bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nurse-initiated spontaneous breathing trials in adult intensive care unit patients: a scoping review
Authors: Starnes Elizabeth , Palokas Michelle , Hinton Elizabeth 
Published: October 2019

ABSTRACT

Objective:
The objective of this scoping review was to explore existing literature on protocols initiated by nurses for a spontaneous breathing trial in adult intensive care unit (ICU) patients in order to examine and conceptually map the evidence, and identify gaps in the literature.

Introduction:
Nurses are vital in the care of the critically ill mechanically ventilated patient. By involving the nurse in the weaning process through implementing the final stage of the weaning process, the spontaneous breathing trial, patients may liberate from mechanical ventilation more readily, thereby reducing the cost of care and number of complications associated with prolonged ventilation.

Inclusion criteria:
This review considered experimental and quasi-experimental study designs, analytical observational studies, case-control studies, analytical cross-sectional studies, descriptive observational studies, qualitative studies, and text and opinion papers. Adult ICU patients, aged 18 and over who were mechanically ventilated and candidates for weaning to spontaneous breathing trials, were included in the review. Adult ICUs included but were not limited to burn ICUs, cardiovascular ICUs, medical ICUs, neurological ICUs, surgical ICUs and trauma ICUs in all geographic locations. This scoping review considered studies that examined the use of nurse-initiated protocols for a spontaneous breathing trial.

Methods:
The Joanna Briggs Institute scoping review methodology was used. Key information sources searched were Cochrane Database of Systematic Reviews, PubMed, PROSPERO, DARE, CINAHL, Embase, Scopus, Academic Search Premier, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, MedNar, ProQuest Dissertations and Theses, Papers First and societal websites with information relevant to the scoping review. Only studies published in English were included, and no date limits were applied. The data extraction tool was developed by the authors to examine information retrieved from the studies.

Results:
Four studies, with 430 participants, were included in this review. One study was a non-randomized controlled trial, two were randomized controlled studies, and one was a text and opinion paper. The four studies included in the review identified both eligibility criteria for spontaneous breathing trial initiation, detailed elements of a spontaneous breathing trial, and criteria for success. Three of the four studies reported outcomes with the use of protocols for spontaneous breathing trials initiated by nurses.

Conclusions:
All included studies support the utilization of protocols and allowing the nurse to initiate the protocol, however variations in the eligibility criteria, details of the spontaneous breathing trial and success criteria create ambiguity in practice.
Positional effects of premature termination codons on the biochemical and biophysical properties of CFTR
Authors: Yeh Jiunn‐Tyng , Hwang Tzyh‐Chang 
Published: October 2019

Key points
Biochemical and biophysical characterizations of three nonsense mutations of cystic fibrosis transmembrane conductance regulator (CFTR) associated with a severe form of cystic fibrosis (CF) reveal the importance and heterogenous effects of the position of the premature termination codon (PTC) on the CFTR protein function.
Electrophysiological studies of W1282X‐CFTR, whose PTC is closer to the C‐terminus of CFTR, suggest the presence of both C‐terminus truncated CFTR proteins that are poorly functional and read‐through, full‐length products.
For G542X‐ and E60X‐CFTR, the only mechanism capable of generating functional proteins is the read‐through, but the outcome of read‐through products is highly variable depending on the interplay between the missense mutation caused by the read‐through and the structural context of the protein.
Pharmacological studies of these three PTCs with various CFTR modulators suggest position‐dependent therapeutic strategies for these disease‐inflicting mutations.
AbstractAbout one‐third of genetic diseases and cancers are caused by the introduction of premature termination codons (PTCs). In theory, the location of the PTC in a gene determines the alternative mechanisms of translation, including premature cessation or reinitiation of translation, and read‐through, resulting in differential effects on protein integrity. In this study, we used CFTR as a model system to investigate the positional effect of the PTC because of its well‐understood structure‐function relationship and pathophysiology. The characterization of three PTC mutations, E60X‐, G542X‐ and W1282X‐CFTR revealed heterogenous effects of these PTCs on CFTR function. The W1282X mutation results in both C‐terminus truncated and read‐through proteins that are partially or fully functional. In contrast, only the read‐through protein is functional with E60X‐ and G542X‐CFTR, although abundant N‐terminus truncated proteins due to reinitiation of translation were detected in E60X‐CFTR. Single‐channel studies of the read‐through proteins of E60X‐ and G542X‐CFTR demonstrated that both mutations have a single‐channel amplitude similar to wild type (WT), and good responses to high‐affinity ATP analogues, suggesting intact ion permeation pathways and nucleotide binding domains (NBDs), albeit with reduced open probability (Po). The comparison of the Po of these mutations with the proposed missense mutations revealed potential identities of the read‐through products. Importantly, a majority of the functional protein studied responds to CFTR modulators like GLPG1837 and Lumacaftor. These results not only expand current understanding of the molecular (patho)physiology of CFTR, but also infer therapeutic strategies for different PTC mutations at large.
Against the Tide
Authors: Bridget Mintz Testa 
Published: October 2019

