bluuebunny/crossref_metadata_2025 huggingface dataset:
Exercising to offset muscle mass loss in hemodialysis patients: The disconnect between intention and intervention
Authors: McKenna Colleen F. , Salvador Amadeo F. , Hendriks Floris K. , Harris Alana P. Y. , van Loon Luc J. C. , Burd Nicholas A.
Published: March 2019

Skeletal muscle loss is the most important hallmark of protein energy wasting syndrome as it contributes to declines in physical independence, poor quality of life, and higher mortality risk in individuals with ESRD on maintenance hemodialysis (HD). As such, exercise and nutritional interventions have been investigated with the goal to preserve skeletal muscle mass and overall quality of life. Unfortunately, current efforts are unable to confirm the capacity of exercise to mitigate ESRD‐associated muscle wasting. However, the inconclusive data are often accompanied by suboptimal exercise prescriptions. Exercise sessions are often implemented in‐clinic during the catabolic and proinflammatory period of dialysis treatment and without concurrent nutritional support. Additionally, indirect considerations like exercise intolerance and exercise program compliance/adherence also inhibit exercise training potential. These shortcomings all stem from the current lack of understanding in skeletal muscle mass regulation within the context of ESRD and intermittent HD. As such, this review summarizes the current understanding of exercise regulation on skeletal muscle mass and ESRD‐related obstacles of anabolism to contextualize the ineffectiveness of current exercise interventions for HD patients.
Does job design make workers happy?
Authors: Böckerman Petri , Bryson Alex , Kauhanen Antti , Kangasniemi Mari
Published: March 2019

Using linked employer‐employee data for Finland we examine associations between job design, employee well‐being and job‐related stress. Three key findings stand out. First, in accordance with the theory of Karasek and Karasek and Theorell, job control and supervisory support are positively correlated with employee well‐being and negatively correlated with job‐related stress. Second, as predicted by theory, job demands are positively correlated with job‐related stress. Third, there is no association between job demands and employee well‐being and, contrary to expectations, neither job control nor supervisory support alleviate the negative relationship between job demands and job‐related stress. Our results confirm the importance of job design for employee well‐being.
The “ugly” face of social investment? The politics of childcare in Central and Eastern Europe
Authors: Szelewa Dorota , Polakowski Michał
Published: March 2019

In this article, we aim to understand the development dynamics of a specific area of social investment (SI), that is, childcare policies, in the context of postcommunist politics and the recent right‐wing turn that took place in the Czech Republic, Hungary, and Poland. This article identifies varieties of channels for promoting SI. First, in taking the perspective of the “mixed economy of welfare,” we argue that attempts made to introduce elements of SI to the childcare policies involved various leading roles available for either the private sector or state/public domain. Second, it is important to distinguish between implicit/unintended and explicit/intended projects both in relation to cases in which SI strategy is applied via marketization/privatization and when it involves a government‐led project. Third, we take into account the politics of SI implementation that might involve applying certain principles central to policy concepts (such as “investment”) in justifying policy instruments incompatible with original ideas. Although arguments about SI have been extensively used by Eastern European leaders, their goal has been to justify welfare reforms that were implicitly or explicitly directed towards the middle class while excluding the “nondeserving” often based on ethnic identity. We characterize Poland as a case of “implicit marketization,” the Czech Republic as a case of “explicit privatization,” and the Hungarian version of SI as a case of “explicit public dualization.” In this, we show that in some cases, the implementation of SI approaches by right‐wing populist parties might rear its “ugly” head.
Enhancing engineering education in the elementary school
Authors: Utley Juliana , Ivey Toni , Hammack Rebekah , High Karen
Published: March 2019

The Next Generation Science Standards emphasizes the inclusion of engineering practices throughout the K–12 science curriculum. Therefore, elementary educators need to be knowledgeable about engineering and engineering careers so that they can expose their students to engineering. The purpose of this study was to examine the effect of engineering professional development on in‐service elementary teachers’: (a) knowledge and perceptions regarding engineering, and (b) self‐efficacy of teaching engineering. This quantitative study revealed that even one professional development opportunity can help to alleviate some misconceptions about the work of engineers and what constitutes technology, as well as increase teachers’ confidence to teach engineering concepts.
Native kidney BK virus nephropathy, a systematic review
Authors: Shah Ankur , Kumar Vinayak , Palmer Matthew B. , Trofe‐Clark Jennifer , Laskin Benjamin , Sawinski Deirdre , Hogan Jonathan J.
Published: March 2019

Background

There is a growing base of literature describing BK nephropathy (BKVN) in patients outside of the setting of kidney transplant. Previous systematic reviews of the literature have been limited by methodology or by the scope of patients included.

Study Design and Methods

Systematic Review (Prospero # CRD42018088524).

Setting & Population

Patients without kidney transplant who had biopsy‐proven BKVN.

Selection Criteria for Studies

Full‐text articles that describe native BKVN patient cases.

Analytical Approach

Descriptive synthesis.

Results

The search identified 630 unique articles of which 51 were included in the final review. Sixty‐five cases (including two new cases presented in this review) were identified, all but one occurred in the setting of known immunosuppression.

Limitations

The primary limitation was the exclusion of studies that did not fulfill the stringent review criteria. We excluded reports with only a clinical diagnosis of BKVN, such as those with viruria and/or viremia without biopsy.

