bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence rate and burden of illness at the Pyeongchang 2018 Paralympic Winter Games
Authors: Derman Wayne , Runciman Phoebe , Jordaan Esme , Schwellnus Martin , Blauwet Cheri , Webborn Nick , Lexell Jan , van de Vliet Peter , Kissick James , Stomphorst Jaap , Lee Young-Hee , Kim Keun-Suh
Published: January 2019

Objective

To describe the incidence rate (IR) and illness burden (IB) at the Pyeongchang 2018 Paralympic Winter Games.

Methods

A total of 567 athletes from 49 countries were monitored for 12 days over the Pyeongchang 2018 Games (6804 athlete days). Illness data were obtained daily from teams with (41 teams, 557 athletes) and teams without (8 teams, 10 athletes) their own medical support, through electronic data capturing systems.

Results

There were 87 illnesses reported, with an illness IR of 12.8 illnesses per 1000 athlete days (95% CI 10.2 to 16.0) and IB of 6.8 days lost per 1000 athlete days (95% CI 3.4 to 13.5). The highest IR was reported for Para snowboard (IR of 19.7 [95% CI 12.0 to 32.2]). Illnesses in the respiratory system (IR of 4.1 [95% CI 2.9 to 5.9]; IB of 1.4 [95% CI 0.6 to 3.0]), skin and subcutaneous system (IR of 2.5 [95% CI 1.5 to 4.1]; IB of 0.6 [95% CI 0.1 to 2.9]), and eye and ocular adnexa (IR of 1.6 [95% CI 0.9 to 3.1]; IB of 0.5 [95% CI 0.1 to 3.3]) were the most common.

Conclusion

This is the first study to report both the IR and IB in this setting. There was a high IR of illness in the new sport of Para snowboard. The respiratory system had both the highest IR and IB.
Path analyses of risk factors for linear growth faltering in four prospective cohorts of young children in Ghana, Malawi and Burkina Faso
Authors: Prado Elizabeth L , Yakes Jimenez Elizabeth , Vosti Stephen , Stewart Robert , Stewart Christine P , Somé Jérôme , Pulakka Anna , Ouédraogo Jean Bosco , Okronipa Harriet , Ocansey Eugenia , Oaks Brietta , Maleta Kenneth , Lartey Anna , Kortekangas Emma , Hess Sonja Y , Brown Kenneth , Bendabenda Jaden , Ashorn Ulla , Ashorn Per , Arimond Mary , Adu-Afarwuah Seth , Abbeddou Souheila , Dewey Kathryn
Published: January 2019

Stunting prevalence is an indicator of a country’s progress towards United Nations’ Sustainable Development Goal 2, which is to end hunger and achieve improved nutrition. Accelerating progress towards reducing stunting requires a deeper understanding of the factors that contribute to linear growth faltering. We conducted path analyses of factors associated with 18-month length-for-age z-score (LAZ) in four prospective cohorts of children who participated in trials conducted as part of the International Lipid-Based Nutrient Supplements Project in Ghana (n=1039), Malawi (n=684 and 1504) and Burkina Faso (n=2619). In two cohorts, women were enrolled during pregnancy. In two other cohorts, infants were enrolled at 6 or 9 months. We examined the association of 42 indicators of environmental, maternal, caregiving and child factors with 18-month LAZ. Using structural equation modelling, we examined direct and indirect associations through hypothesised mediators in each cohort. Out of 42 indicators, 2 were associated with 18-month LAZ in three or four cohorts: maternal height and body mass index (BMI). Six factors were associated with 18-month LAZ in two cohorts: length for gestational age z-score (LGAZ) at birth, pregnancy duration, improved household water, child dietary diversity, diarrhoea incidence and 6-month or 9-month haemoglobin concentration. Direct associations were more prevalent than indirect associations, but 30%–62% of the associations of maternal height and BMI with 18-month LAZ were mediated by LGAZ at birth. Factors that were not associated with LAZ were maternal iron status, illness and inflammation during pregnancy, maternal stress and depression, exclusive breast feeding during 6 months post partum, feeding frequency and child fever, malaria and acute respiratory infections. These findings may help in identifying interventions to accelerate progress towards reducing stunting; however, much of the variance in linear growth status remained unaccounted for by these 42 individual-level factors, suggesting that community-level changes may be needed to achieve substantial progress.
Trends and drivers of government health spending in sub-Saharan Africa, 1995–2015
Authors: Micah Angela E , Chen Catherine S , Zlavog Bianca S , Hashimi Golsum , Chapin Abigail , Dieleman Joseph L
Published: January 2019

Introduction

Government health spending is a primary source of funding in the health sector across the world. However, in sub-Saharan Africa, only about a third of all health spending is sourced from the government. The objectives of this study are to describe the growth in government health spending, examine its determinants and explain the variation in government health spending across sub-Saharan African countries.

Methods

We used panel data on domestic government health spending in 46 countries in sub-Saharan Africa from 1995 to 2015 from the Institute for Health Metrics and Evaluation. A regression model was used to examine the factors associated with government health spending, and Shapley decomposition was used to attribute the contributions of factors to the explained variance in government health spending.