Abstract
Many of the world’s largest cities are near the ocean, and more than 600 million people live within 10 meters of sea level. A lot of hard-to-replace infrastructure—ports, power plants, transmission lines, oil refineries, sewage treatment facilities, telecommunications cables, and highways—have been built close to the water. As glaciers melt and warmed waters expand in volume, that infrastructure will be threatened. In the face of this relentless tide, engineers are looking at what can be done.
Histopathology and selective biomarker expression in human meibomian glands
Authors: Reneker Lixing W , Irlmeier Rebecca T , Shui Ying-Bo , Liu Ying , Huang Andrew J W 
Published: October 2019

Background/aimsMeibomian gland dysfunction (MGD) is the most common form of evaporative dry eye disease, but its pathogenesis is poorly understood. This study examined the histopathological features of meibomian gland (MG) tissue from cadaver donors to identify potential pathogenic processes that underlie MGD in humans.MethodsHistological analyses was performed on the MGs in the tarsal plates dissected from four cadaver donors, two young and two old adults, including a 36-year-old female (36F) and three males aged 30, 63 and 64 years (30M, 63M and 64M).ResultsThe MGs of 36F displayed normal anatomy and structure, whereas the MGs of 30M showed severe ductal obstruction with mild distortion. The obstruction was caused by increased cytokeratin levels in association with hyperproliferation, but not hyperkeratinisation. In two older males, moderate to severe MG atrophy was noted. Cell proliferation was significantly reduced in the MG acini of the two older donors as measured by Ki67 labelling index (6.0%±3.4% and 7.9%±2.8% in 63M and 64M, respectively) when compared with that of the two younger donors (23.2%±5.5% and 16.9%±4.8% in 30M and 36F, respectively) (p<0.001). The expression patterns of meibocyte differentiation biomarkers were similar in the older and younger donors.ConclusionOur histopathological study, based on a small sample size, suggests potentially distinct pathogenic mechanisms in MGD. In the young male adult, hyperproliferation and aberrant differentiation of the central ductal epithelia may lead to the obstruction by overproduced cytokeratins. In contrast, in older adults, decreased cell proliferation in acinar basal epithelia could be a contributing factor leading to MG glandular atrophy.
Comparison of a commercial spectral-domain OCT and swept-source OCT based on an angiography scan for measuring circumpapillary retinal nerve fibre layer thickness
Authors: Tan Bingyao , Chua Jacqueline , Harish Thiyagrajan , Lau Amanda , Gan Alfred Tau Liang , Tan Yar Li , Wong Damon W K , Chong Rachel Shujuan , Ang Marcus , Husain Rahat , Schmetterer Leopold 
Published: October 2019

