bluuebunny/crossref_metadata_2025 huggingface dataset:
Late Miocene to Quaternary slip history across the Qiulitag anticline in the southern Tianshan piedmont
Authors: Charreau Julien , Sartégou Amandine , Saint‐Carlier Dimitri , Lavé Jérôme , Blard Pierre‐Henri , Dominguez Stéphane , Wang Sheng Li , Rao Gang ,   ASTER Team
Published: November 2019

In this study, we reconstruct the Miocene to Quaternary shortening history across the Qiulitag anticline, a complex fault‐bend fold located in southern Tianshan. We studied the Yaha and Kuche sections, where we combined surface structural measurements and seismic imaging to model the stratigraphic horizons. The history of folding was reconstructed based on magnetostratigraphic analyses and eight cosmogenic burial ages in Kuche. Pleistocene deformation rates were also quantified in Yaha based on a deformed fluvial terrace that we dated to ~67 ka using a cosmogenic depth profile. Our results suggest that the fold grew at a mean slip rate of 0.9–1.3 mm/a in both sections but accelerated to ~2.5 mm/a during the Pleistocene in Kuche. These results support a migration of the deformation towards the basin during the Pleistocene and suggest that most of the present deformation in the Tianshan is accommodated across the external structures of the range.
Factors associated with Chinese pregnant women’s preference for a cesarean section based on the theory of planned behaviour
Authors: Sun Na , Yin Xiaoxv , Qiu Lei , Yang Qin , Shi Xinwei , Chang Jun , Feng Ling , Gong Yanhong
Published: November 2019

Objectives

Cesarean delivery on maternal request is one of the important public health issues in China. Our study aimed to apply the theory of planned behaviour to comprehensively determine the factors regarding pregnant women’s preference for cesarean section and to provide references for establishing measures to reduce cesarean delivery on maternal request.

Methods

This cross‐sectional analysis was conducted in four women’s and children’s hospitals in China from May to June 2018. Eligible women arriving for routine antenatal visits at these hospitals were recruited to answer a structured questionnaire. A total of 1853 pregnant women consented to participate in the investigation, with a response rate of 88.75%. Finally, 1677 pregnant women (984 nulliparae and 693 multiparae) were involved in the analysis. Descriptive statistics and logistic regression analyses were used.

Results

Of the study participants, 20.39% preferred cesarean section. For both nulliparae and multiparae, those who had lower scores of attitudes towards vaginal delivery, lower scores of childbirth self‐efficacy and higher scores of subjective norms were more likely to prefer cesarean section.

Conclusions

Pregnant women’s birth preferences were significantly associated with their attitudes towards the delivery mode, childbirth self‐efficacy and subjective norms, which is consistent with the theory of planned behaviour. Interventions to reduce cesarean delivery on maternal request can be developed based on the theory of planned behaviour.
Metabolomics of red‐light‐induced stomatal opening in Arabidopsis thaliana: Coupling with abscisic acid and jasmonic acid metabolism
Authors: Zhu Mengmeng , Geng Sisi , Chakravorty David , Guan Qijie , Chen Sixue , Assmann Sarah M.
Published: November 2019

Environmental stimuli‐triggered stomatal movement is a key physiological process that regulates CO2 uptake and water loss in plants. Stomata are defined by pairs of guard cells that perceive and transduce external signals, leading to cellular volume changes and consequent stomatal aperture change. Within the visible light spectrum, red light induces stomatal opening in intact leaves. However, there has been debate regarding the extent to which red‐light‐induced stomatal opening arises from direct guard cell sensing of red light versus indirect responses as a result of red light influences on mesophyll photosynthesis. Here we identify conditions that result in red‐light‐stimulated stomatal opening in isolated epidermal peels and enlargement of protoplasts, firmly establishing a direct guard cell response to red light. We then employ metabolomics workflows utilizing gas chromatography mass spectrometry and liquid chromatography mass spectrometry for metabolite profiling and identification of Arabidopsis guard cell metabolic signatures in response to red light in the absence of the mesophyll. We quantified 223 metabolites in Arabidopsis guard cells, with 104 found to be red light responsive. These red‐light‐modulated metabolites participate in the tricarboxylic acid cycle, carbon balance, phytohormone biosynthesis and redox homeostasis. We next analyzed selected Arabidopsis mutants, and discovered that stomatal opening response to red light is correlated with a decrease in guard cell abscisic acid content and an increase in jasmonic acid content. The red‐light‐modulated guard cell metabolome reported here provides fundamental information concerning autonomous red light signaling pathways in guard cells.
Characterization and sludge dewaterability evaluation of a chitosan‐based flocculant CMCTS‐g‐CPAM
Authors: Sun Wenquan , Zhu Hui , Sun Yongjun , Tang Mengdan , Zheng Huaili
Published: November 2019