Conclusions

As of May 2018, there are 65 reported cases of BKVN in native kidneys. This represents the most comprehensive description of biopsy‐proven BKVN in native kidneys to date. Evaluation for BK nephropathy should be considered in immunocompromised patients who exhibit unexplained renal failure.
Trends and outcomes in multicomponent blood transfusion: an 11‐year cohort study of a large multisite academic center
Authors: Perelman Iris , Saidenberg Elianna , Tinmouth Alan , Fergusson Dean
Published: March 2019

BACKGROUND

Most studies reporting on blood component utilization overlook patients transfused with more than one type of blood product (multicomponent transfusion). These patients are of importance, as they are large consumers of blood products and likely have different characteristics and outcomes than nontransfused patients and patients transfused with only one blood component type. Our study aimed to determine the prevalence of multicomponent transfusion at a large multisite academic center, as well as the patient characteristics and outcomes associated with multicomponent transfusion.

METHODS

A retrospective cohort study of transfused adult inpatients at the Ottawa Hospital between 2007 and 2017 was performed. Eligible transfusions were red blood cells (RBCs), platelets, plasma, cryoprecipitate, and/or fibrinogen concentrate. Descriptive analyses were done to determine multicomponent transfusion prevalence. Patient characteristics and outcomes associated with multicomponent transfusion were assessed using multivariable regressions.

RESULTS

Of 55,719 adult transfused inpatient admissions, 25% received a multicomponent transfusion. Multicomponent transfusion prevalence was highest in hematology (51%), cardiac surgery (45%), and critical care (40%) patients. Multivariable regression analysis showed that compared to RBC‐only transfusion, multicomponent transfusion was associated with increased odds of in‐hospital mortality (odds ratio, 3.48; 95% confidence interval [CI], 3.26–3.73), greater odds of institutional discharge as opposed to discharge home (odds ratio, 1.22; 95% CI, 1.15–1.30), and a 1.58 time increase in duration of hospitalization (95% CI, 1.54–1.62).

CONCLUSION

Multicomponent transfusion recipients make up a large proportion of transfused patients and have poorer outcomes. It is necessary to continue studying these patients, including outcomes and transfusion appropriateness, to inform best practices.
The Effects of Pilates and Aerobic Exercise on Blood Pressure, Heart Rates, and Blood Serum Lipids in Sedentary Females
Authors: Çetin Semra , Ece Cuma , Şen Murat , Çetin H. Nedim , Aydoğan Alaeddin
Published: March 2019

The aim of this study was to determinate the effects of 12 weeks pilates and aerobic exercise on blood pressure, heart rates, and blood serum lipids in sedentary females. 18 sedentary women with an average age of 45.52 years, height of 161.14 cm and weight of 72.5 kg have been selected and put through a plates and aerobic exercise programmer one hour a day for three days a week. Exercises in each training session were arranged in such a way as to make each woman’s heart rate to reach a level of 130-140 a minute. The waist and hip circumferences were measured using a measuring tape. BMI and waist hip ratio were calculated by standard formulas. Triglyceride (TG), Total Cholesterol (TC), High density lipoprotein (HDL-C) and Low density lipoprotein (LDL-C) levels were determined by Hitachi 717 auto analyzer. Analysis was performed on SPSS 21 version. Paired-t tests were done statistical analysis. Body Weight found before 12 weeks plates and aerobic exercise 72.5 kg and after 63.8 kg. At the end of the 12 weeks exercise program, a decrease of %12.00 in body weight, %14.03 in systolic, %3.96 in diastolic, %13.85 in cholesterol, %25.30 in Triglyceride, and %22.33 in LDL-C have been registered. However, there were increases of %16.34 in HDL-C. The effects of aerobic exercise is on Triglyceride, HDL-C, LDL-C and total cholesterol since (p<0.01). At the end of the 12 weeks exercise program, a decrease %13.34 hip circumference and %4.19 waist circumference. Waist to hip ratio found before 12 weeks plates and aerobic exercise 0.87 cm and after 0.78 cm. The effects of aerobic exercise is on Body weight, Systolic blood pressure, Heart rate, hip and waist circumference since (p<0.05; p<0.01). In this study, together Pilates and aerobic exercise was effective in sedentary women with initially high total cholesterol, triglyceride, and Low density lipoprotein levels. At end of the cycles of 12 weeks Pilates and aerobic exercises, has a positive effect of waist to hip ratio, blood pressure, and heart beats in sedentary females. Risk of heart and vascular disease is reduced. Pilates and aerobic exercises are recommended for decrease risk.
Safety and effectiveness of hypodermoclysis compared to intravenous fluid infusion for rehydrating children with mild to moderate dehydration: a systematic review protocol
Authors: Saganski Gabrielle Freitas , de Souza Freire Márcia Helena
Published: March 2019

Objective:

The objective of this review is to summarize the evidence on the effectiveness and safety of hypodermoclysis (HDC) for the rehydration of children with mild or moderate dehydration.

Introduction:

Children are particularly susceptible to dehydration, which can lead to severe gastrointestinal disturbances. Hypodermoclysis, the infusion of fluids and electrolytes via subcutaneous tissue, is an alternative route of administering fluid replacement when oral or intravenous routes are contraindicated. Although HDC is primarily used in elderly patients, there are no restrictions on its use in children. A review is needed to synthesize the evidence on the effectiveness of HDC for treating dehydration in children.

