bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does liberalisation of cannabis policy influence levels of use in adolescents and young adults? A systematic review and meta-analysis
Authors: Melchior Maria , Nakamura Aurélie , Bolze Camille , Hausfater Félix , El Khoury Fabienne , Mary-Krause Murielle , Azevedo Da Silva Marine 
Published: July 2019

ObjectivesTo examine the effect of cannabis policy liberalisation (decriminalisation and legalisation) levels of use in adolescents and young adults.DesignSystematic review and meta-analysis.Inclusion criteriaIncluded studies were conducted among individuals younger than 25 years and quantitatively assessing consequences of cannabis policy change. We excluded articles: (A) exclusively based on participants older than 25 years; (B) only reporting changes in perceptions of cannabis use; (C) not including at least two measures of cannabis use; (D) not including quantitative data; and (E) reviews, letters, opinions and policy papers. PubMed, PsycINFO, Embase and Web of Science were searched through 1 March 2018.Data extraction and synthesisTwo independent readers reviewed the eligibility of titles and abstracts and read eligible articles, and four authors assessed the risk of bias (Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies). Extracted data were meta-analysed. The protocol was registered with PROSPERO.Results3438 records were identified via search terms and four via citation lists; 2312 were retained after removal of duplicates, 99 were assessed for eligibility and 41 were included in our systematic review. 13 articles examined cannabis decriminalisation, 20 examined legalisation for medical purposes and 8 examined legalisation for recreational purposes. Findings regarding the consequences of cannabis decriminalisation or legalisation for medical purposes were too heterogeneous to be meta-analysed. Our systematic review and meta-analysis suggest a small increase in cannabis use among adolescents and young adults following legalisation of cannabis for recreational purposes (standardised mean difference of 0.03, 95% CI −0.01 to –0.07). Nevertheless, studies characterised by a very low/low risk of bias showed no evidence of changes in cannabis use following policy modifications.ConclusionsCannabis policy liberalisation does not appear to result in significant changes in youths’ use, with the possible exception of legalisation for recreational purposes that requires monitoring.Trial registration numberCRD42018083950.
Efficacy of mindfulness-based intervention (‘mindfulness-based joyful sleep’) in young and middle-aged individuals with insomnia using a biomarker of inflammatory responses: a prospective protocol of a randomised controlled trial in China
Authors: Pan Chen , Wang Xiang , Deng Yunlong , Li Peihuan , Liao Yanhui , Ma Xin , Yang Guo-Ping , Dai Lisha , Tang Qiuping 
Published: July 2019

IntroductionInsomnia is a prevalent and significant public health concern. Insomnia can lead to increased inflammatory markers associated with chronic diseases such as cardiovascular disease, diabetes and cancer. Studies suggest that mindfulness-based interventions (MBIs) are more easily delivered within the community than cognitive behavioural therapy for insomnia (CBT-I) which was recommended as the preferred non-pharmacological treatment by the American Academy of Sleep Medicine, are effective in insomnia treatment and can reduce inflammatory markers level in older individuals with insomnia. This study aims to compare the effectiveness of an MBI to CBT-I in young and middle-aged individuals with insomnia disorder and explore its effect on nuclear factor kappa B (NF-κB), a transcription factor that controls the expression of genes involved in inflammation.Methods and analysisThis report describes a protocol for a randomised controlled trial. Seventy eligible participants will be assigned to mindfulness-based joyful sleep or CBT-I for 2-hour sessions weekly for 8 weeks. The primary outcome is sleep quality assessed by the Pittsburgh Sleep Quality Index, severity of insomnia symptoms assessed by the Insomnia Severity Index and sleep parameters recorded using sleep diary and polysomnography. Secondary outcomes include perceived stress, anxiety and depression. The exploratory outcome is serum level of NF-κB. Outcomes will be evaluated at baseline, the end of the ntervention period and at a 3 month follow-up. Data will be analysed using general linear models, specifically analysis of covariance and analysis of variance will be used.Ethics and disseminationFull ethical approval for this study has been obtained from the Ethics Committee of the Third Xiangya Hospital, Central South University, Changsha, China (2018-S236). If Mindfulness-Based Joyful Sleep is proven effective, its dissemination will help bridge the gap between the unmet need and the demand for insomnia interventions in China.Trial registration numberNCT03268629; Pre-results.
Association between self-reported length of time in the USA and blood lead levels: National Health and Nutrition Examination Survey 2013–2016
Authors: Horton Christelene Jack , Acharya Lalatendu , Wells Ellen M 
Published: July 2019