In this work, a new cationic flocculant, CMCTS‐g‐CPAM was synthesized by acrylamide (AM), methacryloyloxyethyltrimethylammonium chloride (DMC) and carboxymethyl chitosan (CMCTS) through UV initiated graft polymerization techniques. The structure of CMCTS‐g‐CPAM was analysed by infrared spectroscopy (IR), nuclear magnetic resonance spectroscopy (1H NMR) and X‐ray diffraction (XRD) techniques which indicates that AM and DMC are grafted successfully onto CMCTS to obtain CMCTS‐g‐CPAM. The potential of CMCTS‐g‐CPAM for the sludge dewatering was investigated. The effects of cationic degree, intrinsic viscosity, dosage and pH on the sludge dewatering performance were studied. The results indicate that the optimal dewatering performance with minimum supernatant turbidity of 5.40 NTU, the moisture content of the filter cake of 79.28% and the specific resistance of the sludge of 1.96 × 1013 m/kg was obtained at 30 mg/L CMCTS‐g‐CPAM at pH 9–10. Finally, from the microscopic and electron micrographs investigation, it was confirmed that the particle size of the CMCTS‐g‐CPAM treated sludge was significantly large to enhance hydrophobicity and improve dewatering performance.
Investigating the influence of iron–carbon microelectrolysis on the performance and microbial community of constructed wetlands
Authors: Wei Fang , Zhou Qingwei , Wu Weihong , Bian Zhengfu , Feng Xiaoyi , Li Jinye , Shi Mingjuan
Published: November 2019

Iron–carbon microelectrolysis (Fe–C ‐ME) has been used extensively for the treatment of domestic sewage. In this study, CWs incorporated with Fe–C ‐ME were established, and the performance and microbial community structure of CWs were investigated. The results indicated that CWs incorporated with Fe–C‐ME had better performance for treating domestic sewage. The NO3‐–N, TN and TP removal efficiencies of CWs incorporated with Fe–C‐ME were 82.3, 80.3 and 98.2%, respectively, which were 7.8, 4.7 and 25.2% higher than those of the CWs without Fe–C‐ME. High‐throughput sequencing analysis demonstrated that Fe–C‐ME changed the microbial community structure. For example, some dominant groups at the class level, such as Betaproteobacteria (15.2%), Gammaproteobacteria (10.6%) and Deltaproteobacteria(10.0%), were promoted by Fe–C‐ME. The results demonstrated that the relative abundance of bacteria involved in nitrification, denitrification, polyphosphate accumulation or COD reduction at the genus level thrived because of the presence of Fe–C‐ME, which can improve the performance of CWs.
Removal of polycyclic aromatic hydrocarbons from wastewater using dual‐mode ultrasound system
Authors: Ghasemi Negareh , Gbeddy Gustav , Egodawatta Prasanna , Zare Firuz , Goonetilleke Ashantha
Published: November 2019

Treatment of wastewater using ultrasound systems is gaining increasing interest due to its effectiveness for a wide range of pollutants and no secondary pollutant production. This paper proposes two ultrasound systems operating at different ranges of electrical power and frequency developed to remove toxic polycyclic aromatic hydrocarbon (PAH) compounds in wastewater. Both light molecular weight (LMW) and high molecular weight (HMW) compounds were degraded using the developed systems. However, HMW compounds were more affected. The experimental results revealed that treatment at a high power level is not always a proper approach for a large reduction of PAH compounds. Whereas treatment at higher frequencies and lower power can be a suitable alternative to enhance the PAHs removal rate and the system energy efficiency and reduce losses. Therefore, a dual‐mode ultrasound system with adjustable operating frequency and power is a promising approach for the treatment of industrial wastewater containing toxic PAH compounds.
Microplastics contamination in tidelands of the Osaka Bay area in western Japan
Authors: Nakao Satoshi , Ozaki Asako , Yamazaki Kazuo , Masumoto Keiko , Nakatani Tadashi , Sakiyama Takanori
Published: November 2019

Recently, researchers have been examining the actual state of microplastics contamination in the environment. However, pollution in high biodiversity environments such as tidelands has not been sufficiently investigated. Therefore, to assess the actual level of microplastics pollution therein, we conducted a survey of the tidelands of Osaka Bay in Japan to develop a model that included basins in urban and suburban areas. We quantified the levels of microplastics in the mud from four of Osaka Bay's tidelands and detected them based on three inhabitants of the main river estuary tideland, namely, bivalves (Corbicula japonica), crabs (Chiromantes dehaani) and a tufted duck (Aythya fuligula). Microplastics ranging in size from 300 μm to 5 mm were targeted, and the results indicated that the concentration of microplastics in the mud tended to increase with tideland proximity to an urban area where the density of the human population was the highest. Microplastics were detected in 10% of the bivalves and 6.7% of the crabs (n = 30 in both cases), and eight pieces of microplastics were detected in the stomach of one tufted duck. These results indicate that the mud in tidelands near urban areas had more microplastics. In addition, the results suggest that microplastics contamination levels may be higher in higher order predators in the food web.
Seasonal and spatial variation in Toxoplasma gondii contamination in soil in urban public spaces in California, United States
Authors: de Wit Luz A. , Kilpatrick A. Marm , VanWormer Elizabeth , Croll Donald A. , Tershy Bernie R. , Kim Minji , Shapiro Karen
Published: November 2019

Background

Toxoplasma gondii is a zoonotic parasite that can have severe implications for human health. Acutely infected cats shed environmentally resistant T. gondii oocysts in their faeces that contaminate soil, and soil can serve as a reservoir of infection for humans. Free‐roaming domestic cats are thought to play an important role in environmental contamination with T. gondii, but few studies have directly measured the direct contribution of free‐roaming cats to T. gondii in soil.

