bluuebunny/crossref_metadata_2025 huggingface dataset:
Infrequent intrahepatic cystic neoplasm: dilemmas in diagnosis and management
Authors: Budkule Dattaraj Pradeep , Desai Gunjan Shailesh , Pande Prasad , Kulkarni Dattaprasanna R
Published: May 2019

Biliary mucinous cystic neoplasm (BMCN) is a rare intrahepatic neoplasm comprising approximately 5% of cystic liver lesions. It can cause diagnostic dilemmas with most common differentials being complex hepatic cyst, hydatid cyst and intraductal papillary neoplasm of the bile duct. Affecting middle-aged female population, BMCN presents variedly ranging from vague abdominal symptoms to obstructive jaundice. Preoperative diagnosis is difficult. Preoperative CT scan with intravenous contrast and carbohydrate antigen 19.9 levels may give a clue towards the diagnosis. Intraoperative frozen section or cyst fluid aspiration cytology might help confirm the diagnosis. Fine needle aspirations should not be performed if BMCN is suspected, and intraoperative cyst spillage should be avoided to prevent tumour dissemination. We present here a case with a very atypical presentation of BMCN and review its present literature in brief.
Weil’s disease with haemoptysis and acute respiratory distress syndrome
Authors: Roumpou Afroditi , Papaioannou Ioanna , Lampropoulos Christos
Published: May 2019

A 35-year-old male patient reached the emergency department after an episode of massive haemoptysis a few hours ago. Fever and dyspnea were mentioned to be present the last 5 days. His medical history included only malaria, successfully treated 2 years ago. Clinical examination revealed high fever, jaundice, cyanosis, tachypnea and bilateral rales on pulmonary auscultation. Laboratory investigation showed high erythrocyte sedimentation rate and C reactive protein, leucocytosis, anaemia, mild thrombocytopaenia, renal impairment, hyperbilirubinaemia and abnormal liver function tests; arterial blood gas analysis showed respiratory alkalosis with severe hypoxia. Thoracic X-ray revealed bilateral pulmonary infiltrates, whereas abdominal and heart ultrasound detected hepatomegaly and small pericardial infusion, respectively. The diagnosis of leptospirosis along with acute respiratory distress syndrome was confirmed by positive IgMLeptospiraantibodies. Empirical treatment with triple antibiotic therapy and corticosteroids was applied. The patient was discharged after 1 week, without any symptoms and with almost normal laboratory tests.
Cycling and cardiovascular disease risk factors including body composition, blood lipids and cardiorespiratory fitness analysed as continuous variables: Part 2—systematic review with meta-analysis
Authors: Nordengen Solveig , Andersen Lars Bo , Solbraa Ane K , Riiser Amund
Published: May 2019

Objectives

We aimed to examine the relationship between cycling (particularly commuter cycling) and risk factors associated with cardiovascular diseases (CVDs) including body composition, blood lipids and cardiorespiratory fitness. This study differed from our recent (Part 1) systematic review in that risk factors for CVD were analysed as continuous variables rather than being present or absent.

Design

Systematic review and meta-analysis.

Eligibility criteria

We searched four databases (Web of Science, MEDLINE, SPORTDiscus and Scopus). All quantitative studies, published until August 2017, were included when a general population was investigated, cycling was assessed either in total or as a transportation mode, and CVD risk factors were reported.

Methods

We analysed body composition, physical activity (PA), cardiorespiratory fitness (CRF), blood lipids and blood pressure (BP). Skinfold, waist circumference and body mass index were analysed and prioritised in that order when more than one measure were available. PA included measures of counts per minutes, moderate-to-vigorous PA or minutes per week. CRF included results of maximal tests with or without expired air or submaximal test. For blood lipids and BP, separate analyses were run for low-density and high-density lipoprotein, triglycerides, total cholesterol, systolic BP and diastolic BP. Studies were excluded when reporting dichotomous outcomes or when cycling and walking were combined. Heterogeneity was investigated using I
2
.

Results

Fifteen studies were included; the majority reported commuter cycling. In total, we included 5775 cyclists and 39 273 non-cyclists. Cyclists had more favourable risk factor levels in body composition −0.08 (95% CI −0.13 to −0.04), PA 0.13 (95% CI 0.06 to 0.20), CRF 0.28 (95% CI 0.22 to 0.35) and blood lipids compared with non-cyclists. There was no sex difference in risk reduction.

Conclusion/implication

Cycling mitigated the risk factor profile for CVD. A strength of this systematic review is that all the risk factors were analysed as continuous variables. These data provide evidence for practitioners, stakeholders, policy-makers and city planners to accommodate and promote cycling.

