bluuebunny/crossref_metadata_2025 huggingface dataset:
PROSPECT guideline for tonsillectomy: systematic review and procedure‐specific postoperative pain management recommendations
Authors: Aldamluji N. , Burgess A. , Pogatzki‐Zahn E. , Raeder J. , Beloeil H. ,   the PROSPECT Working Group collaborators*
Published: November 2020

Tonsillectomy is one of the most frequently performed surgical procedures; however, pain management remains challenging. Procedure‐specific efficacy as well as specific risks of treatment options should guide selection of pain management protocols based on evidence and should optimise analgesia without harm. The aims of this systematic review were to evaluate the available literature and develop recommendations for optimal pain management after tonsillectomy. A systematic review utilising preferred reporting items for systematic reviews and meta‐analysis guidelines with procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in the English language up to November 2019 assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Out of the 719 potentially eligible studies identified, 226 randomised controlled trials met the inclusion criteria, excluding the studies examining surgical techniques. Pre‐operative and intra‐operative interventions that improved postoperative pain were paracetamol; non‐steroidal anti‐inflammatory drugs; intravenous dexamethasone; ketamine (only assessed in children); gabapentinoids; dexmedetomidine; honey; and acupuncture. Inconsistent evidence was found for local anaesthetic infiltration; antibiotics; and magnesium sulphate. Limited evidence was found for clonidine. The analgesic regimen for tonsillectomy should include paracetamol; non‐steroidal anti‐inflammatory drugs; and intravenous dexamethasone, with opioids as rescue analgesics. Analgesic adjuncts such as intra‐operative and postoperative acupuncture as well as postoperative honey are also recommended. Ketamine (only for children); dexmedetomidine; or gabapentinoids may be considered when some of the first‐line analgesics are contra‐indicated. Further randomised controlled trials are required to define risk and combination of drugs most effective for postoperative pain relief after tonsillectomy.
Do non‐native plants contribute to insect declines?
Authors: Tallamy Douglas W. , Narango Desirée L. , Mitchell Adam B.
Published: November 2020

1. With evidence of significant global insect declines mounting, urgent calls to mitigate such declines are also increasing. Efforts to reverse insect declines will only succeed, however, if we correctly identify and address their major causes.

2. One potential cause that has received little mention is the global spread of non‐native plants as invasive species, agroforestry products, and ornamental plants.

3. Here we (a) review the theory predicting that most insect herbivores are evolutionarily constrained to use a fraction of available plant lineages; (b) document the extent to which nonnative plants have displaced native plant communities around the globe; (c) examine the evidence that non‐native plants reduce insect abundance and diversity; and (d) suggest guidelines for measuring the impact of non‐native plants on insect populations.

4. We conclude that host range expansions to non‐natives do occur among many insect herbivores but not at the frequency required to prevent insect declines when non‐native plants replace native plant communities. Accordingly, we suggest that curbing the spread and use of non‐ native plants at local, national, and international scales will be a necessary and effective way to reduce some insect declines.
Effect of essential oils on oral halitosis treatment: a review
Authors: Dobler Dorota , Runkel Frank , Schmidts Thomas
Published: November 2020

Halitosis is a very common condition which may affect up to 30% of the population. In about 90% of the cases, halitosis originates in the mouth due to inadequate plaque control, periodontal disease, dry mouth, faulty restorations, and in particular due to excessive bacterial growth. Oral malodor is mainly caused by a microbial degradation of amino acids into volatile, bad‐smelling gases (volatile sulfur compounds – VSCs). Management of oral malodor is directed primarily at managing and reducing the VSC‐producing bacteria count as well as masking the odor. Essential oils have been used for this purpose in traditional medicine for centuries. In the present review, data on the antimicrobial activity of essential oils against relevant oral VSC‐producing bacteria are compiled and compared. Additionally, other positive aspects of essential oils with regard to oral odor are considered.
Husband–Wife Religious Denomination Homogamy and Marital Satisfaction Over Time: The Moderating Role of Religious Intensity
Authors: Hwang Woosang , Cakirsoy‐Aslan Ayse Duygu , Brown Maria T. , Silverstein Merril
Published: November 2020

Objective

This study examines the extent to which homogamy and heterogamy in husband–wife religious denomination are associated with initial levels of marital satisfaction and slopes of marital satisfaction over 17 years examining whether those associations are moderated by husbands' and wives' religious intensity.

Background

Longitudinal studies on religion and marital outcomes that incorporate a dyadic component are relatively rare, and few studies have examined couple‐level religiosity with respect to long‐term marital outcomes.

Method

On the basis of six waves of the Longitudinal Study of Generations data between 1988 and 2005, we selected 173 married couples in the baby boom generation and analyzed their musing dyadic growth curve modeling.

Results

Husbands' and wives' religious denomination homogamy was significantly associated with initial levels and slopes of both husbands' and wives' marital satisfaction. In addition, husbands with highly religious wives of the same denomination exhibited greater initial levels of marital satisfaction than those who had wives of weaker religious intensity with a different denomination.

Conclusion

In this research, denominational similarity between spouses was not only beneficial to marital satisfaction but was also paired with the degree of religious intensity.