Methods

Our goals were to determine whether T. gondii soil contamination occurs in public areas with free‐roaming cat colonies in central California and examine spatial and temporal variation in soil contamination. We initially performed spiking experiments to compare the limit of T. gondii detection in soil using three conventional nested PCR assays and one real‐time quantitative PCR. The nested PCR targeting the internal transcribed spacer (ITS‐1) of the small subunit ribosomal RNA was the most sensitive assay, with a limit of detection between 20 and 200 oocysts per gram of soil. We applied the ITS1 PCR assay on soil from sites in city and state parks, public playgrounds and community gardens in central California, USA. Samples were collected during spring, summer and fall and in sites located along the coast and inland.

Results

We detected and sequence‐confirmed T. gondii in 5.6% of all of our soil sub‐samples, but with large seasonal and spatial variation in soil contamination: we only detected T. gondii during fall and only in coastal sites (44.3% soil prevalence), despite similar sampling intensity across space and time.

Conclusions

Our results suggest that free‐roaming cat colonies are an important source of T. gondii in spaces where people recreate and grow food and that soil contamination is highly seasonal and spatially variable. Management of free‐roaming cats could prevent T. gondii infections by reducing environmental contamination with this zoonotic pathogen.
Artisan fresh cheese from raw cow's milk as a possible route of transmission in a toxoplasmosis outbreak, in Brazil
Authors: da Costa Mary Alexandra , Pinto‐Ferreira Fernanda , de Almeida Robélia Pondé Amorim , Martins Felippe Danyel Cardoso , Pires Adriene Lino , Mareze Marcelle , Mitsuka‐Breganó Regina , Freire Roberta Lemos , da Rocha Moreira Rosalynd Vinicios , Borges Juliene Meira , Navarro Italmar Teodorico
Published: November 2019

Background

The objective of this study was to report an outbreak of human toxoplasmosis occurring in the municipality of Montes Claros de Goiás, Goiás, Brazil, from December 2015 to August 2016. Seven acute cases in June 2016 triggered the subsequent search.

Methods

A total of 251 individuals were selected through an active search, of which 114 (45.4%) agreed to participate in the research and blood collection. For serological diagnosis were used enzyme‐linked immunosorbent assay (ELISA) for IgG and IgM and avidity tests.

Results

Of the 114 serum samples evaluated, 12.3% (14/114) showed antibodies againstToxoplasma gondii, with a profile indicative of acute infection. Samples of artisan fresh cheese, public water, vegetables and irrigation water were collected.Toxoplasma gondiiDNA fragments were amplified using the polymerase chain reaction from two samples of artisan fresh cheese and a sample of irrigation water from the vegetable garden. A control case study was carried out, and the variable cow's artisan fresh cheese consumption was statistically significant (p = .01).

Conclusions

The results showed that cheese analysed and/or irrigated water of vegetable represented an important route of transmission for the disease. This is the first reported outbreak possibly caused by cow's artisan fresh cheese. It is difficult to prove that these routes were the cause of the outbreak; however, the findings allow us to infer that the individuals involved in the outbreak were in contact with these risk factors.
Data Analysis and Model Validation of Natural Gas Transmission Pipeline With Compressor Station
Authors: Cheng David
Published: November 2019

Data from the distributed control system (DCS) or supervisory control and data acquisition (SCADA) system provide useful information critical to the evaluation of the performance and transportation efficiency of a gas pipeline system with compressor stations. The pipeline performance data provide correction factors for compressors as part of the operation optimization of natural gas transmission pipelines. This paper presents methods, procedures, and an example of model validation-based performance analysis of a gas pipeline based on actual system operational data. An analysis approach based on statistical methods is demonstrated with actual DCS gas pipeline measurement data. These methods offer practical ways to validate the pipeline hydraulics model using the DCS data. The validated models are then used as performance analysis tools in assessing the pipeline hydraulics parameters that influence the pressure drop in the pipeline such as corrosion (inside diameter change), roughness changes, or basic sediment and water deposition.
General Corrosion of Chromium-Coated Zirconium- and Titanium-Based Alloys in Supercritical Water at 500 °C
Authors: Khumsa-Ang K. , Edwards M. , Rousseau S.
Published: November 2019

The 300 MWel small Canadian supercritical water-cooled reactor (SCWR), which is a scaled-down version of the original 1200 MWel concept, has a smaller core, uses low enriched uranium fuel instead of a plutonium–thorium fuel, and features a lower (maximum) cladding temperature of 500 °C. The lower cladding temperature may permit the use of different alloys, including zirconium alloys, which had been ruled out as candidates for the Canadian SCWR, whose cladding temperature may reach 850 °C. The potential to use zirconium alloys is exciting because they have a low neutron cross section, which in turn means that fewer neutrons are lost, and the fuel can be used more efficiently. One advantage, for example,, is that the fuel cycle can be lengthened. In this paper, we report on the results of corrosion experiments used to screen zirconium- and titanium-based alloys as well as corrosion-resistant coating materials such as Cr and Al as potential candidates for fuel cladding in the small Canadian SCWR. These experiments were conducted in a refreshed autoclave in deaerated supercritical water at 500 °C and 23.5 MPa. After exposure, the weight gain was measured, and the oxide thickness and the oxide phases were examined. Of all materials, the coated and uncoated Ti-grade 2 and Ti-grade 5 alloys met our screening qualification criteria, however, Al/Cr-coated zirconium coupons showed notable improvement and will be explored further in future testing.
Isolated leptomeningeal carcinomatosis and possible fungal meningitis as late sequelae of oesophageal adenocarcinoma
Authors: Dumbill Richard , Thompson Sanja , Peschl Heiko , Turner GDH , Woodrow Charles
Published: November 2019