Systematic review registration

PROSPERO CRD42016052421.
Problem gambling and associated mental health concerns in elite athletes: a narrative review
Authors: Derevensky Jeffrey Lee , McDuff David , Reardon Claudia L , Hainline Brian , Hitchcock Mary E , Richard Jeremie
Published: May 2019

Opportunities to participate in gambling have dramatically changed during the past 20 years. Casinos have proliferated as have electronic gambling machines, lotteries, sports betting, and most recently online gambling. Gambling among the general population has moved from being perceived negatively to a socially acceptable pastime. As over 80% of individuals have reported gambling for money during their lifetime, governments recognise that regulating gambling—a multibillion dollar industry—is a significant source of revenue. While the vast majority of individuals engaged in some form of gambling have no or few gambling-related problems, an identifiable proportion of both adolescents and adults experience significant gambling-related problems. Elite athletes have not been immune to the lure of gambling nor its concomitant problems. Prevalence studies suggest higher rates of gambling problems among athletes than the general population. In this narrative review, we examine several risk factors associated with gambling problems among elite athletes and new forms of gambling that may be problematic for this population. Given the potential serious mental health and performance consequences associated with a gambling disorder for athletes, we aim to increase coaches’, athletic directors’ and health professionals’ knowledge concerning the importance of screening and treatment referrals.
Trends in the risk of cardiovascular disease in women with breast cancer in a Dutch nationwide cohort study
Authors: Buddeke Josefien , Gernaat Sofie A M , Bots Michiel L , van den Bongard Desirée H J G , Grobbee Diederick E , Vaartjes Ilonca , Verkooijen Helena M
Published: May 2019

Objectives

To investigate trends in cardiovascular disease (CVD) risk following breast cancer using national registry data.

Methods

A nationwide cohort study was conducted, comprising 163 881 women with in situ (7.6%) or invasive (92.4%) breast cancer and women of the general population, ranging from 3 661 141 in 1996 to 4 566 573 in 2010. CVD mortality rate in women with and without breast cancer and hospitalisation rate after breast cancer were calculated for the years 1996–2010. Age-adjusted CVD and breast cancer mortality within 5 years after breast cancer admission (1997–2010) were compared with 1996 calculated with a Cox proportional hazard analysis.

Results

The absolute 10-year CVD mortality risk following breast cancer decreased from 56 per 1000 women in 1996 to 41 in 2005 (relative reduction=27.8%). In the general population, this decreased from 73 per 1000 women in 1996 to 55 in 2005 (–23.9%). The absolute risk of CVD hospitalisation within 1 year following breast cancer increased from 54 per 1000 women in 1996 to 67 in 2009 (+23.6%), which was largely explained by an increase in hospitalisation for hypertension, pulmonary embolism, rheumatoid heart/valve disease and heart failure. The 5-year CVD mortality risk was 42% lower (HR 0.58, 95% CI=0.48 to 0.70) for women admitted for breast cancer in 2010 compared with 1996.

Conclusions

CVD mortality risk decreased in women with breast cancer and in women of the general population, with women with breast cancer having a lower risk of CVD mortality. By contrast, there was an increase in hospitalisation for CVD in women with breast cancer.
Method to measure the mismatch between target and achieved received dose intensity of chemotherapy in cancer trials: a retrospective analysis of the MRC BO06 trial in osteosarcoma
Authors: Lancia Carlo , Anninga Jakob , Spitoni Cristian , Sydes Matthew R. , Whelan Jeremy , Hogendoorn Pancras C W , Gelderblom Hans , Fiocco Marta
Published: May 2019

Objectives

In cancer studies, the target received dose intensity (tRDI) for any regimen, the intended dose and time for the regimen, is commonly taken as a proxy for achieved RDI (aRDI), the actual individual dose and time for the regimen. Evaluating tRDI/aRDI mismatches is crucial to assess study results whenever patients are stratified on allocated regimen. The manuscript develops a novel methodology to highlight and evaluate tRDI/aRDI mismatches.

Design

Retrospective analysis of a randomised controlled trial, MRC BO06 (EORTC 80931).

Setting

Population-based study but proposed methodology can be applied to other trial designs.

Participants

A total of 497 patients with resectable high-grade osteosarcoma, of which 19 were excluded because chemotherapy was not started or the estimated dose was abnormally high (>1.25 × prescribed dose).

Intervention(s)

Two regimens with the same anticipated cumulative dose (doxorubicin 6×75 mg/m2/week; cisplatin 6×100 mg/m2/week) over different time schedules: every 3 weeks in regimen-C and every 2 weeks in regimen-DI.

Primary and secondary outcome measures

tRDI distribution was measured across groups of patients derived from k-means clustering of treatment data. K-means creates groups of patients who are aRDI-homogeneous. The main outcome is the proportion of tRDI values in groups of homogeneous aRDI.

Results

For nearly half of the patients, there is a mismatch between tRDI and aRDI; for 21%, aRDI was closer to the tRDI of the other regimen.

Conclusions

For MRC BO06, tRDI did not predict well aRDI. The manuscript offers an original procedure to highlight the presence of and quantify tRDI/aRDI mismatches. Caution is required to interpret the effect of chemotherapy-regimen intensification on survival outcome at an individual level where such a mismatch is present.

The study relevance lies in the use of individual realisation of the intended treatment, which depends on individual delays and/or dose reductions reported throughout the treatment.

Trial registration number

ISRCTN86294690.
Assessment of the quality and readability of online information on autopsy for the general public: a cross-sectional analysis
Authors: Hanley Brian , Brown Philip , O’Neill Shane , Osborn Michael
Published: May 2019

Objectives

Hospital (consented) autopsy rates have dropped precipitously in recent decades. Online medical information is now a common resource used by the general public. Given clinician reluctance to request hospital postmortem examinations, we assessed whether healthcare users have access to high quality, readable autopsy information online.

Design

A cross-sectional analysis of 400 webpages. Readability was determined using the Flesch-Kincaid score, grade level and Coleman-Liau Index. Authorship, DISCERN score andJournal of the American Medical Association (JAMA)criteria were applied by two independent observers. Health on the net code of conduct (HON-code) certification was also assessed. Sixty-five webpages were included in the final analysis.

