bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sleep duration and apolipoprotein B in metabolically healthy and unhealthy overweight/obese phenotypes: a cross-sectional study in Chinese adults
Authors: Ren Huihui , Zhang Lu , Liu Zhelong , Zhou Xinrong , Yuan Gang 
Published: February 2019

ObjectivesShort sleep duration is independently associated with an increased risk of developing cardiovascular disease; however, the association has not yet been examined in obese populations. We assessed the associations between sleep duration, metabolic phenotype and apolipoprotein variables in a nationally representative Chinese population with overweight/obesity.Study designCross-sectional study.SettingsThe study conducted in nine provinces of China that vary substantially in geography and economic development.PatientsData were obtained from 4149 adults with overweight/obesity aged 18 to 94 years from the 2009 China Health and Nutrition Survey. Sleep duration was categorised as ≤6, 7–8 or ≥9 hour. Phenotypes were determined based on body mass index and metabolic health status and categorised as metabolically healthy overweight/obesity (MHOO) and metabolically unhealthy overweight/obesity (MUOO).Main outcome measureThe outcome variables were elevated apolipoproteins.ResultsCompared with MHOO phenotype, MUOO phenotypes were more likely to report shorter sleep duration (12.2%vs9%). In the MUOO group, the multivariate-adjusted OR (95% CI) for elevated apolipoprotein B (apoB) was 1.66 (1.23 to 2.23) for those with ≤6 hours of sleep and 1.12 (0.86 to 1.45) for those with ≥9 hours of sleep, using 7–8 hours of sleep as a reference. Similar results were obtained in the subgroup of subjects who were ≥45 or<45 years old, but shorter sleep duration was more strongly associated with elevated apoB in those <45 years (p interaction=0.023). However, no association was observed in the MHOO phenotype.ConclusionsThe high prevalence of short sleep duration and its strong association with elevated apoB in adults who are metabolically unhealthy overweight/obese suggest an increased risk of cardiovascular disease in this population. The differences in sleep sufficiency among obese phenotypes may account for the disparities in their cardiovascular outcomes.
Identifying priorities for cancer caregiver interventions: protocol for a three-round modified Delphi study
Authors: Blaschke Sarah-May , Lambert Sylvie D , Livingston Patricia M , Aranda Sanchia , Boltong Anna , Schofield Penelope , Chambers Suzanne K , Krishnasamy Meinir , Ugalde Anna 
Published: February 2019

IntroductionCancer is often considered a chronic disease, and most people with cancer have a caregiver, often a family member or friend who provides a significant amount of care during the illness trajectory. Caregivers are frequently in need of support, and a range of interventions have been trialled to improve outcomes. Consensus for optimal ways to support caregivers is not known. The aim of this protocol paper is to describe procedures for a modified Delphi study to explore expert consensus about important factors when developing caregiver interventions.Methods and analysisOnline modified Delphi methodology will be used to establish consensus for important caregiver intervention factors incorporating the Patient problem, Intervention, Comparison and Outcome framework. Round 1 will comprise a free-text questionnaire and invite the panel to contribute factors they deem important in the development and evaluation of caregiver interventions. Round 2 is designed to determine preliminary consensus of the importance of factors generated in round 1. The panel will be asked to rate each factor using a 4-point Likert-type scale. The option for panellists to state reasoning for their rating will be provided. Descriptive statistics (median scores and IQR) will be calculated to determine each item’s relative importance. Levels of consensus will be assessed based on a predefined consensus rating matrix. In round 3, factors will be recirculated including aggregate group responses (statistics and comment summaries) and panellists’ own round 2 scores. Panellists will be invited to reconsider their judgements and resubmit ratings using the same rating system as in round 2. This will result in priority lists based on the panel’s total rating scores.Ethics and disseminationEthics for this study has been gained from the Deakin University Human Ethics Advisory Group. It is anticipated that the results will be published in peer-reviewed journals and presented in a variety of forums.
Quantifying tobacco and alcohol imagery in Netflix and Amazon Prime instant video original programming accessed from the UK: a content analysis
Authors: Barker Alexander B , Smith Jordan , Hunter Abby , Britton John , Murray Rachael L 
Published: February 2019