We describe a case of a 67-year-old man with known chronic obstructive pulmonary disease, type 2 diabetes mellitus, hypertension, osteoarthritis, previous history of excess alcohol intake, and oesophagectomy 3 years earlier for T3N0 adenocarcinoma, referred by his general practitioner with confusion, weight loss and several recent falls. CT of the chest, abdomen and pelvis revealed a right middle-lobe pulmonary embolism, while CT of the head revealed a communicating hydrocephalus. Lumbar puncture was performed, and empirical treatment for tuberculous and fungal meningitis was commenced. Unfortunately, he suffered a rapid neurological deterioration with markedly elevated cerebrospinal fluid (CSF) pressures, leading to an external ventricular drain. Cytological analysis of a CSF sample revealed a cellular infiltrate consistent with leptomeningeal carcinomatosis (adenocarcinoma), with the previous oesophageal malignancy the likely primary. He passed away 17 days after hospital admission. Prolonged culture of CSF later produced evidence of two distinct phaeomycotic moulds (Cladosporiumsp andExophialasp), suggesting that fungal meningitis may also have contributed to the clinical picture.
Rare presentation of a testicular glomus tumour
Authors: Tullie Sebastian Thomas Edmund , Quraishi Mohammed Kamil , Karawita Thiwanka , Anjarwalla Salim
Published: November 2019

Glomus tumours are atypical in extracutaneous locations and very rarely located in reproductive organs. We present an unusual case of an incidentally discovered glomus tumour arising from the testis of a 47-year-old man. The testicular occurrence of this tumour type is not only exceptionally rare but also serves to highlight the debate regarding the optimal management of incidentally discovered small testicular lesions.
Oesophageal tuberculosis with concomitant candidiasis: a rare cause of dysphagia
Authors: Morare Nolitha Makapi Tisetso , Rose David Morris , Appels Olivia
Published: November 2019

We present a case of a 23-year-old woman with dysphagia. She was reportedly newly diagnosed with HIV and had been initiated on antiretroviral treatment and tuberculosis (TB) prophylaxis. Oesophagogastroduodenoscopy revealed an irregular, ulcerative oesophageal lesion. Subsequent histopathology revealedMycobacterium tuberculosisas well asCandida albicans. A CT scan demonstrated widespread disease with miliary TB. She was subsequently initiated on antituberculous and antifungal medications. TB is one of the most common and deadly infectious diseases in the world, with the highest rates seen in the developing countries. It commonly occurs as an opportunistic infection of HIV. Despite its potential for systemic infection, infection of the oesophagus is incredibly rare, more so as a co-infection with candida. This case highlights the need to have a high index of suspicion in high risk groups, as early treatment is crucial in addressing this global health crisis.
Acute tension hydrothorax in chronic liver disease secondary to spontaneous diaphragmatic rupture
Authors: Tharappel Kevin Joseph , Bolanthakodi Nandakrishna , Vidyasagar Sudha , Varma Muralidhar
Published: November 2019

Pleural effusion in liver cirrhotics is more commonly transudative. A transudative pleural effusion secondary to ascites in decompensated cirrhosis is also known as hepatic hydrothorax and is usually due to fluid seepage through congenital pores in the diaphragm. The patient, a known case of decompensated chronic liver disease, presented with a massive, left-sided, rapidly accumulating and transudative pleural effusion secondary to spontaneous diaphragmatic rupture. Clinically, he developed sudden onset shortness of breath and became hypotensive. This is a rare entity, and was confirmed on CT thorax revealing a focal segment defect ~1.6 cm over the left hemidiaphragm. Ascites treatment consisting of diuretics with salt restriction and repeated thoracentesis with albumin replacement improved his symptoms and lead to a complete resolution of the effusion.
New-onset asthma in a bilateral lung transplant patient
Authors: Fyenbo Daniel Benjamin , Degn Kristine Bruun , Schmid Johannes Martin , Bendstrup Elisabeth
Published: November 2019

We present a case of new-onset asthma in a 35-year-old man who had undergone bilateral lung transplantation 11 years before due to idiopathic bronchiectasis and pulmonary hypertension. He presented with recurrent episodes of breathlessness, wheezing and coughing. Spirometry demonstrated severe airway obstruction. After treatment with systemic and inhaled corticosteroids and long-acting bronchodilators as well as short-acting beta-agonists as needed, his symptoms resolved and his spirometry normalised. A bronchial mannitol challenge test showed significant airway hyperresponsiveness and is thus consistent for a diagnosis of asthma. To our best knowledge, this is the first case of late new-onset asthma in a lung transplant recipient.
Mania induced by isoniazid preventive therapy during steroid treatment for rheumatoid arthritis and organising pneumonia
Authors: Nagano Hiroyuki , Miura Tomoaki , Ueda Takeshi
Published: November 2019