Results

The overall quality was poor (mean DISCERN=38.1/80, 28.8% did not fulfil a singleJAMAcriterion and only 10.6% were HON-code certified). Quality scores were significantly different across author types, with scientific and health-portal websites scoring highest by DISCERN (analysis of variance (ANOVA), F=5.447, p<0.001) andJAMA(Kruskal-Wallis, p<0.001) criteria. HON-code certified sites were associated with higherJAMA(Mann-Whitney U, p<0.001) and DISCERN (t-test, t=3.5, p=0.001) scores. The most frequent author type was government (27.3%) which performed lower than average on DISCERN scores (ANOVA, F=5.447, p<0.001). Just 5% (3/65) were at or below the recommended eight grade reading level (aged 13–15 years).

Conclusions

Although there were occasional high quality web articles containing autopsy information, these were diluted by irrelevant and low quality sites, set at an inappropriately high reading level. Given the paucity of high quality articles, healthcare providers should familiarise themselves with the best resources and direct the public accordingly.
Cost-minimisation analysis alongside a pilot study of early Tissue Doppler Evaluation of Diastolic Dysfunction in Emergency Department Non-ST Elevation Acute Coronary Syndromes (TEDDy-NSTEACS)
Authors: Gc Vijay S , Alshurafa Mohamad , Sturgess David J , Ting Joseph , Gregory Kye , Oliveira Gonçalves Ana Sofia , Whitty Jennifer A
Published: May 2019

Objective

To estimate the cost implications of early angiography for patients with suspected non-ST elevation acute coronary syndrome (NSTEACS) using tissue Doppler imaging (TDI).

Design

A decision tree model was used to synthesise data from the pilot study and literature sources. Sensitivity analyses tested the impact of assumptions incorporated into the analysis.

Setting

Emergency department (ED), Brisbane, Australia.

Participants

Patients with suspected NSTEACS.

Interventions

TDI as a diagnostic tool for triaging patients within 4 hours of presentation in addition to conventional risk stratification, compared with conventional risk stratification alone.

Data sources

Resource used for diagnosis and management were recorded prospectively and costed for 51 adults who had echocardiography within 24 hours of admission. Costs for conventional care were based on observed data. Cost estimates for the TDI intervention assumed patients classified as high risk at TDI (E/e’>14) progressed early to angiography with an associated 1-day reduction in length of stay.

Primary outcome measures

Costs until discharge from the Australian healthcare perspective in 2016–2017 prices.

Results

Findings suggest that using TDI as a diagnostic tool for triaging patients with suspected NSTEACS is likely to be cost saving by $A1090 (95% credible interval: $A573 to $A1703) per patient compared with conventional care. The results are mainly driven by the assumed reduction in length of stay due to the inclusion of early TDI in clinical decision-making.

Conclusions

This pilot study indicates that compared with conventional risk stratification, triaging patients presenting with suspected NSTEACS with TDI within 4 hours of ED presentation has potential cost savings. Findings assume a reduction in hospital stay is achieved for patients considered to be high risk at TDI. Larger, comparative studies with longer follow-up are needed to confirm the clinical effectiveness of TDI as a diagnostic strategy for NSTEACS, the assumed reduction in hospital stay and any cost saving.
Evidence on the effect of gender of newborn, antenatal care and postnatal care on breastfeeding practices in Ethiopia: a meta-analysis andmeta-regression analysis of observational studies
Authors: Habtewold Tesfa Dejenie , Sharew Nigussie Tadesse , Alemu Sisay Mulugeta
Published: May 2019

Objectives

The aim of this systematic review and meta-analysis was to investigate the association of gender of newborn, antenatal care (ANC) and postnatal care (PNC) with timely initiation of breast feeding (TIBF) and exclusive breastfeeding (EBF) practices in Ethiopia.

Design

Systematic review and meta-analysis.

Data sources

To retrieve all available literature, PubMed, EMBASE, CINAHL, WHO Global Health Library, Web of Science and SCOPUS databases were systematically searched and complemented by manual searches. The search was done from August 2017 to September 2018.

Eligibility criteria

All observational studies including cross-sectional, case-control, cohort studies conducted in Ethiopia from 2000 to 2018 were included. Newcastle-Ottawa Scale was used for quality assessment of included studies.

Data extraction and synthesis

Study area, design, population, number of mothers (calculated sample size and participated in the study) and observed frequency data were extracted using Joanna Briggs Institute tool. To obtain the pooled effect size, a meta-analysis using weighted inverse variance random-effects model was performed. Cochran’s Q X2test, τ2and I2statistics were used to test heterogeneity, estimate amount of total/residual heterogeneity and measure variability attributed to heterogeneity, respectively. Mixed-effects meta-regression analysis was done to identify possible sources of heterogeneity. Egger’s regression test at p value threshold ≤0.01 was used to examine publication bias. Furthermore, the trend of evidence over time was examined by performing a cumulative meta-analysis.

Results

Of 523 articles retrieved, 17 studies (n=26 146 mothers) on TIBF and 24 studies (n=17 819 mothers) on EBF were included in the final analysis. ANC (OR=2.24, 95% CI 1.65 to 3.04, p<0.001, I2=90.9%), PNC (OR=1.86, 95% CI 1.41 to 2.47, p<0.001, I2=63.4%) and gender of newborn (OR=1.31, 95% CI 1.01 to 1.68, p=0.04, I2=81.7%) significantly associated with EBF. ANC (OR=1.70, 95% CI 1.10 to 2.65, p=0.02, I2=93.1%) was also significantly associated with TIBF but not with gender of newborn (OR=1.02, 95% CI 0.86 to 1.21, p=0.82, I2=66.2%).