Inclusion criteria:

Eligible studies will include infants and children up to 10 years of age with mild or moderate dehydration based on the Gorelick scale. Studies that compare fluid infusion with HDC to intravenous administration, at either hospital or home, will be considered. Outcomes of interest will include dehydration level, safety and pain. Studies published in English, Spanish or Portugese since database inception will be considered for inclusion.

Methods:

PubMed, CINAHL, Web of Science, Embase and Scopus will be searched, as well as multiple sources of unpublished studies. Two independent reviewers will screen titles and abstracts against the inclusion criteria, retrieve and assess the full text of selected studies, critically appraise studies for methodological quality and extract data using a standardized extraction tool. Data will be pooled in a statistical meta-analysis, when feasible. A Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Summary of Findings will be presented.
Long non‐coding RNA activated by transforming growth factor‐β promotes proliferation and invasion of cervical cancer cells by regulating the miR‐144/ITGA6 axis
Authors: Zhu Yingping , Wu Yanping , Yang Liwei , Dou Xiaoqing , Jiang Jun , Wang Liangping
Published: March 2019

New Findings

What is the central question of this study?

This study was designed to investigate the molecular mechanism and biological roles of long non‐coding RNA activated by transforming growth factor‐β (lncRNA ATB) in the progression of cervical cancer.

What is the main finding and its importance?

Our study provided new insight into the cross‐talk between lncRNA ATB, miR‐144 and ITGA6, shedding light on the therapy for cervical cancer.

The present study was designed to investigate the molecular mechanism and biological roles of long non‐coding RNA activated by transforming growth factor‐β (lncRNA ATB) in the progression of cervical cancer. The expression levels of lncRNA ATB, miR‐144 and integrin α6 (ITGA6) were detected in human cervical cancer cell lines using quantitative real‐time PCR and western blotting. Cell viability was quantified by MTT assay at 12, 24, 36, 48 and 72 h after transfection, and cell invasion was determined by the Transwell migration assay. The association among lncRNA ATB, miR‐144 and ITGA6 was disclosed by a dual‐luciferase reporter assay. We found that lncRNA ATB was highly expressed in human cervical cancer cell lines. Further investigation indicated that lncRNA ATB functioned as a competitive endogenous RNA (ceRNA) for miR‐144 to promote cervical cancer cell proliferation and invasion. We demonstrated that ITGA6 was a direct target of miR‐144, and lncRNA ATB facilitated the proliferation and invasion of cervical cancer cells via the miR‐144/ITGA5 axis. In conclusion, the lncRNA ATB/miR‐144/ITGA6 axis might be a promising therapeutic target for cervical cancer.
Cerebellar repetitive transcranial magnetic stimulation restores pharyngeal brain activity and swallowing behaviour after disruption by a cortical virtual lesion
Authors: Sasegbon Ayodele , Watanabe Masahiro , Simons Andre , Michou Emilia , Vasant Dipesh H. , Magara Jin , Bath Philip M. , Rothwell John , Inoue Makoto , Hamdy Shaheen
Published: March 2019

Key points

Despite evidence that the human cerebellum has an important role in swallowing neurophysiology, the effects of cerebellar stimulation on swallowing in the disrupted brain have not been explored.

In this study, for the first time, the application of cerebellar neurostimulation is characterized in a human model of disrupted swallowing (using a cortical virtual lesion).

It is demonstrated that cerebellar stimulation can reverse the suppressed activity in the cortical swallowing system and restore swallowing function in a challenging behavioural task, suggesting the findings may have important therapeutic implications.

Repetitive transcranial magnetic stimulation (rTMS) can alter neuronal activity within the brain with therapeutic potential. Low frequency stimulation to the ‘dominant’ cortical swallowing projection induces a ‘virtual‐lesion’ transiently suppressing cortical excitability and disrupting swallowing behaviour. Here, we compared the ability of ipsi‐lesional, contra‐lesional and sham cerebellar rTMS to reverse the effects of a ‘virtual‐lesion’ in health. Two groups of healthy participants (n = 15/group) were intubated with pharyngeal catheters. Baseline pharyngeal motor evoked potentials (PMEPs) and swallowing performance (reaction task) were measured. Participants received 10 min of 1 Hz rTMS to the pharyngeal motor cortex which elicited the largest PMEPs to suppress cortical activity and disrupt swallowing behaviour. Over six visits, participants were randomized to receive 250 pulses of 10 Hz cerebellar rTMS to the ipsi‐lesional side, contra‐lesional side or sham while assessing PMEP amplitude or swallowing performance for an hour afterwards. Compared to sham, active cerebellar rTMS, whether administered ipsi‐lesionally (P = 0.011) or contra‐lesionally (P = 0.005), reversed the inhibitory effects of the cortical ‘virtual‐lesion’ on PMEPs and swallowing accuracy (ipsi‐lesional, P < 0.001, contra‐lesional, P < 0.001). Cerebellar rTMS was able to reverse the disruptive effects of a ‘virtual lesion’. These findings provide evidence for developing cerebellar rTMS into a treatment for post‐stroke dysphagia.
Numerical Simulations of Breaking Waves and Steep Waves Past a Vertical Cylinder at Different Keulegan–Carpenter Numbers
Authors: Liu Shengnan , Ong Muk Chen , Obhrai Charlotte
Published: March 2019

