bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breakfast skipping is associated with persistently increased arterial stiffness in patients with type 2 diabetes
Authors: Mita Tomoya , Osonoi Yusuke , Osonoi Takeshi , Saito Miyoko , Nakayama Shiho , Someya Yuki , Ishida Hidenori , Gosho Masahiko , Watada Hirotaka 
Published: February 2020

ObjectiveWhile certain lifestyle habits may be associated with arterial stiffness, there is limited literature investigating the relationship between lifestyle habits and longitudinal changes in arterial stiffness in patients with type 2 diabetes mellitus (T2DM). This is an exploratory study to determine whether lifestyle habits, in addition to conventional atherosclerotic risk factors, are associated with increased arterial stiffness.Research design and methodsThe study participants comprised 734 Japanese outpatients with T2DM and no history of apparent cardiovascular diseases. Lifestyle habits were analyzed using self-reported questionnaires, and brachial-ankle pulse wave velocity (baPWV) was measured at baseline, and at years 2 and 5. A multivariable linear mixed-effects model was used to determine the predictive value of lifestyle habits and possible atherosclerotic risk factors for longitudinal change in baPWV.ResultsOver 5 years of follow-up, baPWV values significantly increased. In a multivariable linear mixed-effects model that adjusted for age and gender, a low frequency of breakfast intake was significantly associated with persistently high baPWV, independently of other lifestyle habits. Furthermore, in a multivariable linear mixed-effects model that included both lifestyle habits and possible atherosclerotic risk factors, a low frequency of breakfast intake remained the only independent predictive factor for persistently high baPWV. Subjects who ate breakfast less frequently tended to have additional unhealthy lifestyle habits and atherosclerotic risk factors.ConclusionsOur analyses suggest that breakfast skipping is an independent lifestyle habit that is associated with persistently increased arterial stiffness in patients with T2DM.Trial registration numberUMIN000010932.
Enhancing teamwork communication and patient safety responsiveness in a paediatric intensive care unit using the daily safety huddle tool
Authors: Aldawood Fatima , Kazzaz Yasser , AlShehri Ali , Alali Hamza , Al-Surimi Khaled 
Published: February 2020

BackgroundOpen communication between leadership and frontline staff at the unit level is vital in promoting safe hospital culture. Our hospital staff culture survey identified the failure to address safety issues as one of the areas where staff felt unable to express their concerns openly. Thus, this improvement project using the daily safety huddle tool has been developed to enhance teamwork communication and respond effectively to patient safety issues identified in a paediatric intensive care unit.MethodsWe used the TeamSTEPPS quality approach. TeamSTEPPS is an evidence-based set of teamwork tools developed by the US Agency of Healthcare Research and Quality to enhance teamwork and communication. We applied TeamSTEPPS using a tool called the Daily Safety Huddle, aiming at improving communication and interaction between healthcare workers and building trust by acting immediately when there is any patient safety issue or concern at the unit level.ResultsDuring the period from April to December 2017, the interaction between frontline staff and unit leadership increased through compliance with the daily safety huddle. Initially, compliance was at 73%, but it increased to 97%, with a total of 340 safety issues addressed. The majority of these safety issues pertained to infection control and medication errors (109; 32.05%), followed by communication (83; 24.41%), documentation (59; 17.35%), other issues (37; 10.88%), procedure (20; 5.88%), patient flow (16; 4.7%) and equipment and supplies (16; 4.7%).ConclusionsSystematic use of daily safety huddle is a powerful tool to create an equitable environment where frontline staff can speak up freely about daily patient safety concerns. The huddle leads to a more open and active discussion with unit leadership and to the ability to perform the right action at the right time.
Reducing overutilisation of serum vitamin D testing at a tertiary care centre
Authors: Tai Felicia , Chin-Yee Ian , Gob Alan , Bhayana Vipin , Rutledge Angela 
Published: February 2020