Isoniazid preventative therapy is widely used for latent tuberculosis infection. Isoniazid is highly effective but has many adverse effects, including neuropsychiatric. We describe the case of an 80-year-old woman with mania. She had received isoniazid preventative therapy during steroid treatment for rheumatoid arthritis and organising pneumonia for the previous 5 months. Her mania resolved after discontinuation of isoniazid. Adverse effects of isoniazid should be considered even if a long time has elapsed since the start of administration. Physicians other than infectious disease and respiratory specialists also must be aware of the adverse effects of isoniazid preventative therapy.
An unusual bullous eruption: olanzapine induced pseudoporphyria
Authors: Johnson Oliver Ross , Stewart M Felicity , Bakshi Arti , Weston Philip
Published: November 2019

A 27-year-old man with a background of schizophrenia presented during the summer months with a 2-day history of a blistering eruption predominantly affecting his hands, forearms and face. He had not knowingly been exposed to any chemicals or toxins and was otherwise well. Clinical examination revealed multiple, large, tense blisters affecting the sun-exposed sites. Histology subsequently demonstrated subepidermal blisters with minimal inflammation and negative immunofluorescence. Porphyrin biochemistry including faecal, urinary and serum samples were unremarkable and thus a diagnosis of pseudoporphyria was reached. There were no obvious triggers, however, olanzapine (an atypical antipsychotic) had been commenced 2 months previously and was deemed to be the most likely cause. This is the first report of pseudoporphyria being associated with an atypical antipsychotic and highlights the importance of eliciting an accurate drug history by specifically enquiring about any recent medication changes that could account for the clinical presentation.
Retinopathy progression and the risk of end-stage kidney disease: results from a longitudinal Japanese cohort of 232 patients with type 2 diabetes and biopsy-proven diabetic kidney disease
Authors: Yamanouchi Masayuki , Mori Mikiro , Hoshino Junichi , Kinowaki Keiichi , Fujii Takeshi , Ohashi Kenichi , Furuichi Kengo , Wada Takashi , Ubara Yoshifumi
Published: November 2019

Objective

The predictive value of diabetic retinopathy on end-stage kidney disease (ESKD) has not been fully addressed in patients with type 2 diabetes and diabetic kidney disease.

Research design and methods

We studied 232 patients with type 2 diabetes and biopsy-proven diabetic kidney disease who were screened for diabetic retinopathy during the 1 month of kidney biopsy. We examined the association between retinopathy progression and renal lesions. We used Cox regression analyses to explore the risk of ESKD adjusting for known risk demographic and clinical variables. We assessed the incremental prognostic value of ESKD by adding diabetic retinopathy to the clinical variables.

Results

The diabetic retinopathy progression positively correlated with all scores of renal lesions, especially with the glomerular-based classification (r=0.41), scores of interstitial fibrosis (r=0.41) and diffuse lesion (r=0.48). During a median follow-up of 5.7 years, 114 patients developed ESKD. Adjusting for known risk factors of ESKD, the HR for ESKD (patients with no apparent retinopathy as a reference) were 1.96 (95% CI 0.62 to 6.17) for patients with mild non-proliferative diabetic retinopathy (NPDR), 3.10 (95% CI 1.45 to 6.65) for patients with moderate NPDR, 3.03 (95% CI 1.44 to 6.37) for patients with severe NPDR, and 3.43 (95% CI 1.68 to 7.03) for patients with proliferative diabetic retinopathy, respectively. Addition of the retinopathy grading to the clinical model alone improved the prognostic value (the global χ2statistic increased from 155.2 to 164.5; p<0.001), which is an improvement equivalent to the addition of the renal lesion grading to the clinical model.

Conclusions

Retinopathy progression appeared to be associated with renal lesions and the development of ESKD. Our findings suggest that diabetic retinopathy and kidney disease share the same magnitude of disease progression, and therefore diabetic retinopathy may be useful for prognosticating the clinical course for diabetic kidney disease.
Association between syphilis seroprevalence and age among blood donors in Southern China: an observational study from 2014 to 2017
Authors: Wu Xiaobing , Guan Yang , Ye Jianbin , Fu Hanlin , Zhang Chunlai , Lan Lina , Wu Fengxin , Tang Fen , Wang Feng , Cai Yumao , Yu Weiye , Feng Tiejian
Published: November 2019

Objective

This study investigated the association between syphilis seroprevalence and age among blood donors, and described the distribution of serological titres among syphilis-infected donors, aiming to confirm the syphilis epidemic characteristics and to promote effective interventions for older adults.

Methods

Data were obtained from the Shenzhen Programme for Syphilis Prevention and Control in 2014–2017. Blood samples were screened using the ELISAs, and confirmed using theTreponema pallidumparticle agglutination assay (TPPA) and toluidine red unheated serum test (TRUST).

