bluuebunny/crossref_metadata_2025_split huggingface dataset:
The NICE-GUT trial protocol: a randomised, placebo controlled trial of oral nitazoxanide for the empiric treatment of acute gastroenteritis among Australian Aboriginal children
Authors: Waddington Claire S , McLeod Charlie , Morris Peter , Bowen Asha , Naunton Mark , Carapetis Jonathan , Grimwood Keith , Robins-Browne Roy , Kirkwood Carl D , Baird Robert , Green David , Andrews Ross , Fearon Deborah , Francis Joshua , Marsh Julie A , Snelling Thomas 
Published: September 2019

IntroductionDiarrhoeal disease is the second leading cause of death in children under 5 years globally, killing 525 000 annually. Australian Aboriginal and Torres Strait Islander (hereafter Aboriginal) children suffer a high burden of disease. Randomised trials in other populations suggest nitazoxanide accelerates recovery for children withGiardia, amoebiasis,Cryptosporidium, Rotavirus and Norovirusgastroenteritis, as well as in cases where no enteropathogens are found.Methods and analysisThis double blind, 1:1 randomised, placebo controlled trial is investigating the impact of oral nitazoxanide on acute gastroenteritis in hospitalised Australian Aboriginal children aged 3 months to <5 years. Dosing is based on age-based dosing. The primary endpoint is the time to resolution of ‘significant illness’ defined as the time from randomisation to the time of clinical assessment as medically ready for discharge, or to the time of actual discharge from hospital, whichever occurs first. Secondary endpoints include duration of hospitalisation, symptom severity during the period of significant illness and following treatment, duration of rehydration and drug safety. Patients will be followed for medically significant events for 60 days. Analysis is based on Bayesian inference. Subgroup analysis will occur by pathogen type (bacteria, virus or parasite), rotavirus vaccination status, age and illness severity.Ethics and disseminationEthics approval has been granted by the Central Australian Human Research Ethics Committee (HREC-14–221) and the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (HREC2014-2172). Study investigators will ensure that the trial is conducted in accordance with the principles of the Declaration of Helsinki. Individual participant consent will be obtained. Results will be disseminated via peer-reviewed publication.Trial registration numberACTRN12614000381684.
Clinical and non-clinical variables associated with preventive and curative dental service utilisation: a cross-sectional study among adolescents and young adults in Central Mexico
Authors: Medina-Solís Carlo Eduardo , García-Cortés José Obed , Robles-Minaya José Luis , Casanova-Rosado Juan Fernando , Mariel-Cárdenas Jairo , Ruiz-Rodríguez María del Socorro , Navarrete-Hernández José de Jesús , Ávila-Burgos Leticia , Maupomé Gerardo 
Published: September 2019

ObjectiveThe present study aimed to identify preventive and curative dental health service utilisation (DHSU) in the context of associated clinical and non-clinical factors among adolescents and young adults in Mexico.DesignCross-sectional study.SettingApplicants to a public university in Mexico.ParticipantsParticipants were 638 adolescents and young adults aged 16–25 randomly selected from university applicants.InterventionsData were collected using a self-administered questionnaire filled out by the students. For assessment of dental caries experience, we used the index of decayed, missing and filled teeth.Primary outcomeThe dependent variable was DHSU in the previous 12 months, coded as 0=non-use, 1=use of curative services and 2=use of preventive services.ResultsThe mean age was 18.76±1.76 years, and 49.2% were women. The prevalence of DHSU was 40.9% (95% CI 37.1 to 44.8) for curative services and 22.9% (95% CI 19.7 to 26.3) for preventive services. The variables associated with curative services were age, sex, mother’s education, dental pain in the previous 12 months, caries experience, use of self-care devices and oral health knowledge. For preventive services, the variables associated were mother’s education, dental pain in the previous 12 months, caries experience, use of self-care devices and self-perception of oral health.ConclusionsWhile differences emerged by type of service, a number of variables (sociodemographic and socioeconomic characteristics as well as dental factors) remained in the final model. Greater oral health needs and socioeconomic inequalities remained as predictors of both types of DHSU. Given the differences revealed by our study, oral health policies should refer those seeking dental care for oral diseases to preventive services, and promote the use of such services among the poorer and less educated population groups.
Low back pain in emergency ambulance workers in tertiary hospitals in China and its risk factors among ambulance nurses: a cross-sectional study
Authors: Zhang Qiong , Dong Hongyun , Zhu Chunji , Liu Guangzeng 
Published: September 2019