Background/aimsTo assess the agreement in measuring retinal nerve fibre layer (RNFL) thickness between spectral-domain (SD; Cirrus HD, Carl Zeiss Meditec, USA) optical coherence tomography (OCT) and swept-source (SS; Plex Elite 9000, Carl Zeiss Meditec) OCT using an OCT angiography (OCTA) scanning protocol.Methods57 participants (12 glaucomatous, 8 ocular hypertensive and 74 normal eyes) were scanned with two OCT instruments by a single experienced operator on the same day. Circumpapillary RNFL thicknesses were automatically segmented for SD-OCT and manually segmented for SS-OCTA scans. Agreement of global RNFL thickness, as well as average thickness in four quadrants was assessed using intraclass correlation coefficients (ICCs).ResultsThere was excellent agreement in the inferior and superior quadrants and the global (all ICC >0.90), followed by good agreement in the temporal (ICC=0.79) and nasal (ICC=0.73) quadrants. The ICC values were similar in the subgroups except within the ocular hypertension group, where the nasal quadrant was less agreeable (ICC=0.31). SS-OCTA-derived RNFL thickness was on average 3 µm thicker than SD-OCT, particularly in the nasal (69.7±11.5 µm vs 66.3±9.3 µm; p<0.001) and temporal (75.6±13.7 µm vs 67.9±12.3 µm; p<0.001) quadrants.ConclusionsRNFL measurements taken with SS-OCTA have good-to-excellent agreement with SD-OCT, which suggests that the RNFL thickness can be sufficiently extracted from wide-field OCTA scans.
Optical coherence tomography angiography for the assessment of choroidal vasculature in high myopia
Authors: Devarajan Kavya , Sim Ralene , Chua Jacqueline , Wong Chee Wai , Matsumura Saiko , Htoon Hla M , Schmetterer Leopold , Saw Seang Mei , Ang Marcus 
Published: October 2019

AimsTo assess specific layers of the choroid in highly myopic young adults and to examine their associations with levels of myopia.MethodsWe recruited 51 young myopes (n=91 eyes) from the Singapore Cohort of Risk Factors for Myopia cohort. We performed standardised optical coherence tomography (OCT) and OCT angiography imaging and developed a novel segmentation technique assessing choroidal layers’ thickness (overall choroidal thickness (CT), medium-vessel choroidal layer (MVCL) thickness, large-vessel choroidal layer (LVCL)) and vasculature (choroidal vessel density (%), choroidal branch area (CBA, %) and mean choroidal vessel width (MCVW, mm)).ResultsWe found that eyes with extreme myopia (EM) had thinner vascular layers compared with high myopia (HM), that is, LVCL (36.0±1.5 vs 39.2±1.2 µm, p=0.002) and MVCL (185.5±5.7 vs 198.2±4.6 µm, p=0.014). Overall CT was thinnest in the nasal and inferior quadrants in EM (nasal: 157.1±9.6 vs 187.2±8.3 µm, p<0.001; superior: 236.6±11.1 vs 257.0±9.5 µm, p=0.02; temporal: 228.0±10.6 vs 254.3±8.8 µm, p=0.012; and inferior quadrant: 198.7±10.0 vs 239.8±8.3 µm, p=<0.001) when compared with HM. We also observed significantly more vessel branching in eyes with EM as compared with eyes with HM (CBA, 10.2%±0.7% vs 9.95%±0.8%, p=0.018).ConclusionsThe novel segmentation technique and introduced choroidal parameters may serve as new biomarkers to study disease conditions in myopia.
Can a smartphone-delivered tool facilitate the assessment of surgical site infection and result in earlier treatment? Tracking wound infection with smartphone technology (TWIST): protocol for a randomised controlled trial in emergency surgery patients
Authors: McLean Kenneth A , Mountain Katie E , Shaw Catherine A , Drake Thomas M , Ots Riinu , Knight Stephen R , Fairfield Cameron J , Sgrò Alessandro , Skipworth Richard J E , Wigmore Stephen J , Potter Mark A , Harrison Ewen M 
Published: October 2019

IntroductionNational data suggest that surgical site infection (SSI) complicates 2%–10% of general surgery cases, although the patient-reported incidence is much higher. SSIs cause significant patient morbidity and represent a significant burden on acute healthcare services, in a cohort predominantly suitable for outpatient management. Over three-quarters of UK adults now own smartphones, which could be harnessed to improve access to care. We aim to investigate if a smartphone-delivered wound assessment tool results in earlier treatment.Methods and analysisThis is a randomised controlled trial aiming to recruit 500 patients across National Health Service (NHS) hospitals. All emergency abdominal surgery patients over the age of 16 who own smartphones will be considered eligible, with the exclusion of those with significant visual impairment. Participants will be randomised in a 1:1 ratio between standard postoperative care and the intervention – use of the smartphone tool in addition to standard postoperative care. The main outcome measure will be time-to-diagnosis of SSI with secondary outcome measures considering use of emergency department and general practitioner services and patient experience. Follow-up will be conducted by clinicians blinded to group allocation. Analysis of time-to-diagnosis will be by comparison of means using an independent two sample t-test.Ethics and disseminationThis is the first randomised controlled trial on the use of a smartphone-delivered wound assessment tool to facilitate the assessment of SSI and the impact on time-to-diagnosis. The intervention is being used in addition to standard postoperative care. The study design and protocol were reviewed and approved by Southeast Scotland Research and Ethics Committee (REC Ref: 16/SS/0072 24/05/2016). Study findings will be presented at academic conferences, published in peer-reviewed journals and are expected in 2020. A written lay summary will be available to study participants on request.Trial registration numberNCT02704897; Pre-results.
Questionnaire survey on women’s views after a first caesarean delivery in two tertiary centres in Ireland and their preference for involvement in a future randomised trial on mode of birth
Authors: Ryan Gillian , O Doherty Kate C , Devane Declan , McAuliffe Fionnuala , Morrison John 
Published: October 2019