Results

Among 394 792 blood donors, 733 tested TPPA and TRUST positive (active infection), and 728 tested only TPPA positive (historical infection). The overall prevalence of syphilis seropositivity was 370.1 per 100 000 (95% CI 351.1 to 389.0 per 100 000); the prevalence of active infection was 185.7 per 100 000 (95% CI 172.2 to 199.1 per 100 000). People aged ≥45 years displayed a prevalence of 621.8 per 100 000 in syphilis seropositivity and 280.5 per 100 000 in active infection, which were 3.8 times and 2.4 times higher than that for people aged <25 years, respectively. The prevalence of syphilis seropositivity (χ2trend=311.9, ptrend<0.001) and active infection (χ2trend=72.1, ptrend<0.001) increased significantly with age. After stratification by gender and year of donation, the increasing trend of prevalence with age remained (ptrend<0.05), except for the prevalence of active infection in males and females in 2014. About 16.3% of donors with active infection and aged ≥45 years had a TRUST titre of ≥1∶8, lower than that of patients aged <25 years (51.3%) and 25–34 years (34.1%).

Conclusions

The findings confirm the high prevalence of syphilis among older adults, and suggest the need to increase awareness among healthcare providers and deliver more targeted prevention interventions for older adults to promote early testing.
The structure and predictive value of intrinsic capacity in a longitudinal study of ageing
Authors: Beard John R , Jotheeswaran A T , Cesari Matteo , Araujo de Carvalho Islene
Published: November 2019

Objectives

To assess the validity of the WHO concept of intrinsic capacity in a longitudinal study of ageing; to identify whether this overall measure disaggregated into biologically plausible and clinically useful subdomains; and to assess whether total capacity predicted subsequent care dependence.

Design

Structural equation modelling of biomarkers and self-reported measures in the English Longitudinal Study of Ageing including exploratory factor analysis, exploratory bi-factor analysis and confirmatory factor analysis. Longitudinal mediation and moderation analysis of incident care dependence.

Settings

Community, United Kingdom.

Participants

2560 eligible participants aged over 60 years.

Main outcome measures

Activities of daily living (ADL) and instrumental activities of daily living (IADL).

Results

One general factor (intrinsic capacity) and five subfactors emerged: locomotor, cognitive; psychological; sensory; and ‘vitality’. This structure is consistent with biological theory and the model had a good fit for the data (χ2=71.2 (df=39)). The summary score of intrinsic capacity and specific subfactors showed good construct validity. In a causal path model examining incident loss of ADL and IADL, intrinsic capacity had a direct relationship with the outcome—root mean square error of approximation (RMSEA)=0.02 (90% CI 0.001 to 0.05) and RMSEA=0.008 (90% CI0.001 to 0.03) respectively—and was a strong mediator for the effect of age, sex, wealth and education. Multimorbidity had an independent direct relationship with incident loss of ADLs but not IADLs, and also operated through intrinsic capacity. More of the indirect effect of personal characteristics on incident loss of ADLs and IADLs was mediated by intrinsic capacity than multimorbidity.

Conclusions

The WHO construct of intrinsic capacity appears to provide valuable predictive information on an individual’s subsequent functioning, even after accounting for the number of multimorbidities. The proposed general factor and subdomain structure may contribute to a transformative paradigm for future research and clinical practice.
Difluprednate versus Prednisolone Acetate after Cataract Surgery: a Systematic Review and Meta-Analysis
Authors: KhalafAllah Mahmoud Tawfik , Basiony Ahmed , Salama Ahmed
Published: November 2019

Objective

Topical steroids are the cornerstone in controlling the inflammation after cataract surgery. Prednisolone acetate and difluprednate are the two main products for this purpose. However, it is unclear which one should be used in terms of effectiveness and safety.

Design

Systematic review and meta-analysis.

Data sources

Medline via PubMed, Cochrane Central Register of Controlled Trials, Web of science and clinicaltrials.gov were searched through 10 January 2018, and updated on 20 July 2019, in addition to researching the references’ lists of the relevant articles.

Eligibility criteria

Randomised-controlled trials (RCTs) comparing difluprednate and prednisolone acetate regardless of the dosing regimen used.

Data extraction and synthesis

Two independent authors assessed the included RCTs regarding the risk of bias using the Cochrane tool. Relevant data were extracted, and meta-analysis was conducted using a random-effects model. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to appraise the evidence quality.

Results

We included six RCTs with 883 patients: 441 received difluprednate and 442 received prednisolone acetate. The evidence quality was graded as moderate for corneal oedema and intraocular pressure and low for anterior chamber (AC) clearance. After small incision cataract surgery, difluprednate was superior in clearing AC cells at 1 week (OR=2.5, p>0.00001) and at 2 weeks (OR=2.5, p=0.04), as well as clearing the AC flare at 2 weeks (OR=6.7, p=0.04). After phacoemulsification, difluprednate was superior in terms of corneal clarity at 1 day (OR=2.6, p=0.02) and 1 week after surgery (OR=1.96, p=0.0007). No statistically significant difference was detected between both agents at 1 month in effectiveness. Also, both agents were safe, evaluated by the ocular hypertension (OR=1.23, p=0.8).

Conclusion

With low-to-moderate certainty, difluprednate and prednisolone acetate are safe agents for controlling the inflammation after cataract surgery. Difluprednate showed significant superiority in terms of AC cells and AC flare at 2 weeks postoperatively.
Relationships between dipstick proteinuria and risk of hearing impairment among Japanese workers: a prospective cohort study
Authors: Umesawa Mitsumasa , Hara Mikako , Sairenchi Toshimi , Nagao Masanori , Haruyama Yasuo , Kobashi Gen
Published: November 2019

Objectives

Hearing impairment is among the most significant health problems, and the number of adults with hearing impairment is increasing worldwide. Therefore, the prevention of hearing impairment is important. Proteinuria appears to be a risk factor for hearing impairment, but no prospective studies have examined the association between proteinuria and hearing impairment risk. This prospective study aimed to clarify the association between dipstick proteinuria and risk of hearing impairment.

