bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experience of the implementation and outcomes of universal testing for Lynch syndrome in the United Kingdom
Authors: Cavazza A. , Radia C. , Harlow C. , Monahan K. J. 
Published: February 2019

AbstractAimColorectal cancer (CRC) is diagnosed in approximately 45 000 people annually in the UK, and it is estimated that Lynch syndrome (LS) accounts for 3.1% of these cases. In February 2017, National Institute for Health and Care Excellence (NICE guideline DG27 recommended universal testing of new cases of CRC for mismatch repair (MMR) status. The aim of this study was to implement universal testing for LS in CRC patients in a secondary care setting.MethodWe prospectively collected data on consecutive newly diagnosed CRC patients at our centre from November 2016 to August 2018, including evidence of MMR status determined by immunohistochemistry. We recorded clinicopathological data including age at diagnosis, stage, tumour site, reported histological findings and MMR tumour status. Statistical analysis was performed using the chi‐square test and the two‐tailed t‐test for binary and continuous variables, respectively.ResultsA cohort of 203 consecutive patients were diagnosed with CRC during this period. Universal MMR testing was performed for the 198 CRC patients in whom a diagnosis of adenocarcinoma was confirmed, with colonoscopic biopsy used as the source material in 68.6% of cases. Twenty‐three CRCs (11.6%) were MMR deficient (dMMR). Most dMMR CRCs (21/23) were early stage tumours (Dukes A or B, P = 0.002). In 39 Dukes B CRCs in patients under 70 years of age, the result of MMR testing influenced decision‐making about personalized treatment with 5‐fluorouracil based chemotherapy.ConclusionOur results demonstrate that universal testing of all new cases of CRC for features suggestive of LS is feasible and effective in the UK. Our data also indicate the importance of genetic testing and personalized oncological care.
Interactions between anti‐infective agents and immunosuppressants—Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice
Authors: Sparkes Tracy , Lemonovich Tracy L. ,   the AST Infectious Diseases Community of Practice
Published: February 2019

AbstractThese updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation provide an update on potential drug‐drug interactions between anti‐infectives and immunosuppressants, which are most notable with calcineurin and mTOR inhibitors. Drug‐drug interactions may occur through pharmacokinetic mechanisms leading to altered drug concentrations of either the anti‐infective or immunosuppressive drug, or by pharmacodynamic interactions increasing or decreasing the efficacy or toxicity of the medications. Many of the significant pharmacokinetic interactions occur through inhibition or induction of the cytochrome 3A4 system by anti‐infective agents leading to increased or decreased immunosuppressive agent levels, respectively. The membrane transporter P‐glycoprotein is also often involved in drug interactions. Since the last iteration of these guidelines, multiple new hepatitis C virus direct‐acting antivirals have become available for use in SOT recipients. Of these agents, some are substrates of cytochrome and drug transporter systems, while others inhibit these systems and may affect immunosuppressive agents. Due to the high risk for drug‐drug interactions in the solid organ transplant population, practitioners must be aware of potential interactions and be vigilant in monitoring and adjusting drug dosing when appropriate.
RNA respiratory viral infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice
Authors: Manuel Oriol , Estabrook Michele ,   the American Society of Transplantation Infectious Diseases Community of Practice
Published: February 2019

AbstractThese updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of RNA respiratory viral infections in the pre‐ and post‐transplant period. Viruses reviewed include influenza, respiratory syncytial virus (RSV), parainfluenza, rhinovirus, human metapneumovirus (hMPV), and coronavirus. Diagnosis is by nucleic acid testing due to improved sensitivity, specificity, broad range of detection of viral pathogens, automatization, and turnaround time. Respiratory viral infections may be associated with acute rejection and chronic lung allograft dysfunction in lung transplant recipients. The cornerstone of influenza prevention is annual vaccination and in some cases antiviral prophylaxis. Treatment with neuraminidase inhibitors and other antivirals is reviewed. Prevention of RSV is limited to prophylaxis with palivizumab in select children. Therapy of RSV upper or lower tract disease is controversial but may include oral or aerosolized ribavirin in some populations. There are no approved vaccines or licensed antivirals for parainfluenza, rhinovirus, hMPV, and coronavirus. Potential management strategies for these viruses are given. Future studies should include prospective trials using contemporary molecular diagnostics to understand the true epidemiology, clinical spectrum, and long‐term consequences of respiratory viruses as well as to define preventative and therapeutic measures.
Cytopreparation of duodenal biopsy fixative improves detection rate of giardia in clinically suspected cases
Authors: Garg Neha , Singh Jyoti , Anjum Hasib , Puri Amarender S. , Sakhuja Puja , Batra Vineeta V. 
Published: February 2019