IntroductionTesting of 25-hydroxy (25-OH) vitamin D serum levels has increased drastically in recent years and much of it is considered inappropriate based on current guidelines.MethodsIn consultation with our physician groups (experts and frequent orderers), we modified existing guidelines and implemented a rational policy for 25-OH vitamin D testing and 1,25 dihydroxy (1,25 di-OH) vitamin D testing at a tertiary care centre. A computer decision support tool requiring selection of one of five acceptable testing indications was created for each test as part of a computerised physician order entry system.ResultsAs a result of our intervention, we observed a 27% decrease in the average monthly test volume for 25-OH vitamin D from 504±62 (mean±SD) tests per month to 370±33 (p<0.001). 1,25 di-OH vitamin D testing decreased 58% from 71±18 to 30±10 (p<0.001). The departments ordering the tests were similar during the preintervention and postintervention periods, and further audits, patient chart reviews and individualised physician feedback were required to ensure appropriate ordering of 1,25 di-OH vitamin D. The most common ordering reasons selected were malabsorption/dietary concerns (46%) for 25-OH vitamin D and renal failure (42%) for 1,25 di-OH vitamin D.ConclusionsLimitations of our computer decision support tool include a dependence on an honour system in selecting the testing indication and an inability to limit ordering frequency. Periodic monitoring of test volumes will be required to ensure adherence to guidelines. Despite these limitations, we have improved appropriate utilisation of these tests and reduced costs by approximately $C60 375 per year.
Effectiveness of return to activity and return to school protocols for children postconcussion: a systematic review
Authors: DeMatteo Carol , Bednar E Dimitra , Randall Sarah , Falla Katie 
Published: February 2020

ObjectiveTo determine the effects of following return to activity (RTA) and return to school (RTS) protocols on clinical outcomes for children with concussion. The 12 subquestions of this review focus on the effectiveness of protocols, guidelines and recommendations, and the evidence supporting content of the protocols including rest, exercise and school accommodations.DesignSystematic review.Data sourcesPubMed, MEDLINE, EMBASE, CINAHL, ERIC and manual reference list check.Eligibility criteria for selecting studiesStudies were included if they evaluated RTA or RTS protocols in children aged 5–18 years with a concussion or if they reported a rigorous study design that provided evidence for the recommendations. Included studies were original research or systematic reviews. Articles were excluded if they did not report on their methodology or included participants with significant neurological comorbidities.ResultsThe literature search retrieved 198 non-duplicate articles and a total of 13 articles were included in this review. Despite the adoption of several RTS and RTA protocols in clinical practice there is little evidence to determine their efficacy in the paediatric population.SummaryThe current data support the recommendation that children in the acute stage postconcussion should undergo 1–2 days physical and cognitive rest as they initiate graduated RTA/RTS protocols. Prolonged rest may increase reported symptoms and time to recovery. Further interventional studies are needed to evaluate the effectiveness of RTA/RTS protocols in youth with concussion.
Mental health and psychological well-being among professional rugby league players from the UK
Authors: Nicholls Adam Robert , Madigan Daniel J , Fairs Lucas R W , Bailey Richard 
Published: February 2020

ObjectiveThis study aimed to measure depressive symptoms, anxiety symptoms and psychological well-being among a sample of Super League players, the highest tier of professional rugby league in the northern hemisphere.MethodsBetween November 2018 and July 2019, a sample of 233 Super League players completed questionnaires that assessed depressive symptoms, anxiety symptoms and psychological well-being.ResultsPlayers exhibited normal (85.8%), mild (11.6%) or moderate/severe (2.6%) depressive symptoms. Additionally, players reported normal (67.4%), mild (18.9%) or moderate/severe (13.7%) anxiety symptoms. The mean psychological well-being score across the sample was 25.07 (SD=4.34). 35.2% of players scored below average for this construct.ConclusionThe prevalence of mild depressive symptoms, moderate/severe depressive symptoms and mild anxiety symptoms among Super League players preliminary appear higher than in the general population from the UK. Much more research is needed to understand mental health among elite athletes.
The effect of receiving versus being denied an abortion on making and achieving aspirational 5-year life plans
Authors: McCarthy Molly A , Upadhyay Ushma , Ralph Lauren , Biggs M Antonia , Foster Diana Greene 
Published: February 2020