Results

While the growth rate in government health spending in sub-Saharan Africa has been positive overall, there are variations across subgroups. Between 1995 and 2015, government health spending in West Africa grew by 6.7% (95% uncertainty intervals [UI]: 6.2% to 7.0%) each year, whereas in Southern Africa it grew by only 4.5% (UI: 4.5% to 4.5%) each year. Furthermore, per-person government health spending ranged from $651 (Namibia) in 2017 purchasing power parity dollars to $4 (Central African Republic) in 2015. Good governance, national income and the share of it that is government spending were positively associated with government health spending. The results from the decomposition, however, showed that individual country characteristics made up the highest percentage of the explained variation in government health spending across sub-Saharan African countries.

Conclusion

These findings highlight that a country’s policy choices are important for how much the health sector receives. As the attention of the global health community focuses on ways to stimulate domestic government health spending, an understanding that individual country sociopolitical context is an important driver for success will be key.
Secondary prevention therapies in acute coronary syndrome and relation to outcomes: observational study
Authors: Chow Clara K , Brieger David , Ryan Mark , Kangaharan Nadarajah , Hyun Karice K , Briffa Tom
Published: January 2019

Objective

To ascertain the use of secondary prevention medications and cardiac rehabilitation after an acute coronary syndrome (ACS) and the impact on 2-year outcomes.

Methods

CONCORDANCE (Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events) is a prospective, observational registry of 41 Australian hospitals. A representative sample of 6859 patients with an ACS and 6 months’ follow-up on 31 May 2016 were included. The main outcome measure was use of ≥75% of indicated medications (≥4/5 (or ≥3/4 if contraindicated) of angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker, beta-blocker, lipid-lowering therapy, aspirin and other antiplatelet). Major adverse cardiovascular events (MACE) included myocardial infarction, stroke or cardiovascular death.

Results

The mean age was 65±13 years, 29% were women, and the mean Global Registry of Acute Coronary Events (GRACE) score was 106±30. At discharge, 92% were on aspirin, 93% lipid-lowering therapy, 78% beta-blocker, 74% ACE/angiotensin receptor blocker and 73% a second antiplatelet; 89% were taking ≥75% of medications at discharge, 78% at 6 months and 66% at 2 years. At 6 months, 38% attended cardiac rehabilitation, 58% received dietary advice and 32% of smokers reported quitting. Among 1896 patients followed to 2 years, death/MACE was less frequent among patients on ≥75% vs <75% of medications (8.3% vs 13.9%; adjusted OR 0.75, 95 % CI 0.56 to 0.99), and was less frequent in patients who attended versus who did not attend cardiac rehabilitation (4.6% vs 13.4%; adjusted OR 0.44, 95% CI 0.31 to 0.62).

Conclusions

Use of secondary prevention therapies diminishes over time following an ACS. Patients receiving secondary prevention had decreased rates of death and MACE at 2 years.
Lowering the speed limit from 30 mph to 25 mph in Boston: effects on vehicle speeds
Authors: Hu Wen , Cicchino Jessica B
Published: January 2019

Introduction

Effective 9 January 2017, the default speed limit on Boston streets was reduced from 30 mph to 25 mph. This study evaluated the effects of the speed limit reduction on speeds in Boston.

Method

Vehicle speeds were collected at sites in Boston where the speed limit was lowered, and at control sites in Providence, Rhode Island, where the speed limit remained unchanged, before and after the speed limit change in Boston. A log-linear regression model estimated the change in vehicle speeds associated with the speed limit reduction. Separate logistic regression models estimated changes in the odds of vehicles exceeding 25 mph, 30 mph and 35 mph associated with the lower speed limit.

Results

The speed limit reduction was associated with a 0.3 % reduction in mean speeds (p=0.065), and reductions of 2.9%, 8.5% and 29.3 % in the odds of vehicles exceeding 25 mph, 30 mph and 35 mph, respectively. All these reductions were statistically significant.

Conclusions

Local communities should consider lowering speed limits to reduce speeds and improve safety for all road users. The current practice of setting speed limits according to the 85th percentile free-flow speeds, without consideration of other characteristics of the roadway, can be a hurdle for local communities looking to lower speed limits. Updated state laws that allow municipalities to set lower speed limits on urban streets without requiring costly engineering studies can provide flexibility to municipalities to set speed limits that are safe for all road users.
Neurotrophic tropomyosin or t﻿yrosine receptor kinase (NTRK) genes
Authors: Chetty Runjan
Published: January 2019

The neurotrophic tropomyosin or tyrosine receptor kinase (NTRK) genes (1-3) are proto-oncogenes that when activated are encountered in a wide array of tumours. The recent advent of very specific and selective inhibitors of their gene fusions makes the NRTK gene fusions actionable. NRTK gene fusions are very characteristic of specific tumours: salivary mammary analogue secretory carcinoma, breast secretory carcinoma, infantile fibrosarcoma and congenital mesoblastic nephroma. Over 90% of these tumours bear NTRK gene fusions. While next-generation sequencing is the current platform of choice for the detection of NTRK fusions, immunohistochemistry also shows great promise. Immunohistochemical localisation of the fusion protein to the nucleus, cytoplasm, nuclear membrane and cell membrane is indicative of specific gene fusions involving the NTRK genes.
Housing and health: new evidence using biomarker data
Authors: Clair Amy , Hughes Amanda
Published: January 2019

Background

The link between housing and health is well established and long-standing, however much of the evidence relies on self-reported health measures. While these are useful, the availability of biomarker data allows us to add to this evidence using objective indicators of health.

Methods

In this paper, we use C-reactive protein (CRP), a biomarker associated with infection and stress, alongside information relating to housing details, demographic characteristics and health behaviours taken from the UK Household Longitudinal Study. Hierarchical linear regression models estimate CRP for individual housing characteristics, and all available housing characteristics, controlling for confounders.