IntroductionGiardia intestinalis is a flagellated protozoan, frequently documented as an agent for enteric illness worldwide. Laboratory procedures for diagnosis include stool examination, antigenic detection assays and, at times, mucosal biopsy. We hypothesised that the formalin fixative used as a preservative for mucosal biopsy can be a good diagnostic sample for detecting surface mucosal and luminal infective agents such as giardia. The aim of the study was to find out the utility of processing the remaining formalin fixative as a complementary diagnostic method for detecting giardia.MethodsThis study included 200 cases of duodenal biopsies sampled over 6 months. The biopsies were picked up using clean forceps and the remaining fixative was processed using standard cytospin protocol. The cytospin preparation and formalin‐fixed paraffin‐embedded tissue sections were examined by two pathologists independently blinded to each others findings.ResultsOn cytology, trophozoites of giardia were detected in 23 out of 200 cases (11.50%). The cytomorphology of pear‐shaped organism with paired flagella and nuclei is very diagnostic. One case also showed presence of cryptosporidium spores. No other intestinal parasite was seen. Out of the 23 positive cytology samples, only 12 (6%) corresponding formalin‐fixed paraffin‐embedded tissue sections showed presence of giardia.ConclusionConcurrent examination of duodenal biopsy and the formalin fixative cytopreparation in cases with high index of clinical suspicion of giardiasis proved to be a useful adjunct to biopsy diagnosis of giardiasis, which was statistically significant (P < .0001). This approach adds negligible cost and effort but with good diagnostic yield. We recommend that the formalin cytopreparation be used as a complementary technique to biopsy for cases suspected of intestinal parasitic infection.
Selective adsorption of soil humic acid on binary systems containing kaolinite and goethite: Assessment of sorbent interactions
Authors: Chen Hongfeng , Koopal Luuk K. , Xu Jinling , Wang Mingxia , Tan Wenfeng 
Published: February 2019

Inorganic colloids are ubiquitous in soils and coexist as simple mixtures or as strong associations of particles. The coexisting inorganic colloids with a variety of active sites can selectively adsorb humic substances and thus affect the availability and mobility of organic matter. To investigate the selective adsorption of organic matter by coexisting inorganic colloids, humic acid (JGHA) extracted from soil, a kaolinite and goethite synthetic association (KGA) and a kaolinite and goethite mixture (KGM) were prepared and studied. With the adsorption expressed in μmol m−2, the adsorption affinity of JGHA on KGA (initial slope of isotherms) was slightly higher than that on KGM, although KGM could adsorb more JGHA molecules at larger JGHA concentrations. At pH 4, JGHA was adsorbed on the kaolinite edges and goethite through electrostatic attraction and ligand exchange, and on the kaolinite siloxane plates through hydrophobic interaction. At pH 6 and 8, the adsorption occurred only on the kaolinite siloxane plates and goethite. The overall average adsorption Gibbs energies were moderately negative, and comprised a strongly negative average overall molar entropy and a negative average overall molar entropy contribution. Thus, overall JGHA adsorption on KGA and KGM was enthalpy controlled. The large exothermic enthalpy gains and entropy losses were a result of electrostatic attraction and ligand exchange. The entropy gains because of hydrophobic attraction between JGHA and the kaolinite siloxane plates are masked by the larger entropy loss of adsorption on the hydrophilic surfaces. The fractions of JGHA with molar mass >~12.9 kDa (1 Da = 1 g mol−1) were adsorbed selectively by KGM, whereas the fractions <~12.9 kDa were selectively adsorbed by KGA. High molar mass and hydrophobic fractions adsorb selectively on the kaolinite siloxane plates, whereas low molar mass fractions with hydrophilic groups adsorb selectively on goethite and the kaolinite edges.Highlights