Implication

Family researchers and practitioners are encouraged to acknowledge the characteristics of couples' religious contexts and their influences on marital outcomes over the family life course. Because the LSOG couples represent mostly White and underrepresented families from other ethnicities, there should be caution in generalizing these findings to the general population.
Shall the forthcoming Chinese Antarctic law be obligation‐oriented?
Authors: Li Xueping
Published: November 2020

China has set forth on making its Antarctic law after a long time of ferment. This forthcoming law should refer to the most suitable Chinese theoretical standards of law‐making. It should also clarify China's domestic and international legal dimensions and the doctrine of rights shaped by obligations in the Antarctic Treaty System. All of which determine that this new law shall have the nature of obligation‐orientation and will have high impact on Chinese Antarctic activities in the future, though leaving possible drawbacks relevant to the suspended issues under the Antarctic Treaty System.
Hypofractionated radiotherapy for hepatocellular carcinomas adjacent to the gastrointestinal tract
Authors: Tsurugai Yuichiro , Takeda Atsuya , Eriguchi Takahisa , Sanuki Naosko , Aoki Yousuke
Published: November 2020

Aim

Decisions regarding therapeutic plans for inoperable patients with hepatocellular carcinoma (HCC) adjacent to the gastrointestinal (GI) tract are challenging because radiofrequency ablation has the potential risk of thermal injury. Moreover, the response rate of transcatheter arterial chemoembolization is relatively low and stereotactic body radiotherapy (SBRT) is believed to be too toxic. We have applied hypofractionated radiotherapy (HFRT) for such lesions. This study investigated the outcomes and toxicities of this treatment.

Methods

Among consecutive HCC patients treated with radiotherapy with curative intent at our institution between 2015 and 2019, we retrospectively extracted those outside of the indication for SBRT due to exceeding the constraint of the GI tract and who were treated using HFRT with a prescription dose of 42 Gy in 14 fractions and prophylactic proton pump inhibitor administration for 6 months. The oncological outcomes and toxicities were investigated.

Results

A total of 66 patients with 73 lesions were eligible. The median follow‐up period was 24.0 months. The local recurrence, intrahepatic recurrence, liver‐related death, and overall survival rates at 2 years were 11.3%, 50.6%, 15.9%, and 60.4%, respectively. Six (9.1%) patients experienced Child–Pugh score deterioration ≥2 within 6 months following treatment. Two and one patient developed grades 2 and 3 gastroduodenal bleeding, respectively.

Conclusions

HFRT can achieve good local control in patients with HCC adjacent to the GI tract, with low GI toxicity incidence. Our study demonstrated that HFRT can be a potentially curative treatment option for lesions.
The association of histological progression with biochemical response to ursodeoxycholic acid in primary biliary cholangitis
Authors: Namisaki Tadashi , Fujinaga Yukihisa , Moriya Kei , Yoshiji Hitoshi
Published: November 2020

Primary biliary cholangitis (PBC) is currently diagnosed at an early stage; therefore, the number of patients with PBC without symptoms at the time of diagnosis is increasing. However, up to 30% of patients with PBC exhibit the suboptimal response to ursodeoxycholic acid (UDCA) and are at high risk of end‐stage liver disease. Obeticholic acid is an approved second‐line therapy for patients with PBC that are refractory to UDCA. Novel surrogate endpoints are required to identify individuals eligible for second‐line therapies. An inadequate biochemical response to UDCA is a useful predictor of poor outcomes in patients with PBC. In addition to UDCA effects on biochemical parameters, histological outcomes could be considered as candidate surrogate endpoints. Alterations in liver histology are used as surrogate endpoints in clinical studies. However, current staging systems are insufficient to determine PBC disease severity and progression because of the pathological heterogeneity of the disease. Histological features at baseline and biochemical response to UDCA treatment can affect the disease course of PBC. Therefore, novel surrogate endpoints must be represented by parameters characterized by histological outcomes and treatment responses in PBC. In this review, we discuss the existing histological parameters and newly created factors to identify patients with PBC who are at a high risk of developing end‐stage liver disease and, consequently, the potential need for additional treatments.
Little parallelism in genomic signatures of local adaptation in two sympatric, cryptic sister species
Authors: Hartke Juliane , Waldvogel Ann‐Marie , Sprenger Philipp P. , Schmitt Thomas , Menzel Florian , Pfenninger Markus , Feldmeyer Barbara
Published: November 2020

