bluuebunny/crossref_metadata_2025 huggingface dataset:
Measurement of Selected Differential Cross Sections in 235U Spectrum
Authors: Burianová Nicola , Košt´ál Michal , Schulc Martin , Šimon Jan , Mareček Martin , Uhlíř Jan
Published: February 2019

This paper describes the measurement of 55Mn(n,2n) and 127I(n,2n) reaction rates in a well-defined reactor field in a special core of LR-0 reactor. The reaction rates were derived using gamma-spectrometry by measuring gamma activities of irradiated MnO2 and NaI samples at a high purity germanium (HPGe) detector. The spectral average cross section (SACS) in 235U prompt fission neutron spectrum (PFNS) was experimentally determined to be 0.2393 ± 0.015 × 10−3 b for 55Mn and 1.2087 ± 0.052 × 10−3 b for 127I. These obtained results were compared with calculations by MCNP6 code using ENDF/B VII.1, ENDF/B VII, JEFF-3.1, JEFF-3.2, JENDL-3.3, JENDL-4, ROSFOND- 2010, CENDL-3.1, and IRDFF nuclear data libraries. In a case of 55Mn, a good agreement with ENDF/B VII.1, JEFF 3.1, JENDL 3.3, JENDL 4, ROSFOND, and CENDL 3.1 nuclear data libraries was found, where C/E−1 is 0.1%, while IRDFF underestimated by about 15.8%. In the case of 127I, more significant discrepancies were found, where JENDL 3.3 and JENDL 4 overestimate the result by about 31.3%.
Rewet Temperature Correlations for Liquid Nitrogen Boiling Pipe Flows Across Varying Flow Conditions and Orientations
Authors: Darr S. R. , Dong J. , Glikin N. , Hartwig J. W. , Chung J. N.
Published: February 2019

In many convective liquid–vapor phase-change heat transfer engineering applications, cryogenic fluids are widely used in industrial processes, spacecraft and cryosurgery systems, and so on. For example, cryogens are usually used as liquid fuels such as liquid hydrogen, liquid methane, and liquid oxygen in the rocket industry, liquid nitrogen and helium are frequently used to cool superconducting magnetic device for medical applications. In these systems, proper transport, handling, and storage of cryogenic fluids are of extreme importance. Among all the cryogenic transport processes performed in room temperatures, quenching, also termed chilldown, is an unavoidable initial, transient phase-change heat transfer process that brings the system down to the cryogenic condition. The Leidenfrost temperature or rewet temperature that signals the end of film boiling is practically considered the completion point of a quenching process. Therefore, rewet temperature has been considered the most important parameter for the engineering design of cryogenic thermal management systems. As most of the previous correlations for predicting the Leidenfrost temperature and the rewet temperature have been developed for water, they are shown to disagree with recent liquid nitrogen pipe chilldown experiments in upward and downward flow directions over a wide range of flow rates, pressures, and degrees of inlet subcooling. In addition to a complete review of the literature, two modified correlations are presented, one based on bubble growth and another based on the theoretical maximum limit of superheat. Each correlation performs well over the entire dataset.
Tie2 activation promotes choriocapillary regeneration for alleviating neovascular age-related macular degeneration
Authors: Kim Jaeryung , Park Jang Ryul , Choi Jeongwoon , Park Intae , Hwang Yoonha , Bae Hosung , Kim Yongjoo , Choi WooJhon , Yang Jee Myung , Han Sangyeul , Chung Tae-Young , Kim Pilhan , Kubota Yoshiaki , Augustin Hellmut G. , Oh Wang-Yuhl , Koh Gou Young
Published: February 2019

Angpt-Tie2 is essential for choriocapillary maintenance, and Tie2 activation could be a therapeutic avenue for fundamental treatment of NV-AMD.
DP
2
antagonism reduces airway smooth muscle mass in asthma by decreasing eosinophilia and myofibroblast recruitment
Authors: Saunders Ruth , Kaul Himanshu , Berair Rachid , Gonem Sherif , Singapuri Amisha , Sutcliffe Amanda J. , Chachi Latifa , Biddle Michael S. , Kaur Davinder , Bourne Michelle , Pavord Ian D. , Wardlaw Andrew J. , Siddiqui Salman H. , Kay Richard A. , Brook Bindi S. , Smallwood Rod H. , Brightling Christopher E.
Published: February 2019

Cellular and computational models and bronchial biopsies from asthma patients show that a DP
2
antagonist reduces airway smooth muscle mass in asthma.
IDH1-R132H acts as a tumor suppressor in glioma via epigenetic up-regulation of the DNA damage response
Authors: Núñez Felipe J. , Mendez Flor M. , Kadiyala Padma , Alghamri Mahmoud S. , Savelieff Masha G. , Garcia-Fabiani Maria B. , Haase Santiago , Koschmann Carl , Calinescu Anda-Alexandra , Kamran Neha , Saxena Meghna , Patel Rohin , Carney Stephen , Guo Marissa Z. , Edwards Marta , Ljungman Mats , Qin Tingting , Sartor Maureen A. , Tagett Rebecca , Venneti Sriram , Brosnan-Cashman Jacqueline , Meeker Alan , Gorbunova Vera , Zhao Lili , Kremer Daniel M. , Zhang Li , Lyssiotis Costas A. , Jones Lindsey , Herting Cameron J. , Ross James L. , Hambardzumyan Dolores , Hervey-Jumper Shawn , Figueroa Maria E. , Lowenstein Pedro R. , Castro Maria G.
Published: February 2019