A three-dimensional (3D) numerical two-phase flow model based on solving unsteady Reynolds-averaged Navier–Stokes (URANS) equations has been used to simulate breaking waves and steep waves past a vertical cylinder on a 1:10 slope. The volume of fluid (VOF) method is employed to capture the free surface and the k–ω shear–stress transport (k–ω SST) turbulence model is used to simulate the turbulence effects. Mesh and time-step refinement studies have been conducted. The numerical results of wave forces on the structure are compared with the experimental data (Irschik et al., 2004, “Breaking Wave Loads on a Slender Pile in Shallow Water,” Coastal Engineering, Vol. 4, World Scientific, Singapore, pp. 568–581) to validate the numerical model, and the numerical results are in good agreement with the measured data. The wave forces on the structure at different Keulegan–Carpenter (KC) numbers are discussed in terms of the slamming force. The secondary load cycles are observed after the wave front past the structure. The dynamic pressure and velocity distribution, as well as the characteristics of the vortices around the structure at four important time instants, are studied.
Determinants of Phage Host Range in
Staphylococcus
Species
Authors: Moller Abraham G. , Lindsay Jodi A. , Read Timothy D.
Published: March 2019

Bacteria in the genus
Staphylococcus
are important targets for phage therapy due to their prevalence as pathogens and increasing antibiotic resistance. Here we review
Staphylococcus
outer surface features and specific phage resistance mechanisms that define the host range, the set of strains that an individual phage can potentially infect.
Composition and Origin of the Fermentation Microbiota of Mahewu, a Zimbabwean Fermented Cereal Beverage
Authors: Pswarayi Felicitas , Gänzle Michael G.
Published: March 2019

This study provides insight into the composition and origin of the microbiota of mahewu and the composition of millet malt microbiota. Fermentation microbiota are often hypothesized to be derived from the environment, but the evidence remains inconclusive. Our findings confirm that millet malt is the major source of mahewu microbiota. By complementing culture methods with high-throughput sequencing of 16S rRNA amplicons and strain-specific quantitative PCR, this study provides evidence about the source of mahewu microbiota, which can inform the development of starter cultures for mahewu production. The study also documents the fate of
Enterobacteriaceae
during the fermentation of mahewu. There are concerns regarding the safety of traditionally prepared mahewu, and this requires in-depth knowledge of the fermentation process. Therefore, this study elucidated millet malt microbiota and identified cultures that are able to control the high numbers of
Enterobacteriaceae
that are initially present in mahewu fermentations.
Suppression of Obesity by an Intestinal Helminth through Interactions with Intestinal Microbiota
Authors: Shimokawa Chikako , Obi Seiji , Shibata Mioko , Olia Alex , Imai Takashi , Suzue Kazutomo , Hisaeda Hajime
Published: March 2019

Obesity is increasingly causing lifestyle diseases in developed countries where helminthic infections are rarely seen. Here, we investigated whether an intestinal nematode,
Heligmosomoides polygyrus
, has a suppressive role in diet-induced obesity in mice.
The Importance of Being an Antagonist as Well as Persistent
Authors: Progulske-Fox Ann
Published: March 2019

The current work by Jain et al. (S. Jain, A.
Entry of Polarized Effector Cells into Quiescence Forces HIV Latency
Authors: Dobrowolski Curtis , Valadkhan Saba , Graham Amy C. , Shukla Meenakshi , Ciuffi Angela , Telenti Amalio , Karn Jonathan
Published: March 2019

Current primary cell models for HIV latency correlate poorly with the reactivation behavior of patient cells. We have developed a new model, called QUECEL, which generates a large and homogenous population of latently infected CD4+memory cells. By purifying HIV-infected cells and inducing cell quiescence with a defined cocktail of cytokines, we have eliminated the largest problems with previous primary cell models of HIV latency: variable infection levels, ill-defined polarization states, and inefficient shutdown of cellular transcription. Latency reversal in the QUECEL model by a wide range of agents correlates strongly with RNA induction in patient samples. This scalable and highly reproducible model of HIV latency will permit detailed analysis of cellular mechanisms controlling HIV latency and reactivation.
Gut Microbiota Metabolite Indole Propionic Acid Targets Tryptophan Biosynthesis in
Mycobacterium tuberculosis
Authors: Negatu Dereje Abate , Yamada Yoshiyuki , Xi Yu , Go Mei Lin , Zimmerman Matthew , Ganapathy Uday , Dartois Véronique , Gengenbacher Martin , Dick Thomas
Published: March 2019

New drugs against tuberculosis are urgently needed. The tryptophan (Trp) analog indole propionic acid (IPA) is the first antitubercular metabolite produced by human gut bacteria. Here, we show that this antibiotic blocks Trp synthesis, an
in vivo
essential biosynthetic pathway in
M. tuberculosis
. Intriguingly, IPA acts by decoupling a bacterial feedback regulatory mechanism: it mimics Trp as allosteric inhibitor of anthranilate synthase, thereby switching off Trp synthesis regardless of intracellular Trp levels. The identification of IPA’s target paves the way for the discovery of more potent TrpE ligands employing rational, target-based lead optimization.
Altered Bacterial-Fungal Interkingdom Networks in the Guts of Ankylosing Spondylitis Patients
Authors: Li Ming , Dai Bingbing , Tang Yawei , Lei Lei , Li Ningning , Liu Chang , Ge Teng , Zhang Lilong , Xu Yao , Hu Yuqi , Li Pengfei , Zhang Yan , Yuan Jieli , Li Xia
Published: March 2019

