bluuebunny/crossref_metadata_2025_split huggingface dataset:
Therapist-guided and parent-guided internet-delivered behaviour therapy for paediatric Tourette’s disorder: a pilot randomised controlled trial with long-term follow-up
Authors: Andrén Per , Aspvall Kristina , Fernández de la Cruz Lorena , Wiktor Paulina , Romano Sofia , Andersson Erik , Murphy Tara , Isomura Kayoko , Serlachius Eva , Mataix-Cols David 
Published: February 2019

ObjectiveBehaviour therapy (BT) for Tourette’s disorder (TD) and persistent (chronic) motor or vocal tic disorder (PTD) is rarely available. We evaluated the feasibility of adapting two existing BT protocols for TD/PTD (habit reversal training (HRT) and exposure and response prevention (ERP)) into a therapist-guided and parent-guided online self-help format.DesignA pilot, single-blind, parallel group randomised controlled trial.SettingA specialist outpatient clinic in Sweden.ParticipantsTwenty-three young people with TD/PTD, aged 8–16.InterventionsTwo 10-week therapist-guided and parent-guided internet-delivered programmes (called BIP TIC HRT and BIP TIC ERP).OutcomeThe primary outcome measure was the Yale Global Tic Severity Scale. Blinded evaluators rated symptoms at baseline, post-treatment and 3-month follow-up (primary endpoint). All participants were naturalistically followed up to 12 months after treatment.ResultsPatients and parents rated the interventions as highly acceptable, credible and satisfactory. While both interventions resulted in reduced tic-related impairment, parent-rated tic severity and improved quality of life, only BIP TIC ERP resulted in a significant improvement on the primary outcome measure. Within-group effect sizes and responder rates were, respectively:d=1.12 and 75% for BIP TIC ERP, andd=0.50 and 55% for BIP TIC HRT. The therapeutic gains were maintained up to 12 months after the end of the treatment. Adverse events were rare in both groups. The average therapist support time was around 25 min per participant per week.ConclusionsInternet-delivered BT has the potential to greatly increase access to evidence-based treatment for young people with TD/PTD. Further evaluation of the efficacy and cost-effectiveness of this treatment modality is warranted.Trial registration numberNCT02864589; Pre-results.
Burden of non-accidental mortality attributable to ambient temperatures: a time series study in a high plateau area of southwest China
Authors: Deng Changyu , Ding Zan , Li Liujiu , Wang Yanfang , Guo Pi , Yang Shaoyi , Liu Ju , Wang Yue , Zhang Qingying 
Published: February 2019

ObjectiveTo examine the total non-accidental mortality burden attributable to ambient temperatures and assess the effect modification of the burden by specific causes of death and individual characteristics in a high plateau area in southwest China.MethodsUsing daily mortality and meteorological data from 2009 to 2016, we applied a quasi-Poisson model combined with a distributed lag non-linear model to estimate the temperature–mortality association with the assessment of attributable fraction and number. We calculated attributable fractions and deaths with 95% empirical CIs (eCIs), that were due to cold and heat, defined as temperatures below and above the median temperature, and for mild and extreme temperatures, defined by cut-offs at the 2.5th and 97.5th temperature percentiles.ResultsWe analysed 89 467 non-accidental deaths; 4131 were attributable to overall temperatures, with an attributable fraction of 4.75% (95% eCI 2.33% to 6.79%). Most of the mortality burden was caused by cold (4.08%; 0.86% to 7.12%), whereas the burden due to heat was low and non-significant (0.67%; −2.44% to 3.64%). Extreme cold (1.17%; 0.58% to 1.69%) was responsible for 24.6% (ie, 1.17% divided by 4.75%) of the total death burden. In the stratification analyses, attributable risk due to cold was higher for cardiovascular than respiratory disease (6.18% vs 3.50%). We found a trend of risk of increased death due to ambient temperatures with increasing age, with attributable fractions of 1.83%, 2.27% and 6.87% for age ≤64, 65–74 and ≥75 years old, respectively. The cold-related burden was slightly greater for females, farmers, ethnic minorities and non-married individuals than their corresponding categories.ConclusionsMost of the burden of death was attributable to cold, and specific causes and individual characteristics might modify the mortality burden attributable to ambient temperatures. The results may help make preventive measures to confront climate change for susceptible population in this region.
Breastfeeding and behavioural problems: Propensity score matching with a national cohort of infants in Chile
Authors: Girard Lisa-Christine , Farkas Chamarrita 
Published: February 2019