ObjectivesThe aim of this study is to determine the association between length of time in the USA with blood lead (BPb).DesignPopulation-based cross-sectional study using data from the 2013–2016 National Health and Nutrition Examination Survey.SettingUSA.Participants5933 men and women (≥15 years); subgroups of men only (n=2867), women only (n=3064) and women of childbearing age (15–45 years) (n=1580).Primary and secondary outcomesThe primary outcome was BPb concentration. The main exposure variable was self-reported number of years spent in the USA, categorised as: born in the USA; 0–4 years; 5–9 years; 10–19 years and ≥20 years. We used linear regression models adjusted for race/ethnicity, education, blood cotinine, age, sex (as appropriate) and accounted for complex survey design.ResultsWomen of childbearing age who have lived 0–4 years in the USA have, on average, a 54% (95% CI 36% to 75%) higher BPb compared with women born in the USA. Corresponding results for all women, men and the entire population were 49% (95% CI 34% to 66%), 49% (95% CI 28% to 75%) and 49% (95% CI 33% to 66%), respectively. Similar, statistically significant, results were observed for other time periods (5–9 years, 10–19 years and ≥20 years); the magnitude of the association decreased with increasing time in the USA.ConclusionsThis study provides additional evidence that newcomers to the USA may be a population at higher risk of elevated BPb.
Nosocomial infection prevalence in patients undergoing extracorporeal membrane oxygenation (ECMO): protocol for a point prevalence study across Australia and New Zealand
Authors: Corley Amanda , Lye India , Lavana Jayshree D , Ahuja Abhilasha , Anstey Chris M , Jarrett Paul , Haisz Emma , Parke Rachael , Pellegrino Vincent , Buscher Hergen , Fraser John F 
Published: July 2019

IntroductionExtracorporeal membrane oxygenation (ECMO) provides cardiac and/or respiratory support when other therapies fail. Nosocomial infection is reported in up to 64% of patients receiving ECMO and increases morbidity and mortality. These patients are at high risk of infection due, in part, to the multiple invasive devices required in their management, the largest being the cannulae through which ECMO is delivered. Prevalence of nosocomial infection in ECMO patients, including ECMO cannula-related infection, is not well described across Australia and New Zealand.Methods and analysisThis is a prospective, observational point prevalence study of 12 months duration conducted at 11 ECMO centres across Australia and New Zealand. Data will be collected for every patient receiving ECMO during 12 predetermined data collection weeks. The primary outcome is the prevalence of laboratory-confirmed bloodstream infection, and suspected or probable nosocomial infections; and the secondary outcomes include describing ECMO cannula dressing and securement practices, and adherence to local dressing and securement guidelines. Data collection will be finalised by March 2019.Ethics and disseminationRelevant ethical and governance approvals have been received. Study results will describe the prevalence of suspected and confirmed nosocomial infection in adult, paediatric and neonatal patients receiving ECMO across Australia and New Zealand. It is expected that the results will be hypothesis generating and lead to interventional trials aimed at reducing the high infection rates seen in this cohort. Results will be published in peer-reviewed journals and presented at relevant conferences.Trial registration numberANZCTRN12618001109291; Pre-results.
Qualitative process evaluation of the Perioperative Quality Improvement Programme (PQIP): study protocol
Authors: Wagstaff Duncan , Moonesinghe S Ramani , Fulop Naomi J , Vindrola-Padros Cecilia 
Published: July 2019