Conclusions

In line with our hypothesis, gender of newborn, ANC and PNC were significantly associated with EBF. Likewise, ANC was significantly associated with TIBF. Optimal care during pregnancy and after birth is important to ensure adequate breast feeding. This meta-analysis study provided up-to-date evidence on breastfeeding practices and its associated factors, which could be useful for breastfeeding improvement initiative in Ethiopia and cross-country and cross-cultural comparison.

Trial registration number

CRD42017056768
Psychiatric disorders as risk factors for the development of type 2 diabetes mellitus: an umbrella review protocol
Authors: Lindekilde Nanna , Nefs Giesje , Henriksen Jan Erik , Lasgaard Mathias , Schram Miranda , Rubin Katrine , Rutters Femke , Kivimaki Mika , Pouwer Frans
Published: May 2019

Introduction

Numerous longitudinal studies, systematic reviews and meta-analyses have examined psychiatric disorders as risk factors for the development of type 2 diabetes mellitus. A more comprehensive overview of the area is warranted to summarise current evidence and discuss strengths and weaknesses to guide future research.

Aim

The aim of this umbrella review is to determine whether and to what extent different psychiatric disorders are associated with the development of type 2 diabetes mellitus. Furthermore, the umbrella review also assesses the evidence on potential mediating mechanisms.

Methods and analysis

The present umbrella review will consist of a comprehensive systematic search of published systematic reviews and meta-analyses of observational longitudinal studies investigating whether a psychiatric disorder is associated with the risk of developing type 2 diabetes. PubMed, Embase, PsychINFO and the Cochrane Database of Systematic Reviews will be searched, and the results will be screened for inclusion by two independent reviewers. Furthermore, the reference lists of included publications will be manually searched. Two independent reviewers will extract data and assess the methodological quality in the included systematic reviews and meta-analyses. Evidence on potential mediating mechanisms included in the systematic reviews and meta-analyses will also be reviewed. The implications of the overview will be discussed in light of the quality of the included studies, and suggestions for clinical practice and future research will be made.

Ethics and dissemination

Ethical approval is not required for this umbrella review. Our review will be submitted for publication in a peer-reviewed international journal using open access option if available. The results will also be disseminated at international conferences.

PROSPERO registration number

CRD42018096362
Inequalities in realised access to healthcare among recently arrived refugees depending on local access model: study protocol for a quasi-experimental study
Authors: Wenner Judith , Rolke Kristin , Breckenkamp Jürgen , Sauzet Odile , Bozorgmehr Kayvan , Razum Oliver
Published: May 2019

Introduction

In many countries, including Germany, newly arriving refugees face specific entitlement restrictions and access barriers to healthcare. While entitlement restrictions apply to all refugees who seek protection in Germany during the first months, the barriers to access depend on the model that the states and the municipalities implement locally. Currently, two different models exist: the healthcare voucher model (HcV) and the electronic health card model (eHC). The aim of the study is to analyse the consequences of these two different access models on newly arrived refugees’ realised access to healthcare.

Methods and analysis

The random assignment of refugees to municipalities allows for a quasi-experimental design by comparing realised access to healthcare among refugees in six municipalities in North Rhine-Westphalia which have implemented HcV or eHC. We compare realised access to healthcare using ambulatory care sensitive conditions and health expenditure as outcome indicators, and use of emergency care, preventive care, psychotherapeutic or psychiatric care, and of therapeutic devices as process indicators. Results will be adjusted for aggregated information on age, sex, socioeconomic structure of the municipalities and density of general practitioners or specialists.

Ethics and dissemination

We cooperated with local welfare offices and the statutory health insurance for data collection. Thereby, we were able to avoid recruiting large numbers of refugee patients immediately after arrival while their access and entitlement to healthcare are restricted. We developed an extensive data protection concept and ensured that all data collected are fully anonymised. Results will be published in peer-reviewed journals and summarised in reports to the funding agency.
Effects of epidural analgesia on cancer recurrence and long-term mortality in patients after non-small-cell lung cancer resection: a propensity score-matched study
Authors: Wu Hsiang-Ling , Tai Ying-Hsuan , Chan Min-Ya , Tsou Mei-Yung , Chen Hsiu-Hsi , Chang Kuang-Yi
Published: May 2019

Objectives

Previous studies showed reductions in recurrence and mortality rate of several cancer types in patients receiving perioperative epidural analgesia. This study aimed to investigate the effects of thoracic epidural analgesia on oncological outcomes after resection for lung cancer.

Design

Retrospective study using propensity score matching methodology.

Setting

Single medical centre in Taiwan.

Participants

Patients with stages I–III non-small-cell lung cancer undergoing primary tumour resection between January 2005 and December 2015 and had either epidural analgesia, placed preoperatively and used intra- and postoperatively, or intravenous analgesia were evaluated through May 2017.

Primary and secondary outcome measures

Primary endpoint was postoperative recurrence-free survival and secondary endpoint was overall survival.