Selective adsorption behaviour of HA on binary systems containing kaolinite and goethite.
High molar mass and hydrophobic HA fractions selectively adsorb on kaolinite siloxane plates.
Low molar mass and hydrophilic HA fractions selectively adsorb on kaolinite edges and goethite.
Binding affinity of HA to KGA is stronger than to KGM; mineral associations are more beneficial for fixing OM in soil.
Safety of buccal infiltration local anaesthesia for dental procedures
Authors: Dougall Alison , Apperley Olivia , Smith Gillian , Madden Louise , Parkinson Laura , Daly Blanaid 
Published: February 2019

AimTo assess the safety of buccal infiltration local anaesthetic (LA) without additional factor replacement in patients with haemophilia (PWH) and association with clinical experience of the operator.MethodsA consecutive sample of participants with mild, moderate and severe haemophilia scheduled to have dental treatment were recruited from a comprehensive care centre in Ireland. Infiltration LA was administered using a standard technique. Safety was defined as any adverse event at time of administration, immediate postoperative, or postoperative period. Clinical experience was dichotomized into fewer or greater than three years clinical experience.ResultsN = 135 buccal infiltration LAs without additional factor replacement were provided to N = 71 participants with mild (n = 20; 28%) and moderate to severe haemophilia (n = 51; 72%). Successful local anaesthesia was achieved in n = 133 cases (99%). No (0%) adverse bleeding events were recorded for any participants at time of administration of LA or during follow‐up. Three out of 135 (2.2%) LAs recorded superficial bleeding 30 seconds after administration of LA, all of which resolved within 2 minutes with application of pressure; 4 out of 135 (3%) LAs produced a superficial haematoma at the site of injection no greater than 2 mm all of which resolved at 4 minutes. There were no differences in bleeding rates between clinicians by level of experience (P = 0.435) or by severity of bleeding disorder (P = 1.0).ConclusionLocal anaesthetic is safe to administer via buccal infiltration for people with mild, moderate and severe haemophilia without additional factor cover. This finding holds true regardless of operator experience.
Erectile dysfunction in patients with haemophilia
Authors: Yang Ming , Sun Haowei (Linda) , Jackson Shannon C. 
Published: February 2019

IntroductionPatients with haemophilia (PWH) are experiencing a nearly normal life span with safe factor replacement therapy and effective antiviral treatments for co‐infections. As a result, many ageing‐related health issues are starting to emerge. One rarely discussed health issue is erectile dysfunction (ED). ED can affect overall well‐being and predict future cardiac events, but is not well studied in PWH.AimThis prospective study aims to examine the prevalence and risk factors for ED in PWH using the validated International Index of Erectile Function (IIEF) questionnaire.MethodsPatients with haemophilia A and B at all severities were invited to participate in IIEF questionnaire at the provincial Hemophilia Treatment Centre. Risk factors for ED including cardiovascular risk factors, prior surgeries, viral infections, medications and haemophilia‐specific factors were obtained. Fasting laboratory tests including but not limited to renal function, haemoglobin, lipid profile, glucose and CRP were performed the same day. Blood pressure and anthropomorphic indices were measured. Endothelial function was assessed by brachial artery flow‐mediated dilation (FMD and hyperaemic velocity time integral [VTI]).ResultsOut of the 56 subjects approached, 44 completed the IIEF. Median age was 49 years. About 38.6% of the cohort reported ED symptoms. There was no significant difference in endothelial function measured by FMD and VTI between patient with ED and without. IIEF score correlated with age in multivariable analysis.ConclusionErectile dysfunction symptoms appear prevalent in PWH, particularly in the older group. This disorder along with the underlying causes needs to be explored further in future larger observational study.
The potential for long‐term cost‐effectiveness of obesity prevention interventions in the early years of life
Authors: Brown Vicki , Ananthapavan Jaithri , Sonntag Diana , Tan Eng Joo , Hayes Alison , Moodie Marj 
Published: February 2019