ObjectiveTo assess the views of women after a first caesarean section (CS) on their birth experience, preference for future mode of birth and willingness to participate in a randomised controlled trial on mode of birth in a future pregnancy.DesignQuestionnaire survey.SettingTwo tertiary maternity centres Ireland, Galway University Hospital, Galwayand the National Maternity Hospital, Dublin.ParticipantsWomen with one previous CS.MethodsEligible women consented to participate, and postal surveys were forwarded. Results were collected and analysed. Results were compared between women who had elective operations and women who had emergency operations.Primary outcome measuresThe satisfaction levels of women after a first caesarean, their preference for mode of birth in a future pregnancy and their willingness to participate in a randomised trial on mode of birth.ResultsThere were 347 completed surveys of 633 women who consented to participate (54.8%), of whom 285 and 62 had emergency and elective caesarean deliveries, respectively. In general, satisfaction ratings with the delivery were greater than 90%, with similar levels of satisfaction with the care received from doctors and midwives. Women who an emergency procedure expressed lower satisfaction levels with the information about the caesarean and the debriefing received afterwards than women who had a planned operation (p<0.05). For future mode of birth, 39.5% expressed a preference for vaginal birth after caesarean (VBAC) in a subsequent pregnancy, and 80% said they would consider involvement in a randomised trial in a future pregnancy.ConclusionDebriefing and counselling women after a CS is an important part of pregnancy care and can significantly impact on a woman’s overall birth experience. A significant proportion of this cohort considered VBAC as a future birth option. These data indicate that a randomised trial on mode of birth after caesarean would be viewed positively by women in our population.
Feasibility of a 6-month pilot randomised controlled trial of resistance training on cognition and brain health in Canadian older adults at-risk for diabetes: study protocol
Authors: Furlano Joyla A , Nagamatsu Lindsay S 
Published: October 2019

IntroductionType 2 diabetes (T2D) is associated with cognitive deficits and increased risk of dementia, and thus individuals at high risk for T2D (ie, those who are overweight or prediabetic) are also at greater risk for cognitive decline. Aerobic exercise is known to preserve and improve cognitive function, but the effects of resistance training (RT) are much less known in older adults. Moreover, research on the effects of RT on cognition and brain health (structure and function) in older adults at-risk for diabetes is limited. To address this question, a 6-month RT intervention is needed. Importantly, before conducting a full-scale randomised controlled trial (RCT), we are conducting a feasibility pilot study to assess potential recruitment rates, adherence and retention in this specific population.Methods and analysisWe are conducting a 6-month, thrice-weekly RT RCT. Participants (aged 60–80; sedentary; fasting plasma glucose of 6.1–7.0 mmol/L or body mass index ≥25) are randomised into one of two groups: (1) RT or (2) balance and tone (control). Based on other exercise trials using a similar population, we will consider our trial feasible if we have adherence and retention at 70%. Recruitment rate will be measured as time it takes to enrol 20 participants. To assess behavioural and MRI data, we will report descriptive statistics and estimation using a 95% CI.Ethics and disseminationOur study has received ethics approval from the Health Sciences Research Ethics Board at Western University. As this is a small pilot study, data will only be made available to other researchers on request. Results from this study will be disseminated via academic publication.Trial registration numberNCT03254381
Patient-reported outcome measures in the management of neovascular age-related macular degeneration: a 1-year prospective study
Authors: Jelin Elma , Wisløff Torbjørn , Jørstad Øystein Kalsnes , Heiberg Turid , Moe Morten Carstens 
Published: October 2019