Design

This was a prospective cohort study based on annual health check-up data, 2008–2016.

Setting

Data were collected on 7005 employees of a single company who worked in offices and factories throughout Japan.

Participants

We analysed data from 5699 subjects (88.6% men) who underwent annual health check-ups twice or more from 2008 to 2016, had no missing data, and were free from hearing impairment at baseline. We regarded the first health check-up as the baseline examination.

Primary and secondary outcome measures

Hearing tests were performed using audiometry at two frequencies (1 and 4 kHz) during the health check-ups. Defining total moderate hearing impairment as the inability to respond to 30 dB at 1 kHz and/or 40 dB at 4 kHz, we examined the association between dipstick proteinuria at baseline and risk of hearing impairment at final examination.

Results

Total moderate hearing impairment was noted in 162 (2.8%) subjects. Compared with subjects without proteinuria at baseline, the multivariable adjusted OR (95% CI) was 5.35 (1.87–15.25) for subjects with proteinuria ≥2+, 0.92 (0.40–2.13) for those with proteinuria +/−, and 1.33 (0.63–2.80) for those with proteinuria+ at baseline.

Conclusions

Severe dipstick proteinuria was positively associated with risk of hearing impairment in the future. Our results suggest that medical examinations including urine testing are effective for detecting subjects with high risk of hearing impairment.
Pharmaceutical use and costs in patients with coronary artery disease, using Australian observational data
Authors: McCreanor Victoria , Parsonage William A , Whiteman David C , Olsen Catherine , Barnett Adrian G , Graves Nicholas
Published: November 2019

Objectives

We aimed to estimate the annual pharmaceutical costs for patients with stable coronary artery disease, using Australian administrative data, comparing patients who had undergone interventional treatment with those had not. We also aimed to compare the duration of dual antiplatelet therapy (DAPT) prescription in the real-world, with recommended guidelines.

Design

An observational study using administrative data.

Participants

We used data from theQSkinstudy, a population-based prospective study assessing skin cancer risk. Participants were invited from the Queensland population, not based on perceived skin cancer risk, and had consented to future use of their data for approved research projects.

Main outcome measures

We calculated 12-month costs of pharmaceutical therapy for coronary artery disease for patients in each of three clinically relevant groups: medical therapy only, following coronary stent implantation and following coronary artery bypass graft surgery. We measured the duration of DAPT following stent implantation and total duration of DAPT, where it was prescribed, in the medical therapy only group.

Results

Estimated mean annual pharmaceutical costs were highest in the stent group at AUD$1920, compared with AUD$1481 in the medical therapy group, and AUD$881 in the coronary artery bypass group. There were similar rates of prescriptions of symptom relief drugs following stent insertion, compared with the medical therapy only group. The median duration of DAPT in the stent group was 16, and 31 months in the medical therapy group.

Conclusions

Our results suggest that despite the common expectation that the burden of medical therapy is reduced following coronary stent insertion for stable coronary artery disease, this does not occur in practice. Many patients also appear to continue DAPT longer than guidelines recommend, which may put them at unnecessarily elevated risk of bleeding events.
Fostering humanism: a mixed methods evaluation of the Footprints Project in critical care
Authors: Hoad Neala , Swinton Marilyn , Takaoka Alyson , Tam Benjamin , Shears Melissa , Waugh Lily , Toledo Feli , Clarke France J , Duan Erick Huaileigh , Soth Mark , Cook Deborah J
Published: November 2019

Objectives

The objectives of this mixed-methods study were to assess the uptake, sustainability and influence of the Footprints Project.

Setting

Twenty-two-bed university-affiliated ICU in Hamilton, Canada.

Participants

ICU patients admitted and their families, as well as clinicians.

Interventions

We developed a personalised patient Footprints Form and Whiteboard to facilitate holistic, patient-centred care, to inform clinical encounters, and to create deeper connections among patients, families and clinicians.

Outcome measures

We conducted 3 audits to examine uptake and sustainability. We conducted semi-structured interviews with 10 clinicians, and held 5 focus groups with 25 clinicians; and we interviewed 5 patients and 13 family representatives of 5 patients who survived and 5 who died in the ICU. Transcripts were analysed using qualitative content analysis.

Results

The Footprints Project facilitated holistic, patient-centred care by setting the stage for patient and family experience, motivating the patient and humanising the patient for clinicians. Through informing clinical encounters, Footprints helped clinicians initiate more personal conversations, foster deeper connections and guide treatment. Professional practice influences included more focused attention on the patient, enhanced interdisciplinary communication and changes in community culture. Initially used in 15.8% of patients (audit A), uptake increased to 51.4% in audit B, and was sustained at 57.8% in audit C.