The human gut is colonized by diverse fungi (mycobiota), and fungi have long been suspected in the pathogenesis of SpA. Our study unraveled a disease-specific interkingdom network alteration in AS, suggesting that fungi, or the interkingdom interactions between bacteria and fungi, may play an essential role in AS development. However, our study is limited by sample size, and in-depth mechanism studies and additional large-scale investigations characterizing the gut mycobiome in AS patients are needed to form a foundation for research into the relationship between mycobiota dysbiosis and AS development.
Percutaneous cryoablation of a solitary, soft-tissue metastasis from renal cell carcinoma: a new local minimal invasive curative treatment
Authors: Junker Theresa , Rasmussen Benjamin Schnack , Toft Anja , Graumann Ole
Published: March 2019

Cryoablation is a well-established treatment option, proven to be successful in treating local renal cell carcinoma (RCC). We treated a 67-year-old man in an outpatient setting with late onset of a 25 mm solitary soft-tissue metastasis of from RCC with cryoablation. The treatment was performed under sedation and in local anaesthesia. There were no complications during the procedure. The patient did not experience any adverse effects to the treatment. He was able to resume his normal daily routines the day after his treatment. A follow-up CT scan at 3, 8 and 12 months after treatment reported sufficient cryoablation and no sign of recurrence or other metastases.
Case series of Pulmonary Alveolar Microlithiasis from India
Authors: Chopra Manu , Tendolkar Manjit Sharad , Vardhan Vasu
Published: March 2019

Pulmonary alveolar microlithiasis (PAM) is a rare disease characterised by calcific deposits in lung parenchyma. PAM being a progressive disease with dissociation between severity of clinical symptoms and radiological picture, it is often detected incidentally. Mutations in the SLC34A2 gene encoding the type IIb sodium phosphate cotransporter in alveolar type II cells are considered to be involved in the pathogenesis of PAM. The majority of the patients are diagnosed usually between the ages of 20 and 40 years, although paediatric PAM has also been reported. Diagnosis is confirmed by combination of radiological features, bronchial lavage and histopathological testing. At present, lung transplant is the only definitive treatment available. Though rare, the prevalence of PAM is worldwide. Till June 2018, 86 cases have been reported from India and 1042 cases have been reported worldwide. We report three cases from India, including a student, cement factory worker and a tailor, which will highlight the varied clinical and radiological presentations of this rare disease along with the response to treatment.
Dengue fever presenting as quadriparesis due to hypokalaemia: a rare presentation
Authors: Zubair Syed Muhammad , Ali Syed Ahsan , Furqan Saira
Published: March 2019

Dengue is one of the leading causes of arthropod borne viral haemorrhagic fever. Majority of the times, it clinically manifests as fever, arthralgia and rash; however, we present a case of a young man who presented with progressively increasing weakness of all four limbs. Initial investigations showed low potassium, hence he was managed as hypokalaemic periodic paralysis. With initial history of fever and low platelets, dengue was suspected. Dengue antibody was checked which came out to be positive. Potassium was replaced which led to improvement in power of his limbs. He was discharged in a stable condition with a diagnosis of dengue with hypokalaemic quadriparesis.
Reversible iatrogenic paraparesis secondary to masked hypokalaemia in thrombocytosis-associated pseudohyperkalaemia
Authors: Dubin Ina , Schattner Ami
Published: March 2019

An elderly patient who presented with recent recurrent falls was admitted, reporting inability to stand and recent acute diarrhoeal illness. Paraparesis was diagnosed but extensive investigations did not elucidate its cause. He had atherosclerotic cardiac and vascular disease, diabetes, hypertension, chronic kidney disease and pancreatectomy/splenectomy for a lesion that turned out to be benign. He was receiving multiple medications including kayexalate, which was started a few weeks prior, and the dose increased, due to hyperkalaemia up to 6.3 mEq/L. Although the postsplenectomy thrombocytosis was not striking (700×109/L), spurious hyperkalaemia (pseudohyperkalaemia) was suspected when no cause of hyperkalaemia could be identified and widely fluctuating serum potassium levels were noted. Concurrent K+determination in the serum and plasma revealed that the patient actually had significant maskedhypokalaemia(2.4 mEq/L). Once kayexalate was stopped and normokalaemia (in plasma) achieved by replacement therapy, paraparesis completely resolved (5/5 muscle strength) and no more falls occurred after discharge.
Infected tooth extraction, bone grafting, immediate implant placement and immediate temporary crown insertion in a patient with severe type-B hemophilia
Authors: Calvo-Guirado Jose Luis , Romanos Georgios E , Delgado-Ruiz Rafael Arcesio
Published: March 2019