BackgroundPopular support for access to abortion and contraceptive services is often based on the idea that they will help women determine the trajectory of their life course. This study examined whether receiving versus being denied an abortion affects aspirational life goal setting and attainment 5 years later.MethodsWe compared women who sought and were denied an abortion because they were 3 weeks beyond the gestational limit (‘Parenting-Turnaways’) to those who received an abortion in the first trimester (‘First-Trimesters’); received an abortion within 2 weeks of the facility’s gestational limit (‘Near-Limits’); and sought an abortion, were turned away and received an abortion elsewhere or placed their baby for adoption (‘Non-Parenting-Turnaways’). We used mixed effects logistic regression analyses to estimate the odds of setting an aspirational plan and to estimate the odds of both setting and achieving an aspirational 5-year plan.ResultsAt 1 week post abortion-seeking, 791 women reported 1864 5-year plans, most of which were aspirational (n=1692, 91%). Parenting-Turnaways had lower odds of setting an aspirational 5-year plan than Near-Limits (OR 0.36, 95% CI 0.18 to 0.73). There were no differences by group in achieving aspirational 5-year plans among those who had them.ConclusionsSoon after abortion-seeking, women denied a wanted abortion were less optimistic about their long-term futures than women who received a wanted abortion. Abortion access can help women set positive long-term goals.
CCL5-armed oncolytic virus augments CCR5-engineered NK cell infiltration and antitumor efficiency
Authors: Li Feng , Sheng Yuqiao , Hou Weizhou , Sampath Padma , Byrd Daniel , Thorne Stephen , Zhang Yi 
Published: February 2020

BackgroundNatural killer (NK) cells have potent antitumor activities. Nevertheless, adoptive transfer therapy of NK cells has gained very limited success in patients with solid tumors as most infused NK cells remain circulating in the peripheral blood instead of entering tumor sites. Chemokines and their receptors play important roles in NK cell distribution. Enhancing chemokine receptors on immune cells to match and be driven to tumor-specific chemokines may improve the therapeutic efficacy of NK cells.MethodsThe CCR5-CCL5 axis is critical in NK cell homing to tumor sites. Thus, we analyzed CCR5 expression on NK cells from patients with cancer and healthy donors. We then upregulated CCR5 and CCL5 with lentiviruses and oncolytic viruses in NK and tumor cells, respectively. Animal experiments were also carried out to test the efficacy of the combination of oncolytic virus with NK cells.ResultsIn NK cells from patients with various solid tumors or healthy subjects, CCR5 was expressed at low levels before and after expansion in vitro. CCR5-engineered NK cells showed enhanced tumor infiltration and antitumor effects, but no complete regressions were noted in the in vivo tumor models. To further improve therapeutic efficacy, we constructed CCL5-expressing oncolytic vaccinia virus. In vitro data demonstrated that vaccinia virus can produce CCL5 in tumor cells while infectivity remained unaffected. Supernatants from tumor cells infected by CCL5-modified vaccinia virus enhanced the directional movement of CCR5-overexpressed NK cells but not green fluorescent protein (GFP)-expressing cells. More importantly, NK cells were resistant to the vaccinia virus and their functions were not affected after being in contact. In vivo assays demonstrated that CCL5-expressing vaccinia virus induced a greater accumulation of NK cells within tumor lesions compared with that of the prototype virus.ConclusionEnhancement of matched chemokines and chemokine receptors is a promising method of increasing NK cell homing and therapeutic effects. Oncolytic vaccinia viruses that express specific chemokines can synergistically augment the efficacies of NK cell-based therapy.
Evaluation of hepatitis B virus in clinical trials of baricitinib in rheumatoid arthritis
Authors: Harigai Masayoshi , Winthrop Kevin , Takeuchi Tsutomu , Hsieh Tsu-Yi , Chen Yi-Ming , Smolen Josef S , Burmester Gerd , Walls Chad , Wu Wen-Shuo , Dickson Christina , Liao Ran , Genovese Mark C 
Published: February 2020

