bluuebunny/crossref_metadata_2025_split huggingface dataset:
Six versus two weeks treatment with doxycycline in Lyme neuroborreliosis: the protocol of a multicentre, non-inferiority, double-blinded and randomised controlled trial
Authors: Solheim Anne Marit , Ljøstad Unn , Mygland Åse 
Published: June 2019

IntroductionCurrent treatment guidelines for European Lyme neuroborreliosis (LNB) recommend cephalosporins, penicillin or doxycycline for 14–28 days but evidence for optimal treatment length is poor. Treatment lengths in clinical practice tend to exceed the recommendations. Most patients experience a rapid improvement of symptoms and neurological findings within days of treatment, but some report long-term complaints. The underlying mechanisms of remaining complaints are debated, and theories as ongoing chronic infection withBorrelia burgdorferi, dysregulated immune responses, genetic predisposition, coinfection with multiple tick-borne pathogens, structural changes in CNS and personal traits have been suggested. The main purpose of our trial is to address the hypothesis of improved outcome after long-term antibiotic treatment of LNB, by comparing efficacy of treatment with 2 and 6 weeks courses of doxycycline.Methods and analysisThe trial has a multicentre, non-inferiority, double-blinded design. One hundred and twenty patients diagnosed with LNB according to European Federation of Neurological Societies (EFNS)guidelines will be randomised to 6 or 2 weeks treatment with oral doxycycline. The patients will be followed for 12 months. The primary endpoint is improvement on a composite clinical score (CCS) from baseline to 6 months after inclusion. Secondary endpoints are improvements in the CCS 12 months after inclusion, fatigue scored on Fatigue Severity Scale, subjective symptoms on the Patient Health Questionnaire-15 scale, health-related quality of life scored on RAND 36-item short form health survey and safety as measured by side effects of the two treatment arms. Blood and cerebrospinal fluid (CSF) are collected from inclusion and throughout the follow-up and a biobank will be established. The study started including patients in November 2015 and will continue throughout December 2019.Ethics and disseminationThe study is approved by the Norwegian regional committees for medical and health research ethics and the Norwegian Medicines Agency. Data from the study will be published in peer-reviewed medical journals.Trial registration number2015-001481-25
Change in prevalence and severity of metabolic syndrome in the Sami and non-Sami population in rural Northern Norway using a repeated cross-sectional population-based study design: the SAMINOR Study
Authors: Michalsen Vilde L , Kvaløy Kirsti , Svartberg Johan , Siri Susanna R A , Melhus Marita , Broderstad Ann R 
Published: June 2019

ObjectiveTo examine the change in both the prevalence and severity of metabolic syndrome (MetS) in the Sami and non-Sami in Northern Norway due to a lack of knowledge regarding the development of MetS in this population.DesignRepeated cross-sectional study.SettingThe study is based on data from the SAMINOR 1 Survey (2003–2004, n=6550) and the SAMINOR 2 Clinical Survey (2012–2014, n=6004), conducted in 10 municipalities in Northern Norway.ParticipantsMen and women aged 40–79 years were invited. We excluded participants not handing in the questionnaire and with missing information concerning ethnicity questions or MetS risk factors resulting in a final sample of 6308 (36.0% Sami) subjects in SAMINOR 1 and 5866 (40.9% Sami) subjects in SAMINOR 2.Outcome measuresMetS prevalence was determined using the harmonised Adult Treatment Panel III (ATP-III) criteria, and severity was assessed with the MetS severity Z-score. Generalised estimating equations with an interaction term (survey × ethnicity) were used to compare prevalence and severity between the two surveys while accounting for partly repeated measurements.ResultsThe overall, age-standardised ATP-III-MetS prevalence was 31.2% (95% CI: 29.8 to 32.6) in SAMINOR 1 and 35.6% (95% CI: 34.0 to 37.3) in SAMINOR 2. Both the ATP-III-MetS prevalence and the mean MetS severity Z-score increased between the surveys in all subgroups, except the ATP-III-MetS prevalence in non-Sami women, which remained stable. Over time, Sami men showed a slightly larger increase in MetS severity than non-Sami men (p<0.001): the score increased by 0.20 (95% CI: 0.14 to 0.25) and 0.06 (95% CI: 0.01 to 0.10) in Sami and non-Sami men, respectively. Abdominal obesity increased markedly between the surveys in all subgroups.ConclusionThe prevalence and severity of MetS increased over time in rural Northern Norway. Abdominal obesity appeared to drive the increase in ATP-III-MetS prevalence. Sami men had a slightly larger increase in severity than non-Sami.
Vaping cannabis among adolescents: prevalence and associations with tobacco use from a cross-sectional study in the USA
Authors: Kowitt Sarah D , Osman Amira , Meernik Clare , Zarkin Gary A , Ranney Leah M , Martin Jim , Heck Courtney , Goldstein Adam O 
Published: June 2019