Mutant IDH1 coexpressed with inactivating TP53 and ATRX mutations in glioma enhances DNA repair, causing resistance to genotoxic therapies.
Platelet decoys inhibit thrombosis and prevent metastatic tumor formation in preclinical models
Authors: Papa Anne-Laure , Jiang Amanda , Korin Netanel , Chen Michelle B. , Langan Erin T. , Waterhouse Anna , Nash Emma , Caroff Jildaz , Graveline Amanda , Vernet Andyna , Mammoto Akiko , Mammoto Tadanori , Jain Abhishek , Kamm Roger D. , Gounis Matthew J. , Ingber Donald E.
Published: February 2019

Human platelet decoys prevented thrombosis in rabbits and inhibited cancer cell aggregation and extravasation in vitro and in a mouse model.
Disruption of Quorum Sensing and Virulence in
Burkholderia cenocepacia
by a Structural Analogue of the
cis
-2-Dodecenoic Acid Signal
Authors: Cui Chaoyu , Song Shihao , Yang Chunxi , Sun Xiuyun , Huang Yutong , Li Kang , Zhao Shuo , Zhang Yongliang , Deng Yinyue
Published: February 2019

Burkholderia cenocepacia
is an important opportunistic pathogen which can cause life-threatening infections in susceptible individuals, particularly in cystic fibrosis and immunocompromised patients. It usually employs two types of quorum sensing (QS) systems, including the
cis
-2-dodecenoic acid (BDSF) system and
N
-acyl homoserine lactone (AHL) system, to regulate virulence. In this study, we have designed and identified an unsaturated fatty acid compound (
cis
-14-methylpentadec-2-enoic acid [14-Me-C
16:Δ2
]) that is capable of interfering with
B. cenocepacia
QS signaling and virulence. We demonstrate that 14-Me-C
16:Δ2
reduced BDSF and AHL signal production in
B. cenocepacia
. It also impaired QS-regulated phenotypes in various
Burkholderia
species. These results suggest that 14-Me-C
16:Δ2
could interfere with QS signaling in many
Burkholderia
species and might be developed as a new antibacterial agent.
Multilocus Sequence Analysis Reveals Three Distinct Populations of “
Candidatus
Phytoplasma palmicola” with a Specific Geographical Distribution on the African Continent
Authors: Pilet Fabian , Quaicoe Robert Nketsia , Osagie Isaac Jesuorobo , Freire Marcos , Foissac Xavier
Published: February 2019

Coconut is an important crop for both industry and small stakeholders in many intertropical countries. Phytoplasma-associated lethal yellowing-like diseases have become one of the major pests that limit coconut cultivation as they have emerged in different parts of the world. We developed a multilocus sequence typing scheme (MLST) for tracking epidemics of “
Ca
. Phytoplasma palmicola,” which is responsible for coconut lethal yellowing disease (CLYD) on the African continent. MLST analysis applied to diseased coconut samples collected in western and eastern African countries also showed the existence of three distinct populations of “
Ca
. Phytoplasma palmicola” with low intrapopulation diversity. The reasons for the observed strong geographic patterns remain to be established but could result from the lethality of CLYD and the dominance of short-distance insect-mediated transmission.
Disulfide Bond Formation in the Periplasm of
Escherichia coli
Authors: Manta Bruno , Boyd Dana , Berkmen Mehmet
Published: February 2019

The formation of disulfide bonds is critical to the folding of many extracytoplasmic proteins in all domains of life. With the discovery in the early 1990s that disulfide bond formation is catalyzed by enzymes, the field of oxidative folding of proteins was born.
Escherichia coli
played a central role as a model organism for the elucidation of the disulfide bond-forming machinery. Since then, many of the enzymatic players and their mechanisms of forming, breaking, and shuffling disulfide bonds have become understood in greater detail. This article summarizes the discoveries of the past 3 decades, focusing on disulfide bond formation in the periplasm of the model prokaryotic host
E. coli
.
Insights into the Unique Nature of the East Asian Clade of the Emerging Pathogenic Yeast Candida auris
Authors: Welsh Rory M. , Sexton D. Joseph , Forsberg Kaitlin , Vallabhaneni Snigdha , Litvintseva Anastasia
Published: February 2019

The emerging yeast
Candida auris
can be highly drug resistant, causing invasive infections, and large outbreaks.
C. auris
went from an unknown pathogen a decade ago to being reported in over thirty countries on six continents.
Visceral leishmaniasis with haemophagocytic lymphohistiocytosis
Authors: George John Titus , Sadiq Mohammad , Sigamani Elanthenral , Mathuram Alice Joan
Published: February 2019

A 27-year-old man presented with high-grade intermittent fever for 4 months, generalised fatigue for 2 months, intermittent gum bleeds for 1 month and loss of weight of 15 kg. He appeared cachectic with generalised wasting, had pallor and features of reticuloendothelial system proliferation. His liver span was 17 cm. He had massive splenomegaly. His cardiovascular, respiratory and neurological examination were normal. He was diagnosed to have visceral leishmaniasis (VL) based on bone marrow (BM) examination that showed Leishmania donovani (LD) bodies and was treated with liposomal amphotericin (LA). During the course of therapy, he developed bleeding from various mucosal and venepuncture sites. His further evaluation, which included a repeat BM aspirate, showed haemophagocytes. Final diagnosis made was VL with secondary haemophagocytic lymphohistiocytosis. He was continued on LA with intravenous hydrocortisone. He developed refractory distributive shock with multiorgan dysfunction and succumbed to his illness.
Spontaneous pneumomediastinum and subcutaneous emphysema in a child with unknown aetiology
Authors: Chidambaram Anoopkishore , Donekal Sirisha
Published: February 2019