Results

The 3-year recurrence-free and overall survival rates were 69.8% (95% CI 67.4% to 72.2%) and 92.4% (95% CI 91% to 93.8%) in the epidural group and 67.4% (95% CI 62.3% to 72.5%) and 89.6% (95% CI 86.3% to 92.9%) in the non-epidural group, respectively. Multivariable Cox regression analysis before matching demonstrated no significant difference in recurrence or mortality between groups (adjusted HR: 0.93, 95% CI 0.76 to 1.14 for recurrence; 0.81, 95% CI 0.58 to 1.13 for mortality), similar to the results after matching (HR: 0.97, 95% CI 0.71 to 1.31; 0.94, 95% CI 0.57 to 1.54). Independent risk factors for both recurrence and mortality were male, higher pretreatment carcinoembryonic antigen level, advanced cancer stage, poor differentiation, lymphovascular invasion, microscopic necrosis and postoperative radiotherapy.

Conclusions

Thoracic epidural analgesia was not associated with better recurrence-free or overall survival in patients receiving surgical resection for stages I–III non-small-cell lung cancer.
Design of a prospective observational study on the effectiveness and real-world usage of recombinant factor VIII Fc (rFVIIIFc) compared with conventional products in haemophilia A: the A-SURE study
Authors: Oldenburg Johannes , Hay Charles R M , Jiménez-Yuste Víctor , Peyvandi Flora , Schved Jean-François , Szamosi Johan , Winding Bent , Lethagen Stefan
Published: May 2019

Introduction

Haemophilia A is a rare bleeding disorder caused by coagulation factor VIII (FVIII) deficiency. This is treated with factor VIII, conventionally using products with a half-life of 8–12 hours typically administered every 2–3 days. Recombinant FVIII Fc (rFVIIIFc) represents a new generation of products with an extended half-life allowing higher FVIII levels and longer dosing interval. The efficacy and safety of rFVIIIFc have been established in clinical studies and several years of postmarketing use. However, there remains a need to compare treatment outcome with conventional products in routine clinical use.

Methods and analysis

A-SURE is an ongoing, non-interventional European study with the primary objective to compare the clinical effectiveness of rFVIIIFc with conventional factor products used for haemophilia A prophylaxis. Data covering a 24-month prospective period and a 12-month retrospective period will be collected. Three primary endpoints: bleeding rate, injection frequency and factor consumption will be used to evaluate treatment outcomes. Enrolment of 175 patients on rFVIIIFc and 175 on conventional products is planned. All eligible patients from participating centres will be invited to participate. Visits and treatments follow routine clinical practice. Bias will be reduced by patient matching for age at baseline and the last weekly prophylaxis dose of a conventional product prior to baseline. Propensity scores will be calculated based on prognostic factors and potential confounders assessed at baseline and adjusted for in the estimation of the treatment effect.

Ethics and dissemination

Study approval was obtained by local independent ethics committees and/or authorities, and informed consent from patients or their legal representative is a requirement for participation. Names of ethical committees and approval numbers are provided as supplementary information. The study results will be submitted for publication in a peer-reviewed scientific journal and presented at scientific conferences.

Trial registration number

NCT02976753, Pre-results.
User-centred clinical decision support to implement emergency department-initiated buprenorphine for opioid use disorder: protocol for the pragmatic group randomised EMBED trial
Authors: Melnick Edward R , Jeffery Molly Moore , Dziura James D , Mao Jodi A , Hess Erik P , Platts-Mills Timothy F , Solad Yauheni , Paek Hyung , Martel Shara , Patel Mehul D , Bankowski Laura , Lu Charles , Brandt Cynthia , D’Onofrio Gail
Published: May 2019

Introduction

The goal of this trial is to determine whether implementation of a user-centred clinical decision support (CDS) system can increase adoption of initiation of buprenorphine (BUP) into the routine emergency care of individuals with opioid use disorder (OUD).

Methods

A pragmatic cluster randomised trial is planned to be carried out in 20 emergency departments (EDs) across five healthcare systems over 18 months. The intervention consists of a user-centred CDS integrated into ED clinician electronic workflow and available for guidance to: (1) determine whether patients presenting to the ED meet criteria for OUD, (2) assess withdrawal symptoms and (3) ascertain and motivate patient willingness to initiate treatment. The CDS guides the ED clinician to initiate BUP and facilitate follow-up. The primary outcome is the rate of BUP initiated in the ED. Secondary outcomes are: (1) rates of receiving a referral, (2) fidelity with the CDS and (3) rates of clinicians providing any ED-initiated BUP, referral for ongoing treatment and receiving Drug Addiction Act of 2000 training. Primary and secondary outcomes will be analysed using generalised linear mixed models, with fixed effects for intervention status (CDS vs usual care), prespecified site and patient characteristics, and random effects for study site.

Ethics and dissemination

The protocol has been approved by the Western Institutional Review Board. No identifiable private information will be collected from patients. A waiver of informed consent was obtained for the collection of data for clinician prescribing and other activities. As a minimal risk implementation study of established best practices, an Independent Study Monitor will be utilised in place of a Data Safety Monitoring Board. Results will be reported in ClinicalTrials.gov and published in open-access, peer-reviewed journals, presented at national meetings and shared with the clinicians at participating sites via a broadcast email notification of publications.