Species living in sympatry and sharing a similar niche often express parallel phenotypes as a response to similar selection pressures. The degree of parallelism within underlying genomic levels is often unexplored, but can give insight into the mechanisms of natural selection and adaptation. Here, we use multi‐dimensional genomic associations to assess the basis of local and climate adaptation in two sympatric, crypticCrematogaster leviorant species along a climate gradient. Additionally, we investigate the genomic basis of chemical communication in both species. Communication in insects is mainly mediated by cuticular hydrocarbons (CHCs), which also protect against water loss and, hence, are subject to changes via environmental acclimation or adaptation. The combination of environmental and chemical association analyses based on genome‐wide Pool‐Seq data allowed us to identify single nucleotide polymorphisms (SNPs) associated with climate and with chemical differences. Within species, CHC changes as a response to climate seem to be driven by phenotypic plasticity, since there is no overlap between climate‐ and CHC‐associated SNPs. The only exception is the odorant receptor OR22c, which may be a candidate for population‐specific CHC recognition in one of the species. Within both species, climate is significantly correlated with CHC differences, as well as to allele frequency differences. However, associated candidate SNPs, genes and functions are largely species‐specific and we find evidence for minimal parallel evolution only on the level of genomic regions (J = 0.04). This highlights that even closely related species may follow divergent evolutionary trajectories when expressing similar adaptive phenotypes.
The forgotten feeding ground: patterns in seasonal and depth‐specific food intake of adult cod Gadus morhua in the western Baltic Sea
Authors: Funk Steffen , Frelat Romain , Möllmann Christian , Temming Axel , Krumme Uwe
Published: November 2020

This study presents the diet composition of western Baltic cod Gadus morhua based on 3150 stomachs sampled year‐round between 2016 and 2017 using angling, gillnetting and bottom trawling, which enhanced the spatio‐temporal coverage of cod habitats. Cod diet composition in shallow areas (<20 m depth) was dominated by benthic invertebrate species, mainly the common shore crab Carcinus maneas. Compared to historic diet data from the 1960s and 1980s (limited to depth >20 m), the contribution of herring Clupea harengus decreased and round goby Neogobius melanostomus occurred as a new prey species. Statistical modelling revealed significant relationships between diet composition, catch depth, fish length and season. Generalized additive modelling identified a negative relationship between catch depth and stomach content weight, suggesting reduced food intake in winter when cod use deeper areas for spawning and during peak summer when cod tend to avoid high water temperatures. The results of this study highlight the importance of shallow coastal areas as major feeding habitats of adult cod in the western Baltic Sea, which were previously unknown because samples were restricted to deeper trawlable areas. The results strongly suggest that historic stomach analyses overestimated the role of forage fish and underestimated the role of invertebrate prey. Eventually, this study shows the importance of a comprehensive habitat coverage for unbiased stomach sampling programmes to provide a more reliable estimation of top predator diet, a key information for food web analyses and multispecies models.
History of paediatric gastroenterology in Australia
Authors: O'Loughlin Edward V , Cameron Donald J S
Published: November 2020

Paediatric gastroenterology in Australia has undergone remarkable changes over the more than six decades since Charlotte Anderson's pioneering work, and is now a well‐established specialty in its own right. Australian paediatric gastroenterologists have made important contributions nationally and internationally.
Local Capacity for Emergency Births in Rural Hospitals Without Obstetrics Services
Authors: Kozhimannil Katy B. , Interrante Julia D. , Tuttle Mariana S. , Gilbertson Mary , Wharton Kristin DeArruda
Published: November 2020

Background

Rural hospitals are closing obstetric units, and limited information is available about local emergency obstetric preparedness and capacity in rural communities where hospitals do not routinely provide this care.

Objective

To describe emergency obstetric capacity at rural US hospitals that do not routinely offer childbirth services.

Methods

Data from the 2018 American Hospital Association Annual Survey were used to identify a random sample of rural hospitals that did not offer obstetric services. A survey was developed based on World Health Organization criteria for obstetric emergencies. With data collected from 69 rural hospital emergency departments (48% response rate), we analyzed local capacity to support childbirth.

Results

Most responding hospitals (65%) were located 30 or more miles away from a hospital with obstetric services. Some reported having emergency room births in the past year (28%), an unanticipated adverse birth outcome (32%), and/or a delay in urgent transport for a pregnant patient (22%). More than 90% of responding hospitals had capacity for blood transfusion, intravenous antibiotics or anticonvulsants, and basic neonatal resuscitation. However, less than one‐fifth had capacity to perform surgery (16%), remove retained products of delivery (17%), or had a policy for emergency cesarean (18%). Almost all respondents (80%) reported the need for additional training or resources to handle emergency obstetric situations.

Conclusion

Many rural hospitals do not have basic capacity to provide emergency obstetric services. Programs and policies to improve this may focus on surgical care, clinician and staff training, transportation, and coordination with nearby hospitals that provide obstetric services.
Risk of dietary and breastmilk exposure to mycotoxins among lactating women and infants 2–4 months in northern India
Authors: Mehta Rukshan V. , Wenndt Anthony J. , Girard Amy Webb , Taneja Sunita , Ranjan Samriddhi , Ramakrishnan Usha , Martorell Reynaldo , Ryan P. Barry , Rangiah Kannan , Young Melissa F.
Published: November 2020