ObjectivesExposure to tobacco and alcohol content in audio-visual media is a risk factor for smoking and alcohol use in young people. Previous UK research has quantified tobacco and alcohol content in films and broadcast television but not that of video-on-demand (VOD) services such as Netflix and Amazon Prime. Furthermore, it is not clear whether regulation by Dutch (Netflix) or UK (Amazon Prime) authorities results in differences in content. We report an analysis of tobacco and alcohol content in a sample of episodes from the most popular programmes from these two VOD providers, and compare findings with earlier studies of UK prime-time television content.SettingUK.ParticipantsNone. Content analysis of a sample of 50 episodes from the five highest rated series released on Netflix and Amazon Prime in 2016, using 1 min interval coding of any tobacco or alcohol content, actual or implied use, paraphernalia and branding.ResultsOf 2704 intervals coded, any tobacco content appeared in 353 (13%) from 37 (74%) episodes. Any alcohol content appeared in 363 (13%) intervals in 47 (94%) episodes. There were no significant differences between the two services, however the proportion of episodes containing tobacco and alcohol was significantly higher in VOD original programmes than those recorded in an earlier study of prime-time UK television.ConclusionsAudio-visual tobacco and alcohol content is common in VOD original programmes and represents a further source of exposure to imagery causing smoking uptake and alcohol use in young people. This appears to be equally true of services regulated in the UK and The Netherlands. Given that VOD services are consumed by a global audience, it appears likely that VOD content is an important global driver of tobacco and alcohol consumption.
Mapping of modifiable barriers and facilitators of medication adherence in bipolar disorder to the Theoretical Domains Framework: a systematic review protocol
Authors: Prajapati Asta Ratna , Dima Alexandra Lelia , Clark Allan B , Gant Claire , Gibbons Chris , Gorrod Richard , Mosa George , Scott Sion , Song Fujian , Teague Bonnie , Twigg Michael J , Wilson Jon , Bhattacharya Debi 
Published: February 2019

IntroductionPeople with bipolar disorder require long-term treatment but it is estimated that 40% of these people do not adhere to prescribed medication regimens. Non-adherence increases the risk of relapse, hospitalisation and suicide. Some evidence syntheses report barriers to mental health treatment adherence but rarely delineate between modifiable and non-modifiable barriers. They also fail to distinguish between the patients’ perspective and that of other stakeholders such as clinicians despite of their different understanding and priorities about adherence. Facilitators of adherence, which are also important for informing adherence intervention design, are also lacking from syntheses and few syntheses focus on medications for bipolar disorder.This systematic review aims to identify modifiable barriers and facilitators (determinants) of medication adherence in bipolar disorder. We also plan to report determinants of medication adherence from perspectives of patients, carers, healthcare professionals and other third parties. A unique feature of this systematic review in the context of mental health is the use of the Theoretical Domains Framework (TDF) to organise the literature identified determinants of medication adherence.Methods and analysisThe protocol adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and ENhancing Transparency in REporting the synthesis of Qualitative research (ENTREQ) guidelines. This review will include both qualitative and quantitative primary studies exploring determinants of medication adherence in bipolar disorder. We will search the following databases using a preplanned strategy: CINAHL, Cochrane Library (CENTRAL), Embase, LiLACS, Medline, PsychINFO, PubMed without date restrictions. We will report the quality of included studies. We will use framework synthesis using the TDF as an a priori ‘framework’. We will map the literature identified modifiable determinants to the domains of TDF.Ethics and disseminationEthical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication.PROSPERO registration numberCRD42018096306.
Pneumomediastinum in marijuana users: a retrospective review of 14 cases
Authors: Weiss Zoe Freeman , Gore Sara , Foderaro Andrew 
Published: February 2019