ImportancePotential effects of breast feeding on children’s behaviour remains an elusive debate given inherent methodological challenges. Propensity score matching affords benefits by ensuring greater equivalence on observable social and health determinants, helping to reduce bias between groups.ObjectivesWe examined whether the duration of breast feeding had an impact on children’s externalising and internalising behaviours.Study designA cohort study (Encuesta Longitudinal de la Primera Infancia cohort) that included 3037 Chilean families who were enrolled in 2010. Follow-up data was collected in 2012.SettingGeneral community.ParticipantsPopulation-based sample. Eligibility criteria: children born full-term with complete data on matching variables. Matching variables included: healthcare system as a proxy of income, presence of a partner/spouse in the household, maternal age, educational level, IQ, working status, type of work, diagnosis of prenatal depression by a healthcare professional, smoking during pregnancy, delivery type, child sex, weight at birth, incubation following delivery, and child age.ExposureDuration of breast feeding.Main outcomes and measuresExternalising and internalising problems assessed using the Child Behaviour Checklist.ResultsMatched results revealed benefits of any breast feeding, up to 6 months, on emotional reactivity and somatic complaints (mean difference of −1.00, 95% CI, −1.84 to −0.16 and −1.02, 95% CI, −1.76 to −0.28, respectively). Children breast fed between 7 and 12 months also had reduced scores on emotional reactivity, in addition to attention problems (mean difference of −0.86, 95% CI, −1.66 to −0.06 and −0.50, 95% CI, −0.93 to −0.07, respectively). No benefits were observed for children breast fed 13 months or more.ConclusionReduced internalising difficulties and inattention were found in children breast fed up to a year, suggesting that breast feeding may have beneficial impacts on these areas of development. The magnitude of effect was modest. Extended durations of breast feeding did not appear to offer any benefits.
Medical management of acute upper respiratory infections in an urban primary care out-of-hours facility: cross-sectional study of patient presentations and expectations
Authors: O’Connor Raymond , O’Doherty Jane , O’Regan Andrew , O’Neill Aoife , McMahon Claire , Dunne Colum P 
Published: February 2019

ObjectivesThe purpose of this study was to examine the expectations of patients attending an urban primary care out-of-hours (OOH) facility with acute upper respiratory tract infection (acute URTI) regarding clinical examination, symptom management, information on their condition, reassurance, antibiotic treatment and other possible options including referral.DesignCross-sectional design.SettingOne urban primary care OOH facility located in the midwest of Ireland.Participants457 patients filled out a questionnaire while waiting in the OOH facility; 22 surveys were excluded as the patients did not present with symptoms of acute URTI resulting in 435 patients’ data being included in this study. There were 59.5% female participants and 40.5% male participants.Results435 patients with acute URTI symptoms participated in the survey, representing 25.4% of those attending the single branch where the survey was conducted (n=1715). Of the study participants, 43% were aged under 6 years and 60% were women. The most common presenting symptoms were cough (72%), throat ache (46%) and common cold (26%). The most common expectations were for further examination (53%), reassurance (51%), information (49%) and medication for cough (47%), with 34% expecting an antibiotic.ConclusionsOnly one in three patients attending this primary care OOH facility with acute URTI symptoms had an expectation of antibiotics, with most seeking further assessment, information and reassurance. Recognition of such expectations may be important considerations for clinicians when deciding on management options for patients with acute URTI.
Trends in resource use and effectiveness of ultrasound detection of fetal structural anomalies in France: a multiple registry-based study
Authors: Ferrier Clément , Dhombres Ferdinand , Khoshnood Babak , Randrianaivo Hanitra , Perthus Isabelle , Guilbaut Lucie , Durand-Zaleski Isabelle , Jouannic Jean-Marie 
Published: February 2019