IntroductionThe Perioperative Quality Improvement Programme (PQIP) is designed to measure complications after major elective surgery and improve these through feedback of data to clinicians. Previous research suggests that despite the significant resources which go into collecting data for national clinical audits, the information they contain is not always used effectively to improve local services.Methods and analysisWe will conduct a formative process evaluation of PQIP comprising a multisited qualitative study to analyse PQIP’s programme theory, barriers, facilitators and wider contextual factors that influence implementation. The research will be carried out with the PQIP project team and six National Health Service (NHS) Trusts in England, selected according to geographical location, type of hospital, size and level of engagement with PQIP. We will include one Trust which has not expressed interest in the PQIP for comparison and to explore the role of secular trend in any changes in practice. We will use semi-structured interviews (up to 144 in Trusts and 12 with the project team), non-participant observations (up to 150  hours) and documentary analysis. We will track the lifecycle of perioperative data, exploring the transformations it undergoes from creation to use. We will use framework analysis with categories both from our research questions and from themes emerging from the data.Ethics and disseminationEthical approval has been granted from the University College London Research Ethics Committee (ref 10375/001). Permissions to conduct research at NHS Trusts have been granted by local Research and Development offices in coordination with the Health Research Authority. We will follow guidelines for data security, confidentiality and information governance. Findings will be shared at regular time points with the PQIP project team to inform the implementation of the programme, and with participating NHS Trusts to help them reflect on how they currently use data for improvement of perioperative services.
ASSERT (Acute Sacral inSufficiEncy fractuRe augmenTation) randomised controlled, feasibility in older people trial: a study protocol
Authors: van Berkel Dawn , Ong Terence , Drummond Avril , Hendrick Paul , Leighton Paul , Jones Matthew , Salem Khalid , Quraishi Nasir , Brookes Cassandra , Suazo Di Paola Ana , Edwards Sarah , Sahota Opinder 
Published: July 2019

IntroductionPelvic fragility fractures (PFF) are common in older people and associated with a significant burden of mortality and morbidity. This is related to the challenges of appropriate pain control and early mobilisation. The current standard for treatment of PFF is non-surgical management. Minimally invasive surgical techniques for sacral fracture stabilisation have been shown to improve outcomes in terms of pain control and mobility, and they are safe. Randomised controlled trials are required before recommendations can be made for surgical management of PFF to become the new standard of care. This feasibility study will explore several uncertainties around conducting such a trial.Methods and analysisASSERT (Acute Sacral inSufficiEncy fractuRe augmenTation) is a single-site randomised controlled, parallel-arm, feasibility trial of surgical stabilisation versus non-surgical management of acute sacral fragility fractures in people aged 70 years and over. Patients will be randomised to either surgical or non-surgical group on a 1:1 ratio. Follow-up of participants will occur at 2, 4 and 12 weeks with safety data collected at 52 weeks. Primary objectives are to determine feasibility and design of a future trial, including outcomes on recruitment, adherence to randomisation and safety. This will be supplemented with a qualitative interview study of participants and clinicians. Secondary objectives will inform study design procedures to determine clinical and economic outcomes between groups, including scored questionnaires, analgesia requirements, resource use and quality of life data. Data analysis will be largely descriptive to inform outcomes and future sample size.Ethics and disseminationEthical approval was granted by the North East Newcastle and North Tyneside 2 Research Ethics Committee (reference 18/NE/0212). ASSERT was approved and sponsored by Nottingham University Hospitals NHS Trust (reference 18HC001) and the Health Research Authority (reference IRAS 232791). Recruitment is ongoing. Results will be presented at relevant conferences and submitted to appropriate journals on study completion.Trial registration numberISRCTN16719542; Pre-results.
Factors associated with oesophagogastric cancers missed by gastroscopy: a case–control study
Authors: Tai Foong Way David , Wray Nicholas , Sidhu Reena , Hopper Andrew , McAlindon Mark 
Published: July 2019