IntroductionInhaled marijuana has been infrequently identified as a potential risk factor for the development of spontaneous pneumomediastinum (SPM), a rare finding of free air in the mediastinum likely caused by barotrauma during breathing manoeuvres. The mechanism of inhalation drug use is often not ascertained by physicians, thus little is known about how different smoking techniques precipitate pulmonary injury. We aimed to evaluate the frequency of marijuana use in patients with non-traumatic pneumomediastinum over a 12-month period, identifying additional relevant clinical features or risk factors, and determining the extent to which clinicians record smoking techniques.MethodsWe performed a retrospective chart review over a 1-year period, identifying patients presenting to the hospital with a diagnosis of pneumomediastinum in the absence of trauma, malignancy or iatrogenic cause.ResultsWe identified 21 cases, 14 of which (66.7%) were associated with marijuana use, average age was 22.5 years (range 18–30), with male predominance (64.2%). Daily or more use was reported in 50% of cases. Concurrent risk factors including vomiting (57.1%) and coughing (42.9%) were commonly present. The mechanism of smoking was described in only two cases (14.3%).DiscussionInhaled marijuana may be an underappreciated risk factor for the development of SPM, caused by air leakage around the bronchovascular sheaths during successive inhalation through a high-resistance smoking apparatus or forced exhalation against a closed glottis. Physicians should be aware of this association in order to provide appropriate counselling. Further research is needed to direct the safe use of smoking devices and techniques.
Feasibility of Safe-Tea: a parent-targeted intervention to prevent hot drink scalds in preschool children
Authors: Bennett C Verity , Hollén Linda , Quinn-Scoggins Harriet Dorothy , Emond Alan , Kemp Alison Mary 
Published: February 2019

ObjectiveDespite the high prevalence of preventable hot drink scalds in preschool children, there is a paucity of research on effective prevention interventions and a serious need to improve parents’ knowledge of first aid. This study investigates the feasibility of ‘Safe-Tea’, an innovative multifaceted community-based intervention delivered by early-years practitioners.Methods‘Safe-Tea’ was implemented at Childcare, Stay&Play and Home Visit settings in areas of deprivation in Cardiff, UK. A mixed-methods approach was used, including preintervention and postintervention parent questionnaires and focus groups with parents and practitioners to test the acceptability, practicality and ability of staff to deliver the intervention, and parents’ knowledge and understanding.ResultsIntervention materials, activities and messages were well received and understood by both parents and community practitioners. Interactive and visual methods of communication requiring little to no reading were most acceptable. Parents’ understanding of the risk of hot drink scalds in preschool children and knowledge of appropriate first aid improved postintervention. Parents knew at baseline that they ‘should’ keep hot drinks out of reach. Focus group discussions after intervention revealed improved understanding of likelihood and severity of scald injury to children, which increased vigilance. Parents gained confidence to correct the behaviours of others at home and pass on first aid messages.ConclusionThis feasibility study is a vital step towards the development of a robust, evidence-based behaviour change intervention model. Work is underway to refine intervention materials based on improvements suggested by parents, and test these more widely in communities across the UK.
Accuracy of renal tumour biopsy for the diagnosis and subtyping of papillary renal cell carcinoma: analysis of paired biopsy and nephrectomy specimens with focus on discordant cases
Authors: Prendeville Susan , Richard Patrick O , Jewett Michael A S , Kachura John R , Sweet Joan M , van der Kwast Theodorus H , Cheung Carol C , Finelli Antonio , Evans Andrew John 
Published: February 2019

AimsRenal tumour biopsy (RTB) is increasingly recognised as a useful diagnostic tool in the management of small renal masses, particularly those that are incidentally found. Intratumoural heterogeneity with respect to morphology, grade and molecular features represents a frequently identified limitation to the use of RTB. While previous studies have evaluated pathological correlation between RTB and nephrectomy, no studies to date have focused specifically on the role of RTB for the diagnosis of papillary renal cell carcinoma (PRCC) and its further subclassification into clinically relevant subtypes.MethodsThis single-institution study evaluated 60 cases of PRCC for concordance between RTB and nephrectomy with respect to diagnosis, grading and subtyping (type 1/type 2).ResultsWe observed 93% concordance (55 of 59 evaluable cases) between RTB and nephrectomy for the diagnosis of PRCC, although seven tumours (12%) were undergraded on RTB. Subtyping of PRCC on RTB was concordant with nephrectomy in 89% of cases reported as type 1 PRCC on RTB (31/35), but only 40% of cases reported as type 2 PRCC on RTB (4/10). Morphological misclassification of PRCC on RTB was most likely to occur in tumours showing a solid growth pattern. Discordant PRCC subtyping most often occurred in tumours with eosinophilia/oncocytic change.ConclusionThere was good concordance between RTB and nephrectomy for the primary diagnosis of PRCC. Although further subtyping of PRCC can aid therapeutic stratification, this can be challenging on RTB and tumours with overlapping or ambiguous features are best reported as PRCC not otherwise specified pending development of more robust methods to facilitate definitive subclassification.
Labour market marginalisation among refugees from different countries of birth: a prospective cohort study on refugees to Sweden
Authors: Helgesson Magnus , Wang Mo , Niederkrotenthaler Thomas , Saboonchi Fredrik , Mittendorfer-Rutz Ellenor 
Published: February 2019