Results

Results indicate that housing tenure, type, cost burden and desire to stay in current home are associated with CRP. Private renters have significantly higher (worse) CRP than owners with a mortgage. In terms of housing type, respondents living in detached homes had lower CRP than those in semidetached or terraced houses, or those living in flats. Housing cost burden is associated with lower CRP, although further analysis indicates that this is the case only for low-income renters. Desire to stay in current home is significantly associated with higher CRP.

Conclusions

A number of housing characteristics were associated with CRP. These results further support an important role for housing in health.
Ultra-high-dose methylcobalamin in amyotrophic lateral sclerosis: a long-term phase II/III randomised controlled study
Authors: Kaji Ryuji , Imai Takashi , Iwasaki Yasuo , Okamoto Koichi , Nakagawa Masanori , Ohashi Yasuo , Takase Takao , Hanada Takahisa , Shimizu Hiroki , Tashiro Kunio , Kuzuhara Shigeki
Published: January 2019

Objective

To evaluate the efficacy and safety of intramuscular ultra-high-dose methylcobalamin in patients with amyotrophic lateral sclerosis (ALS).

Methods

373 patients with ALS (El Escorial definite or probable; laboratory-supported probable; duration ≤36 months) were randomly assigned to placebo, 25 mg or 50 mg of methylcobalamin groups. The primary endpoints were the time interval to primary events (death or full ventilation support) and changes in the Revised ALS Functional Rating Scale (ALSFRS-R) score from baseline to week 182. Efficacy was also evaluated using post-hoc analyses in patients diagnosed early (entered ≤12 months after symptom onset).

Results

No significant differences were detected in either primary endpoint (minimal p value=0.087). However, post-hoc analyses of methylcobalamin-treated patients diagnosed and entered early (≤12 months’ duration) showed longer time intervals to the primary event (p<0.025) and less decreases in the ALSFRS-R score (p<0.025) than the placebo group. The incidence of treatment-related adverse events was similar and low in all groups.

Conclusion

Although ultra-high-dose methylcobalamin did not show significant efficacy in the whole cohort, this treatment may prolong survival and retard symptomatic progression without major side effects if started early.

Trial registration number

NCT00444613.
HLA class II alleleDRB1*16:02is associated with anti-NMDAR encephalitis
Authors: Shu Yaqing , Qiu Wei , Zheng Junfeng , Sun Xiaobo , Yin Junping , Yang Xiaoli , Yue Xiaoyang , Chen Chen , Deng Zhihui , Li Shasha , Yang Yu , Peng Fuhua , Lu Zhengqi , Hu Xueqiang , Petersen Frank , Yu Xinhua
Published: January 2019

Background and objective

Aetiology and pathogenesis of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, the most common autoimmune encephalitis, is largely unknown. Since an association of the disease with the human leucocyte antigen (HLA) has not been shown so far, we here investigated whether anti-NMDAR encephalitis is associated with the HLA locus.

Methods

HLA loci of 61 patients with anti-NMDAR encephalitis and 571 healthy controls from the Chinese Han population were genotyped and analysed for this study.

Results

Our results show that theDRB1*16:02allele is associated with anti-NMDAR encephalitis (OR 3.416, 95% CI 1.817 to 6.174, p=8.9×10−5, padj=0.021), with a higher allele frequency in patients (14.75%) than in controls (4.82%). This association was found to be independent of tumour formation. Besides disease susceptibility,DRB1*16:02is also related to the clinical outcome of patients during treatment, where patients withDRB1*16:02showed a lower therapeutic response to the treatment than patients with other HLA alleles (p=0.033). Bioinformatic analysis using HLA peptide-binding prediction algorithms and computational docking suggested a close relationship between the NR1 subunit of NMDAR and theDRB1*16:02.

Conclusions

This study for the first time demonstrates an association between specific HLA class II alleles and anti-NMDAR encephalitis, providing novel insights into the pathomechanism of the disease.
Usefulness of point-of-care ultrasound in military medical emergencies performed by young military medicine residents
Authors: Perrier Pierre , Leyral J , Thabouillot O , Papeix D , Comat G , Renard A , Cazes N
Published: January 2019

Introduction

To evaluate the usefulness of point-of-care ultrasound (POCUS) performed by young military medicine residents after short training in the diagnosis of medical emergencies.

Methods

A prospective study was performed in the emergency department of a French army teaching hospital. Two young military medicine residents received ultrasound training focused on gall bladder, kidneys and lower limb veins. After clinical examination, they assigned a‘clinical diagnostic probability’(CP) on a visual analogue scale from 0 (definitely not diagnosis) to 10 (definitive diagnosis). The same student performed ultrasound examination and assigned an‘ultrasound diagnostic probability’(UP) in the same way. The absolute difference between CP and UP was calculated. This result corresponded to the Ultrasound Diagnostic Index (UDI), which was positive if UP was closer to the final diagnosis than CP (POCUS improved the diagnostic accuracy), and negative conversely (POCUS decreased the diagnostic accuracy).

Results

Forty-eight patients were included and 48 ultrasound examinations were performed. The present pathologies were found in 14 patients (29%). The mean UDI value was +3 (0–5). UDI was positive in 35 exams (73%), zero in 12 exams (25%) and negative in only one exam (2%).