ObjectiveTo prospectively explore the following patient-reported outcome measures (PROMs) in the management of neovascular age-related macular degeneration (nAMD): (1) self-reported visual function, (2) symptom-state, (3) general-health and (4) satisfaction of treatment.Methods and analysisCorresponding to the four PROMs, participants responded to the following questionnaires: (1) National Eye Institute Visual-Functioning-Questionnaire (NEI-VFQ-25), (2) Patient-Acceptable-Symptom-Status (PASS 5), (3) EuroQol-Group-Questionnaire (EQ-5D-3L) and (4) Dimensions of Importance in Treatment of nAMD (DITAMD). Data were collected at baseline and after 3, 6 and 12 months of intravitreal antivascular endothelial growth factor treatment. Results were evaluated with t-tests and mixed linear regression analyses.ResultsThe study included 197 patients. At baseline NEI-VFQ-25 (79.53±14.52) and EQ-5D (0.74±0.28) had relatively high scores, whereas PASS 5 was below ‘acceptable’ (3.30±0.80). At 12 months NEI-VFQ-25 and PASS 5 showed significant improvement, whereas EQ-5D and DITAMD remained unchanged. At baseline patients receiving treatment of the better-seeing eye (BSE) (n=52) reported significantly worse NEI-VFQ-25 and PASS 5 than patients for whom treatment only involved the worse-seeing eye (WSE), (n=145). In contrast to BSE patients, there was no improvement of NEI-VFQ-25 for WSE patients at 12 months, despite a significant improvement in best-corrected visual acuity (BCVA). Two independent variables, treatment including the BSE and BCVA for the treated eye, were found to predict both NEI-VFQ-25 and PASS 5.ConclusionAfter 12 months of nAMD treatment, there was a significant improvement in PASS 5 and NEI-VFQ-25, the latter depending on whether therapy included BSE. EQ-5D and DITAMD remained unaltered.
Patient experience of COPD care: outcomes from the British Lung Foundation Patient Passport
Authors: Philip Keir , Gaduzo Stephen , Rogers Judith , Laffan Michael , Hopkinson Nicholas S 
Published: October 2019

IntroductionThe British Lung Foundation (BLF) COPD Patient Passport (www.blf.org.uk/passport) was developed as a resource to help people with chronic obstructive pulmonary disease (COPD) and clinicians to consider the care received and identify essential omissions. We used the online data collected to evaluate the delivery of COPD care in the UK from a patient perspective.MethodsThe patient passport consists of 13 questions relating to key aspects of COPD care including: spirometry confirmation of diagnosis, understanding their diagnosis, support and a written management plan, vaccinations, smoking cessation, physical activity, exercise, eating well, pulmonary rehabilitation, exacerbations, medications and yearly reviews. Data were presented as proportions with an answer corresponding to good care, and plotted over time to identify trends.ResultsAfter removing identifiable duplicates, data from 41 769 entries, completed online between November 2014 and April 2019, remained (table 1). Twenty-four per cent reported getting support to manage their care and a written action plan; 53% could spot the signs of an acute exacerbation; 34% had discussed pulmonary rehabilitation and 41% stated they understood their COPD, and their doctor or nurse had explained where to find information, advice and emotional support. A quarter reported not receiving influenza vaccination and a third of those who smoke were not offered support to quit smoking. Even the strongest areas including spirometry-confirmed diagnosis, and knowing the importance of being active and eating well, achieved only around 80%. Response patterns remained stable or worsened over time.DiscussionResponses to the BLF COPD Patient Passport identify substantial gaps in patients’ experience of care, which did not appear to improve during the 5 years covered. These data provide a unique yet commonly overlooked perspective on care quality, and highlight that new approaches will be needed to meet the ambitions to improve respiratory care set out in the NHS Long Term Plan.
Reducing antimicrobial use on dairy farms using a herd health approach
Authors: Hyde Robert , Tisdall David , Gordon Paddy , Remnant John 
Published: October 2019

Background: There has been much scrutiny of antimicrobial use in the livestock sector, since the O’Neill report, a 2015 government ‐commissioned review of antimicrobial resistance, called for the agriculture industry to reduce its use of antimicrobials.Aim of the article: This article outlines key herd health approaches to common diseases on dairy farms that will result in a decrease in antimicrobial use, with a focus on those interventions that are most likely to result in the biggest reductions.