BackgroundThe aim was to elucidate if the risk of labour market marginalisation (LMM), measured as long-term unemployment, long-term sickness absence, disability pension and a combined measure of these three measures, differed between refugees and non-refugee migrants with different regions of birth compared with native Swedes.MethodsAll non-pensioned individuals aged 19–60 years who were resident in Sweden on 31 December 2009 were included (n=4 441 813, whereof 216 930 refugees). HRs with 95% CIs were computed by Cox regression models with competing risks and time-dependent covariates with a follow-up period of 2010–2013.ResultsRefugees had in general a doubled risk (HR: 2.0, 95% CI 1.9 to 2.0) and non-refugee migrants had 70% increased risk (HR: 1.7, 95% CI 1.7 to 1.7) of the combined measure of LMM compared with native Swedes. Refugees from Somalia (HR: 2.7, 95% CI 2.6 to 2.8) and Syria (HR: 2.5, 95% CI 2.5 to 2.6) had especially high risk estimates of LMM, mostly due to high risk estimates of long-term unemployment (HR: 3.4, 95% CI 3.3 to 3.5 and HR: 3.2, 95% CI 3.1 to 3.2). African (HR: 0.7, 95% CI 0.6 to 0.7) and Asian (HR: 1.0, 95% CI 1.0 to 1.1) refugees had relatively low risk estimates of long-term sickness absence compared with other refugee groups. Refugees from Europe had the highest risk estimates of disability pension (HR: 1.9, 95% CI 1.8 to 2.0) compared with native Swedes.ConclusionRefugees had in general a higher risk of all measures of LMM compared with native Swedes. There were, however, large differences in risk estimates of LMM between subgroups of refugees and with regard to type of LMM. Actions addressing differences between subgroups of refugees is therefore crucial in order to ensure that refugees can obtain as well as retain a position on the labour market.
Shorter pulse width reduces gait disturbances following deep brain stimulation for essential tremor
Authors: Kroneberg Daniel , Ewert Siobhan , Meyer Anne-Christiane , Kühn Andrea A 
Published: February 2019

ObjectiveGait disturbances are frequent side effects occurring during chronic thalamic deep brain stimulation (DBS) in patients with essential tremor (ET). Adapting stimulation settings to shorter pulse widths has been shown to reduce side effects of subthalamic DBS. Here, we assess how a reduction of pulse width changes gait performance of affected patients.MethodsSensor-based gait assessment was performed to record spatiotemporal gait parameters in 10 healthy subjects (HS) and 7 patients with ET with gait disturbances following thalamic DBS. Patients were tested during standard DBS, after 72 hours of stimulation withdrawal and at least 30 days after adjusting DBS settings to a shorter pulse width of 40 µs (DBS40PW).ResultsPatients with ET on standard DBS showed significantly higher variability of several spatiotemporal gait parameters compared with HS. Variability of stride length and range of motion of the shanks significantly decreased OFF DBS as compared with standard DBS. This improvement was maintained over 30 days with DBS40PW while providing effective tremor suppression in six out of seven patients.ConclusionShorter pulse widths may reduce gait disturbances in patients with ET that are induced by DBS while preserving a level of tremor suppression equal to standard stimulation settings.
P31 Optimising trajectories in computer assisted planning for cranial laser interstitial thermal therapy: a machine learning approach
Authors: Li K , Vakharia VN , Sparks R , França LGS , McEvoy A , Miserocchi A , Ourselin S , Duncan J 
Published: February 2019