Conclusion

POCUS performed after clinical examination increases the diagnostic accuracy of young military medicine residents.
Fractional flow reserve in acute coronary syndrome: a meta-analysis and systematic review
Authors: Liou Kevin P , Ooi Sze-Yuan M , Hoole Stephen P , West Nick E J
Published: January 2019

Background

The utility of fractional flow reserve (FFR) to guide revascularisation in the management of acute coronary syndrome (ACS) remains unclear.

Objective

This study aims to compare the clinical outcomes of patients following FFR-guided revascularisation for either ACS or stable angina (SA) and in particular focuses on the outcome of those with deferred revascularisation after FFR.

Methods

A meta-analysis of existing literature was performed. Outcomes including the rate of major adverse cardiovascular events (MACE), recurrent myocardial infarction (MI), mortality and unplanned revascularisation were analysed.

Results

A review of 937 records yielded 9 studies comparing 5457 patients, which were included in the analyses. Patients with ACS had a higher rate of recurrent MI (OR 1.81, p=0.02) and a strong trend towards more MACE and all-cause mortality compared with patients with SA when treated by an FFR-guided revascularisation strategy. Deferral of invasive therapy on the basis of FFR led to a higher rate of MACE (17.6% vs 7.3 %; p=0.004), recurrent MI (5.3% vs 1.5%, p=0.001) and target vessel revascularisation (16.4% vs 5.6 %; p=0.02) in patients with ACS, and a strong trend towards a higher cardiovascular mortality at follow-up when compared with patients with SA.

Conclusion

The event rate in patients with ACS is much higher than SA despite following an FFR-guided revascularisation strategy. Deferring revascularisation does not appear to be as safe for ACS as it is for SA using contemporary FFR cut-offs validated in SA. Refinement of the therapeutic strategy for patients with ACS with multivessel disease is needed to redress the balance.
Procedural predictors of epidural blood patch efficacy in spontaneous intracranial hypotension
Authors: Pagani-Estévez Gabriel L , Cutsforth-Gregory Jeremy K , Morris Jonathan M , Mokri Bahram , Piepgras David G , Mauck William D , Eldrige Jason S , Watson James C
Published: January 2019

Background and objective

Epidural blood patch (EBP) is a safe and effective treatment for spontaneous intracranial hypotension (SIH), but clinical and procedural variables that predict EBP efficacy remain nebulous.

Methods

This study is an institutional review board-approved retrospective case series with dichotomized EBP efficacy defined at 3 months. The study included 202 patients receiving 604 EBPs; iatrogenic cerebrospinal fluid leaks were excluded.

Results

Of the EBPs, 473 (78%) were single-level, 349 (58%) lumbar, 75 (12%) bilevel, and 56 (9%) multilevel (≥3 levels). Higher volume (OR 1.64; p<0.0001), bilevel (3.17, 1.91–5.27; p<0.0001), and multilevel (117.3, 28.04–490.67; p<0.0001) EBP strategies predicted greater efficacy. Only volume (1.64, 1.47–1.87; p<0.0001) remained significant in multivariate analysis. Site-directed patches were more effective than non-targeted patches (8.35, 0.97–72.1; p=0.033). Lower thoracic plus lumbar was the most successful bilevel strategy, lasting for a median of 74 (3–187) days.

Conclusions

In this large cohort of EBP in SIH, volume, number of spinal levels injected, and site-directed strategies significantly correlated with greater likelihood of first EBP efficacy. Volume and leak site coverage likely explain the increased efficacy with bilevel and multilevel patches. In patients with cryptogenic leak site, and either moderate disability, negative prognostic brain MRI findings for successful EBP, or failed previous lumbar EBP, a low thoracic plus lumbar bilevel EBP strategy is recommended. Multilevel EBP incorporating transforaminal administration and fibrin glue should be considered in patients refractory to bilevel EBP. An algorithmic approach to treating SIH is proposed.
Preprocedural checklist for regional anesthesia: impact on the incidence of wrong site nerve blockade (an 8-year perspective)
Authors: Henshaw Daryl S , Turner James D , Dobson Sean W , Douglas Jaffe Jonathan , Wells Reynolds John , Edwards Christopher J , Weller Robert S
Published: January 2019

Background

The term “Wrong-Site Surgery (WSS)” is commonly associated with surgical procedures; however, The Joint Commission (TJC) considers any invasive procedure, not just a surgical procedure, performed on the wrong side, at the wrong site, or on the wrong patient to be a WSS. For anesthesia providers, this means that a wrong-site nerve block (WSNB) also constitutes a WSS and would be considered a sentinel event by TJC. In an attempt to combat WSNB, the American Society of Regional Anesthesia and Pain Medicine published guidelines in 2014 recommending the use of a preprocedural checklist before performing regional blocks. The effectiveness of such a checklist, however, to reduce the occurrence of WSNB has not yet been demonstrated. We hypothesized that the introduction of a preprocedural checklist specific for regional anesthesia would be associated with a lower rate of WSNB procedures.

Methods

A retrospective review was performed to compare the incidence of WSNB 2 years before, to 6 years after the implementation of a preprocedural checklist specific to regional anesthesia.

Results

Prior to checklist implementation, 4 WSNB events occurred during 10 123 procedures (3.95 per 10 000 (95% CI 1.26 to 9.53). Following implementation, WSNB events occurred during 35 890 procedures (0 per 10 000 (95% CI 0 to 0.84)); p=0.0023.