Spontaneous subcutaneous emphysema and pneumomediastinum in children without any predisposing factors is a rare entity. We present a case of an adolescent boy with spontaneous pneumomediastinum. He is a 14-year-old boy brought to the hospital with an odd feeling in the neck and chest. Initial chest X-ray revealed subcutaneous emphysema and pneumomediastinum. He was further evaluated with CT thorax and abdomen with contrast which revealed extensive pneumomediastinum with associated surgical emphysema in the chest wall and neck. Expert opinions from the cardiothoracic and respiratory teams were obtained. The child was discharged with safety netting and description of red flag signs. Repeat chest X-ray in 2 weeks showed complete resolution of the pneumomediastinum and subcutaneous emphysema. We will briefly discuss about the diagnosis and treatment of spontaneous pneumomediastinum and subcutaneous emphysema.
Morvan’s syndrome treated successfully with rituximab and lacosamide
Authors: Sveinsson Olafur , Al Nimer Faiez , Piehl Fredrik
Published: February 2019

We describe a woman with both central and peripheral nervous system symptoms consistent with Morvan’s syndrome who was successfully treated with immunosuppression including rituximab and the new antiepileptic drug lacosamide against peripheral nerve hyperexcitability. Despite being over 8 months in hospital and 4 months in an intensive care unit she recovered fully. It is also the first case where cerebrospinal fluid neurofilament-light (NfL) levels were followed during the disease course. The clinical course resembled that of anti-NMDA receptor encephalitis, where patients often recover surprisingly well despite severe symptoms and an extensive time in intensive care. A possible explanation is the comparatively low levels of NfL, indicating disease processes that are not characterised by extensive neuroaxonal degeneration.
Unusual presentation of acute pancreatitis following high tibial osteotomy
Authors: O’Connor Adam , Asaad Peter
Published: February 2019

We report a case of a 55-year-old man taxi driver admitted electively for high tibial osteotomy for relief of bilateral medial compartment osteoarthritis. He was obese and an ex-smoker but medical history was otherwise unremarkable. Day 1 postoperatively the patient started to suffer vomiting episodes and the abdomen was distended. C Reactive protein and white cell count were both elevated but other bloods were normal. CT abdomen and pelvis was performed which showed acute interstitial pancreatitis. Glasgow score was calculated as 2. He was treated aggressively with analgesia, intravenous fluid and intravenous antibiotics. He has made a good recovery following these conservative measures. To our knowledge, this is the first case in the literature reporting pancreatitis as a complication of high tibial osteotomy. This case highlights the importance of close monitoring for abdominal complications even in the setting of elective orthopaedic surgery where it is a rare phenomenon.
Bilateral osteonecrosis of the hip in panhypopituitarism
Authors: Uppal Jasmene , Burbridge Brent , Arnason Terra
Published: February 2019

Osteonecrosis, also known as avascular necrosis, is a condition that causes significant morbidity and loss of function. It is a common complication seen with supraphysiological steroid use. Early diagnosis is critical as it impacts prognosis. We report a 20-year-old man who developed bilateral osteonecrosis of the hip following 6 years of low-dose steroid replacement therapy for panhypopituitarism secondary to a transsphenoidal resection of a growth hormone-secreting pituitary macroadenoma. The patient presented with several weeks of right-sided hip pain and significant loss of function. X-ray and MRI showed bilateral osteonecrosis of the hips with the right side more severely affected than the left. He was initiated on analgesics and bisphosphonates and underwent right hip total arthroplasty followed 1 year later by left hip arthroplasty. Postsurgery, the patient is mobilising well and his pituitary hormones are well balanced. He continues on low-dose glucocorticoid replacement which will continue lifelong.
Spontaneous cholecystocutaneous fistula: empirically treated for a missed diagnosis, managed by laparoscopy
Authors: Pol Manjunath Maruti , Vyas Surabhi , Singh Priyanka , Rathore Yashwant Singh
Published: February 2019

A 70-year-old woman was referred to our hospital from primary health centre with complaints of pain in the abdomen, swelling and discharging sinus in the right hypochondrium since 2 years. She had received anti-tubercular treatment for 18 months as the wedge biopsy of the sinus tract suggested granulomatous lesion. As the symptoms did not subside she was referred to our hospital. Her blood investigation reports at our hospital were normal. Ultrasound of the abdomen suggested cholelithiasis with normal common bile duct. CT fistulogram findings were diagnostic of cholecystocutaneous fistula (CCCF). She underwent laparoscopic cholecystectomy and excision of the sinus tract. Postoperative recovery was uneventful. Indiscriminate usage of anti-tubercular drugs should be discouraged and possibility of CCCF should be considered in patients presenting with discharging sinus in the anterior abdominal wall. CT fistulogram is helpful in making diagnosis of CCCF. Cholecystectomy with excision of the sinus tract is the treatment of choice.
Recurrent corneal erosion syndrome
Authors: Lin Shawn Rong , Aldave Anthony J , Chodosh James
Published: February 2019