Trial registration number

NCT03658642; Pre-results.
Association of low birth weight with thinness and severe obesity in children aged 3–12 years: a large-scale population-based cross-sectional study in Shanghai, China
Authors: Chen Chang , Jin Zhijuan , Yang You , Jiang Fan , Huang Hong , Liu Shijian , Jin Xingming
Published: May 2019

Objectives

Low birth weight (BW) is a general symbol of inadequate intrauterine conditions that elicit abnormal fetal growth and development. The aim of current study is to investigate the relationship between low BW and thinness or severe obesity during maturation.

Design

A large-scale cross-sectional population-based survey.

Setting

134 kindergartens and 70 elementary schools.

Participants

70 284 Chinese children aged 3–12 years.

Outcome measures

International Obesity Task Force body mass index (BMI) cut-offs were used to define grade 1, grade 2 and grade 3 thinness, overweight, obesity and severe obesity. Multinomial logistic regression was used to estimate the association between BW and BMI category.

Results

A total of 70 284 children participated in the survey. The percentage of grade 1 thinness and severe obesity in children with low BW is significantly higher than that in children with normal BW (p<0.05). Low BW was associated with an increased risk of grade 1 thinness (OR 1.56, 95% CI 1.38 to 1.75), grade 2 thinness (OR 1.34, 95% CI 1.10 to 1.64), grade 3 thinness (OR 1.99, 95% CI 1.63 to 2.42) and severe obesity (OR 1.27, 95% CI 1.03 to 1.55) but was not associated with obesity (OR 0.85, 95% CI 0.67 to 1.06).

Conclusion

There is a positive association between low BW and thinness or severe obesity risk.
Supporting the spread and scale-up of electronic consultation across Canada: cross-sectional analysis
Authors: Liddy Clare , Bello Aminu , Cook Jean , Drimer Neil , Pilon Maxine Dumas , Farrell Gerard , Glassford Jodi , Ireland Laurie , McDonald Rana , Nabelsi Véronique , Oppenheimer Luis , Singer Alex , Keely Erin
Published: May 2019

Objective

To examine the process of implementing an electronic consultation (eConsult) service and evaluate its impact along key metrics outlined by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework.

Design

Cross-sectional study.

Setting

Clinics using eConsult in four provinces across Canada: Alberta, Manitoba, Quebec and Newfoundland and Labrador.

Participants

All eConsult cases submitted in four participating provinces were included.

Intervention

The eConsult service is a secure online application that allows primary care providers and specialists to communicate regarding a patient’s care. We measured the impact using system utilisation data and mandatory close-out surveys completed at the end of each eConsult.

Main outcome measures

Implementation progress and impact were examined using the five categories outlined by the RE-AIM framework: reach, effectiveness, adoption, implementation and maintenance.

Results

Four provinces provided data from different periods, ranging from 4 years (Alberta) to 10 months (Manitoba). Total cases completed ranged from 96 (Manitoba) to 6885 (Alberta). Newfoundland had the largest menu of available specialties (n=35), while Alberta and Quebec had the smallest (n=22). The most frequently requested groups varied across provinces, with only endocrinology appearing in the top five for all provinces. The average specialist response time ranged from 3 days (Manitoba) to 16.7 days (Alberta). Between 54% (Newfoundland) and 66% (Manitoba) of cases resulted in new or additional information. Primary care providers avoided completing referrals they had originally considered in 36% (Newfoundland) to 53% of cases (Manitoba), while only between 27 % (Quebec) and 29% (Newfoundland) of cases resulted in a referral. In every province, services demonstrated higher rates of usage in their last quarter of data than their first.

Conclusions

eConsult was successfully implemented in four new provinces across Canada. Implementation strategies and scope varied, but services demonstrated substantial consistency on several key metrics, most notably on whether new information was learnt and impact on decision to refer.
Dose and formulation of azithromycin in mass drug administration studies: a systematic review protocol
Authors: Yue Yan , Xiong Tao , Zeng Linan , Choonara Imti , Qazi Shamim , Chen Hongju , Mu Dezhi
Published: May 2019

Introduction

Azithromycin has been given for tropical infectious diseases such as trachoma and yaws by mass drug administration (MDA). As well as controlling the infectious disease in question, MDA may have a beneficial effect in reducing mortality in young children. However, the dose, formulation, frequency and duration of azithromycin used in certain infectious diseases may vary in different studies, and these differences may have impacts on the effectiveness of azithromycin MDA. Furthermore, whether the dose, formulation, frequency and duration are associated with the effectiveness of azithromycin for reducing child mortality—if indeed this effect can be confirmed—remain unknown. In this study, we will investigate whether different strategies such as different dose, formulation, frequency and duration affect the effectiveness of azithromycin MDA on the prevalence of certain infectious diseases or child mortality.

Methods and analysis

A narrative systematic review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform will be searched. No language restrictions will be applied. All randomised/quasi-controlled trials, observational studies (cross-sectional studies, cohort studies and case–control studies), case series and registered protocols will be considered. Dose, duration, frequency, rounds and formulations of azithromycin used in MDA will be collected and reviewed. The outcomes will be disease prevalence/control in children and child mortality. Data from the individual studies will not be pooled.

Ethics and dissemination

Formal ethical approval is not required since data will be collected from published studies. This systematic review will be published in a peer-reviewed journal and presented at conference meetings.