Conclusions

Implementation of a regional anesthesia specific preprocedural checklist was associated with a significantly lower incidence of WSNB procedures. While prospective controlled studies would be required to demonstrate causation, this study suggests that for regional anesthesia procedures, a preprocedural checklist may positively impact patient safety.
Qualitative analysis of the experiences of gay, bisexual and other men who have sex with men who useGetCheckedOnline.com: a comprehensive internet-based diagnostic service for HIV and other STIs
Authors: Knight Rod Eric , Chabot Cathy , Carson Anna , Thomson Kimberly , Haag Devon , Gilbert Mark , Shoveller Jean
Published: January 2019

Objectives

To describe the factors that influence gay, bisexual and other men who have sex with men’s (gbMSM) experiences withGetCheckedOnline.com(GCO) in British Columbia (BC), Canada. GCO clients complete an internet-based risk assessment and print a laboratory test requisition form for HIV and other STIs to take to a private laboratory for diagnostic services.

Methods

Drawing on a purposive stratified sampling framework, we conducted 37 in-depth semistructured interviews with gbMSM who had used GCO at least once between 2015 and 2017.

Results

Participants expressed a preference for GCO (instead of clinic-based testing) because of convenience, privacy and control over specimen collection (specifically with doing one’s own throat or anal swab). Participants preferred receiving their results online via GCO compared with phone or email follow-up by clinic staff. GCO was viewed positively because it offers gbMSM living outside of urban city centres easy access to diagnostic services, including access to pooled nucleic acid amplification testing. Many participants also continued to positively view the clinic-based services available for gbMSM in their community. These services were frequently described as highly competent, tailored and comprehensive in responding to more complex needs. For example, attending a clinic was viewed as preferential to GCO in instances where there was a desire to access services addressing co-occurring health issues (eg, mental health; substance use disorders). Almost all of the participants anticipated using both GCO and clinic-based services in the future.

Conclusions

gbMSM report positive experiences and perceptions of GCO; however, they do not view GCO as a panacea. The results of this study point to the need to ensure that a wide range of integrated service options (eg, online; clinic-based) are available to address the range of sexual health needs of gbMSM living in BC's diverse settings.
Post-test comparison of HIV test knowledge and changes in sexual risk behaviour between clients accessing HIV testing online versus in-clinic
Authors: Salway Travis , Thomson Kimberly , Taylor Darlene , Haag Devon , Elliot Elizabeth , Wong Tom , Fairley Christopher K , Grennan Troy , Shoveller Jean , Ogilvie Gina , Gilbert Mark
Published: January 2019

Objective

Internet-based HIV testing offers the potential to address privacy-related barriers to testing and increase frequency of testing but may result in missed opportunities related to sexual health education and prevention that typically occur in face-to-face encounters. In this study, we assessed the HIV test knowledge and sexual risk behaviour of clients testing for HIV throughGetCheckedOnline, an internet-based sexually transmitted and bloodborne infection testing platform inclusive of HIV testing, in comparison to clients testing through a large sexual health clinic.

Methods

We concurrently recruitedGetCheckedOnlineclients and clinic clients from Vancouver, Canada, over the course of a 10-month period during 2015–2016. Participants completed baseline and 3-month questionnaires, anonymous and online. A six-item score was used to estimate knowledge of HIV test concepts typically conveyed during an HIV pretest encounter in a clinic. We used multiple regression to estimate associations between testing modality (online vs clinic based) and two outcomes—HIV test knowledge and change in condom use pre/post-test—with adjustment for relevant background factors.

Results

Among 352 participants, online testers demonstrated higher HIV post-test knowledge than clinic-based testers (mean score 4.65/6 vs 4.09/6; p<0.05); this difference was reduced in adjusted analysis (p>0.05). Men who have sex with men, clients with a university degree, those who have lived in Canada >10 years and English speakers had higher HIV post-test knowledge (p<0.05). Eighteen per cent of online testers and 10% of clinic-based testers increased condom use during the 3 months post-test (p>0.05).

Conclusions

In this comparative study between online and clinic-based testers, we found no evidence of decreased HIV test knowledge or decreased condom use following HIV testing throughGetCheckedOnline. Our findings suggest that with careful design and attention to educational content, online testing services may not lead to missed opportunities for HIV education and counselling.
Baseline HPV prevalence in rectal swabs from men attending a sexual health clinic in Scotland: assessing the potential impact of a selective HPV vaccination programme for men who have sex with men
Authors: Cameron Ross Liam , Cuschieri Kate , Pollock Kevin G J
Published: January 2019

Objectives

A human papillomavirus (HPV) vaccination programme targeted towards men who have sex with men who are disproportionately affected by HPV anogenital infection and related disease was established in Scotland in July 2017. We aimed to establish a baseline HPV prevalence to assess the potential impact of the programme.

Methods

Residual rectal swabs taken in a sexual health clinic (n=1 248) were tested for the presence of HPV and HPV-type prevalence was collated and stratified by age. Prevalence of HPV types included in the quadrivalent and nonavalent vaccines was specifically assessed.

Results

72.8% (95% CI 70.2% to 75.3%) of swabs were positive for HPV with 59.1% (95% CI 56.3% to 61.9%) of samples positive for at least one high-risk type. A least one of HPV 6, 11, 16 and 18 was detected in approximately half of the swabs. HPV prevalence generally increased with age but did not significantly differ between older age groups. The presence of more than one HPV type increased with age and over half of samples had multiple types present.