Recurrent corneal erosion syndrome (RCES) is a disorder characterised by a dysfunctional epithelial ecosystem. It often begins after trauma, or in the setting of epithelial basement membrane degeneration or dystrophy. Historically, RCES has been understood as a structural derangement of the anterior corneal architecture. More recently, studies have demonstrated the important role of neuropeptides in corneal homoeostasis. Thus, RCES may also be understood as a disorder of corneal epithelial cell biology. Management of RCES can be challenging, but newer therapies have demonstrated improved efficacy for this condition. This review examines the aetiology and pathogenesis of RCES, and provides an update on current and emerging treatment modalities for the management of this disorder.
How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years
Authors: Downie Aron , Hancock Mark , Jenkins Hazel , Buchbinder Rachelle , Harris Ian , Underwood Martin , Goergen Stacy , Maher Chris G
Published: February 2019

Objectives

To (1) estimate the proportion of patients seeking care for low back pain (LBP) who are imaged and (2) explore trends in the proportion of patients who received diagnostic imaging over time. We also examined the effect of study-level factors on estimates of imaging proportion.

Data sources

Electronic searches of MEDLINE, Embase and CINAHL databases from January 1995 to December 2017.

Eligibility criteria for selecting studies

Observational designs and controlled trials that reported imaging for patients presenting to primary care or emergency care for LBP. We assessed study quality and calculated pooled proportions by care setting and imaging type, with strength of evidence assessed using the GRADE system.

Results

45 studies were included. They represented 19 451 749 consultations for LBP that had resulted in 4 343 919 imaging requests/events over 21 years. Primary care: moderate quality evidence that simple imaging proportion was 16.3% (95% CI 12.6% to 21.1%) and complex imaging was 9.2% (95% CI 6.2% to 13.5%). For any imaging, the pooled proportion was 24.8% (95% CI 19.3%to 31.1%). Emergency care: moderate quality evidence that simple imaging proportion was 26.1% (95% CI 18.2% to 35.8%) and high-quality evidence that complex imaging proportion was 8.2% (95% CI 4.4% to 15.6%). For any imaging, the pooled proportion was 35.6% (95% CI 29.8% to 41.8%). Complex imaging increased from 7.4% (95% CI 5.7% to 9.6%) for imaging requested in 1995 to 11.4% (95% CI 9.6% to 13.5%) in 2015 (relative increase of 53.5%). Between-study variability in imaging proportions was only partially explained by study-level characteristics; there were insufficient data to comment on some prespecified study-level factors.

Summary/conclusion

One in four patients who presented to primary care with LBP received imaging as did one in three who presented to the emergency department. The rate of complex imaging appears to have increased over 21 years despite guideline advice and education campaigns.

Trial registration number

CRD42016041987.
New airway device as good as tracheal tube insertion for out-of-hospital resuscitation
Authors: Cook Rob , Thomas Vaughan , Martin Rosie
Published: February 2019

The study

Effect of a strategy of a supraglottic airway device versus tracheal intubation during out-of-hospital cardiac arrest on functional outcome: the AIRWAYS-2 randomised clinical trial

Benger JR, Kirby K, Black S, Brett SJ, Clout M, Lazaroo MJ, Nolan JP, Reeves BC, Robinson M, Scott LJ, Smartt H, South A, Stokes EA, Taylor J, Thomas M, Voss S, Wordsworth S, Rogers CA

Published on 28 August 2018
JAMA
2018;320:779-91

This study was funded by the National Institute for Health Research Health Technology Assessment Programme (project number 12/167/102).

To read the full NIHR Signal, go to:
https://discover.dc.nihr.ac.uk/content/signal-000686/new-airway-device-as-good-as-tracheal-tube-for-resuscitation-out-of-hospita
Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017: population based cohort study
Authors: Taylor Clare J , Ordóñez-Mena José M , Roalfe Andrea K , Lay-Flurrie Sarah , Jones Nicholas R , Marshall Tom , Hobbs F D Richard
Published: February 2019

Objectives

To report reliable estimates of short term and long term survival rates for people with a diagnosis of heart failure and to assess trends over time by year of diagnosis, hospital admission, and socioeconomic group.

Design

Population based cohort study.

Setting

Primary care, United Kingdom.

Participants

Primary care data for 55 959 patients aged 45 and over

with a new diagnosis of heart failure and 278 679 age and sex matched controls in the Clinical Practice Research Datalink from 1 January 2000 to 31 December 2017 and linked to inpatient Hospital Episode Statistics and Office for National Statistics mortality data.

Main outcome measures

Survival rates at one, five, and 10 years and cause of death for people with and without heart failure; and temporal trends in survival by year of diagnosis, hospital admission, and socioeconomic group.

Results

Overall, one, five, and 10 year survival rates increased by 6.6% (from 74.2% in 2000 to 80.8% in 2016), 7.2% (from 41.0% in 2000 to 48.2% in 2012), and 6.4% (from 19.8% in 2000 to 26.2% in 2007), respectively. There were 30 906 deaths in the heart failure group over the study period. Heart failure was listed on the death certificate in 13 093 (42.4%) of these patients, and in 2237 (7.2%) it was the primary cause of death. Improvement in survival was greater for patients not requiring admission to hospital around the time of diagnosis (median difference 2.4 years; 5.3
v
2.9 years, P<0.001). There was a deprivation gap in median survival of 0.5 years between people who were least deprived and those who were most deprived (4.6
v
4.1 years, P<0.001).