Haemorrhagic disorders combined with soft tissue inflammation and infection may lead to severe bleeding complications before, during or after dental treatment. In selected cases, a combined therapeutic approach involving clinical therapies and systemic and local medication could improve the treatment outcomes and the patient’s quality of life. This clinical case report, presents for the first time a successful combined approach, completed in a 38-year-old male patient with severe type-B haemophilia in which an infected tooth was extracted, an immediate implant was inserted, bone grafting was performed and early implant loading was successfully applied. In addition to the clinical therapy, medication was provided orally, systemically and locally, thus preventing the haemorrhagic complications and improving the patient’s quality of life.
Measures of central sensitisation and their measurement properties in the adult musculoskeletal trauma population: a protocol for a systematic review and data synthesis
Authors: Middlebrook Nicola , Rushton Alison B , Heneghan Nicola R , Falla Deborah
Published: March 2019

Introduction

Pain following musculoskeletal trauma is common with poor outcomes and disability well documented. Pain is complex in nature and can include the four primary mechanisms of pain: nociceptive, neuropathic, inflammatory and central sensitisation (CS). CS can be measured in multiple ways; however, no systematic review has evaluated the measurement properties of such measures in the musculoskeletal trauma population. This systematic review aims to evaluate the measurement properties of current measures of CS in this population.

Methods/analysis

This protocol is informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-P. MEDLINE, EMBASE, CINAHL, ZETOC, Web of Science, PubMed and Google Scholar as well as key journals and grey literature will be searched in two stages to (1) identify what measures are being used to assess CS in this population and (2) evaluate the measurement properties of the identified measures. Two independent reviewers will conduct the search, extract the data, assess risk of bias for included studies and assess overall quality. The Consensus-based Standards for the selection of Health Measurement Instruments Risk of Bias Checklist and a modified Grading of Recommendations, Assessment, Development and Evaluation guidelines will be used. Meta-analysis will be conducted if deemed appropriate. Alternatively, a narrative synthesis will be conducted and summarised per measurement property per outcome measure.

Ethics and dissemination

This review will aid clinicians in using the most appropriate tool for assessing central sensitisation in this population and is the first step towards a more standardised approach in pain assessment. The results of this study will be submitted to a peer reviewed journal and presented at conferences.

PROSPERO registrationnumber

CRD42018091531.
Childhood maltreatment and biomarkers for cardiometabolic disease in mid-adulthood in a prospective British birth cohort: associations and potential explanations
Authors: Li Leah , Pinto Pereira Snehal M , Power Christine
Published: March 2019

Objectives

Research on associations between childhood maltreatment and adult cardiometabolic disease risk is sparse. We aimed to investigate associations between different forms of child maltreatment and mid-adult cardiometabolic markers and whether potential intermediaries could account for the associations observed.

Setting

1958 British birth cohort.

Participants

Approximately 9000 cohort members with data on cardiometabolic markers.

Outcomes

Adult (45y) cardiometabolic markers (blood pressure, lipids and glycated haemoglobin [HbA1c]).

Results

Seventeen per cent of participants were identified as neglected; 6.1%, 1.6% and 10.0% were identified as experiencing physical, sexual and psychological abuse, respectively. Childhood neglect and physical abuse were associated with high body mass index (BMI) and large waist circumference when adjusting for early-life covariates. For neglect, the adjusted odds ratio (AOR) was 1.16 (95% CI: 1.02 to 1.32) and 1.15 (1.02 to 1.30) for general and central obesity, respectively, and for physical abuse, the respective AOR was 1.36 (1.13 to 1.64) and 1.38 (1.16 to 1.65). Neglect was also associated with raised triglycerides by 3.9 (0.3 to 7.5)% and HbA1cby 1.2 (0.4 to 2.0)%, and among females, lower high-density lipoprotein cholesterol (HDL-c) by 0.05 (0.01 to 0.08)mmol/L after adjustment. For physical abuse, the AOR was 1.25 (1.00 to 1.56) for high low-density lipoprotein cholesterol, HbA1cwas raised by 2.5 (0.7 to 4.3)% (in males) and HDL-c was lower by 0.06 (0.01 to 0.12)mmol/L (in females). Associations for sexual abuse were similar to those for physical abuse but 95% CIs were wide. For psychological abuse, the AOR for elevated triglycerides was 1.21 (1.02 to 1.44) and HDL-c was lower by 0.04 (0.01 to 0.07)mmol/L. Maltreatments were not associated with raised blood pressure. In analyses of potential intermediary factors, several associations attenuated after adjustment for adult lifestyles (mainly smoking and alcohol consumption rather than physical activity) and child-to-adult BMI.

Conclusions

Childhood maltreatments, particularly neglect and physical abuse, were associated with greater adiposity and poorer lipid and HbA1cprofiles decades later in adulthood. Associations were modest but independent of early-life factors linked to these outcomes. Findings implicate adult lifestyles as an important intermediary between child maltreatment and outcomes.
Utilisation and perceptions towards smart device visual acuity assessment in Australia: a mixed methods approach
Authors: Keel Stuart , Scheetz Jane , Holloway Edith , Han Xiaotong , Yan William , Mueller Andreas , He Mingguang
Published: March 2019

Objectives

To investigate mobile health product use in Australia and societal and clinician perceptions towards smartphone based visual acuity (VA) assessment tools.