ObjectivePrevious research suggests that some adolescents are using e-cigarette devices to vaporise (‘vaping’) cannabis in the form of hash oil, tetrahydrocannabinol (THC) wax or oil, or dried cannabis buds or leaves. However, it is unclear how adolescents who vape cannabis use other tobacco products. This study examined the extent to which adolescents reported ever vaping cannabis and investigated how demographic variables and tobacco behaviours were associated with use.DesignWe used cross-sectional data from adolescents (total response rate 64.5%) who participated in the 2017 North Carolina Youth Tobacco Survey. SAS logistic regression survey procedures were used to account for the complex survey design and sampling weights.SettingNorth Carolina, USA.ParticipantsAdolescents in high school (n=2835).Primary outcome and measureAdolescents were asked to indicate whether they had ever used an e-cigarette device with marijuana, THC or hash oil, or THC wax.ResultsApproximately 1 in 10 high school students reported ever vaping cannabis in the overall sample (9.6%). In multivariable models, adolescents who reported using cigars (adjusted OR (aOR) 3.76, 95% CI 2.33 to 6.07), waterpipe (aOR 2.32, 95% CI 1.37 to 3.93) or e-cigarettes (aOR 3.18, 95% CI 2.38 to 4.25) in the past 30 days had higher odds of reporting ever vaping cannabis compared with their counterparts. There was no significant association between use of smokeless tobacco (aOR 0.89, 95% CI 0.42 to 1.91) or use of cigarettes (aOR 1.27, 95% CI 0.71 to 2.29) in the past 30 days and odds of reporting ever vaping cannabis.ConclusionsThese findings provide evidence that large numbers of high school students who use tobacco products have vaped cannabis. As tobacco control policies—such as communication campaigns or smoke-free laws—increasingly focus on e-cigarettes, attention to understanding how adolescents use e-cigarettes to vape substances other than nicotine is essential.
Anti-VEGF intervention in neovascular AMD: benefits and risks restated as natural frequencies
Authors: Clearkin Louis , Ramasamy Balasubramanian , Wason James , Tiew Stephenie 
Published: June 2019

ObjectiveClear information is essential to properly determine preference in medical intervention. In neovascular age-related macular degeneration, patients need to understand the balance of risk and benefit of anti-vascular endothelial growth factor (VEGF) treatment. This balance is altered by the number of injections administered.MethodsNatural frequencies, displayed as pictographically as icon arrays, are used to show material outcomes from the MARINA and HARBOR (12 months) trials. We also calculated the number needed to treat (NNT) and number needed to harm (NNH).ResultsMARINA 24-month data show the absolute risk reduction is 37% and the NNT is 3; meaning for one patient to benefit three need to be treated.12 months’ HARBOR data show that compared with as-needed treatment, scheduled monthly injection treatment increases the number of patients achieving a better visual outcome. The number of patients suffering harm is also increased by the additional injections.ConclusionDisplaying MARINA and HARBOR trial data as natural frequencies, with numbers needed to treat and harm, communicates complimentary information on the positive and negative aspects of anti-VEGF treatment.
Motivating Change: a grounded theory of how to achieve large-scale, sustained change, co-created with improvement organisations across the UK
Authors: Breckenridge Jenna P , Gray Nicola , Toma Madalina , Ashmore Sue , Glassborow Ruth , Stark Cameron , Renfrew Mary J 
Published: June 2019