SummaryBackgroundEarly childhood obesity prevention is gaining increasing importance, as the prevalence of children with overweight and obesity aged 5 years and under increases worldwide. Along with understanding the effectiveness of obesity interventions, it is important to understand the cost‐effectiveness of interventions over time.ObjectivesTo estimate the long‐term health benefits and health care cost‐savings of reductions in BMI for the Australian population of children aged between 2 and 5 years.MethodsA proportional multistate, multiple cohort lifetable model estimated the health benefits and health care cost‐savings related to hypothetical reductions in BMI, informed by a scoping review of systematic reviews reporting the effectiveness of obesity prevention interventions in preschool aged children.ResultsResults suggest significant potential for cost‐effectiveness of obesity prevention interventions in preschool‐aged children if intervention effect can be maintained. A relatively small population level reduction in BMI z‐score (−0.13 BMIz) in children aged 2 to 5 years would result in 36 496 health‐adjusted life years saved (95% uncertainty interval [UI], 30 283‐42 945) and health care cost‐savings of approximately $301 million (95% UI $234 million‐$369 million) if modelled over the lifetime.ConclusionsScenario results highlight the importance of obesity intervention in the early years of life.
Mothers’ perception about health education in brazilian primary health care: A qualitative study
Authors: Herval Álex Moreira , de Oliveira Fernanda Piana Santos Lima , Machado Kecyanne Malheiros , Vasconcelos Mara , Ferreira Raquel Conceição , Ferreira Efigênia Ferreira e , Amaral João Henrique Lara do , Vargas Andréa Maria Duarte , Gomes Viviane Elisângela 
Published: February 2019

AbstractBackgroundHealth education actions are strategic actions aimed at health promotion. Moreover, better health education practices have been linked to comprehensive care developed by primary health services.AimTo understand the perception of mothers about the health education developed by the Primary Health Care (PHC) services.DesignWe adopted a qualitative research approach, conducted using semi‐structured interviews, and assuming, as the theoretical reference, the attributes derived from PHC. Pregnant women and mothers of children under 1 year old attended by Brazilian Family Health teams were included.ResultsEight pregnant women and twelve mothers of children under 1 year of age participated in the study. These mothers perceive educational actions as necessary only for primiparous mothers. They value the guidance of informal networks and maternity hospitals to the detriment of primary services, and they do not adhere to care that conflicts with their previous knowledge. The evidence shows that the educational actions of the primary health services do not adequately respond to the attributes of community orientation, family focus, and cultural competence.ConclusionIt is necessary to modify the educational practices in order to incorporate and value the existing knowledge in the territory, thereby adapting the care guidelines to the local context.
Informed consent practice for obstetric and gynaecologic procedures: A patients' perspective from a developing country
Authors: Zeeshan Muhammad F. , Yousufi Zainab , Khan Durdana , Malik Farhat R. , Ashfaq Fizza , Batool Fatima , Atta Lyaba , Tariq Hira , Huma Zille , Ghafoor Rahat , Jamil Ayisha , Qazi Umair 
Published: February 2019

AbstractObjectivesTo assess the surgical informed consent (SIC) practices for obstetric and gynaecological (OB‐GYN) procedures at different hospitals in Pakistan.MethodsStudy was conducted in five hospitals (three public and two private) of Peshawar, Pakistan. A pretested structured tablet‐based questionnaire was administered from October 2016 through January 2017 among post‐op OB‐GYN patients.ResultsAbout 27% of the patients (significantly more in private hospitals, P = 0.001) did not remember a formal consent administration. Most patients (80%) felt they had no choice about signing the consent. About 65% (mostly in public as compared with private hospitals) mentioned that they would have signed it regardless of the specifics in it (P < 0.001). Patients had increased odds to recall consent if they felt empowered, odds ratio (OR) = 4.5; had an opportunity to ask questions, OR = 7.2; wanted more explanation, OR = 2.8; and had consent administered in their mother tongue, OR = 6.9.DiscussionPatients' recall of key elements of consent was low. The time spent with the patient for consenting was much shorter than recommended. The printed consent forms were mostly not available in patients' mother tongue.ConclusionsConsent practice for OB‐GYN procedures was suboptimal in studied hospitals. Patients' attitude toward informed consent practices largely reflected providers' focus on obtaining a legally valid signed consent as opposed to administering a consent that empowers patients to make an informed decision in the absence of any external pressure.
Effect of combined microwave, hot air, and vacuum treatments on cooking characteristics of rice
Authors: Agrawal Swati , Raigar Rakesh Kumar , Mishra Hari Niwas 
Published: February 2019

