Scale (SEIS)
Authors: Delshad Mohammad Hossien , Tavafian Sedigheh Sadat , Kazemnejad Anoshirvan
Published: May 2019

Objective

The lack of reliable and valid tools for assessing the factors that influence stretching exercises (SEs) among Iranian office employees is obvious. This study aimed to design and evaluate psychometric properties of this instrument.

Design

Cross-sectional study of psychometric properties.

Setting

Data were gathered from May to September 2017.

Participants

Participants were 420 office employees who were working in 10 health centres affiliated to the Shahid Beheshti University of Medical Sciences in Tehran, Iran.

Primary outcome measures

The instrument was designed on the basis of the constructs of the health promotion model (HPM) and extant literature. Exploratory factor analysis (EFA), Cronbach’s α and intraclass correlation coefficient (ICC) were employed to check the scale’s psychometric properties.

Results

In total, 420 questionnaires were completed. The mean age of the office employees was 37.1±8.03 years. Among the 86 items, 77 items had significant item-to-total correlations (p<0.05). The results showed good internal consistency and reliability for the whole questionnaire and each domain. EFA results confirmed 53.32% of the total variance of the items yielded in 11 subscales. The ICC was acceptable (0.78, 95% CI 0.70 to 0.88).

Conclusions

The Stretching Exercise Influencing Scale (SEIS) can be a reliable and valid instrument for measuring the factors that influence SEs among office employees.

Trial registration

IRCT20160824295512N1
Risk stratification model for in-hospital death in patients undergoing percutaneous coronary intervention: a nationwide retrospective cohort study in Japan
Authors: Inohara Taku , Kohsaka Shun , Yamaji Kyohei , Ishii Hideki , Amano Tetsuya , Uemura Shiro , Kadota Kazushige , Kumamaru Hiraku , Miyata Hiroaki , Nakamura Masato
Published: May 2019

Objectives

To provide an accurate adjustment for mortality in a benchmark, developing a risk prediction model from its own dataset is mandatory. We aimed to develop and validate a risk model predicting in-hospital mortality in a broad spectrum of Japanese patients after percutaneous coronary intervention (PCI).

Design

A retrospective cohort study was conducted.

Setting

The Japanese-PCI (J-PCI) registry includes a nationally representative retrospective sample of patients who underwent PCI and covers approximately 88% of all PCIs in Japan.

Participants

Overall, 669 181 patients who underwent PCI between January 2014 and December 2016 in 1018 institutes.

Main outcome measures

In-hospital death.

Results

The study population (n=669 181; mean (SD) age, 70.1(11.0) years; women, 24.0%) was divided into two groups: 50% of the sample was used for model derivation (n=334 591), while the remaining 50% was used for model validation (n=334 590). Using the derivation cohort, both ‘full’ and ‘preprocedure’ risk models were developed using logistic regression analysis. Using the validation cohort, the developed risk models were internally validated. The in-hospital mortality rate was 0.7%. The preprocedure model included age, sex, clinical presentation, previous PCI, previous coronary artery bypass grafting, hypertension, dyslipidaemia, smoking, renal dysfunction, dialysis, peripheral vascular disease, previous heart failure and cardiogenic shock. Angiographic information, such as the number of diseased vessel and location of the target lesion, was also included in the full model. Both models performed well in the entire validation cohort (C-indexes: 0.929 and 0.926 for full and preprocedure models, respectively) and among prespecified subgroups with good calibration, although both models underestimated the risk of mortality in high-risk patients with the elective procedure.

Conclusions

These simple models from a nationwide J-PCI registry, which is easily applicable in clinical practice and readily available directly at the patients’ presentation, are valid tools for preprocedural risk stratification of patients undergoing PCI in contemporary Japanese practice.
Health promotion at the workplace setting: a protocol for a systematic review of effectiveness and sustainability of current practice in low-income and middle-income countries
Authors: Wanjau Mary Njeri , Zapata-Diomedi Belen , Veerman Lennert
Published: May 2019

Introduction

Low-income and middle-income countries (LMICs) are experiencing a growing disease burden due to non-communicable diseases (NCDs). Changing behavioural practices, such as diets high in saturated fat, salt and sugar and sedentary lifestyles, have been associated with the increase in NCDs. Health promotion at the workplace setting is considered effective in the fight against NCDs and has been reported to yield numerous benefits. However, there is a need to generate evidence on the effectiveness and sustainability of workplace health promotion practice specific to LMICs. We aim to synthesise the current literature on workplace health promotion in LMICs focusing on interventions effectiveness and sustainability.