Conclusions

By sharing valuable personal information about patients before and beyond their illness on individualised whiteboards at each bedside, the Footprints Project fosters humanism in critical care practice.
Animal-related injuries and fatalities: evidence from a large-scale population-based cross-sectional survey in rural Bangladesh
Authors: Bhuiyan Md Al Amin , Agrawal Priyanka , Wadhwaniya Shirin , Li Qingfeng , Alonge O , Rahman AKM Fazlur , Rahman Aminur
Published: November 2019

Objective

This study determines the magnitude and pattern of animal-related injury mortalities and morbidities in rural Bangladesh.

Design and setting

A cross-sectional survey was conducted in 51 Unions of 7 subdistricts of Bangladesh from June 2013 to September 2013.

Participants

A total of approximately 1.17 million individuals across all age and gender profiles were included in the survey. The participants had to be residents of the seven subdistricts and have provided consent to participate in the study.

Primary and secondary outcome measures

Animal-related injury characteristics and demographic information was collected in the study. Frequency, proportion and 95% CIs of variables such as type of animal, type of animal attack, activity of the person prior to attack and the seasonality of the injury were reported. Data was then statistically analysed for associations between injury and sociodemographic characteristics.

Results

The incidence rate of fatal and non-fatal animal-related injuries across all ages were 0.7 (95% CI 0.4 to 1.4) and 1635.3 (95% CI 1612.0 to 1658.0) per 100 000 populations, respectively. Non-fatal animal-related injury rates were highest among adults 18 years and older (1820.6 per 100 000 population (1777.2 to 1865.1)), and in males across all age groups. The most common animal injury was wasp/hornet/bee sting (49%), followed by cow/buffalo (25%), dog bite (9%) and snake bites (9%).

Conclusions

Animal-related injuries are an important public health issue in rural Bangladesh. The incidence of animal-related morbidities was found high in the study area. Males, school-going and productive age groups were at high risk. Immediate attention should be given to prevent these events.
Using the General Social Survey – National Death Index cohort to study the relationship between neighbourhood fear and mortality in the USA
Authors: Grinshteyn Erin , Muennig Peter , Pabayo Roman
Published: November 2019

Objectives

Fear of crime is associated with adverse mental health outcomes and reduced social interaction independent of crime. Because mental health and social interactions are associated with poor physical health, fear of crime may also be associated with death. The main objective is to determine whether neighbourhood fear is associated with time to death.

Setting and participants

Data from the 1978–2008 General Social Survey were linked to mortality data using the National Death Index (GSS-NDI) (n=20 297).

Methods

GSS-NDI data were analysed to assess the relationship between fear of crime at baseline and time to death among adults after removing violent deaths. Fear was measured by asking respondents if they were afraid to walk alone at night within a mile of their home. Crude and adjusted HRs were calculated using survival analysis to calculate time to death. Analyses were stratified by sex.

Results

Among those who responded that they were fearful of walking in their neighbourhood at night, there was a 6% increased risk of death during follow-up in the adjusted model though this was not significant (HR=1.06, 95% CI 0.99 to 1.13). In the fully adjusted models examining risk of mortality stratified by sex, findings were significant among men but not women. Among men, in the adjusted model, there was an 8% increased risk of death during follow-up among those who experienced fear at baseline in comparison with those who did not experience fear (HR=1.08, 95% CI 1.02 to 1.14).

Conclusions

Research has recently begun examining fear as a public health issue. With an identified relationship with mortality among men, this is a potential public health problem that must be examined more fully.
Multidisciplinary interventions for reducing the avoidable displacement from home of frail older people: a systematic review
Authors: Sempé Lucas , Billings Jenny , Lloyd-Sherlock Peter
Published: November 2019

Objectives

To synthesise existing literature on interventions addressing a new concept of avoidable displacement from home for older people with multimorbidity or frailty. The review focused on home-based interventions by any type of multidisciplinary team aimed at reducing avoidable displacement from home to hospital settings. A second objective was to characterise these interventions to inform policy.

Design

A systematic search of the main bibliographic databases was conducted to identify studies relating to interventions addressing avoidable displacement from home for older people. Studies focusing on one specific condition or interventions without multidisciplinary teams were excluded. A narrative synthesis of data was conducted, and themes were identified by using an adapted thematic framework analysis approach.

Results

The search strategy was performed using the following electronic databases: the American National Library of Medicine and the National Institutes of Health (PubMed), Scopus, Cochrane Library (Central and CDRS), CINAHL, Social Care Online, Web of Science as well as the database of the Latin American and Caribbean Health Sciences Literature. The database search was done in September 2018 and completed in October 2018. Overall 3927 articles were identified and 364 were retained for full text screening. Fifteen studies were included in the narrative review. Four themes were identified and discussed: (1) types of interventions, (2) composition of teams, (3) intervention effectiveness and (4) types of outcomes. Within intervention types, three categories of care types were identified; transitional care, case-management services and hospital at home. Each individual article was assessed in terms of risk of bias following Cochrane Collaboration guidelines.

Conclusions

The review identified some potential interventions and relevant topics to be addressed in order to develop effective and sustainable interventions to reduce the avoidable displacement from home of older people. However the review was not able to identify robust impact evidence, either in terms of quantity or quality from the studies presented. As such, the available evidence is not sufficiently robust to inform policy or interventions for reducing avoidable displacement from home. This finding reflects the complexity of these interventions and a lack of systematic data collection.

PROSPERO registration number

CRD42018108116.