BackgroundReactivation of hepatitis B virus (HBV) replication is a well-recognised complication in patients receiving disease-modifying anti-rheumatic drugs (DMARDs) for rheumatoid arthritis (RA). Limited data exist on HBV reactivation among patients with RA treated with janus kinase (JAK) inhibitors. The objective of the current study was to assess HBV reactivation in clinical trials of baricitinib, an oral selective JAK1 and JAK2 inhibitor in RA.MethodsData were integrated from four completed Phase 3 trials and one ongoing long-term extension (data up to 1 April 2017) in patients naïve to DMARDs or who had inadequate response (IR) to DMARDs including methotrexate (MTX)-IR and/or other conventional synthetic DMARD (csDMARD)-IR, or tumour necrosis factor inhibitors-IR. Within the clinical programme, baricitinib-treated patients may have received concomitant csDMARDs including MTX, or previous treatment with active comparators including MTX or adalimumab + MTX. At screening, all patients were tested for HBV surface antigen (HBsAg), core antibody (HBcAb) and surface antibody (HBsAb). Patients were excluded if they had (1) HBsAg+, (2) HBcAb+/HBsAb− (in Japan, could enrol if HBV DNA−) or (3) HBsAb+ and HBV DNA+. HBV DNA monitoring, following randomisation in the originating Phase 3 studies, was performed in Japan for patients with HBcAb+ and/or HBsAb+ at screening, and was later instituted globally for HBcAb+ patients in accordance with evolving guidance for HBV monitoring and management with immunomodulatory therapy.ResultsIn total, 2890 patients received at least one dose of baricitinib in Phase 3 (6993 patient-years exposure). Of 215 patients with baseline serology suggestive of prior HBV infection (HbcAb+) who received a post-baseline DNA test, 32 (14.9%) were HBV DNA+ at some point following treatment initiation; 8 of 215 patients (3.7%) had a single quantifiable result (≥29 IU/mL). Of these eight patients, four met the definition of reactivation of HBV (HBV DNA level ≥100 IU/mL); baricitinib was permanently discontinued in four patients, and temporarily interrupted in two patients. No patient developed clinical evidence of hepatitis and in five of eight patients, antiviral therapy was not used.ConclusionHBV reactivation can occur among RA patients treated with DMARDs, including baricitinib, with prior HBV exposure. Our data suggest that such patients should be monitored for HBV DNA during treatment and might be treated safely with the use of antiviral therapy as needed. The risk of HBV reactivation in patients with HBsAg treated with baricitinib is unknown.
Can blood serum amyloid A concentrations in horses differentiate synovial sepsis from extrasynovial inflammation and determine response to treatment?
Authors: Sinovich Matthew , Villarino Nicolas F , Singer Ellen , Robinson Claire S , Rubio-Martínez Luis M 
Published: February 2020

BackgroundSerum amyloid A (SAA) concentrations in blood and synovial fluid of horses with synovial sepsis have diagnostic value. Studies suggest serial blood SAA measurements could act as a prognostic indicator. This study evaluated the use of serial blood SAA concentrations for monitoring of horses with synovial sepsis.MethodsA prospective clinical trial was performed of horses referred to a single hospital with synovial sepsis that survived (n=17), synovial sepsis that were euthanised (n=5), non-septic intrasynovial pathologies (n=14) or extensive extrasynovial lacerations (n=5). SAA concentrations were determined on admission and every 24 hours thereafter. The area under the concentration–time curve from 0 to 144 hours of each group was compared by Kruskal-Wallis and post hoc Dunn’s tests (P<0.05).ResultsSignificant difference in mean blood concentration of SAA was found between synovial sepsis that survived and non-septic pathologies in the first 48 hours, as well as between non-septic intrasynovial pathologies and non-responsive sepsis requiring euthanasia. No difference was found between extensive extrasynovial lacerations and any septic group.ConclusionsWhile serial blood SAA is useful for monitoring clinical response of intrasynovial septic pathologies, interpretation should consider other clinical findings since blood SAA is not a specific marker for synovial sepsis.
Self‐reported snake management practices among owners in Victoria, Australia
Authors: Howell Tiffani Josey , Warwick Clifford , Bennett Pauleen C 
Published: February 2020