Methods and analysis

We will conduct a systematic review of published studies from LMICs up to 31 March 2019. We will search the following databases: EMBASE, MEDLINE, PubMed, Web of Science, Scopus, ProQuest and CINAHL. Two reviewers will independently screen potential articles for inclusion and disagreements will be resolved by consensus. We will appraise the quality and risk of bias of included studies using two tools from the Cochrane handbook for systematic reviews of interventions. We will present a narrative overview and assessment of the body of evidence derived from the comprehensive review of the studies. The reported outcomes will be summarised by study design, duration, intensity/frequency of intervention delivery and by the six-priority health promotion action areas set out in the Ottawa Charter. We will conduct a thematic analysis to identify the focus areas of current interventions. This systematic review protocol has been prepared according to the Preferred Reporting Items for Systematic reviews and Meta- analyses for Protocols 2015 statement.

Ethics and dissemination

This study does not require ethics approval. We will disseminate the results of this review through peer-reviewed publications and conference presentations.

Trial registration number

CRD42018110853.
Development and validation of an emotional picture set of self-injury (EPSI) for borderline personality disorder: protocol for a validation study
Authors: Bachmann Katharina , Schulze Marcel , Sörös Peter , Schmahl Christian , Philipsen Alexandra
Published: May 2019

Introduction

Borderline personality disorder (BPD) is a severe psychiatric disorder that is characterised by major problems in emotion regulation. Affected persons frequently engage in non-suicidal self-injury (NSSI) to regulate emotions. NSSI is associated with high emotionality in patients with BPD and it can be expected that stimuli depicting scenes of NSSI elicit an emotional response indicative of BPD. The present study protocol describes the development and validation of an emotional picture set of self-injury (EPSI) to advance future research on emotion regulation in BPD.

Methods and analysis

The present validation study aims to develop and validate an emotional picture set relevant for BPD. Emotional responses to EPSI as well as to a neutral picture set will be investigated in a sample of 30 patients with BPD compared with 30 matched, healthy controls and to 30 matched depressive controls. Emotional responses will be assessed by heart rate variability, facial expression and Self-Assessment Manikin.

Ethics and dissemination

Ethics approval was obtained by the medical ethics committee of the Carl-von-Ossietzky University of Oldenburg, Germany (registration: 2017–044). The results of the trial will be submitted for publication in a peer-reviewed journal.

Trial registration number

NCT03149926; Pre-results.
Drugs targeting the JAK/STAT pathway for the treatment of immune-mediated inflammatory skin diseases: protocol for a scoping review
Authors: Gómez-García Francisco , Gómez-Arias Pedro Jesús , Hernandez Jorge , Montilla Ana María , Gay-Mimbrera Jesús , Aguilar-Luque Macarena , Viguera-Guerra Isabel , Velez García-Nieto Antonio , Isla-Tejera Beatriz , Ruano Juan
Published: May 2019

Introduction

The Janus kinase and Signal Transducer and Activator of Transcription protein (JAK/STAT) pathway is known to be involved in inflammatory and neoplastic skin diseases, like psoriasis, atopic dermatitis, alopecia areata, vitiligo and melanoma. Improved knowledge of the components of this pathway has allowed the development of drugs, which act by inhibiting the pathway, blocking specific components. This offers new therapeutic opportunities. Although evidence on the use of JAK/STAT blockades in dermatological diseases is growing, none have been approved for use in treating skin diseases. The aim of this study is to develop an a priori protocol to broadly review the available evidence on the use of drugs targeting the JAK/STAT pathway in the treatment of dermatological diseases.

Methods and analysis

For the conduction of the scoping review protocol, we will employ an established scoping review methodology described in the Joanna Briggs Institute manual. This methodology outlines a five-stage approach: (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data and (5) collate, summarise and report the results, with an optional consultation exercise. Finally, we will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews to present the results.

Ethics and dissemination

Since this is a review of the literature, ethics approval is not indicated. We will disseminate the findings from this study in publications in peer-reviewed journals as well as presentations at relevant national and international conferences.
Personalised antiplatelet therapy based on pharmacogenomics in acute ischaemic minor stroke and transient ischaemic attack: study protocol for a randomised controlled trial
Authors: Zhang Xiao-Guang , Zhu Xiao-Qiong , Xue Jie , Li Zhi-Zhang , Jiang Hua-Yu , Hu Liang , Yue Yun-Hua
Published: May 2019

Introduction

Antiplatelet therapy combining aspirin and clopidogrel is considered to be a key intervention for acute ischaemic minor stroke (AIMS) and transient ischaemic attack (TIA). However, the interindividual variability in response to clopidogrel resulting from the polymorphisms in clopidogrel metabolism-related genes has greatly limited its efficacy. To date, there are no reports on individualised antiplatelet therapy for AIMS and TIA based on the genetic testing and clinical features. Therefore, we conduct this randomised controlled trial to validate the hypothesis that the individualised antiplatelet therapy selected on the basis of a combination of genetic information and clinical features would lead to better clinical outcomes compared with the standard care based only on clinical features in patients with AIMS or TIA.