Conclusions

While HPV prevalence in this population is high, the potential impact of the vaccination programme is substantial given that 50% are not infected with a vaccine type. Defining a preimmunisation baseline in this group will be important for longitudinal monitoring of impact.
Human papillomavirus DNA detected in fingertip, oral and bathroom samples from unvaccinated adolescent girls in Tanzania
Authors: Houlihan Catherine F , Baisley Kathy , Bravo Ignacio G , Pavón Miguel A , Changalucha John , Kapiga Saidi , De Sanjosé Silvia , Ross David A , Hayes Richard J , Watson-Jones Deborah
Published: January 2019

Objective

Human papillomavirus (HPV) DNA has been detected in vaginal samples from adolescent girls who report no previous sex and, in high-income settings, from fingertips, raising the possibility of non-sexual transmission. No such studies originate from East Africa which bears among the highest cervical cancer incidence and HPV prevalence worldwide. HPV-related oral cancer incidence is increasing, but oral HPV prevalence data from East Africa are limited. We aimed to describe the HPV DNA prevalence in genital and non-genital sites and in the bathroom of unvaccinated adolescent girls, and examine genotype concordance between sites.

Methods

We nested a cross-sectional study of HPV in genital and extragenital sites within a cohort study of vaginal HPV acquisition. Unvaccinated girls age 16–18 years in Tanzania, who reported ever having had sex, were consented, enrolled and tested for the presence of HPV DNA in vaginal samples collected using self-administered swabs, oral samples collected using an oral rinse, and on fingertips and bathroom surfaces collected using a cytobrush.

Results

Overall, 65 girls were enrolled and 23 (35%, 95% CI 23% to 47%) had detectable vaginal HPV. Adequate (β-globin positive) samples were collected from 36 girls’ fingertips and HPV was detected in 7 (19%, 95% CI 6% to 33%). 63 girls provided adequate oral samples, 4 (6%, 95% CI 0% to 13%) of which had HPV DNA detected. In bathroom samples from 58 girls, 4 (7%, 95% CI 0% to 14%) had detectable HPV DNA. Of the 11 girls with extragenital HPV, six had the same genotype in >1 site.

Conclusion

We found a high prevalence of HPV in non-genital sites in adolescent girls and in their bathrooms, in this region with a high cervical cancer incidence. Concordance of genotypes between sites supports the possibility of autoinoculation.
Iron toxicity, lipid peroxidation and ferroptosis after intracerebral haemorrhage
Authors: Wan Jieru , Ren Honglei , Wang Jian
Published: January 2019

Intracerebral haemorrhage (ICH) is a devastating type of stroke with high mortality and morbidity. However, we have few options for ICH therapy and limited knowledge about post-ICH neuronal death and related mechanisms. In the aftermath of ICH, iron overload within the perihaematomal region can induce lethal reactive oxygen species (ROS) production and lipid peroxidation, which contribute to secondary brain injury. Indeed, iron chelation therapy has shown efficacy in preclinical ICH studies. Recently, an iron-dependent form of non-apoptotic cell death known as ferroptosis was identified. It is characterised by an accumulation of iron-induced lipid ROS, which leads to intracellular oxidative stress. The ROS cause damage to nucleic acids, proteins and lipid membranes, and eventually cell death. Recently, we and others discovered that ferroptosis does occur after haemorrhagic stroke in vitro and in vivo and contributes to neuronal death. Inhibition of ferroptosis is beneficial in several in vivo and in vitro ICH conditions. This minireview summarises current research on iron toxicity, lipid peroxidation and ferroptosis in the pathomechanisms of ICH, the underlying molecular mechanisms of ferroptosis and the potential for combined therapeutic strategies. Understanding the role of ferroptosis after ICH will provide a vital foundation for cell death-based ICH treatment and prevention.
Outcome in elderly patients with aortic stenosis undergoing hip fracture surgery. Results may suggest a different postoperative strategy?
Authors: Rostagno Carlo , Ranalli Claudia , Polidori Gianluca , Cartei Alessandro , Boccaccini Alberto , Peris Adriano
Published: January 2019

Background

Five to ten percent of patients with hip fracture have severe aortic valve stenosis (AS). The aim of the present investigation was to evaluate the impact of AS on early and long-term outcome after surgery for hip fracture.

Methods

145 patients with AS and 283 consecutive patients without AS (control group) aged >70 years referred to Azienda Ospadaliera Universitaria (AOU) Careggi for hip fracture were included in the study. The endpoints were incidence of postoperative myocardial infarction, 30-day and 1-year mortality, and a composite endpoint (30-day mortality + myocardial infarction).

Results

66 patients had mild, 47 moderate and 32 severe AS according to the European Society of Cardiology guidelines. 30-day mortality was 6.2% in AS and 3.1% in controls. Postoperative non-fatal myocardial infarction and composite endpoint were more frequent in AS than in the control group (8.3% vs 1.1%, p<0.001 and 14.5% vs 4.2%, p<0.001, respectively). The risk was significantly higher for patients with severe AS (28.1%). 1-year mortality in patients with moderate/severe AS was 46% in comparison with 16% in mild AS or in the control group (p<0.001). Coronary disease, atrial fibrillation, age, and aortic gradient were independent predictors of mortality in AS.

Discussion

AS significantly affects postoperative outcome after surgery for hip fracture. Since not infrequently AS is incidentally diagnosed during hospitalization after trauma, which should be the management in these patients after hip surgery? How many might benefit from surgical valve replacement or transcatheter aortic valve replacement? A heart team evaluation may be suggested before discharge for most of these patients.