Conclusions

Survival after a diagnosis of heart failure has shown only modest improvement in the 21st century and lags behind other serious conditions, such as cancer. New strategies to achieve timely diagnosis and treatment initiation in primary care for all socioeconomic groups should be a priority for future research and policy.
Enterovirus as trigger of coeliac disease: nested case-control study within prospective birth cohort
Authors: Kahrs Christian R , Chuda Katerina , Tapia German , Stene Lars C , Mårild Karl , Rasmussen Trond , Rønningen Kjersti S , Lundin Knut E A , Kramna Lenka , Cinek Ondrej , Størdal Ketil
Published: February 2019

Objective

To determine whether infection with human enterovirus or adenovirus, both common intestinal viruses, predicts development of coeliac disease.

Design

Case-control study nested within Norwegian birth cohort recruited between 2001 and 2007 and followed to September 2016.

Setting

Norwegian population.

Participants

Children carrying the HLA genotype DR4-DQ8/DR3-DQ2 conferring increased risk of coeliac disease.

Exposures

Enterovirus and adenovirus detected using real time polymerase chain reaction in monthly stool samples from age 3 to 36 months.

Main outcome measure

Coeliac disease diagnosed according to standard criteria. Coeliac disease antibodies were tested in blood samples taken at age 3, 6, 9, and 12 months and then annually. Adjusted odds ratios from mixed effects logistic regression model were used to assess the relation between viral infections before development of coeliac disease antibodies and coeliac disease.

Results

Among 220 children, and after a mean of 9.9 (SD 1.6) years, 25 children were diagnosed as having coeliac disease after screening and were matched to two controls each. Enterovirus was found in 370 (17%) of 2135 samples and was significantly more frequent in samples collected before development of coeliac disease antibodies in cases than in controls (adjusted odds ratio 1.49, 95% confidence interval 1.07 to 2.06; P=0.02). The association was restricted to infections after introduction of gluten. High quantity samples (>100 000 copies/μL) (adjusted odds ratio 2.11, 1.24 to 3.60; P=0.01) and long lasting infections (>2 months) (2.16, 1.16 to 4.04; P=0.02) gave higher risk estimates. Both the commonly detected enterovirus species Enterovirus A and Enterovirus B were significantly associated with coeliac disease. The association was not found for infections during or after development of coeliac disease antibodies. Adenovirus was not associated with coeliac disease.

Conclusions

In this longitudinal study, a higher frequency of enterovirus, but not adenovirus, during early childhood was associated with later coeliac disease. The finding adds new information on the role of viral infections in the aetiology of coeliac disease.
Immune checkpoint inhibitors: an emerging cause of insulin-dependent diabetes
Authors: Kotwal Anupam , Haddox Candace , Block Matthew , Kudva Yogish C
Published: February 2019

Objective

Insulin-dependent diabetes can occur with immune checkpoint inhibitor (ICI) therapy. We aimed to characterize the frequency, natural history and potential predictors of ICI-induced diabetes.

Research design and methods

We reviewed 1444 patients treated with ICIs over 6 years at our cancer center, and from the 1163 patients who received programmed cell death protein 1 (PD-1) inhibitors, we identified 21 such cases, 12 of which developed new-onset insulin-dependent diabetes and 9 experienced worsening of pre-existing type 2 diabetes.

Results

ICI-induced diabetes occurred most frequently with pembrolizumab (2.2%) compared with nivolumab (1%) and ipilimumab (0%). The median age was 61 years, and body mass index was 31 kg/m2, which are both higher than expected for spontaneous type 1 diabetes. Other immune-related adverse events occurred in 62%, the most common being immune mediated thyroid disease. New-onset insulin-dependent diabetes developed after a median of four cycles or 5 months; 67% presented with diabetic ketoacidosis and 83% with low or undetectable C-peptide. Autoantibodies were elevated in 5/7 (71%) at the time of new-onset diabetes. Diabetes did not resolve during a median follow-up of 1 year.

Conclusions

PD-1 inhibitors can lead to insulin deficiency presenting as new-onset diabetes or worsening of pre-existing type 2 diabetes, with a frequency of 1.8 %. The underlying mechanism appears similar to spontaneous type 1 diabetes but there is a faster progression to severe insulin deficiency. Better characterization of ICI-induced diabetes will improve patient care and enhance our understanding of immune-mediated diabetes.
Using research to prepare for outbreaks of severe acute respiratory infection
Authors:   For the SPRINT-SARI investigators
Published: February 2019

Severe acute respiratory infections (SARI) remain one of the leading causes of mortality around the world in all age groups. There is large global variation in epidemiology, clinical management and outcomes, including mortality. We performed a short period observational data collection in critical care units distributed globally during regional peak SARI seasons from 1 January 2016 until 31 August 2017, using standardised data collection tools. Data were collected for 1 week on all admitted patients who met the inclusion criteria for SARI, with follow-up to hospital discharge. Proportions of patients across regions were compared for microbiology, management strategies and outcomes. Regions were divided geographically and economically according to World Bank definitions. Data were collected for 682 patients from 95 hospitals and 23 countries. The overall mortality was 9.5%. Of the patients, 21.7% were children, with case fatality proportions of 1% for those less than 5 years. The highest mortality was in those above 60 years, at 18.6%. Case fatality varied by region: East Asia and Pacific 10.2% (21 of 206), Sub-Saharan Africa 4.3% (8 of 188), South Asia 0% (0 of 35), North America 13.6% (25 of 184), and Europe and Central Asia 14.3% (9 of 63). Mortality in low-income and low-middle-income countries combined was 4% as compared with 14% in high-income countries. Organ dysfunction scores calculated on presentation in 560 patients where full data were available revealed Sequential Organ Failure Assessment (SOFA) scores on presentation were significantly associated with mortality and hospital length of stay. Patients in East Asia and Pacific (48%) and North America (24%) had the highest SOFA scores of >12. Multivariable analysis demonstrated that initial SOFA score and age were independent predictors of hospital survival. There was variability across regions and income groupings for the critical care management and outcomes of SARI. Intensive care unit-specific factors, geography and management features were less reliable than baseline severity for predicting ultimate outcome. These findings may help in planning future outbreak severity assessments, but more globally representative data are required.
Sleep duration and apolipoprotein B in metabolically healthy and unhealthy overweight/obese phenotypes: a cross-sectional study in Chinese adults
Authors: Ren Huihui , Zhang Lu , Liu Zhelong , Zhou Xinrong , Yuan Gang
Published: February 2019