Methods and analysis

This trial will recruit 2382 patients with AIMS or TIA who meet eligibility criteria. Patients are randomly assigned in a 1:1 ratio to pharmacogenetic group and standard group. Both groups receive a loading dose of 300 mg aspirin and 300 mg clopidogrel on day 1, followed by 100 mg aspirin per day on days 2–365. The P2Y12 receptor antagonist is selected by the clinician according to the genetic information and clinical features for pharmacogenetic group and clinical features for the standard group on days 2–21. The primary efficacy endpoint is a new stroke event (ischaemic or haemorrhagic) that happens within 1 year. The secondary efficacy endpoint is analysed as the individual or composite outcomes of the new clinical vascular event (ischaemic stroke, haemorrhagic stroke, myocardial infarction or vascular death). Baseline characteristics and outcomes after treatment will be evaluated.

Ethics and dissemination

This protocol has been approved by the ethics committee of Yangpu Hospital, Tongji University School of Medicine (No. LL-2018-KY-012). We will submit the results of this trial for publication in a peer-reviewed journal.

Trial registration number

ChiCTR1800019911; Pre-results.
EPISYNC study: predictors of patient-ventilator asynchrony in a prospective cohort of patients under invasive mechanical ventilation - study protocol
Authors: Sousa Mayson Laercio de Araujo , Magrans Rudys , Hayashi Fátima K , Blanch Lluis , Kacmarek R M , Ferreira Juliana C
Published: May 2019

Introduction

Patient-ventilator asynchrony is common during the entire period of invasive mechanical ventilation (MV) and is associated with worse clinical outcomes. However, risk factors associated with asynchrony are not completely understood. The main objectives of this study are to estimate the incidence of asynchrony during invasive MV and its association with respiratory mechanics and other baseline patient characteristics.

Methods and analysis

We designed a prospective cohort study of patients admitted to the intensive care unit (ICU) of a university hospital. Inclusion criteria are adult patients under invasive MV initiated for less than 72 hours, and with expectation of remaining under MV for more than 24 hours. Exclusion criteria are high flow bronchopleural fistula, inability to measure respiratory mechanics and previous tracheostomy. Baseline assessment includes clinical characteristics of patients at ICU admission, including severity of illness, reason for initiation of MV, and measurement of static mechanics of the respiratory system. We will capture ventilator waveforms during the entire MV period that will be analysed with dedicated software (Better Care, Barcelona, Spain), which automatically identifies several types of asynchrony and calculates the asynchrony index (AI). We will use a linear regression model to identify risk factors associated with AI. To assess the relationship between survival and AI we will use Kaplan-Meier curves, log rank tests and Cox regression. The calculated sample size is 103 patients. The statistical analysis will be performed by the software R Programming (www.R-project.org) and will be considered statistically significant if the p value is less than 0.05.

Ethics and dissemination

The study was approved by the Ethics Committee of Instituto do Coração, School of Medicine, University of São Paulo, Brazil, and informed consent was waived due to the observational nature of the study. We aim to disseminate the study findings through peer-reviewed publications and national and international conference presentations.

Trial registration number

NCT02687802; Pre-results.
Primary care clinicians’ views of paediatric respiratory infection surveillance information to inform clinical decision-making: a qualitative study
Authors: Anderson Emma C , Kesten Joanna May , Lane Isabel , Hay Alastair D , Moss Timothy , Cabral Christie
Published: May 2019

Aim

To investigate primary care clinicians’ views of a prototype locally relevant, real-time viral surveillance system to assist diagnostic decision-making and antibiotic prescribing for paediatric respiratory tract infections (RTI). Clinicians’ perspectives on the content, anticipated use and impact were explored to inform intervention development.

Background

Children with RTIs are overprescribed antibiotics. Pressures on primary care and diagnostic uncertainty can lead to decisional biases towards prescribing. We hypothesise that real-time paediatric RTI surveillance data could reduce diagnostic uncertainty and help reduce unnecessary antibiotic prescribing.

Methodology

Semistructured one-to-one interviews with 21 clinicians from a range of urban general practitioner surgeries explored the clinical context and views of the prototype system. Transcripts were analysed using thematic analysis.

Results

Though clinicians self-identified as rational (not over)prescribers, cognitive biases influenced antibiotic prescribing decisions. Clinicians sought to avoid ‘anticipated regret’ around not prescribing for a child who then deteriorated. Clinicians were not aware of formal infection surveillance information sources (tending to assume many viruses are around), perceiving the information as novel and potentially useful. Perceptions of surveillance information as presented included: not relevant to decision-making/management; useful to confirm decisions post hoc; and increasing risks of missing sick children. Clinicians expressed wariness of using population-level data to influence individual patient decision-making and expressed preference for threat (high-risk) information identified by surveillance, rather than reassuring information about viral RTIs.