Level of evidence

IV.
Introduction and evaluation of the ACS BCon basic course in Zaragoza, Spain
Authors: Yanez Carlos , Güemes Antonio , Navarro Ana , Vazquez Jacqueline , Moreno Alberto
Published: January 2019

Background

The American College of Surgeons Bleeding Control Basic (BCon) course aimed at teaching hemorrhage control techniques in the USA had not yet been taught in Spain. The purpose of this study is to assess its implementation among students and healthcare employees in the Lozano Blesa University Hospital of Zaragoza, a middle-sized Spanish city.

Methods

The study was conducted in a University Hospital and at the University of Zaragoza, scheduling four free B-Con sessions from 2017 to 2018. Two groups were identified as forming the population: healthcare employees and medical students. An anonymous questionnaire was completed at the end of the course regarding content, applicability, usefulness, relevance, and satisfaction. Study variables were ranked from 0 to 10: poor (when graded from 0 to 3), fair (4 to 6) and good (7 to 10). Results were compared between the groups, expressed in percentages and χ2 tested to analyze significant differences if any.

Results

Among the 83 individuals who completed the course, 46 were medical students and 37 healthcare employees; 61% women and 39% men; aged 21 years to 52 years. Attendees evaluated satisfaction with the highest grade (84%), followed by usefulness (73%), applicability (70%), and relevance (66%). There was no variable graded as poor. The comparison of perceptions between groups did not reveal statistical differences based on a 0.05 significance level.

Conclusion

We concluded that the B-Con course was valued as good for relevance, usefulness, applicability, and satisfaction by the majority of the studied population.

Level of evidence

Level III.
Community Need Index (CNI): a simple tool to predict emergency department utilization after hospital discharge from the trauma service
Authors: Huang Dih-Dih , Shehada Mahmoud Z , Chapple Kristina M , Rubalcava Nathaniel S , Dameworth Jonathan L , Goslar Pamela W , Israr Sharjeel , Petersen Scott R , Weinberg Jordan A
Published: January 2019

Background

Emergency department (ED) visits after hospital discharge may reflect failure of transition of care to the outpatient setting. Reduction of postdischarge ED utilization represents an opportunity for quality improvement and cost reduction. The Community Need Index (CNI) is a Zip code-based score that accounts for a community’s unmet needs with respect to healthcare and is publicly accessible via the internet. The purpose of this study was to determine if patient CNI score is associated with postdischarge ED utilization among hospitalized trauma patients.

Methods

Level 1 trauma patient admitted between January 2014 and June 2016 were stratified by 30-day postdischarge ED utilization (yes/no). CNI is a nationwide Zip code-based score (1.0–5.0) and was determined per patient from the CNI website. Higher scores indicate greater barriers to healthcare per aggregate socioeconomic factors. Patients with 30-day postdischarge ED visits were compared with those without, evaluating for differences in CNI score and clinical and demographic characteristics.

Results

309 of 3245 patients (9.5%) used the ED. The ED utilization group was older (38.3±15.7 vs. 36.3±16.4 years, p=0.034), more injured (Injury Severity Score 10.4±8.7 vs. 7.7±8.0, p<0.001), and more likely to have had in-hospital complications (17.5% vs. 5.4%, p<0.001). Adjusted for patient age, injury severity, gender, race/ethnicity, penetrating versus blunt injury, alcohol above the legal limit, illicit drug use, the presence of one or more complications and comorbidities, hospital length of stay, and insurance category, CNI score ≥4 was associated with increased utilization (OR 2.0 [95% CI 1.4 to 2.9, p<0.001]).

Discussion

CNI is an easily accessible score that independently predicts postdischarge ED utilization in trauma patients. Patients with CNI score ≥4 are at significantly increased risk. Targeted intervention concerning discharge planning for these patients represents an opportunity to decrease postdischarge ED utilization.

Level of evidence

III, Prognostic and Epidemiological.
Uncommon thalamic metastasis of an osteosarcoma causing central diabetes insipidus in a young barsoi dog
Authors: Dettwiler Martina , Borel Nicole , Schäfer Sandra , Ivan Daniel , Hilbe Monika
Published: January 2019

A five‐year‐old male barsoi dog presented with lameness of the left hindlimb. Radiographs, CT and MRI studies revealed a mono‐ostotic aggressive bone lesion in the proximal tibial metaphysis expanding into the epiphysis, complicated by a pathological fracture. Conservative treatment was pursued. Two months later, the dog was presented again to our clinic, now in comatose state. Brain MRI detected a large intra‐axial space‐occupying lesion in the thalamic region. The dog was euthanased. Necropsy revealed a mass in the left proximal tibial epiphysis and metaphysis and a bony mass in the pituitary region compressing the surrounding nervous tissue. Histologically, both masses were diagnosed as osteosarcoma, most likely chondroblastic type. The metastatic brain mass infiltrated the thalamus, hypothalamus and pituitary stalk, causing disruption of ADH synthesis and/or transport. This is an uncommon case of a clinically manifest central diabetes insipidus caused by a metastatic osteosarcoma.
Imaging and histopathological characteristics of carcinoma‐induced bone formation in skeletal muscle
Authors: Luce Brooke , Magagna Michelle , Policelli Smith Rachel , Vilar Saavedra Paulo
Published: January 2019