PROSPERO registration number

CRD42018114902
Loss-of-function mutations in SPEF2 cause multiple morphological abnormalities of the sperm flagella (MMAF)
Authors: Liu Wensheng , Sha Yanwei , Li Yang , Mei Libin , Lin Shaobin , Huang Xianjing , Lu Jinhua , Ding Lu , Kong Shuangbo , Lu Zhongxian
Published: May 2019

Background

Multiple morphological abnormalities of the sperm flagella (MMAF) is a kind of severe teratozoospermia. Patients with the MMAF phenotype are infertile and present aberrant spermatozoa with absent, short, coiled, bent and/or irregular flagella. Mutations in several genes can explain approximately 30%–50% of MMAF cases and more genetic pathogenies need to be explored. SPEF2 was previously demonstrated to play an essential role in sperm tail development in mice and pig. Dysfunctional mutations inSPEF2impair sperm motility and cause a short-tail phenotype in both animal models.

Objective

Based on 42 patients with severe infertility and MMAF phenotype, we explored the new genetic cause of human MMAF phenotype.

Methods and results

By screening gene variants in 42 patients with MMAF using whole exome sequencing, we identified the c. 12delC, c. 1745-2A > G, c. 4102 G > T and c. 4323dupA mutations in theSPEF2gene from two patients. Both of these mutations are rare and potentially deleterious. Transmission electron microscope (TEM) analysis showed a disrupted axonemal structure with mitochondrial sheath defects in the patients’ spermatozoa. The SPEF2 protein level was significantly decreased in the spermatozoa of the patients revealed by Western blot (WB) and immunofluorescence (IF) analyses.

Conclusion

Our experimental findings indicate that loss-of-function mutations in theSPEF2gene can cause the MMAF phenotype in human.
Treatment of broad-based intracranial aneurysms with low profile braided stents: a single center analysis of 101 patients
Authors: Djurdjevic Tanja , Young Victoria , Corkill Rufus , Briley Dennis , Küker Wilhelm
Published: May 2019

Background and purpose

Low profile braided stents have facilitated the endovascular treatment of broad-based intracranial aneurysms.

Methods

Between 2013 and June 2018, we attempted 104 Leo baby stent placements in 101 patients. Locations were the anterior communicating artery (AcomA) (37 aneurysms, 35.6%), middle cerebral artery (MCA) bifurcation (29 aneurysms, 27.9%) and basilar artery (23aneurysms, 22.1%). Mean neck size was 4.9 mm (2.2–8.2). 60 aneurysms were incidental, 31 of 37 recurrent aneurysms had ruptured before.

Results

Stent deployment was successful in 89.4% of cases. Common reasons for failure were inability to access the parent artery (n=5) or to deploy the stent across the aneurysm neck (n=4). Two patients had poor outcomes within 24 hours. One patient developed a brain hemorrhage caused by guide wire perforation (MRS 5), the other an early thrombotic stent occlusion (MRS 4). No patient died. Nine (8.7%) patients experienced transient neurological deficits with ischemic lesions on diffusion weighted imaging (DWI). Initially Raymond-Roy class 1 occlusion was achieved in 23 aneurysms (24.7%), class 2 occlusion in 40 (43%), class 3a occlusion in 14 (15.0%), and 3b occlusion in 16 aneurysms (17.2%). Follow-up imaging in 87 patients showed stable or improved occlusion grades in 76%. Six patients required retreatment while the rest were managed conservatively. Four delayed stent occlusions occurred in three patients, with severe morbidity in one patient (MRS 5). There were no aneurysm ruptures or deaths.

Conclusion

Stent assisted treatment of broad-based aneurysms with the Leo baby stent is safe and effective. The frequency of delayed thrombotic complications is low and similar to other stents.
Strategies and barriers to achieving the goal of Finland’s tobacco endgame
Authors: Timberlake David S , Laitinen Ulla , Kinnunen Jaana M , Rimpela Arja H
Published: May 2019

Objectives

Finland boldly legislated the end of tobacco use in its 2010 Tobacco Act, and subsequently expanded the goal in 2016 to eradicate other nicotine-containing products. This study explored stakeholders’ perceptions about the strengths, barriers, solutions and rationale for Finland’s comprehensive but conventional strategy to achieve its nicotine-free goal.

Design

Study participants were selected based on expertise in policy or practice of tobacco control (n=32). Semi-structured interviews, conducted in 2017 and 2018, covered topics ranging from consensus among stakeholders to Finland’s ranking on the 2016 Tobacco Control Scale. The framework method was chosen for analysing interview transcripts.

Results

A perceived strength of Tobacco-Free Finland 2030 was the consensus and cooperation among members of the tobacco control community. The objective of becoming a nicotine- versus smoke-free society had almost unanimous support, challenged by a small minority who argued for greater discussion of harm reduction approaches. The need for maintaining legitimacy and historical successes in tobacco control were reasons for using a conventional strategy. Barriers to achieving the endgame goal included insufficient funding and over-reliance on non-governmental organisations, political/legal constraints, impact of institutional practices on tobacco disparities, ambivalence about the role of mass media and lack of prioritising smoking cessation.