Objectives

Short sleep duration is independently associated with an increased risk of developing cardiovascular disease; however, the association has not yet been examined in obese populations. We assessed the associations between sleep duration, metabolic phenotype and apolipoprotein variables in a nationally representative Chinese population with overweight/obesity.

Study design

Cross-sectional study.

Settings

The study conducted in nine provinces of China that vary substantially in geography and economic development.

Patients

Data were obtained from 4149 adults with overweight/obesity aged 18 to 94 years from the 2009 China Health and Nutrition Survey. Sleep duration was categorised as ≤6, 7–8 or ≥9 hour. Phenotypes were determined based on body mass index and metabolic health status and categorised as metabolically healthy overweight/obesity (MHOO) and metabolically unhealthy overweight/obesity (MUOO).

Main outcome measure

The outcome variables were elevated apolipoproteins.

Results

Compared with MHOO phenotype, MUOO phenotypes were more likely to report shorter sleep duration (12.2%vs9%). In the MUOO group, the multivariate-adjusted OR (95% CI) for elevated apolipoprotein B (apoB) was 1.66 (1.23 to 2.23) for those with ≤6 hours of sleep and 1.12 (0.86 to 1.45) for those with ≥9 hours of sleep, using 7–8 hours of sleep as a reference. Similar results were obtained in the subgroup of subjects who were ≥45 or<45 years old, but shorter sleep duration was more strongly associated with elevated apoB in those <45 years (p interaction=0.023). However, no association was observed in the MHOO phenotype.

Conclusions

The high prevalence of short sleep duration and its strong association with elevated apoB in adults who are metabolically unhealthy overweight/obese suggest an increased risk of cardiovascular disease in this population. The differences in sleep sufficiency among obese phenotypes may account for the disparities in their cardiovascular outcomes.
Identifying priorities for cancer caregiver interventions: protocol for a three-round modified Delphi study
Authors: Blaschke Sarah-May , Lambert Sylvie D , Livingston Patricia M , Aranda Sanchia , Boltong Anna , Schofield Penelope , Chambers Suzanne K , Krishnasamy Meinir , Ugalde Anna
Published: February 2019

Introduction

Cancer is often considered a chronic disease, and most people with cancer have a caregiver, often a family member or friend who provides a significant amount of care during the illness trajectory. Caregivers are frequently in need of support, and a range of interventions have been trialled to improve outcomes. Consensus for optimal ways to support caregivers is not known. The aim of this protocol paper is to describe procedures for a modified Delphi study to explore expert consensus about important factors when developing caregiver interventions.

Methods and analysis

Online modified Delphi methodology will be used to establish consensus for important caregiver intervention factors incorporating the Patient problem, Intervention, Comparison and Outcome framework. Round 1 will comprise a free-text questionnaire and invite the panel to contribute factors they deem important in the development and evaluation of caregiver interventions. Round 2 is designed to determine preliminary consensus of the importance of factors generated in round 1. The panel will be asked to rate each factor using a 4-point Likert-type scale. The option for panellists to state reasoning for their rating will be provided. Descriptive statistics (median scores and IQR) will be calculated to determine each item’s relative importance. Levels of consensus will be assessed based on a predefined consensus rating matrix. In round 3, factors will be recirculated including aggregate group responses (statistics and comment summaries) and panellists’ own round 2 scores. Panellists will be invited to reconsider their judgements and resubmit ratings using the same rating system as in round 2. This will result in priority lists based on the panel’s total rating scores.

Ethics and dissemination

Ethics for this study has been gained from the Deakin University Human Ethics Advisory Group. It is anticipated that the results will be published in peer-reviewed journals and presented in a variety of forums.
Quantifying tobacco and alcohol imagery in Netflix and Amazon Prime instant video original programming accessed from the UK: a content analysis
Authors: Barker Alexander B , Smith Jordan , Hunter Abby , Britton John , Murray Rachael L
Published: February 2019

Objectives

Exposure to tobacco and alcohol content in audio-visual media is a risk factor for smoking and alcohol use in young people. Previous UK research has quantified tobacco and alcohol content in films and broadcast television but not that of video-on-demand (VOD) services such as Netflix and Amazon Prime. Furthermore, it is not clear whether regulation by Dutch (Netflix) or UK (Amazon Prime) authorities results in differences in content. We report an analysis of tobacco and alcohol content in a sample of episodes from the most popular programmes from these two VOD providers, and compare findings with earlier studies of UK prime-time television content.