ObjectiveLow back pain (LBP) could cause serious consequences and has been shown to be prevalent among emergency ambulance workers. Studies on the prevalence of and risk factors for LBP among emergency ambulance workers are scarce in China. The study aimed to determine the prevalence of LBP among ambulance workers, including doctors, nurses and drivers, and to explore the risk factors for ambulance nurses’ chronic LBP (lasting for at least 3 months).DesignCross-sectional study.SettingEmergency ambulance systems from 38 tertiary hospitals in Shandong, China were selected by random cluster sampling.ParticipantsA total of 1560 ambulance workers completed the study.Outcome measuresA paper-based questionnaire that included the Nordic Musculoskeletal Questionnaire, which evaluated LBP, the Dutch Musculoskeletal Questionnaire, which assessed ergonomic factors, and the Job Content Questionnaire, which assessed stress, was used. Multivariate logistic regression analysis was conducted to quantify the association of potential risk factors with chronic LBP among ambulance nurses.ResultsThe 1 year prevalence of LBP lasting for at least 24 hours, 7 days and 3 months was 86.1%, 50.6% and 21.1%, respectively, among 498 ambulance nurses; 70.5%, 36.4% and 15.8% among 519 doctors; and 57.5%, 23.8% and 12.3% among 543 drivers. The factors contributing to chronic LBP among ambulance nurses were the frequent bending of the trunk, heavy or awkward lifting, shift work, low job satisfaction, high psychological fatigue, high psychological job demand, low job control, low supervisor support, older age, female sex and obesity.ConclusionsLBP was more prevalent among ambulance nurses than among ambulance doctors and drivers. Many factors, especially psychosocial and ergonomic factors, contributed to ambulance nurses’ chronic LBP. Comprehensive measures might be needed to control LBP.
Early childhood vaccination and subsequent mortality or morbidity: are observational studies hampered by residual confounding? A Danish register-based cohort study
Authors: Jensen Andreas , Andersen Per Kragh , Stensballe Lone Graff 
Published: September 2019

ObjectivesTo estimate the association between childhood vaccination and subsequent morbidity and mortality by adjusting for environmental and host factors. Further, to examine the degree of residual confounding in such observational studies.DesignRegister-based cohort study including 1 122 929 Danish children.ParticipantsAll children born in Denmark in the period 1999–2016 who survived until 16 months of age without prior migration followed from 16 months until the first of the following: event of interest, migration, 5 years of age or 31 December 2016.Main outcome measuresAdjusted HRs (aHRs) and absolute risks were calculated for the three outcomes: mortality, hospitalisation for infection and asthma using register data on deaths, specific hospital contacts and dispensed prescribed medication. The exposure was the combination of the routine vaccines against diphteria–tetanus–pertussis–polio–Haemophilus influenzaetype b and measles–mumps–rubella (DTP and MMR in short) administered in early childhood. Hospitalisation due to accidents was analysed as a negative control outcome to examine residual confounding.ResultsChildren with 3DTP+MMR had a lower hazard of mortality than the reference group with 3DTP, adjusted HR (aHR)=0.45 (95% CI: 0.35 to 0.57), whereas the children with 1 or 2 DTP had higher hazards of dying, aHR=1.55 (95% CI: 1.14 to 2.13) and aHR=1.96 (95% CI: 1.34 to 2.89). The vaccination group 3DTP+MMR was associated with a reduced hazard of asthma aHR=0.94 (95% CI: 0.92 to 0.96). Also, the vaccination group 3DTP+MMR was associated with a reduced hazard of hospitalisation due to accidents, aHR=0.83 (0.80 to 0.85) compared with the reference group with 3 DTP.ConclusionsThe results suggested a beneficial impact of MMR on under-five mortality but did not support the hypothesis that DTP is detrimental, since the group of children with fewer DTP vaccinations experienced increased mortality. The results of the study may to some degree be prone to residual confounding since an unexpected association between MMR vaccination and hospitalisation for accidents was observed.
A protocol for a systematic review of process evaluations of interventions investigating sedentary behaviour in adults
Authors: Corepal Rekesh , Hall Jessica Faye , English Coralie , Farrin Amanda , Fitzsimons Claire F , Forster Anne , Lawton Rebecca , Mead Gillian , Clarke David 
Published: September 2019