IntroductionThere is increasing demand for gastroscopy in the United Kingdom. In around 10% of patients, gastroscopy is presumed to have missed oesophagogastric (OG) cancer prior to diagnosis. We examine patient, endoscopist and service level factors that may affect rates of missed OG cancers.MethodsGastroscopies presumed to have missed OG cancers performed up to 3 years prior to diagnosis were identified over 6 years in Sheffield, UK. Factors related to the patient, endoscopist and endoscopy lists were examined in a case–control study. Procedures which missed cancer were compared with two procedure controls: the procedures which subsequently diagnosed cancer in the same patient, and second, endoscopist matched procedures diagnostic of small benign focal lesions.ResultsWe identified 48 (7.7%) cases of missed OG cancer. Endoscopy lists on which OG cancer diagnoses were missed contained a greater number of total procedures compared with lists on which diagnoses were subsequently made (OR 1.42 95% CI 1.13 to 1.78) and when compared with lists during which matched endoscopists diagnosed benign small focal lesions (OR 1.25, 95% CI 1.02 to 1.52). The use of sedation, endoscopist profession and experience, or time of procedure were not associated with a missed cancer.Conclusion7.7% of patients diagnosed with OG cancer could have been diagnosed and treated earlier. Our study suggests that endoscopy lists with greater numbers of procedures may be associated with missed OG cancers. The use of sedation, endoscopist background or time of procedure did not increase the risk of missed cancer procedures.
Effectiveness of vedolizumab dose intensification to achieve inflammatory bowel disease control in cases of suboptimal response
Authors: Samaan Mark A , Birdi Siddharth , Morales Maria Sierra , Honap Sailish , Tamilarasan Aravind Gokul , Cunningham Georgina , Koumoutsos Ioannis , Ray Shuvra , Mawdsley Joel , Anderson Simon H C , Sanderson Jeremy , Irving Peter M 
Published: July 2019

BackgroundDespite the proven efficacy of vedolizumab (VDZ) for ulcerative colitis (UC) and Crohn’s disease (CD), suboptimal response is commonly encountered. However, data regarding the effectiveness of dose intensification (by interval shortening) to achieve response are limited.ObjectivesWe evaluated the effectiveness of dose intensification at achieving response in patients with a previously suboptimal response to VDZ. Additionally, we aimed to identify predictors of response to this strategy.MethodsWe performed a retrospective cohort study of patients who underwent VDZ dose intensification for suboptimal response. Clinical disease activity was evaluated at the point of dose intensification (baseline) and at weeks 12 and 24. Response was defined as Harvey-Bradshaw Index (HBI) or Simple Clinical Colitis Activity Index (SCCAI) reduction of ≥3, and remission as HBI <5 or SCCAI <3.ResultsA total of 36 patients received dose intensification to 4-weekly infusions: 18 CD, 14 UC and 4 inflammatory bowel disease-unclassified (analysed in the UC group). Median SCCAI scores fell from 6 (range 0–11) at baseline to 4 (0–6, p=0.008) at week 24, while HBI scores did not change significantly (4 (0–27) and 3 (0–8), p=0.092). Overall median C reactive protein (CRP) fell from 6 mg/L (1–23) to 2 mg/L (1–17, p=0.011). Of 20 patients with clinically active disease at baseline, 10 (50%) responded, of whom 4 (20%) achieved remission at week 24. Univariate analysis demonstrated low baseline CRP (p=0.045) and response at week 12 (0.020) were associated with week 24 response.ConclusionsOur findings demonstrate VDZ dose intensification to be effective at achieving clinical response in half of patients. Low baseline CRP and response at week 12 are potential predictors of week 24 response.
Racial and economic disparities in the access to treatment of unruptured intracranial aneurysms are persistent problems
Authors: Rinaldo Lorenzo , Rabinstein Alejandro A , Cloft Harry J , Knudsen John M , Lanzino Giuseppe , Rangel Castilla Leonardo , Brinjikji Waleed 
Published: July 2019

Background and purposePrevious studies have documented disparate access to cerebrovascular neurosurgery for patients of different racial and socioeconomic backgrounds. We further investigated the effect of race and insurance status on access to treatment of unruptured intracranial aneurysms (UIAs) and compared it with data on patients with aneurysmal subarachnoid hemorrhage (aSAH).MethodsThrough the use of a national database, admissions for clipping or coiling of an UIA and for aSAH were identified. Demographic characteristics of patients were characterized according to age, sex, race/ethnicity, and insurance status, and comparisons between patients admitted for treatment of an UIA versus aSAH were performed.ResultsThere were 10 545 admissions for clipping or coiling of an UIA and 33 166 admissions for aSAH between October 2014 and July 2018. White/non-Hispanic patients made up a greater proportion of patients presenting for treatment of an UIA than those presenting with aSAH (64.3% vs 48.2%; P<0.001), whereas black/Hispanic patients presented more frequently with aSAH than for treatment of an UIA (29.3% vs 26.1%; P=0.006). On multivariate linear regression analysis, the proportion of patients admitted for management of an UIA relative to those admitted for aSAH increased with the proportion of patients who were women (P<0.001) and decreased with the proportion of patients with a black/Hispanic background (P=0.010) and those insured with Medicaid or without insurance (P=0.003).ConclusionFor patients with UIAs, racial, ethnic, and socioeconomic backgrounds appear to continue to influence access to treatment.
Contrasting effects of corn straw biochar on soil water infiltration and retention at tilled and compacted bulk densities in the Yellow River Delta
Authors: Sun Junna , Yang Runya , Zhu Jinjin , Zhou Cuixiang , Yang Mao , Pan Yinghua , Zhang Zhenhua 
Published: July 2019