Setting

UK.

Participants

None. Content analysis of a sample of 50 episodes from the five highest rated series released on Netflix and Amazon Prime in 2016, using 1 min interval coding of any tobacco or alcohol content, actual or implied use, paraphernalia and branding.

Results

Of 2704 intervals coded, any tobacco content appeared in 353 (13%) from 37 (74%) episodes. Any alcohol content appeared in 363 (13%) intervals in 47 (94%) episodes. There were no significant differences between the two services, however the proportion of episodes containing tobacco and alcohol was significantly higher in VOD original programmes than those recorded in an earlier study of prime-time UK television.

Conclusions

Audio-visual tobacco and alcohol content is common in VOD original programmes and represents a further source of exposure to imagery causing smoking uptake and alcohol use in young people. This appears to be equally true of services regulated in the UK and The Netherlands. Given that VOD services are consumed by a global audience, it appears likely that VOD content is an important global driver of tobacco and alcohol consumption.
Mapping of modifiable barriers and facilitators of medication adherence in bipolar disorder to the Theoretical Domains Framework: a systematic review protocol
Authors: Prajapati Asta Ratna , Dima Alexandra Lelia , Clark Allan B , Gant Claire , Gibbons Chris , Gorrod Richard , Mosa George , Scott Sion , Song Fujian , Teague Bonnie , Twigg Michael J , Wilson Jon , Bhattacharya Debi
Published: February 2019

Introduction

People with bipolar disorder require long-term treatment but it is estimated that 40% of these people do not adhere to prescribed medication regimens. Non-adherence increases the risk of relapse, hospitalisation and suicide. Some evidence syntheses report barriers to mental health treatment adherence but rarely delineate between modifiable and non-modifiable barriers. They also fail to distinguish between the patients’ perspective and that of other stakeholders such as clinicians despite of their different understanding and priorities about adherence. Facilitators of adherence, which are also important for informing adherence intervention design, are also lacking from syntheses and few syntheses focus on medications for bipolar disorder.

This systematic review aims to identify modifiable barriers and facilitators (determinants) of medication adherence in bipolar disorder. We also plan to report determinants of medication adherence from perspectives of patients, carers, healthcare professionals and other third parties. A unique feature of this systematic review in the context of mental health is the use of the Theoretical Domains Framework (TDF) to organise the literature identified determinants of medication adherence.

Methods and analysis

The protocol adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and ENhancing Transparency in REporting the synthesis of Qualitative research (ENTREQ) guidelines. This review will include both qualitative and quantitative primary studies exploring determinants of medication adherence in bipolar disorder. We will search the following databases using a preplanned strategy: CINAHL, Cochrane Library (CENTRAL), Embase, LiLACS, Medline, PsychINFO, PubMed without date restrictions. We will report the quality of included studies. We will use framework synthesis using the TDF as an a priori ‘framework’. We will map the literature identified modifiable determinants to the domains of TDF.

Ethics and dissemination

Ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication.

PROSPERO registration number

CRD42018096306.
Pneumomediastinum in marijuana users: a retrospective review of 14 cases
Authors: Weiss Zoe Freeman , Gore Sara , Foderaro Andrew
Published: February 2019

Introduction

Inhaled marijuana has been infrequently identified as a potential risk factor for the development of spontaneous pneumomediastinum (SPM), a rare finding of free air in the mediastinum likely caused by barotrauma during breathing manoeuvres. The mechanism of inhalation drug use is often not ascertained by physicians, thus little is known about how different smoking techniques precipitate pulmonary injury. We aimed to evaluate the frequency of marijuana use in patients with non-traumatic pneumomediastinum over a 12-month period, identifying additional relevant clinical features or risk factors, and determining the extent to which clinicians record smoking techniques.

Methods

We performed a retrospective chart review over a 1-year period, identifying patients presenting to the hospital with a diagnosis of pneumomediastinum in the absence of trauma, malignancy or iatrogenic cause.

Results

We identified 21 cases, 14 of which (66.7%) were associated with marijuana use, average age was 22.5 years (range 18–30), with male predominance (64.2%). Daily or more use was reported in 50% of cases. Concurrent risk factors including vomiting (57.1%) and coughing (42.9%) were commonly present. The mechanism of smoking was described in only two cases (14.3%).

Discussion

Inhaled marijuana may be an underappreciated risk factor for the development of SPM, caused by air leakage around the bronchovascular sheaths during successive inhalation through a high-resistance smoking apparatus or forced exhalation against a closed glottis. Physicians should be aware of this association in order to provide appropriate counselling. Further research is needed to direct the safe use of smoking devices and techniques.
Diagnosis and management of catheter-related bloodstream infections in patients on home parenteral nutrition
Authors: Bond Ashley , Chadwick Paul , Smith Trevor R , Nightingale Jeremy M D , Lal Simon
Published: February 2019

Catheter-related bloodstream infections (CRBSIs) commonly arise from a parenteral nutrition catheter hub. A target for a Nutrition Support Team is to have a CRBSI rate of less than 1 per 1000. The diagnosis of CRBSI is suspected clinically by a temperature shortly after setting up a feed, general malaise or raised blood inflammatory markers. It is confirmed by qualitative and quantitative blood cultures from the catheter and peripherally. Treatment of inpatients may involve central venous catheter removal and antibiotics for patients needing short-term parenteral nutrition, but catheter salvage is generally recommended for patients needing long-term parenteral nutrition, where appropriate.
Feasibility of Safe-Tea: a parent-targeted intervention to prevent hot drink scalds in preschool children
Authors: Bennett C Verity , Hollén Linda , Quinn-Scoggins Harriet Dorothy , Emond Alan , Kemp Alison Mary
Published: February 2019

Objective

Despite the high prevalence of preventable hot drink scalds in preschool children, there is a paucity of research on effective prevention interventions and a serious need to improve parents’ knowledge of first aid. This study investigates the feasibility of ‘Safe-Tea’, an innovative multifaceted community-based intervention delivered by early-years practitioners.