ObjectivesOptimal trajectory planning for cranial laser interstitial thermal therapy (cLITT) in drug resistant focal mesial temporal lobe epilepsy (MTLE).DesignA composite ablation score of ablated AHC minus ablated PHG volumes were calculated and normalised. Random forest and linear regression were implemented to predict composite ablation scores and determine the optimal entry and target point combinations to maximize this.SubjectsTen patients with hippocampal sclerosis were included.MethodsComputer Assisted Planning (CAP) cLITT trajectories were generated using entry regions that include the inferior occipital gyri (IOG), middle occipital gyri (MOG), inferior temporal gyri (ITG) and middle temporal gyri (MTG). Target points were varied by sequential erosions and transformations of the centroid of the amygdala. In total 760 trajectory combinations were generated per patient and ablation volumes were calculated based on a conservative 15 mm maximum ablation diameter.ResultsLinear regression was superior to random forest predictions. Linear regression indicated that maximal composite ablation scores were associated with entry points that clustered around the junction of the IOG, MOG and MTG. The optimal target point was a translation of the centroid of the amygdala anteriorly and medially.ConclusionsMachine learning techniques accurately predict composite ablation scores with linear regression outperforming the random forest approach. Optimal CAP entry points for cLITT maximize ablation of the AHC and spare the PHG.
P33 On lambs, DBS, and diathermy
Authors: Tipper G , Low H , Taqvi A , Singh A , Pohl U 
Published: February 2019

ObjectivesOver 1 50 000 patients have been treated with deep brain stimulation (DBS), but some aspects of their ongoing management are poorly defined. Guidelines for the use of electrocautery in patients undergoing further surgery are vague, suggesting the use of bipolar cautery only. However there is likely to be a safe limit for the use of monopolar electrocautery, a useful if not necessary adjunct for most surgeons. Establishing this would be valuable.DesignLiterature review, correspondence with equipment representatives, and animal cadaveric model.MethodsPubMed, the Cochrane Database, and Google Scholar were used for the literature review. Technical team advisers were approached for DBS systems and electrocautery devices. A commercially available freshly slaughtered lamb was prepared in a room with constant ambient temperature. A DBS system was implanted in tandem with a thermocouple at depths and distances matching patient practice. Monopolar electrocautery was employed in coagulation and cutting modes at set distances and levels with constant temperature recording. The implant site was examined microscopically post procedure.ResultsThe current ‘ban’ on monopolar use appears to be extrapolated from the use of medical diathermy, a very different modality. At no point did the implant site temperature rise more than 2.4°C. Microscopic analysis post procedure revealed no thermal damage.ConclusionsElectrocautery in the context of DBS is safer than previously thought.
P56 Virtual reality simulation in neurosurgical training: a single blinded randomised controlled trial & review of all available training models
Authors: Ansaripour A , Haddad AR , Maratos E , Zebian B 
Published: February 2019

ObjectivesVirtual reality (VR) simulators are one of the training models allowing the practice of surgical skills for trainees. We aim to assess the benefit of VR training in neurosurgery.DesignA single-blinded randomised controlled trial and a literature review.SubjectsTrainees (n=12), Fellows and Consultant Neurosurgeons (n=4) and Medical Students (n=6) with no experience of VR.MethodsParticipants were randomised according to their grades. Both groups completed microsurgical tasks and duration and quality of each task was recorded at the start and the endpoint of the study. Questionnaires were used to assess the participants’ confidence in microsurgical skills. The intervention group underwent structured training using a VR simulator (NeuroVR). The primary outcome measure was microsurgical performance assessed by three independent assessors blinded to trainee status. The secondary outcome measure was performance time and confidence levels.ResultsObserved improvements in the primary outcome were not significant. The performance time in the intervention group improved significantly with a mean difference of 79.8 s (8–178 s) (p<0.05). The intervention group reported significantly improved confidence levels in all microsurgical skills (8.8%, p<0.001). Less experienced trainees had the greatest reductions in time and improved confidence levels.ConclusionsVR training in neurosurgery, particularly in less experienced trainees, can prove useful. Future studies should assess the effect of VR training on clinical procedures.