IntroductionSedentary behaviour is defined as any waking behaviour characterised by low energy expenditure ≤1.5 metabolic equivalents while in a sitting, lying or reclining posture. The expanding evidence base suggests that sedentary behaviour may have a detrimental effect on health, well-being and is associated with an increased risk of all-cause mortality. We aim to review process evaluations of randomised controlled trials (RCTs) which included a measure of sedentary behaviour in adults in order to develop an understanding of intervention content, mechanisms of impact, implementation and delivery approaches and contexts, in which interventions were reported to be effective or effective. A secondary aim is to summarise participants, family and staff experiences of such interventions.Methods and analysisTen electronic databases and reference lists from previous similar reviews will be searched. Eligible studies will be process evaluations of RCTs that measure sedentary behaviour as a primary or secondary outcome in adults. As this review will contribute to a programme to develop a community-based intervention to reduce sedentary behaviour in stroke survivors, interventions delivered in schools, colleges, universities or workplaces will be excluded. Two reviewers will perform study selection, data extraction and quality assessment. Disagreements between reviewers will be resolved by a third reviewer. Process evaluation data to be extracted include the aims and methods used in the process evaluation; implementation data; mechanisms of impact; contextual factors; participant, family and staff experiences of the interventions. A narrative approach will be used to synthesise and report qualitative and quantitative data. Reporting of the review will be informed by Preferred Reporting Items for Systematic Review and Meta-Analysis guidance.Ethics and disseminationEthical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations.PROSPERO registration numberCRD42018087403.
Accuracy of endoscopic staging and targeted biopsies for routine gastric intestinal metaplasia and gastric atrophy evaluation study protocol of a prospective, cohort study: the estimate study
Authors: Nieuwenburg Stella A V , Waddingham William W , Graham David , Rodriguez-Justo Manuel , Biermann Katharina , Kuipers Ernst J , Banks Matthew , Jansen Marnix , Spaander Manon C W 
Published: September 2019

IntroductionPatients with chronic atrophic gastritis (CAG) and intestinal metaplasia (IM) are at risk of developing gastric adenocarcinoma. Their diagnosis and management currently rely on histopathological guidance after random endoscopic biopsy sampling (Sydney biopsy strategy). This approach has significant flaws such as under-diagnosis, poor reproducibility and poor correlation between endoscopy and histology. This prospective, international multicentre study aims to establish whether endoscopy-led risk stratification accurately and reproducibly predicts CAG and IM extent and disease stage.Methods and analysisPatients with CAG and/or IM on standard white light endoscopy (WLE) will be prospectively identified and invited to undergo a second endoscopy performed by an expert endoscopist using enhanced endoscopic imaging techniques with virtual chromoendoscopy. Extent of CAG/IM will be endoscopically staged with enhanced imaging and compared with standard WLE. Histopathological risk stratification through targeted biopsies will be compared with endoscopic disease staging and to random biopsy staging on WLE as a reference. At least 234 patients are required to show a 10 % difference in sensitivity and accuracy between enhanced imaging endoscopy-led staging and the current biopsy-led staging protocol of gastric atrophy with a power (beta) of 80 % and a 0.05 probability of a type I error (alpha).Ethics and disseminationThe study was approved by the respective Institutional Review Boards (Netherlands: MEC-2018-078; UK: 19/LO/0089). The findings will be published in peer-reviewed journals and presented at scientific meetings.Trial registration numberNTR7661; Pre-results.
Quantifying disruption of workflow by phone calls to the neuroradiology reading room
Authors: Sabat Shyam , Kalapos Paul , Slonimsky Einat 
Published: September 2019