Methods

‘Safe-Tea’ was implemented at Childcare, Stay&Play and Home Visit settings in areas of deprivation in Cardiff, UK. A mixed-methods approach was used, including preintervention and postintervention parent questionnaires and focus groups with parents and practitioners to test the acceptability, practicality and ability of staff to deliver the intervention, and parents’ knowledge and understanding.

Results

Intervention materials, activities and messages were well received and understood by both parents and community practitioners. Interactive and visual methods of communication requiring little to no reading were most acceptable. Parents’ understanding of the risk of hot drink scalds in preschool children and knowledge of appropriate first aid improved postintervention. Parents knew at baseline that they ‘should’ keep hot drinks out of reach. Focus group discussions after intervention revealed improved understanding of likelihood and severity of scald injury to children, which increased vigilance. Parents gained confidence to correct the behaviours of others at home and pass on first aid messages.

Conclusion

This feasibility study is a vital step towards the development of a robust, evidence-based behaviour change intervention model. Work is underway to refine intervention materials based on improvements suggested by parents, and test these more widely in communities across the UK.
Crash characteristics of on-road single-bicycle crashes: an under-recognised problem
Authors: Beck Ben , Stevenson Mark R , Cameron Peter , Oxley Jennie , Newstead Stuart , Olivier Jake , Boufous Soufiane , Gabbe Belinda J
Published: February 2019

Compared with crashes with motor vehicles, single-bicycle crashes are an under-recognised contributor to cycling injury and the aetiology is poorly understood. Using an in-depth crash investigation technique, this study describes the crash characteristics and patient outcomes of a sample of cyclists admitted to hospital following on-road bicycle crashes. Enrolled cyclists completed a structured interview, and injury details and patient outcomes were extracted from trauma registries. Single-bicycle crashes (n=62) accounted for 48% of on-road crashes and commonly involved experienced cyclists. Common single-bicycle crash types included loss-of-control events, interactions with tram tracks, striking potholes or objects or resulting from mechanical issues with the bicycle. To address single-bicycle crashes, targeted countermeasures are required for each of these specific crash types.
Accuracy of renal tumour biopsy for the diagnosis and subtyping of papillary renal cell carcinoma: analysis of paired biopsy and nephrectomy specimens with focus on discordant cases
Authors: Prendeville Susan , Richard Patrick O , Jewett Michael A S , Kachura John R , Sweet Joan M , van der Kwast Theodorus H , Cheung Carol C , Finelli Antonio , Evans Andrew John
Published: February 2019

Aims

Renal tumour biopsy (RTB) is increasingly recognised as a useful diagnostic tool in the management of small renal masses, particularly those that are incidentally found. Intratumoural heterogeneity with respect to morphology, grade and molecular features represents a frequently identified limitation to the use of RTB. While previous studies have evaluated pathological correlation between RTB and nephrectomy, no studies to date have focused specifically on the role of RTB for the diagnosis of papillary renal cell carcinoma (PRCC) and its further subclassification into clinically relevant subtypes.

Methods

This single-institution study evaluated 60 cases of PRCC for concordance between RTB and nephrectomy with respect to diagnosis, grading and subtyping (type 1/type 2).

Results

We observed 93% concordance (55 of 59 evaluable cases) between RTB and nephrectomy for the diagnosis of PRCC, although seven tumours (12%) were undergraded on RTB. Subtyping of PRCC on RTB was concordant with nephrectomy in 89% of cases reported as type 1 PRCC on RTB (31/35), but only 40% of cases reported as type 2 PRCC on RTB (4/10). Morphological misclassification of PRCC on RTB was most likely to occur in tumours showing a solid growth pattern. Discordant PRCC subtyping most often occurred in tumours with eosinophilia/oncocytic change.

Conclusion

There was good concordance between RTB and nephrectomy for the primary diagnosis of PRCC. Although further subtyping of PRCC can aid therapeutic stratification, this can be challenging on RTB and tumours with overlapping or ambiguous features are best reported as PRCC not otherwise specified pending development of more robust methods to facilitate definitive subclassification.
Glossary of health equity concepts for public health action in the Canadian context
Authors: Oickle Dianne , Clement Connie
Published: February 2019

Despite increased interest in addressing health equity through public health initiatives, practitioner and decision maker comprehension of core concepts is limited and inconsistent. Absence of a shared understanding of equity and related terminology contributes to lack of coordinated solutions as practitioners focus on individual level issues, unrelated to social justice. Taking action to decrease population health inequities requires a comprehension of where inequities are rooted, who is affected and interventions that consider the complexity of inequities being addressed. Public health decision making would be strengthened with greater common understanding of health equity concepts and terminology as an initial step to collaborative action. This glossary defines key concepts related to health equity in public health practice as well as broad-level approaches for taking action on health inequities at a population health level. Exploring terminology in this way supports going beyond individual practitioner responsibility and shifts towards organisational accountability for action.