During field application of biochar, the bulk density of tilled soil initially decreases and then increases over time, until reaching the initial level of compacted soil. This study evaluated the optimal biochar particle size for promotion of water infiltration and retention in a saline soil with various bulk densities after application. Corn straw biochar, pyrolyzed at 450 °C for 0.5 h, was prepared in different particle sizes (S1 ≤ 0.25 mm, S2 = 0.25–1 mm, and S3 = 1–2 mm) and separately mixed into the 0–30 cm soil layer at two rates (R1 = 10 g kg−1 and R2 = 100 g kg−1), with tilled (D1 = 1.1–1.43 g cm−3) and compacted (D2 = 1.45 g cm−3) bulk densities. Five models were applied to simulate water infiltration into biochar-amended soils. Compared with the non-biochar control, the S1 treatment increased cumulative water infiltration by 41% (bulk density = 1.26 g cm−3) to 11% (bulk density = 1.45 g cm−3). However, the effect of the S3 treatment on cumulative water infiltration shifted from positive (+19.3%) to negative (–22.4%) with increasing bulk density. The S2 treatment resulted in the highest water retention at the tilled bulk density, whereas a significant increase (12.7%) in water retention was observed in the S1 treatment at the compacted bulk density. The Kostiakov–Lewis, Kostiakov, and United States Department of Agriculture – Natural Resources Conservation Service models performed better than the Philip and Horton models to describe the relationship between cumulative water infiltration and infiltration time, except for the D2R2S1 treatment. This study provides evidence for amelioration of saline soil by straw biochar in the Yellow River Delta.
Rapid radiochemical filter paper assay for determination of hexokinase activity and affinity for glucose-6-phosphate
Authors: Hingst Janne R. , Bjerre Rie D. , Wojtaszewski Jørgen F. P. , Jensen Jørgen 
Published: July 2019

Glucose phosphorylation by hexokinase (HK) is a rate-limiting step in glucose metabolism. Regulation of HK includes feedback inhibition by its product glucose-6-phosphate (G6P) and mitochondria binding. HK affinity for G6P is difficult to measure because its natural product (G6P) inhibits enzyme activity. HK phosphorylates several hexoses, and we have taken advantage of the fact that 2-deoxyglucose (2-DG)-6-phosphate does not inhibit HK activity. By this, we have developed a new method for rapid radiochemical analysis of HK activity with 2-DG as a substrate, which allows control of the concentrations of G6P to investigate HK affinity for inhibition by G6P. We verified that 2-DG serves as a substrate for the HK reaction with linear time and concentration dependency as well as expected maximal velocity and KM. This is the first simple assay that evaluates feedback inhibition of HK by its product G6P and provides a unique technique for future research evaluating the regulation of glucose phosphorylation under various physiological conditions.NEW & NOTEWORTHY Traditionally, hexokinase activity has been analyzed spectrophotometrically in which the product formation of glucose-6-phosphate (G6P) is analyzed by an indirect reaction coupled to NADPH formation during conversion of G6P to 6-P gluconolactone. By nature, this assay prevents measurements of hexokinase (HK) affinity for inhibition by G6P. We have developed a rapid radiochemical filter paper assay to study HK affinity for G6P by use of radiolabeled 2-deoxyglucose as substrate to study physiological regulation of HK affinity for G6P-induced inhibition.