Mycotoxins are carcinogenic secondary metabolites of fungi that have been linked to infant growth faltering. In this study, we quantified co‐occurring mycotoxins in breast milk and food samples from Haryana, India, and characterized determinants of exposure. Deterministic risk assessment was conducted for mothers and infants. We examined levels of eight mycotoxins (Aflatoxin B1, B2, G1, G2, M1, M2; Ochratoxin A, B) in 100 breast milk samples (infants 2–4 months) using ultra‐high‐performance liquid chromatography tandem mass spectrometry. Aflatoxin B1 (AFB1), fumonisin B1 (FB1) and deoxynivalenol (DON) were detected in several food items (n = 298) using enzyme‐linked immunosorbent assays. We report novel data on the presence of mycotoxins in breast milk samples from India. Whereas breast milk concentrations (AFM1 median: 13.7; range: 3.9–1200 ng/L) remain low, AFM1 was detected above regulatory limits in 27% of animal milk samples. Additionally, 41% of infants were above provisional maximum tolerable daily intake (PMTDI) limits for AFM1 due to consumption of breast milk (mean: 3.04, range: 0.26–80.7 ng kg−1 bw day−1). Maternal consumption of breads (p < 0.05) was associated with breast milk AFM1 exposure. AFB1 (μg/kg) was detected in dried red chilies (15.7; 0–302.3), flour (3.13; 0–214.9), groundnuts (0; 0–249.1), maize (56.0; 0–836.7), pearl millet (1.85; 0–160.2), rice (0; 0–195.6), wheat (1.9; 0–196.0) and sorghum (0; 0–63.5). FB1 (mg/kg) was detected in maize (0; 0–61.4), pearl millet (0; 0–35.4) and sorghum (0.95; 0–33.2). DON was not detected in food samples. Mothers in our study exceeded PMTDI recommendations for AFB1 due to consumption of rice and flour (mean: 75.81; range: 35.2–318.2 ng kg−1 bw day−1). Our findings show the presence of Aflatoxin B1 and M1 at various levels of the food chain and in breast milk, with estimated intakes exceeding PMTDI recommendations. Aflatoxins are known carcinogens and have also been linked to stunting in children. Their presence across the food system and in breast milk is concerning, thus warranting further research to replicate and expand on our findings and to understand implications for maternal and child health.
Climatic drivers of latitudinal variation in Late Triassic tetrapod diversity
Authors: Dunne Emma M. , Farnsworth Alexander , Greene Sarah E. , Lunt Daniel J. , Butler Richard J.
Published: November 2020

The latitudinal biodiversity gradient (LBG), the increase in biodiversity from the poles to the equator, is one of the most widely recognized global macroecological patterns, yet its deep time evolution and drivers remain uncertain. The Late Triassic (237–201 Ma), a critical interval for the early evolution and radiation of modern tetrapod groups (e.g. crocodylomorphs, dinosaurs, mammaliamorphs), offers a unique opportunity to explore the palaeolatitudinal patterns of tetrapod diversity since it is extensively sampled spatially when compared with other pre‐Cenozoic intervals, particularly at lower palaeolatitudes. Here, we explore palaeolatitudinal patterns of Late Triassic tetrapod diversity by applying sampling standardization to comprehensive occurrence data from the Paleobiology Database (PBDB). We then use palaeoclimatic model simulations to explore the palaeoclimatic ranges occupied by major tetrapod groups, allowing insight into the influence of palaeoclimate on the palaeolatitudinal distribution of these groups. Our results show that Late Triassic tetrapods generally do not conform to a modern‐type LBG; instead, sampling‐standardized species richness is highest at mid‐palaeolatitudes. In contrast, the richness of pseudosuchians (crocodylians and their relatives) is highest at the palaeoequator, a pattern that is retained throughout their subsequent evolutionary history. Pseudosuchians generally occupied a more restricted range of palaeoclimatic conditions than other tetrapod groups, a condition analogous to modern day reptilian ectotherms, while avemetatarsalians (the archosaur group containing dinosaurs and pterosaurs) exhibit comparatively wider ranges, which is more similar to modern endotherms, such as birds and mammals, suggesting important implications for the evolution of thermal physiology in dinosaurs.
Lung cancer screening implementation: Complexities and priorities
Authors: Rankin Nicole M. , McWilliams Annette , Marshall Henry M.
Published: November 2020

Lung cancer is the number one cause of cancer death worldwide. The benefits of lung cancer screening to reduce mortality and detect early‐stage disease are no longer in any doubt based on the results of two landmark trials using LDCT. Lung cancer screening has been implemented in the US and South Korea and is under consideration by other communities. Successful translation of demonstrated research outcomes into the routine clinical setting requires careful implementation and co‐ordinated input from multiple stakeholders. Implementation aspects may be specific to different healthcare settings. Important knowledge gaps remain, which must be addressed in order to optimize screening benefits and minimize screening harms. Lung cancer screening differs from all other cancer screening programmes as lung cancer risk is driven by smoking, a highly stigmatized behaviour. Stigma, along with other factors, can impact smokers' engagement with screening, meaning that smokers are generally ‘hard to reach’. This review considers critical points along the patient journey. The first steps include selecting a risk threshold at which to screen, successfully engaging the target population and maximizing screening uptake. We review barriers to smoker engagement in lung and other cancer screening programmes. Recruitment strategies used in trials and real‐world (clinical) programmes and associated screening uptake are reviewed. To aid cross‐study comparisons, we propose a standardized nomenclature for recording and calculating recruitment outcomes. Once participants have engaged with the screening programme, we discuss programme components that are critical to maximize net benefit. A whole‐of‐programme approach is required including a standardized and multidisciplinary approach to pulmonary nodule management, incorporating probabilistic nodule risk assessment and longitudinal volumetric analysis, to reduce unnecessary downstream investigations and surgery; the integration of smoking cessation; and identification and intervention for other tobacco related diseases, such as coronary artery calcification and chronic obstructive pulmonary disease. National support, integrated with tobacco control programmes, and with appropriate funding, accreditation, data collection, quality assurance and reporting mechanisms will enhance lung cancer screening programme success and reduce the risks associated with opportunistic, ad hoc screening. Finally, implementation research must play a greater role in informing policy change about targeted LDCT screening programmes.
Antimicrobial use quantification in adult dairy cows – Part 2 – Developing a foundation for pharmacoepidemiology by comparing measurement methods
Authors: Schrag Nora F.D. , Apley Michael D. , Godden Sandra M. , Singer Randall S. , Lubbers Brian V.
Published: November 2020