ObjectiveTo analyse trends in the number of ultrasound examinations in relation to the effectiveness of prenatal detection of birth defects using population-based data in France.DesignA multiple registry-based study of time trends in resource use (number of ultrasounds) and effectiveness (proportion of cases prenatally diagnosed).SettingThree registries of congenital anomalies and claims data on ultrasounds for all pregnant women in France.ParticipantsThere were two samples of pregnant women. Effectiveness was assessed using data from three French birth defect registries. Resource use for ultrasound screening was based on the French national healthcare database.Main outcome measuresThe main outcome measures were prenatal diagnosis (effectiveness) and the average number of ultrasounds (resource use). Statistical analyses included linear and logistic regression models to assess trends in resource use and effectiveness of prenatal testing, respectively.ResultsThe average number of ultrasound examinations per pregnancy significantly increased over the study period, from 2.47 in 2006 to 2.98 in 2014 (p=0.005). However, there was no significant increase in the odds of prenatal diagnosis. The probability of prenatal diagnosis was substantially higher for cases associated with a chromosomal anomaly (91.2%) than those without (51.8%). However, there was no evidence of an increase in prenatal detection of either over time.ConclusionsThe average number of ultrasound examinations per pregnancy increased over time, whereas the probability of prenatal diagnosis of congenital anomalies did not. Hence, there is a need to implement policies such as high-quality training programmes which can improve the efficiency of ultrasound examinations for prenatal detection of congenital anomalies.
Paramedics’ experiences of administering fascia iliaca compartment block to patients in South Wales with suspected hip fracture at the scene of injury: results of focus groups
Authors: Evans Bridie Angela , Brown Alan , Bulger Jenna , Fegan Greg , Ford Simon , Guy Katy , Jones SIan , Keen Leigh , Khanom Ashrafunnesa , Longo Mirella , Pallister Ian , Rees Nigel , Russell Ian T , Seagrove Anne C , Watkins Alan , Snooks Helen 
Published: February 2019

ObjectivesTo explore paramedics’ experience of delivering fascia iliaca compartment block(FICB) to patients with suspected hip fracture at the scene of injury.DesignFocus groups within a randomised controlled trial.SettingParamedics based at ambulance stations in the catchment area of one Emergency Department in South Wales, recruited and trained in a feasibility study about an alternative to routine prehospital pain management for patients with suspected hip fracture.Participants11 paramedics.InterventionParamedic-administered FICB to patients with suspected hip fracture. We randomly allocated eligible patients to FICB, a local anaesthetic injection directly into the hip region—or usual care, most commonly morphine - using audited scratch cards.OutcomesParamedics’ experiences of administering FICB gathered through thematic analysis of interview transcripts by two researchers, one paramedic and one lay member.ResultsRespondents believed that FICB was a suitable intervention for paramedics to deliver. It aligned with routine practice and was within people’s capabilities. They said it took up to 10 minutes longer than usual care to prepare and deliver, in part due to nervousness and unfamiliarity with a new procedure. They praised the training provided but said they were anxious about causing harm by injecting into the wrong location. Confidence increased after one paramedic team successfully treated a patient for local anaesthetic toxicity. Reported challenges related to the emergency context: patients often waited many hours for ambulance arrival; moving patients exacerbated their pain; family and neighbours were present as paramedics administered treatment.ConclusionsParamedics are willing and able to administer FICB to patients with suspected hip fracture before ambulance transport to hospital. Feasibility study findings will inform further research.Trial registration numberISRCTN60065373; Pre results.
VaccHemInf project: protocol for a prospective cohort study of efficacy, safety and characterisation of immune functional response to vaccinations in haematopoietic stem cell transplant recipients
Authors: Conrad Anne , Boccard Mathilde , Valour Florent , Alcazer Vincent , Tovar Sanchez Aydee-Tamara , Chidiac Christian , Laurent Frédéric , Vanhems Philippe , Salles Gilles , Brengel-Pesce Karen , Meunier Boris , Trouillet-Assant Sophie , Ader Florence 
Published: February 2019