Design

Quantitative analysis of a cross-sectional survey delivered to the general public and thematic analysis of in-depth interviews of eye health clinicians.

Setting

Online survey within Australia and face-to-face in-depth interviews of clinicians.

Participants

1016 adults were recruited via Survey Monkey Audience, social media (Facebook and Twitter), Rotary Australia and Lions Clubs Australia. Six clinicians were recruited from private and public settings in Melbourne, Australia.

Primary and secondary outcome measures

The study assessed socio-demographic characteristics, history of mobile health product use and perceived advantages and potential drawbacks of smartphone based VA assessment tools.

Results

A total of 14.4% of the study population had previously used a mobile-based health product. After adjusting for covariates, younger age (p=0.001), male gender (p=0.01) and higher income (>$45 000) were associated with increased likelihood of having used a mobile health product (p=0.005). Seventy-two per cent of participants would use an automated smartphone based VA assessment tool, provided that the accuracy was on par to that of human assessors. Convenience (37.3%) and cost-savings (15.5%) were ranked as the greatest perceived advantages. While test accuracy (50.6%), a lack of personal contact with healthcare providers (18.3%) and data security (11.9%) were the greatest concerns. Themes to emerge from clinician qualitative data included the potential benefits for identifying refractive error in patients, as well as the ability to self-monitor vision. Concerns were raised over the potential misuse of self-testing vision apps and the inability to detect pathology.

Conclusion

Our findings suggest that a substantial proportion of the Australian population do not use mobile health products. Furthermore, there remains notable concerns, including test accuracy and data privacy, with smartphone-based VA assessment tools by both clinicians and the public.
Modelling the effect of the introduction of antenatal screening for group BStreptococcus(GBS) carriage in the UK
Authors: Bevan David , White Alicia , Marshall John , Peckham Catherine
Published: March 2019

Objectives

To estimate the potential impact of the addition of culture-based screening for group B streptococcus (GBS) carriage in pregnancy to a risk-based prevention policy in the UK. We aimed to establish agreement within a multidisciplinary group of key stakeholders on the model input parameters.

Design

Deterministic model using a consensus approach for the selection of input parameters.

Setting and participants

A theoretical annual cohort of 711 999 live births in the UK (excluding births by elective caesarean section).

Interventions

Culture-based screening for GBS at 35–37 weeks of pregnancy added to the recommended risk-based prevention policy in place on the date of modelling.

Outcome measures

Outcomes assessed included use of intrapartum antibiotic prophylaxis (IAP), early onset GBS (EOGBS), EOGBS mortality, severe EOGBS-related morbidity and maternal penicillin anaphylaxis.

Results

With no prophylaxis strategy, the model estimated that there would be 421 cases of culture positive EOGBS in a year (0.59/1000 live births). In the risk-based prophylaxis scenario, 30 666 women were estimated to receive IAP and 70 cases of EOGBS were prevented. Addition of screening resulted in a further 96 260 women receiving IAP and the prevention of an additional 52 to 57 cases of EOGBS. This resulted in the prevention of three EOGBS deaths and four cases of severe disability. With screening, an additional 1675 to 1854 women receive IAP to prevent one EOGBS case and 24 065 to 32 087 receive IAP to prevent one EOGBS death.

Conclusions

The evidence base available for a broad range of model input parameters was limited, leading to uncertainty in the estimates produced by the model. Where data was limited, the model input parameters were agreed with the multidisciplinary stakeholder group, the first time this has been done to our knowledge. The main impact of screening is likely to be on the large group of low-risk women where the clinical impact of EOGBS tends to be less severe. This model suggests that the reduction in mortality and severe disability due to EOGBS with antenatal GBS screening is likely to be very limited, with a high rate of overdetection and overuse of antibiotics.
Effect of CPAP therapy on kidney function in patients with obstructive sleep apnoea and chronic kidney disease: a protocol for a randomised controlled clinical trial
Authors: Rimke Alex N , Ahmed Sofia B , Turin Tanvir C , Pendharkar Sachin R , Raneri Jill K , Lynch Emma J , Hanly Patrick J
Published: March 2019

Introduction

Obstructive sleep apnoea (OSA) is common in patients with chronic kidney disease (CKD) and may contribute to the progression of kidney disease either through direct effects of hypoxia on the kidney or indirectly through hypoxaemia-induced oxidative stress, endothelial dysfunction, inflammation, activation of the renin–angiotensin and sympathetic nervous systems, and hypertension. Treatment of OSA with continuous positive airway pressure (CPAP) improves many of these physiological abnormalities in patients with normal renal function, though to date there are no trials evaluating the effect of OSA treatment on kidney function in patients with CKD. The purpose of this study is to test the feasibility and efficacy of CPAP therapy in CKD patients with OSA.

Methods and analysis

The study is a randomised, controlled, non-blinded, parallel clinical trial in which patients with established CKD are screened for OSA. Patients with OSA are randomised to either conventional medical therapy (control group) or medical therapy and CPAP (CPAP group) and followed for 1 year. The primary outcome is the change in estimated glomerular filtration rate. Secondary outcomes are the change in the urinary albumin/creatinine ratio, the Epworth Sleepiness Scale , Pittsburgh Sleep Quality Index and Kidney Disease Quality of Life questionnaire.