As stewardship programmes seek to influence therapeutic choices and reduce resistance selection pressure, it is essential to understand the multiple factors which may influence any given antimicrobial use measure. This article compares 9 measures of antimicrobial use pertaining to adult cows in US dairy systems based on treatment records standardized to a single standardized regimen (SReg) format. There are 3 fundamental parameters underlying the nine measures: amount of active substance (AMOUNT), number of SRegs (ANIMALS) and treatment time (TIME). Additionally, three use categories were considered in the analysis: control of mastitis (Dry Cow), treatment of detected mastitis (Clinical Mastitis) and treatment of other diseases (Other Treatment). The assumptions necessary for calculation of each of the nine measures are identified. The influence of measure choice on farm rank was explored at the farm level both within and across fundamental parameters. Across all use categories, when measures of TIME and ANIMALS were compared, correlations between measures were greater than 0.91. However, when measures of AMOUNT were compared to either measures of TIME or ANIMALS, the correlation between measures was more variable across use categories (R = 0.31–0.91). These comparisons demonstrate that the selection of antimicrobial use metric can affect which dairies are considered the highest users of antimicrobials. Measurement selection also influences which use category has the greatest potential for use reduction. This indicates that measure selection can influence which use category is prioritized as a target for reduction of antimicrobial use. Utilization of this information may allow those developing dairy antimicrobial stewardship programmes to better understand the potential effects of measurement selection on driving changes in antimicrobial use.
Antimicrobial use quantification in adult dairy cows – Part 3 – Use measured by standardized regimens and grams on 29 dairies in the United States
Authors: Schrag Nora F. D. , Godden Sandra M. , Apley Michael D. , Singer Randall S. , Lubbers Brian V.
Published: November 2020

This study describes antimicrobial use in terms of standardized regimens per cow year (REG/CY) and grams per cow year (GMS/CY) for 29 dairies in the United States during the years 2016 and 2017. To explore potential priorities for antimicrobial stewardship programs, these measures were stratified by both disease syndrome and antimicrobial class. Potential confounders of use measurements are discussed and challenges for measure interpretation are identified. When measured as REG/CY, the results indicate that mastitis is the disease syndrome with the greatest contribution to overall antimicrobial use. However, when GMS/CY is measured, metritis, lameness and unknown disease syndromes are also significant contributors. When use is stratified by antimicrobial class, measures of REG/CY indicate the greatest magnitude of use is the cephalosporin class. However, when measures of GMS/CY are stratified by drug class, use within the penicillin class contributes more than any other single class. These differences highlight the need for a more complete understanding of the relationship between antimicrobial use measures and their relationship to antimicrobial resistance selection pressure.
Pregnant and postnatal women's experiences of interacting with health care providers about their tobacco smoking: a qualitative systematic review protocol
Authors: Small Sandra P. , Swab Michelle , Maddigan Joy
Published: November 2020

Objective:

The objective of this review is to comprehensively identify and synthesize the best available evidence about the experiences of women who smoked tobacco during pregnancy or postnatally (or both) concerning their health care providers’ interactions with them about their smoking.

Introduction:

Smoking tobacco during pregnancy and postnatally continue to be important global public health challenges. Maternal smoking poses risks to the woman's general health and causes pregnancy complications and serious adverse health effects for the fetus and child. Hence, it is essential that health care providers support pregnant and postnatal women to achieve smoking cessation and not relapse. Learning about these women's experiences of health care provider interactions may inform recommendations for health care provider best practice in interpersonal approach.

Inclusion criteria:

The participants of interest are women who smoked tobacco during pregnancy, the postnatal period, or both, with the phenomenon of interest being their experiences of health care provider interactions with them about their smoking. The context is any setting globally. Studies for consideration will have qualitative data, including any mixed methods studies.

Methods:

This qualitative systematic review will be conducted according to JBI methodology. Databases to be searched for published studies include CINAHL, PubMed, APA PsycINFO, Embase, Sociological Abstracts, and SocINDEX. Gray literature will be searched for unpublished studies. The authors will conduct an initial screening and then a full-text review of studies for congruence with the inclusion criteria. A critical appraisal will be performed on eligible studies and data will be extracted from included studies. Meta-aggregation will be used to yield synthesized findings, which will be assigned confidence scores.