IntroductionImmune reconstitution after haematopoietic stem cell transplantation (HSCT) is a complex and dynamic process, varying from a state of nearly complete immunosuppression to an expected full immune recovery. Specific vaccination guidelines recommend reimmunisation after HSCT but data regarding vaccine efficacy in this unique population are scarce. New immune functional assays could enable prediction of vaccine response in the setting of HSCT.Methods and analysisA prospective, longitudinal single-centre cohort study of autologous and allogeneic HSCT recipients was designed in order to determine the vaccine response to five vaccine targets (pneumococcus, hepatitis B virus,Haemophilus Influenzaetype b, tetanus and diphtheria) and to correlate it to immune function parameters. A workflow was set up to study serological response to vaccines and to describe the functional immune status of 100 HSCT recipients (50 autologous and 50 allogeneic) before and 3, 12 and 24 months after primary immunisation. At each time point, ‘basic’ immune status recording (serology, immunophenotyping of lymphocyte subsets by flow cytometry) will be assessed. The immune response will furthermore be evaluated before and 3 months after primary vaccination by two ex vivo immune functional assays assessing: (1) tumour necrosis factor alpha, interferon gamma production and host messenger RNA expression on whole-blood stimulation by lipopolysaccharide orStaphylococcus aureusenterotoxin B and (2) T-lymphocyte proliferation in response to a standard mitogen (phytohaemagglutinin) or to selected recall antigens. Reference intervals will be determined from a cohort of 30 healthy volunteers. This translational study will provide data describing vaccine response, immune functionality of HSCT recipients over time and will allow mapping HSCT recipients with regard to their immune function.Ethics and disseminationEthical approval has been obtained from the institutional review board (no 69HCL17_0769). Results will be communicated at scientific meetings and submitted for publication in peer-reviewed journals.Trial registration numberNCT03659773; Pre-results.
Novel use of tranexamic acid to reduce the need for Nasal Packing in Epistaxis (NoPac) randomised controlled trial: research protocol
Authors: Reuben Adam , Appelboam Andrew , Barton Andy , Vickery Patricia Jane , Body Richard , Hilton Malcolm , Coppell Jason , Ewings Paul 
Published: February 2019

IntroductionPatients presenting to emergency departments (EDs) with epistaxis uncontrolled by subsequent simple first aid measures or application of topical vasoconstrictors will typically undergo anterior nasal packing. Packing is effective, but can be extremely painful and unpleasant and patients usually need hospital admission. Tranexamic acid (TXA) is a cheap, safe, readily available antifibrinolytic agent known to be beneficial in a variety of clinical settings where uncontrolled bleeding may be a problem. Anecdotal evidence suggests that topical TXA may be of value in persistent epistaxis; however, further evaluation is required.Methods and analysisThis is a multicentre, double-blind, parallel group, randomised, controlled trial comparing the use of topical intranasal TXA with indistinguishable placebo in adults presenting to UK EDs with persistent atraumatic epistaxis. Follow-up is at 1 week by structured telephone review. The primary outcome measure is the subsequent need for anterior nasal packing in the ED. Key secondary outcomes include the need for hospital admission, blood transfusion and/or further treatment for epistaxis during the index ED attendance. Recruiting 450 patients will provide 90% power to demonstrate an absolute reduction in packing rate from 95% to 85%. An improvement of this magnitude would be of significant benefit to patients and healthcare providers and justify a change to standard practice. Given the low cost of TXA and its short administration time, a full economic evaluation is not being undertaken.Ethics and disseminationThe study has been approved by the South West—Bristol Research Ethics Committee (reference 17/SW/0010). We aim to publish the findings in a high impact, international peer-reviewed journal. Results will also be shared with the Hereditary Haemorrhagic Telangiectasia foundation and telangiectasia UK for dissemination through appropriate related forums.Trial registration numberISRCTN34153772and EudraCT No: 2016-001530-10.
Dispersive viscosurgical devices demonstrate greater efficacy in protecting corneal endothelium in vitro
Authors: Yildirim Timur Mert , Auffarth Gerd U , Son Hyeck-Soo , Khoramnia Ramin , Munro Donald John , Merz Patrick R 
Published: February 2019