Ethics and dissemination

Ethics approval has been obtained from the Conjoint Health Research Ethics Board (ID: REB15-0055). Results from this study will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals.

Trial registration number

NCT02420184; Pre-results.
How does priority setting for resource allocation happen in commissioning dental services in a nationally led, regionally delivered system: a qualitative study using semistructured interviews with NHS England dental commissioners
Authors: Vernazza Christopher Robert , Taylor Greig , Donaldson Cam , Gray Joanne , Holmes Richard , Carr Katherine , Exley Catherine
Published: March 2019

Objectives

To understand approaches to priority setting for healthcare service resource allocation at an operational level in a nationally commissioned but regionally delivered service.

Design

Qualitative study using semistructured interviews and a Framework analysis.

Setting

National Health Service dentistry commissioning teams within subregional offices in England.

Participants

All 31 individuals holding the relevant role (dental lead commissioner in subregional offices) were approached directly and from this 14 participants were recruited, with 12 interviews completed. Both male and female genders and all regions were represented in the final sample.

Results

Three major themes arose. First, ‘Methods of priority setting and barriers to explicit approaches’ was a common theme, specifically identifying the main methods as: perpetuating historical allocations, pressure from politicians and clinicians and use of needs assessments while barriers were time and skill deficits, a lack of national guidance and an inflexible contracting arrangements stopping resource allocation. Second, ‘Relationships with key stakeholders and advisors’ were discussed, showing the important nature of relationships with clinical advisors but variation in the quality of these relationships was noted. Finally, ‘Tensions between national and local responsibilities’ were illustrated, where there was confusion about where power and autonomy lay.

Conclusions

Commissioners recognised a need for resource allocation but relied on clinical advice and needs assessment in order to set priorities. More explicit priority setting was prevented by structure of the commissioning system and standard national contracts with providers. Further research is required to embed and simplify adoption of tools to aid priority setting.
LUCSO-1—French pilot study of LUng Cancer Screening with low-dose computed tomography in a smokers population exposed to Occupational lung carcinogens: study protocol
Authors: Delva Fleur , Laurent François , Paris Christophe , Belacel Milia , Brochard Patrick , Bylicki Olivier , Chouaïd Christos , Clin Benedicte , Dewitte Jean-Dominique , Le Denmat Véronique , Gehanno Jean-François , Lacourt Aude , Margery Jacques , Verdun-Esquer Catherine , Mathoulin-Pélissier Simone , Pairon Jean-Claude
Published: March 2019

Introduction

Guidelines concerning the follow-up of subjects occupationally exposed to lung carcinogens, published in France in 2015, recommended the setting up of a trial of low-dose chest CT lung cancer screening in subjects at high risk of lung cancer.

Objective

To evaluate the organisation of low-dose chest CT lung cancer screening in subjects occupationally exposed to lung carcinogens and at high risk of lung cancer.

Methods and analysis

This trial will be conducted in eight French departments by six specialised reference centres (SRCs) in occupational health. In view of the exploratory nature of this trial, it is proposed to test initially the feasibility and acceptability over the first 2 years in only two SRCs then in four other SRCs to evaluate the organisation. The target population is current or former smokers with more than 30 pack-years (who have quit smoking for less than 15 years), currently or previously exposed to International Agency for Research on Cancer group 1 lung carcinogens, and between the ages of 55 and 74 years. The trial will be conducted in the following steps: (1) identification of subjects by a screening invitation letter; (2) evaluation of occupational exposure to lung carcinogens; (3) evaluation of the lung cancer risk level and verification of eligibility; (4) screening procedure: annual chest CT scans performed by specialised centres and (5) follow-up of CT scan abnormalities.

Ethics and dissemination

This protocol study has been approved by the French Committee for the Protection of Persons. The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings.

Trial registration number

NCT03562052; Pre-results.
Risk of depressive disorders after tobacco smoking cessation: a retrospective cohort study in Fukuoka, Japan
Authors: Fujita Takako , Babazono Akira , Harano Yumi , Jiang Peng
Published: March 2019

Objective

We sought to examine the effect of smoking cessation on subsequent development of depressive disorders.

Design

This was a retrospective cohort study.

Methods

We used administrative claim and health check data from fiscal years 2010 to 2014, obtained from the largest health insurance association in Fukuoka, Japan. Study participants were between 30 and 69 years old. The end-point outcome was incidence of depressive disorders. Survival analysis and Cox proportional hazards models were conducted. The evaluated potential confounders were sex, age, standard monthly income and psychiatric medical history.

Results

The final number of participants was 87 255, with 7841 in the smoking cessation group and 79 414 in the smoking group. The result of survival analysis showed no significant difference in depressive disorders between the two groups. The results of Cox proportional hazards models showed no significant difference by multivariate analysis between participants, including users of smoking cessation medication (HR 1.04, 95% Cl 0.89 to 1.22) and excluding medication use (HR 0.97, 95% Cl 0.82 to 1.15).

Conclusions

The present study showed that there were no significant differences with respect to having depressive disorders between smoking cessation and smoking groups. We also showed that smoking cessation was not related to incidence of depressive disorders among participants, including and excluding users of smoking cessation medication, after adjusting for potential confounders. Although the results have some limitations because of the nature of the study design, our findings will provide helpful information to smokers, health professionals and policy makers for improving smoking cessation.