Systematic review registration number:

PROSPERO CRD42020178866
Risk factors for hyperglycemia and hypoglycemia in adults with pharmacologically treated type 2 diabetes mellitus: a quantitative systematic review protocol
Authors: Lopes Rafael Oliveira Pitta , Barbosa Genesis de Souza , Leite Kênia Rocha , Mercês Claudia Angélica Mainenti Ferreira , Santana Rosimere Ferreira , Brandão Marcos Antônio Gomes
Published: November 2020

Objective:

The objective of this review is to identify and synthesize the risk factors for hyperglycemia or hypoglycemia in adults with pharmacologically treated type 2 diabetes mellitus in any scenarios and environments for health care.

Introduction:

Studies around the world have investigated which factors are associated with episodes of alteration of blood glucose level. It is through the characterization of these factors that nurses can plan and intervene accurately in the control of serum glucose levels in people with diabetes.

Inclusion criteria:

This review will include studies conducted among adults with pharmacologically treated type 2 diabetes mellitus in any scenarios and environments for health care. Studies should focus on risk factors for the variation of fasting glycemic levels lower than 3.9 mmol/L and higher than 7.21 mmol/L, as well as postprandial glycemic levels lower than 3.9 mmol/L and higher than 10 mmol/L.

Methods:

Databases to be searched include MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, Scopus, LILACS, and ScienceDirect. Following the search, titles and abstracts will be screened by two independent reviewers for assessment against the inclusion criteria for the review. The full text of selected citations will be assessed in detail against the inclusion criteria, and studies selected for retrieval will be assessed by two independent reviewers for methodological validity using JBI critical appraisal tools. Studies will not be excluded based on their quality assessment. Data will be extracted using the standardized data extraction tools. Quantitative data will, where possible, be pooled in statistical meta-analysis.

Systematic review registration number:

PROSPERO (CRD42019134755)
Identification of Spacer and Protospacer Sequence Requirements in the Vibrio cholerae Type I-E CRISPR/Cas System
Authors: Bourgeois Jacob , Lazinski David W. , Camilli Andrew
Published: November 2020

Bacterial CRISPR/Cas systems provide immunity by defending against phage and other invading elements. A thorough comprehension of the molecular mechanisms employed by these diverse systems will improve our understanding of bacteriophage-bacterium interactions and bacterial adaptation to foreign DNA. The
Vibrio cholerae
type I-E system was previously identified in an extinct classical biotype and was partially characterized for its function. Here, using both bioinformatic and functional assays, we extend that initial study. We have found that the type I-E system still exists in modern strains of
V. cholerae
. Furthermore, we defined additional sequence elements both in the CRISPR array and in target DNA that are required for immunity. CRISPR/Cas systems are now commonly used as precise and powerful genetic engineering tools. Knowledge of the sequences required for CRISPR/Cas immunity is a prerequisite for the effective design and experimental use of these systems. Our results greatly facilitate the effective use of one such system. Furthermore, we provide a publicly available software program that assists in the detection and validation of CRISPR/Cas immunity requirements when such a system exists in a bacterial species.
Analysis of the interaction effect of 48 SNPs and obesity on type 2 diabetes in Chinese Hans
Authors: Liu Jia , Wang Lu , Qian Yun , Shen Qian , Chen Hai , Ma Hongxia , Dai Juncheng , Shen Chong , Jin Guangfu , Hu Zhibin , Shen Hongbing
Published: November 2020

Introduction

Both environmental and genetic factors contribute to type 2 diabetes (T2D) risk. Dozens of T2D susceptibility loci have been identified by genome-wide association study. However, these loci account for only a small fraction of the familial T2D risk. We hypothesized that the gene-obesity interaction may contribute to the missing heritability.

Research design and method

Forty-eight T2D-associated variants were genotyped using the TaqMan OpenArray Genotyping System and iPLEX Sequenom MassARRAY platform in two separate studies. Obesity was defined according to multiple indexes (body mass index (BMI), waist circumference and waist-hip ratio). Multiplicative interactions were tested using general logistic regression to assess the gene-obesity interaction effect on T2D risk among a total of 6206 Chinese Hans.

Results

After adjusting for the main effects of genes and obesity, as well as covariates (age, sex, smoking and alcohol consumption status), robust multiplicative interaction effects were observed between rs10811661 inCDKN2A/CDKN2Band multiple obesity indices (p ranged from 0.001 to 0.043 for BMI, waist circumference and waist-hip ratio). Obese individuals with the TT genotype had a drastically higher risk of T2D than normal weight individuals without the risk allele (OR=17.58, p<0.001). There were no significant differences between subgroups in the stratification analysis. Plausible biological explanations were established using a public database. However, there were no significant interaction effects between the other 47 single nucleotide polymorphism (SNPs) and obesity.