ObjectiveDuring phacoemulsification, the corneal endothelium is protected by an ophthalmic viscosurgical device (OVD). In this in vitro study, we assessed six different OVDs for their effectiveness in protecting the corneal endothelium.Methods and analysisPhacoemulsification was performed in cadaver eyes of young pigs. Five syringe units of six different OVDs were tested (Healon EndoCoat, Viscoat, Methylvisc, Healon, Healon GV, ProVisc). After surgery, the area of endothelium coated with OVD was determined in relation to the total endothelial surface. Additionally, an endothelial cell count was obtained. As a control, an endothelial cell count was obtained from freshly trephined corneas. Statistical analysis was performed using the Mann-Whitney U test and the Spearman correlation.ResultsThe least postoperative endothelial coating and cell count were observed in the cohesive OVDs while the dispersive OVDs showed statistically significant higher values. Healon EndoCoat and Viscoat yielded a coating area of 86 (85–92)% and 85 (85-90)%, respectively. Endothelial cell count was highest in the two dispersive groups with 4065 (3928–4088) cells/mm2(Methylvisc) and 4032 (4015–4115) cells/mm2(Viscoat). Endothelial coating area and endothelial cell count correlated statistically significantly.ConclusionDispersive OVDs from this study showed greater adherence to the endothelial surface than the cohesive ones. Furthermore, postoperative endothelial cell counts of corneas treated with dispersive OVDs were higher than of corneas treated with cohesive OVDs. Our in vitro results suggest that dispersive OVDs protect the corneal endothelium better during phacoemulsification than cohesive OVDs.
Bandage contact lens and topical steroids are risk factors for the development of microbial keratitis after epithelium-off CXL
Authors: Tzamalis Argyrios , Romano Vito , Cheeseman Robert , Vinciguerra Riccardo , Batterbury Mark , Willoughby Colin , Neal Timothy , Ahmad Sajjad , Kaye Stephen 
Published: February 2019

ObjectiveTo investigate the role of bandage contact lenses (BCL) and topical steroids as risk factors for the development of microbial keratitis after epithelium-off corneal collagen cross-linking (CXL).Methods and AnalysisPatients undergoing CXL between February 2011 and July 2017 were included. Patients were divided into two groups: those who were treated postoperatively with a BCL, topical antimicrobial and steroids (group 1) and those who received only a topical antimicrobial until healing of the epithelial defect before introduction of topical steroids (group 2).Results1273 eyes of 964 patients were included. Group 1 comprised 316 eyes and group 2 comprised 957 eyes. There were no significant differences in the presence of persisting corneal haze or scarring between the two groups (p=0.57). Microbial keratitis occurred in nine eyes (0.71% of eyes) of eight (0.83%) patients (one case was bilateral) out of 1273 eyes.Staphylococcus aureuswas cultured from corneal scrapes in seven out of nine (77.8%) cases and from contiguous sites in the two cases. All cases occurred in group 1 (incidence=2.85%) and none in group 2 (p<0.0001). A greater proportion of patients who developed microbial keratitis were atopic (75%, p=0.4).ConclusionThe use of BCL and topical steroids prior to healing of the epithelium is a significant risk factor for microbial keratitis.S. aureusis the most common micro-organism and is likely to originate from an endogenous site. Not using a BCL and delaying the introduction of topical steroids until epithelial healing significantly reduce the risk of developing microbial keratitis without increasing the risk of persistent corneal haze.