IntroductionThe purpose of this study was to understand the source and the reason for the phone calls to our neuroradiology suit and to quantify the size of the problem in terms of duration of individual and aggregated calls.Materials and methodsObservation of the neuroradiology reading room for the entire duration of the working hours over three non-consecutive days was performed, and included telephone calls start time, end time and calls duration for incoming telephone calls. After each phone call the recipients were queried on the details of the phone call; the origin of the call, the reason for the call and the response.ResultsThe average total number of minutes (min) spent on the phone each day was 64 min per working day with a total of 39 phone calls per day and 4.4 per hour on average. The trainees answered 71% of the phone calls with additional intervention by attending in 13% of phone calls. The most common source of phone calls was from either the MRI/CT technicians (48%), followed by providers (20%) and returning pages (18%).ConclusionCumulative time spent on the phone by neuroradiologists in the reading room ended up in more than an hour per working day, while trainees were taking the majority of phone calls. Most phone calls originated from technicians, hence, requiring specific solutions to mitigate this kind of interruption.
Clinical validation of the Swedish version of Dyspnoea-12 instrument in outpatients with cardiorespiratory disease
Authors: Sundh Josefin , Bornefalk Hans , Sköld Carl Magnus , Janson Christer , Blomberg Anders , Sandberg Jacob , Bornefalk-Hermansson Anna , Igelström Helena , Ekström Magnus 
Published: September 2019

IntroductionBreathlessness is the cardinal symptom in both cardiac and respiratory diseases, and includes multiple dimensions. The multidimensional instrument Dyspnoea-12 has been developed to assess both physical and affective components of breathlessness. This study aimed to perform a clinical validation of the Swedish version of Dyspnoea-12 in outpatients with cardiorespiratory disease.MethodsStable outpatients with cardiorespiratory disease and self-reported breathlessness in daily life were recruited from five Swedish centres. Assessments of Dyspnoea-12 were performed at baseline, after 30–90 min and after 2 weeks. Factor structure was tested using confirmatory factor analysis and internal consistency using Cronbach’s alpha. Test–retest reliability was analysed using intraclass correlation coefficients (ICCs). Concurrent validity at baseline was evaluated by examining correlations with lung function and several instruments for the assessment of symptoms and health status.ResultsIn total, 182 patients were included: with the mean age of 69 years and 53% women. The main causes of breathlessness were chronic obstructive pulmonary disease (COPD; 25%), asthma (21%), heart failure (19%) and idiopathic pulmonary fibrosis (19%). Factor analysis confirmed the expected underlying two-component structure with two subdomains. The Dyspnoea-12 total score, physical subdomain score and affective subdomain scores showed high internal consistency (Cronbach’s alpha 0.94, 0.84 and 0.80, respectively) and acceptable reliability after 2 weeks (ICC total scores 0.81, 0.79 and 0.73). Dyspnoea-12 showed concurrent validity with the instruments modified Medical Research Council scale, COPD Assessment Test, European Quality of Life-Five Dimensions-Five levels, the Functional Assessment of Chronic Illness Therapy-Fatigue, the Hospital Anxiety and Depression Scale, and with forced expiratory volume in 1 s in percentage of predicted value. The results were consistent across different cardiorespiratory conditions.ConclusionThe Dyspnoea-12 is a valid instrument for multidimensional assessment of breathlessness in Swedish patients with cardiorespiratory diseases.
Fidelity is fundamental: intervention predictors in advance care plans in terminal cancer
Authors: Vaccaro Lisa , Butow Phyllis N , Lee Deborah , Johnson Stephanie B , Bell Melanie , Clayton Josephine , Detering Karen Margaret , Tattersall Martin 
Published: September 2019