Conclusion

Our findings indicated that theCDKN2A/CDKN2Bgene-obesity interaction significantly increases T2D risk in Chinese Hans. The interaction effect identified in our study may help to explain some of the missing heritability in the context of T2D susceptibility. In addition, the interaction effect may play a role in the precise prevention of T2D in Chinese individuals.
Glutathione S-transferases gene polymorphism influence on the age of diabetes type 2 onset
Authors: Klusek Justyna , Błońska-Sikora Ewelina , Witczak Bartosz , Orlewska Katarzyna , Klusek Jolanta , Głuszek Stanisław , Orlewska Ewa
Published: November 2020

Introduction

Type 2 diabetes (T2D) is a multifactorial disease affecting mostly adults older than 40 years. The aim of the study was to examineGSTgene polymorphism influence on the risk of T2D, especially in young adults.

Research design and methods

200 diabetic patients and 221 healthy controls participated in this study. ThreeGSTgene polymorphism have been analyzed:GSTP1(single-nucleotide polymorphism Ile105Val), homozygous deletion ofGSTT1(null/null) andGSTM1(null/null), using TaqMan real-time quantitative PCR.

Results

The distribution of examined polymorphisms was similar in patient group and control group. Statistically significant differences were demonstrated for the combination ofGSTP1 Val/ValandGSTT1 null/nullgenotypes between patients diagnosed before 40 years of age and healthy people (12.5% vs 0.9%, p=0.016). Moreover, all three examined gene polymorphism together (GSTP1 Val/Val,GSTM1nul/nullandGSTT1 null/nullgenotype) was observed in 12.5% of patients diagnosed before 40 years of age and in 0.5% of healthy individuals (p=0.013).

Conclusion

In conclusion, the results suggest thatGSTpolymorphism may be one of the risk factors for developing T2D at a younger age than the T2D population average.
Development of an informational support questionnaire of transitional care for aged patients with chronic disease
Authors: Shi Xiaoliu , Geng Guiling , Hua Jianing , Cui Min , Xiao Yuhua , Xie Juan
Published: November 2020

Objectives

We developed an informational support questionnaire of transitional care (ISQTC) for aged patients with chronic disease and investigated its reliability and validity.

Setting

This study was conducted in three large general hospitals in Nantong, Jiangsu Province, China.

Participants

A total of 130 aged patients with chronic diseases, admitted into outpatient and inpatient departments from three hospitals in China, participated in the study. The inclusion criteria were: (1) patients must provide consent to participate; (2) being 60 years and above; (3) being diagnosed with at least one chronic disease and hospitalised more than two times within the last 1 year; (4) being able to listen, speak, read and write. The exclusion criteria were: (1) refusing to participate; (2) language expression and communication barriers (and having no caregiver to assist in participation); (3) being in intensive care or long-term hospitalisation.

Primary and secondary outcome measures

The developed questionnaire was validated and tested for reliability. The content validity of the questionnaire was determined through experts’ interviews and Delphi expert consultation, and the structure validity of the questionnaire was determined by performing exploratory factor analysis. The coefficient of reliability of the questionnaire was measured using Cronbach’s alpha.

Results

Through Delphi expert consultation and exploratory factor analysis, the questionnaire was reduced from four dimensions and 12 items to three dimensions and 11 items. A total of 130 patients responded to the questionnaire. The alpha coefficient was 0.747.

Conclusion

The ISQTC is a reliable and valid instrument for evaluating aged patients with chronic disease in transitional care.

Trial registration details

ChiCTR1900020923. The trial was registered on 22 January 2019.
National trends in sexual health indicators among gay and bisexual men disaggregated by ethnicity: repeated cross-sectional behavioural surveillance in New Zealand
Authors: Lachowsky Nathan J , Saxton Peter J W , Dickson Nigel Patrick , Hughes Anthony J , Summerlee Alastair J S , Dewey Cate E
Published: November 2020

Objectives

To assess trends in sexual health outcomes among men who have sex with men (MSM) disaggregated by ethnicity.

Design

Repeated cross-sectional.

Setting

Behavioural surveillance data from 2006, 2008, 2011 and 2014 were collected in-person and online across Aotearoa New Zealand.

Participants

Eligible participants were self-identified men aged 16 years or older who reported sex with another man in the past 5 years. We classified 10 525 participants’ ethnicities: Asian (n=1003, 9.8%), Māori (Indigenous people of Aotearoa New Zealand, n=1058, 10.3%), Pacific (n=424, 4.1%) and European (n=7867, 76.8%).

Outcome measures

The sexual health outcomes examined were >20 recent (past 6 months) male sexual partners, past-year sexually transmitted infection (STI) testing, past-year STI diagnosis, lifetime and past-year HIV testing, lifetime HIV-positive diagnosis and any recent (past 6 months) condomless anal intercourse with casual or regular partners.

Results

When disaggregated, Indigenous and ethnic minority groups reported sexual health trends that diverged from the European MSM and each other. For example, Asian MSM increased lifetime HIV testing (adjusted OR, AOR=1.31 per survey cycle, 95% CI 1.17 to 1.47) and recent HIV testing (AOR=1.14, 95% CI 1.02 to 1.28) with no changes among Māori MSM or Pacific MSM. Condomless anal intercourse with casual partners increased among Māori MSM (AOR=1.13, 95% CI 1.01 to 1.28) with no changes for Asian or Pacific MSM. Condomless anal intercourse with regular partners decreased among Pacific MSM (AOR=0.83, 95% CI 0.69 to 0.99) with no changes for Asian or Māori MSM.