Conclusions

Stakeholders’ broad confidence in reaching the goal of Finland’s tobacco endgame suggests that future policy initiatives will reflect the current, conventional strategy. If the Finnish government chooses to continue this approach, then it should designate separate funds for Tobacco-Free Finland 2030 and implement structural changes that will facilitate tobacco control initiatives.
The taste of smoke: tobacco industry strategies to prevent the prohibition of additives in tobacco products in Brazil
Authors: Oliveira da Silva Andre Luiz , Bialous Stella Aguinaga , Albertassi Patrícia Gonçalves Duarte , Arquete Daniela Aparecida dos Reis , Fernandes Ana Marcia Messeder Sebrao , Moreira Josino Costa
Published: May 2019

Background

The tobacco industry (TI) uses several strategies to attract new consumers, including using additives in tobacco products, which makes tobacco especially attractive to youth. Based on scientific evidence and the principles of the WHO Framework Convention on Tobacco Control, the Brazilian Health Regulatory Agency (ANVISA, for the name in Portuguese), published the Collegiate Board Resolution (RDC, for the name in Portuguese) 14/2012 in 2012, prohibiting the addition of substances that enhance the flavour and taste of tobacco products in order to make them more attractive. In response, the TI used various strategies to prevent RDC 14/2012 from entering into force. At the time, the Brazilian additive ban was the most comprehensive in the world as it included a ban on menthol.

Objectives

This paper analyses the arguments and strategies used by the TI to prevent the implementation of the additives ban.

Methods

Review of published articles, reports, legislation and legislative activity, internal TI documents, media stories and other documents to describe TI’s reaction to the ban.

Results

The results show that the TI used some well-known strategies to delay or cancel the entering into force of the resolution. For example, the TI attempted political interference, used litigation and commissioned studies with findings that questioned the resolution’s rationale. The TI strategies used in Brazil are similar to those used at the global level to oppose other tobacco control measures.

Conclusions

TI successfully delayed the most comprehensive additive ban in the world using its usual tactics, despite the fact that none of the arguments presented by the TI had an acceptable scientific basis or evidence.
Non-coding RNAs: what are we missing?
Authors: Carvalho Barbosa Cristina , Calhoun Sydnee H. , Wieden Hans-Joachim
Published: May 2019

Over the past two decades, the importance of small non-coding RNAs (sncRNAs) as regulatory molecules has become apparent in all three domains of life (archaea, bacteria, eukaryotes). In fact, sncRNAs play an important role in the control of gene expression at both the transcriptional and the post-transcriptional level, with crucial roles in fine-tuning cell responses during internal and external stress. Multiple pathways for sncRNA biogenesis and diverse mechanisms of regulation have been reported, and although biogenesis and mechanisms of sncRNAs in prokaryotes and eukaryotes are different, remarkable similarities exist. Here, we briefly review and compare the major sncRNA classes that act post-transcriptionally, and focus on recent discoveries regarding the ribosome as a target of regulation and the conservation of these mechanisms between prokaryotes and eukaryotes.
Active transform faults in the Gulf of Guinea: insights from geophysical data and implications for seismic hazard assessment
Authors: Meghraoui Mustapha , Amponsah Paulina , Bernard Paul , Ateba Bekoa
Published: May 2019

The seismotectonics of Western Africa show the occurrence of major earthquakes (e.g., 1636 southwestern Ghana, 1855 offshore Monrovia, 1939 offshore Accra, and 1983 Gaoual-Guinea) and prominent offshore transform faults. However, there is no analysis that links the continental active tectonics with the oceanic fault zones of the Gulf of Guinea. We study the active tectonics by firstly mapping the main transform faults using a combination of bathymetric, gravimetric, and magnetic data. The data analysis associates regional seismicity (historical and instrumental) with focal mechanisms as extracted from the recently published seismotectonic map of Africa. We identify active transform faults, the Chain (CFZ), Romanche (RFZ), Saint Paul (SPFZ), and Arkhangelskiy (AFZ) fault zones. We also calculate strain rates on these faults from Late Cretaceous (–85 Ma) to present time using paleomagnetic data and infer slip rates from the seismic moment data. The strain rates show a first stable trend around 2 cm/year and then accelerate to 4 cm/year in the last 10 million years. The comparison of Late Quaternary strain rates with geodetic strain rates shows an accumulation of seismic energy that could lead to the initiation of an Mw 7–7.5 earthquakes on the Saint Paul transform fault. Our seismotectonic analysis clearly links oceanic and continental tectonics, with about a 20°–30° anticlockwise fault trend rotation for CFZ, RFZ, and SPFZ. The potential for the occurrence of large earthquakes in the Gulf of Guinea should be taken into account for a realistic regional seismic and tsunami hazard of the Gulf of Guinea.
Species differentiation in Axelrod’s model
Authors: Reia Sandro M. , Madeira Gustavo D. M. , Fiorelli João P. , Neves Ubiraci P. C.
Published: May 2019

We have proposed a new approach for Axelrod’s model to describe newly recognized mechanisms of speciation based on the interbreedings between genetically similar species. By tracking the propagation of genetic information through the network, our modeling suggests that species (agents) that once were able to exchange genetic information tend to evolve to a predominant species or even differentiate into distinct species. Furthermore, a genome distance measurement (separation degree) is here defined and shown to capture the phase transition of the model, thus working as an alternative and computationally less costly order parameter.
Size of the early universe and GUP
Authors: Nesic Ljubisa , Radovancevic Darko
Published: May 2019

This paper presents the effects of the Generalized Uncertainty Principle (GUP), i.e. its classical version expressed through the deformed Poisson brackets in the phase–space of a one-dimensional minisuperspace Friedmann cosmological model with a mixture of non-interacting dust and radiation. It is shown, in the case of this model, that starting from the specific representation of the deformed Poisson algebra, which corresponds to the change of the potential energy term of the oscillator, the size of the early universe can be related to its inflationary GUP expansion.