AbstractInstant rice is a precooked and dried, whole grain rice kernel, which can be prepared relatively in a very short period by adding boiled water. Precooking method employed plays a major role in lowering the cooking time while maintaining the quality of the product. The rice kernels were pretreated and then were subjected to convective hot air at temperature 70°C for 90 min. The combination of microwave, hot air, and vacuum was also used in processing the rice kernels. Microwave power of 200 W for 2 min along with hot air at 70°C for 90 min was used with vacuum of 400 mmHg for 2 min. The study found that the internal porous structure of the instant rice plays a crucial role in determining the physical characteristics like weight gain percent, hardness, and springiness. Based on weight gain percent, texture analysis, DSC, and SEM it was found that the combination of microwave (200 W for 2 min), hot air (70°C for 90 min), and vacuum of 400 mmHg was the optimal processing condition for making instant rice that takes 2 min to cook.Practical applicationsInstant rice has a very short reconstitution time; hence, for convenience of preparation of the cooked rice within 2 min the instant rice is of immense value for those situated in very high altitudes, especially army personnel and also for the western countries. The study of the variation in the microstructure of the instant rice explains the mechanism of faster cooking. The preparation of instant rice requires no special cooking appliances and cooked rice matches with that of conventionally cooked rice. This data will also be very helpful for ready‐to‐eat food industries.
Evaluation frameworks in health services: An integrative review of use, attributes and elements
Authors: Bradford Natalie , Chambers Shirley , Hudson Adrienne , Jauncey‐Cooke Jacqui , Penny Robyn , Windsor Carol , Yates Patsy 
Published: February 2019

AbstractAims and objectiveTo synthesise the evidence on the use of evaluation frameworks by nurses and midwives in research designed to improve healthcare services and practice. A secondary aim was to identify the attributes and elements of evaluation frameworks.BackgroundEvaluation is an integral component of any initiative to improve outcomes or change clinical practice. Yet often an evaluation may not yield the information required to sustain or integrate an initiative into practice. Evaluation frameworks can support effective evaluations, but there is a lack of consensus regarding elements and attributes of frameworks that support use.MethodsWe undertook an integrative review to synthesise the use of evaluation frameworks in practice guided by the Preferred Reporting Items for Systematic review and Meta‐Analysis flow diagram and checklist 2009 (Supporting Information File 4). The protocol was registered with PROSPERO (CRD42018087033). A broad range of electronic databases were systematically searched using keywords.FindingsTwenty‐five papers were included from a diverse range of clinical areas and across high‐, middle‐ and low‐income nations. Twenty of the research projects had used nine existing frameworks, and five had developed an evaluation specific to an initiative. Frameworks supported the processes of evaluation and made them more meaningful by simplifying a complex process (providing structure and guidance for the evaluation processes); identifying and including stakeholders; explaining reasons for outcomes; generating transferable lessons; and identifying the mechanisms driving or inhibiting change.ConclusionNurses and midwives reported that frameworks were useful in undertaking evaluations. Each framework had positive attributes and missing or confusing elements. When undertaking an evaluation, it is pertinent to review the elements and attributes of a framework to ensure it includes evaluation measures that are relevant to specific projects.Relevance to clinical practiceNurses are actively involved in evaluation of clinical practice. This review identifies important elements to consider when choosing a framework for evaluation.