Conclusions

Population-level trends were driven by European MSM, masking important differences for Indigenous and ethnic minority sub-groups. Surveillance data disaggregated by ethnicity highlight inequities in sexual health service access and prevention uptake. Future research should collect, analyse and report disaggregated data by ethnicity to advance health equity.
Characteristics and well-being of urban informal home care providers during COVID-19 pandemic: a population-based study
Authors: Chan Emily YY , Lo Eugene SK , Huang Zhe , Kim Jean H , Hung Heidi , Hung Kevin KC , Wong Eliza LY , Wong Samuel YS , Gobat Nina
Published: November 2020

Objectives

Globally, the COVID-19 pandemic has overwhelmed many healthcare systems, which has hampered access to routine clinical care during lockdowns. Informal home care, care provided by non-healthcare professionals, increases the community’s healthcare capacity during pandemics. There is, however, limited research about the characteristics of informal home care providers and the challenges they face during such public health emergencies.

Design

A random, cross-sectional, population-based, RDD, telephone survey study was conducted to examine patterns of home care, characteristics of informal home care providers and the challenges experienced by these care providers during this pandemic.

Setting

Data were collected from 22 March to 1 April 2020 in Hong Kong, China.

Participants

A population representative study sample of Chinese-speaking adults (n=765) was interviewed.

Primary and secondary outcome measures

The study examined the characteristics of informal home care providers and self-reported health requirements of those who needed care. The study also examined providers’ self-perceived knowledge to provide routine home care as well as COVID-19 risk reduction care. Respondents were asked of their mental health status related to COVID-19.

Results

Of the respondents, 25.1% of 765 provided informal home care during the studied COVID-19 pandemic period. Among the informal home care providers, 18.4% of respondents took leave from school/work during the epidemic to provide care for the sick, fragile elderly and small children. Care providers tended to be younger aged, female and housewives. Approximately half of care providers reported additional mental strain and 37.2% reported of challenges in daily living during epidemic. Although most informal home care providers felt competent to provide routine care, 49.5% felt inadequately prepared to cope with the additional health risks of COVID-19.

Conclusion

During public health emergencies, heavy reliance on informal home healthcare providers necessitates better understanding of their specific needs and increased government services to support informal home care.
Beyond the numbers—understanding women’s experiences of accessing care for abnormal uterine bleeding (AUB): a qualitative study
Authors: Henry Claire , Jefferies Regina , Ekeroma Alec , Filoche Sara
Published: November 2020

Objective

To gain a deeper understanding of women’s experiences of accessing care for abnormal uterine bleeding (AUB) in order to inform future strategies to improve care pathways, including the early detection of endometrial cancer.

Design

We conducted semistructured interviews with 15 women who attended their first gynaecological specialist consultation for AUB at Wellington Regional Hospital between October and December 2019. Inductive thematic analysis was used to explore experiences and barriers to seeking care.

Results

The median age of the participant cohort was 45 years, with women self-identifying as New Zealand European (9/15), Māori (2/15) and Pasifika (4/15). All women had sought investigation for their AUB in primary care, for some women this was over a timeframe of many years. For all women, AUB had a significant and traumatic impact on their quality of life including their relationships and their work or education. Women described how they felt they often received inadequate care for AUB, and reported negative experiences with their general practitioner. Timely access was further compounded by feelings of embarrassment and that AUB was a taboo subject, and being able to discuss it with family, friends and their general practitioners was difficult.

Conclusion

Women in our cohort experienced a multitude of compounding influences that acted as barriers to them having access to appropriate and timely care. Information campaigns that create awareness around ‘abnormal periods’ alongside better health provider practice guidelines for AUB investigation need to be a priority.
Failure modes and effects analysis to assess COVID-19 protocols in the management of obstetric emergencies
Authors: Curtis Sam , Flower Rebecca , Emanuel-Kole Lola , Nadarajah Premala
Published: November 2020

The Royal Free Hospital is one of four High Consequence Infectious Disease centres in England and as of the end of May 2020, seven women were confirmed COVID-19 peri-delivery. We developed a standard operating procedure (SOP) for suspected and confirmed COVID-19 women undergoing operative delivery. This was revised in response to our ongoing clinical experience and changes in guidance from medical and public health organisations. Following 10 weeks of clinical practice, we formally tested the SOP using point-of-care simulation to enable optimisation for a potential second surge. Our high-fidelity simulation of a COVID-19-positive parturient requiring an emergency caesarean was facilitated by the simulation team in our obstetric unit. It was designed to test the performance and safety of our SOP as well as staff performance. We used the Failure Modes and Effect Analysis tool (a systematic, prospective method of process mapping) to identify how a complex task might fail and assess the relative impact of different failures. The decision-to-delivery was 17 minutes, which we considered to be successful. However, a number of operational deficiencies were identified. The main failures related to lack of situational awareness, ill-fitting personal protective equipment and difficulties communicating between theatre and the neonatal teams located outside, posing serious potential risks to safe neonatal care. Subsequently, we have modified our SOP to include a communication check, implemented communication training for the neonatal team and organised further simulation training for theatre staff unfamiliar with COVID-19 considerations.