ObjectivesAssessing whether interventions are implemented as intended (fidelity) is critical to establishing efficacy in clinical research yet rarely applied in advance care planning (ACP) interventions. We aimed to develop and implement a fidelity audit tool for an ACP intervention.MethodsWe developed a fidelity audit tool assessing: (A) content; (B) quality (general communication, eliciting EOL preferences and prognostic communication); and (C) family/caregiver involvement. We audited (double-coded) 55 audio-recordings of ACP discussions delivered to advanced cancer patients and caregivers, within a clinical trial.ResultsFidelity tocontentwas high: mean=9.38/11 but lower for thequalityof general communication (mean=12.47/20), discussion of patient preferences (mean=4.67/7), prognosis (mean=3.9/6) and family/caregiver involvement (mean=2.67/4). Older patient age and caregiver religiosity were associated with higher fidelity. Higher fidelity tocontentwas associated with the trial primary outcome of family caregiver report of patient wishes being discussed and met.ConclusionsFidelity to content, but not quality, of the ACP intervention is strong. Communication skills training is critical for ACP interventionists. Adherence was higher with older patients and religious carers, factors that may influence acceptance of death and readiness to undertake ACP, making the discussion easier.Trial registration numberACTRN12613001288718.
Comparative analysis of isoform-specific and non-selective histone deacetylase inhibitors in attenuating the intestinal damage after hemorrhagic shock
Authors: Bhatti Umar F , Williams Aaron M , Kathawate Ranganath G , Chang Panpan , Zhou Jing , Biesterveld Ben E , Wu Zhenyu , Dahl Julia , Liu Baoling , Li Yongqing , Alam Hasan B 
Published: September 2019

BackgroundIsoform-specific histone deacetylase inhibitors (HDACIs) MC1568 and ACY1083 are comparable to the non-selective HDACI valproic acid (VPA) in improving survival in rodents undergoing lethal hemorrhage. However, the organ-specific properties of isoform-specific HDACIs have not been fully evaluated. Also, whether they can act synergistically is not known. We hypothesized that isoform-specific HDACIs are superior to VPA in attenuating intestinal injury and act synergistically when coadministered.MethodsSprague Dawley rats were hemorrhaged (40% of total blood volume) and randomized to receive (n=4 per group) (1) MC1568 (5 mg/kg), (2) ACY1083 (30 mg/kg), (3) MC1568+ACY1083 (combination: 5 mg/kg + 30 mg/kg, respectively), (4) VPA (250 mg/kg), or (5) normal saline (NS; vehicle; 250 μL). Animals were observed for 3 hours, after which blood samples were collected and samples of the ileum were harvested. Expression of interleukin 1 beta (IL-1β), tumor necrosis factor alpha (TNF-α), and cytokine-induced neutrophil chemoattractant 1 (CINC-1) was assessed in the tissues using enzyme-linked immunosorbent assay. Intestinal cleaved caspase 3 (c-caspase 3) levels were assessed as a marker of apoptosis, and histologic sections of the ileum were examined for signs of bowel injury. Levels of IL-1β and TNF-α were also measured in the serum as global markers of inflammation.ResultsTreatments with MC1568, ACY1083, MC1568+ACY1083, and VPA were associated with decreased IL-1β levels in the intestine and serum compared with NS. IL-1β and TNF-α levels were significantly lower in the ACY1083 group compared with the VPA group. CINC-1 levels were significantly lower in the isoform-specific HDACI groups compared with the NS; however, no significant differences were seen with VPA. All treatment groups had a lower expression of intestinal c-caspase 3 compared with NS. Furthermore, MC1568 and ACY1083 groups had lower apoptosis compared with the VPA group. Bowel injury scores were significantly lower in the isoform-specific HDACI groups compared with the NS group; however, the attenuation in the VPA-treated animals did not reach statistical significance.DiscussionIsoform-specific HDACIs provide superior intestinal protection compared with VPA in a rodent model of hemorrhagic shock.Level of evidencePreclinical study.
Successful resection of an osteoma in a great horned owl (Bubo virginianus) with subsequent lack of regional feather regrowth
Authors: Barbosa Lorraine , Tom Duane , Han Sushan 
Published: September 2019

A free‐living adult great horned owl (Bubo virginianus) was presented to a wildlife rehabilitation centre in Southern California with a firm, pedunculated mass arising from the caudal‐dorsal border of the left ulna. Two secondary covert feathers were incorporated into the mass and multiple secondary flight and covert feathers adjacent to the mass were broken. Radiographs revealed a calcified mass with no cortical involvement. The mass was surgically removed. Histopathology was consistent with a diagnosis of osteoma. Despite tumour removal, the owl sustained a significant flight impairment resulting from lack of regional feather regrowth. Waiting for a natural moult to take place would likely require 9–12 months. An attempt was made at inducing moult by manually pulling feathers but was not successful. As the rehabilitation facility was space limited and the bird was behaviourally a poor candidate for long‐term rehabilitation, humane euthanasia was elected.