Conclusions

More work is needed to develop a surveillance intervention if it is to beneficially influence decision-making and antibiotic prescribing in primary care. Key challenges for developing interventions are how to address cognitive biases and how to communicate reassuring information to risk-oriented clinicians.
Neighbourhood disparities in the price of the cheapest cigarettes in the USA
Authors: Mills Sarah D , Golden Shelley D , Henriksen Lisa , Kong Amanda Y , Queen Tara L , Ribisl Kurt M
Published: May 2019

Background

There is evidence that the cheapest cigarettes cost even less in neighbourhoods with higher proportions of youth, racial/ethnic minorities and low-income residents. This study examined the relationship between the price of the cheapest cigarette pack and neighbourhood demographics in a representative sample of tobacco retailers in the USA.

Methods

Data collectors recorded the price of the cheapest cigarette pack (regardless of brand) in 2069 retailers in 2015. Multilevel linear modelling examined the relationship between price and store neighbourhood (census tract) characteristics, specifically median household income and percentage of youth, Black, Asian/Pacific Islander and Hispanic residents.

Results

Average price for the cheapest pack was $5.17 (SD=1.73) and it was discounted in 19.7% of stores. The price was $0.04 less for each SD increase in the percentage of youth and $0.22 less in neighbourhoods with the lowest as compared with the highest median household incomes. Excluding excise taxes, the average price was $2.48 (SD=0.85), and associations with neighbourhood demographics were similar.

Conclusion

The cheapest cigarettes cost significantly less in neighbourhoods with a greater percentage of youth and lower median household income. Non-tax mechanisms to increase price, such as minimum price laws and restrictions on discounts/coupons, may increase cheap cigarette prices.
Improving the improvisational pelvic circumferential compression technique for open-book pelvic fractures using a simulation model and a sphygmomanometer
Authors: Rega Paul Patrick , Fink B , Sexton M , Schneiderman J , Kakish E , McKenzie N , Kenney K , Jones C
Published: May 2019

Background

Open-book pelvic fractures are associated with significant mortality. Emergency management may require a commercial pelvic circumferential compression device to reduce the fracture and compress haemorrhaging pelvic vasculature. Standard, commercial, twin-sized bedsheets are acceptable should commercial devices be unavailable. However, obese victims or personnel with insufficient body strength may impede successful reduction.

Objective

To demonstrate the value of an improvisational windlass (intravenous pole) in improving the ability to reduce an open-book pelvic fracture.

Methods

The Institutional Review Board-approved study involved 28 diverse healthcare students and emergency medicine residents. Each participant’s demographic information and physical characteristics were recorded. A METIman was prepared with knee and ankle binding and a sphygmomanometer set at 40 mm Hg placed over the symphysis pubis. Two-person teams were randomly selected to place a bedsheet at greater trochanter level and atop the sphygmomanometer. The bedsheet was secured with maximum effort by the pairs and the pressure recorded. Following this, the pairs inserted an intravenous pole in the knot and torqued the pole to maximum effort and a repeat pressure recorded.

Results

The mean increase in pressure using only the bedsheet was 106.43 mm Hg per team. With bedsheet and intravenous pole, the mean pressure increase was 351.79 mm Hg per team. The difference was statistically significant (independent samples t-test: t = 17.177, p < 0.001, 95% CI (216.65 to 274.07 mm Hg). There was no correlation between pressure increases and the individual physical characteristics of the subjects (r = − 0.183, p = 0.352).

Conclusions

Regardless of personnel’s physical attributes, the addition of an improvisational windlass to a pelvic circumferential compression bedsheet can improve the ability to reduce an open-book fracture, especially in obese victims.
Familial genetic risks: how can we better navigate patient confidentiality and appropriate risk disclosure to relatives?
Authors: Dove Edward S , Chico Vicky , Fay Michael , Laurie Graeme , Lucassen Anneke M , Postan Emily
Published: May 2019

This article investigates a high-profile and ongoing dilemma for healthcare professionals (HCPs), namely whether the existence of a (legal) duty of care to genetic relatives of a patient is a help or a hindrance in deciding what to do in cases where a patient’s genetic information may have relevance to the health of the patient’s family members. The English caseABC v St George’s Healthcare NHS Trust and othersconsidered if a duty of confidentiality owed to the patient and a putative duty of care to the patient’s close relatives could coexist in this context. This article examines whether embracing the concept of coexisting duties could enable HCPs to respect duties in line with their clinical judgement, thereby providing legal support and clarity to professionals to allow them to provide the best possible genetics service to both the patient and their family. We argue that these dual duties, framed as a novel, composite duty to consider the interests of genetic relatives, could allow HCPs to exercise and act on their professional judgements about the relative value of information to family members, without fears of liability for negligence or breach of confidence.