BackgroundA large number of snakes are kept as pets in Western societies. Few studies have been undertaken to assess keeping practices of snakes by private owners in Australia. Therefore, there is concern that some owners may not understand even basic husbandry requirements. The aim of this preliminary study was to identify the most common practices used by snake owners in Victoria, Australia.MethodAn online survey asked 251 snake owners to describe ways in which they attempt to meet their snake’s environmental, behavioural, dietary, social and health needs.ResultsFewer than half of participants had an enclosure large enough for the snake to fully stretch out, and just over half had an enclosure large enough to meet the requirements in the Victorian Code of Practice. Only 60 per cent of owners correctly identified their snake’s activity patterns based on information about wild snakes of the same species.ConclusionEducational campaigns may help improve outcomes for snakes in the future, but more research is needed about captive snake husbandry, to provide an evidence base for informing snake management recommendations.
Family Study Designs Informed by Tumor Heterogeneity and Multi-Cancer Pleiotropies: The Power of the Utah Population Database
Authors: Hanson Heidi A. , Leiser Claire L. , Madsen Michael J. , Gardner John , Knight Stacey , Cessna Melissa , Sweeney Carol , Doherty Jennifer A. , Smith Ken R. , Bernard Philip S. , Camp Nicola J. 
Published: February 2020

Abstract

Background:
Previously, family-based designs and high-risk pedigrees have illustrated value for the discovery of high- and intermediate-risk germline breast cancer susceptibility genes. However, genetic heterogeneity is a major obstacle hindering progress. New strategies and analytic approaches will be necessary to make further advances. One opportunity with the potential to address heterogeneity via improved characterization of disease is the growing availability of multisource databases. Specific to advances involving family-based designs are resources that include family structure, such as the Utah Population Database (UPDB). To illustrate the broad utility and potential power of multisource databases, we describe two different novel family-based approaches to reduce heterogeneity in the UPDB.

Methods:
Our first approach focuses on using pedigree-informed breast tumor phenotypes in gene mapping. Our second approach focuses on the identification of families with similar pleiotropies. We use a novel network-inspired clustering technique to explore multi-cancer signatures for high-risk breast cancer families.

Results:
Our first approach identifies a genome-wide significant breast cancer locus at 2q13 [P = 1.6 × 10−8, logarithm of the odds (LOD) equivalent 6.64]. In the region, IL1A and IL1B are of particular interest, key cytokine genes involved in inflammation. Our second approach identifies five multi-cancer risk patterns. These clusters include expected coaggregations (such as breast cancer with prostate cancer, ovarian cancer, and melanoma), and also identify novel patterns, including coaggregation with uterine, thyroid, and bladder cancers.

Conclusions:
Our results suggest pedigree-informed tumor phenotypes can map genes for breast cancer, and that various different cancer pleiotropies exist for high-risk breast cancer pedigrees.

Impact:
Both methods illustrate the potential for decreasing etiologic heterogeneity that large, population-based multisource databases can provide.
See all articles in this CEBP Focus section, “Modernizing Population Science.”
Long-term Consequences of Pelvic Irradiation: Toxicities, Challenges, and Therapeutic Opportunities with Pharmacologic Mitigators
Authors: Huh Jung Wook , Tanksley Jarred , Chino Junzo , Willett Christopher G. , Dewhirst Mark W. 
Published: February 2020

Abstract
A percentage of long-term cancer survivors who receive pelvic irradiation will develop treatment-related late effects, collectively termed pelvic radiation disease. Thus, there is a need to prevent or ameliorate treatment-related late effects in these patients. Modern radiotherapy methods can preferentially protect normal tissues from radiation toxicities to permit higher doses to targets. However, concerns about chronic small bowel toxicity, for example, still constrain the prescription dose. This provides strong rationale for considering adding pharmacologic mitigators. Implementation of modern targeted radiotherapy methods enables delivery of focused radiation to target volumes, while minimizing dose to normal tissues. In prostate cancer, these technical advances enabled safe radiation dose escalation and better local tumor control without increasing normal tissue complications. In other pelvic diseases, these new radiotherapy methods have not resulted in the low probability of normal tissue damage achieved with prostate radiotherapy. The persistence of toxicity provides rationale for pharmacologic mitigators. Several new agents could be readily tested in clinical trials because they are being or have been studied in human patients already. Although there are promising preclinical data supporting mitigators, no clinically proven options to treat or prevent pelvic radiation disease currently exist. This review highlights therapeutic options for prevention and/or treatment of pelvic radiation disease, using pharmacologic mitigators. Successful development of mitigators would reduce the number of survivors who suffer from these devastating consequences of pelvic radiotherapy. It is important to note that pharmacologic mitigators to ameliorate pelvic radiation disease may be applicable to other irradiated sites in which chronic toxicity impairs quality of life.