An 11‐year‐old neutered male Groenendael canine presented with suspected neoplastic disease associated with pelvic limb lameness. Clinical examination revealed firm and thickened ventral abdominal musculature, pitting oedema with a spiculated texture within pelvic limb and inguinal subcutaneous tissues, sublumbar lymphadenopathy and multifocal hard foci along the floor of the pelvic canal. CT revealed a severe active polyostotic periosteal reaction and muscular mineralisation of the hindlimbs and caudal trunk. Skeletal muscle biopsy revealed a histopathological diagnosis of metastatic carcinoma with chondroid osseous metaplasia characterised by ossification (bone formation) within the tissue matrix. Paliative therapy was provided for the dog for two weeks before being euthanized.
Experimental assessments of marine species sensitivities to ocean acidification and co-stressors: how far have we come?
Authors: Baumann Hannes
Published: January 2019

Experimental studies assessing the potential impacts of ocean acidification on marine organisms have rapidly expanded and produced a wealth of empirical data over the past decade. This perspective examines four key areas of transformative developments in experimental approaches: (1) methodological advances; (2) advances in elucidating physiological and molecular mechanisms behind observed CO2effects; (3) recognition of short-term CO2variability as a likely modifier of species sensitivities (Ocean Variability Hypothesis); and (4) consensus on the multistressor nature of marine climate change where effect interactions are still challenging to anticipate. No single experiment allows predicting the fate of future populations. But sustaining the accumulation of empirical evidence is critical for more robust estimates of species reaction norms and thus for enabling better modeling approaches. Moreover, advanced experimental approaches are needed to address knowledge gaps including changes in species interactions and intraspecific variability in sensitivity and its importance for the adaptation potential of marine organisms to a high CO2world.
Regularized Group Sparse Discriminant Analysis for P300-Based Brain–Computer Interface
Authors: Wu Qiang , Zhang Yu , Liu Ju , Sun Jiande , Cichocki Andrzej , Gao Feng
Published: January 2019

Event-related potentials (ERPs) especially P300 are popular effective features for brain–computer interface (BCI) systems based on electroencephalography (EEG). Traditional ERP-based BCI systems may perform poorly for small training samples, i.e. the undersampling problem. In this study, the ERP classification problem was investigated, in particular, the ERP classification in the high-dimensional setting with the number of features larger than the number of samples was studied. A flexible group sparse discriminative analysis algorithm based on Moreau–Yosida regularization was proposed for alleviating the undersampling problem. An optimization problem with the group sparse criterion was presented, and the optimal solution was proposed by using the regularized optimal scoring method. During the alternating iteration procedure, the feature selection and classification were performed simultaneously. Two P300-based BCI datasets were used to evaluate our proposed new method and compare it with existing standard methods. The experimental results indicated that the features extracted via our proposed method are efficient and provide an overall better P300 classification accuracy compared with several state-of-the-art methods.
Towards formalization of the soliton counting technique for the Khovanov–Rozansky invariants in the deformed ℛ-matrix approach
Authors: Anokhina A.
Published: January 2019

We consider recently developed Cohomological Field Theory (CohFT) soliton counting diagram technique for Khovanov (Kh) and Khovanov–Rozansky (KhR) invariants.[Formula: see text] Although, the expectation to obtain a new way for computing the invariants has not yet come true, we demonstrate that soliton counting technique can be totally formalized at an intermediate stage, at least in particular cases. We present the corresponding algorithm, based on the approach involving deformed [Formula: see text]-matrix and minimal positive division, developed previously in Ref. 3. We start from a detailed review of the minimal positive division approach, comparing it with other methods, including the rigorous mathematical treatment.4 Pieces of data obtained within our approach are presented in the Appendices.
Dynamical projective curvature in gravitation
Authors: Brensinger Samuel , Rodgers Vincent G. J.
Published: January 2019

By using a projective connection over the space of two-dimensional affine connections, we are able to show that the metric interaction of Polyakov two-dimensional gravity with a coadjoint element arises naturally through the projective Ricci tensor. Through the curvature invariants of Thomas and Whitehead, we are able to define an action that could describe dynamics to the projective connection. We discuss implications of the projective connection in higher dimensions as related to gravitation.
Wide Tuning Range Varactorless Tunable Active Inductor-Based Voltage Controlled Oscillator for Wireless Applications
Authors: Faruqe Omar , Amin Md Tawfiq
Published: January 2019

This paper presents a varactorless tunable active inductor-based voltage controlled oscillator (VCO) in 90[Formula: see text]nm CMOS process. The proposed VCO yields a wide tuning range of 116% with an output frequency of 1.19–4.46[Formula: see text]GHz for the tuning voltage of 0.3–1.5[Formula: see text]V. It consumes a low dc power ranging from 2.44[Formula: see text]mW to 4.79[Formula: see text]mW for the specified tuning range. The variation of phase noise ranges from [Formula: see text][Formula: see text]dBc/Hz to [Formula: see text][Formula: see text]dBc/Hz at 1[Formula: see text]MHz offset with the change of tuning voltage as well as tuning frequency. The proposed varactorless VCO has a maximum Figure of Merit (FOM) of [Formula: see text][Formula: see text]dBc/Hz with a differential output power of 1.8[Formula: see text]dBm at tuning voltage of 0.7[Formula: see text]V. The elimination of varactor which abates the silicon area consumption and the minimization of the variation of performance parameters are the special outcomes of the proposed active inductor-based VCO. Comparing the performance parameters such as power consumption, FOM and tuning range, the proposed design outperforms most of the cited designs.