BackgroundVarious theories provide guidance on implementing, sustaining and evaluating innovations within healthcare. There has been less attention given, however, to personal theories drawn from practice and the expertise of managers and front-line staff is a largely untapped resource. In this paper, we share learning from experienced improvement organisations to provide a conceptual level explanation of the conditions necessary to facilitate and sustain improvement at scale.MethodsStaff (n=42) from three leading change organisations in the UK, spanning health, education and social care, took part in three consultation meetings with the aim of sharing knowledge about sustaining large-scale change. This included one government organisation, one National Health Service Board and one large charity organisation. Using a participatory grounded theory approach, the workshops resulted in a co-created theory.ResultsThe theory of Motivating Change describes the psychosocial-structural conditions for large-scale, sustained change from the perspectives of front-line staff. The theory posits that change is more likely to be sustained at scale if there is synergy between staff’s perceived need and desire for improvement, and the extrinsic motivators for change. Witnessing effective change is motivating for staff and positive outcomes provide a convincing argument for the need to sustain improvement activity. As such, evidenceofchange becomes evidenceforchange. This is only possible when there is a flow of trust within organisations that capitalises on positive peer pressure and suppresses infectious negativity. When these conditions are in place, organisations can generate self-proliferating improvement.ConclusionsThe theory of Motivating Change has been co-created with staff and offers a useful explanation and guide for others involved in change work that capitalises on front-line expertise.
Patient safety superheroes in training: using a comic book to teach patient safety to residents
Authors: Maatman Theresa Camille , Prigmore Heather , Williams Joni Strom , Fletcher Kathlyn E 
Published: June 2019

ProblemMedical errors are a health burden. Residents must be aware of patient safety threats and have confidence reporting concerns. Creative modalities for teaching such content (eg, simulation) are resource intensive, while lectures do not assimilate clinical practice. Therefore, the objective of this project was to assess the use of a comic book to train Internal Medicine residents to identify patient safety issues. We report acceptability of the teaching tool and awareness and confidence in identifying patient safety issues using a comic book.ApproachResidents from the Medical College of Wisconsin participated in a 1-hour session to identify 24 safety topics in a comic book. The primary outcomes were awareness and confidence. Engagement and enjoyment were also measured as forms of acceptability of the tool. Comparisons were made using Fisher’s exact tests and paired t-tests for awareness questions and Fisher’s exact tests for confidence questions. Analyses were performed using SAS V.9.4.OutcomesFifty participants were included in the analyses. Proportions in each awareness category were significantly different on post-test in 21 of 24 topics included. The confidence in both identifying safety topics (55.1% precourse to 96% postcourse) and reporting them (35.42%–90%) increased significantly after the curriculum. 90% found the tool enjoyable and 98% found the tool engaging.Next stepsThis curriculum was successful in increasing resident awareness and confidence regarding patient safety. The use of a comic book was acceptable to residents. Future directions include digital conversion of the curriculum and expansion to include multiple settings within the hospital.
Visual assessment of movement quality in the single leg squat test: a review and meta-analysis of inter-rater and intrarater reliability
Authors: Ressman John , Grooten Wilhelmus Johannes Andreas , Rasmussen Barr Eva 
Published: June 2019

Single leg squat (SLS) is a common tool used in clinical examination to set and evaluate rehabilitation goals, but also to assess lower extremity function in active people.ObjectivesTo conduct a review and meta-analysis on the inter-rater and intrarater reliability of the SLS, including the lateral step-down (LSD) and forward step-down (FSD) tests.DesignReview with meta-analysis.Data sourcesCINAHL, Cochrane Library, Embase, Medline (OVID) and Web of Science was searched up until December 2018.Eligibility criteriaStudies were eligible for inclusion if they were methodological studies which assessed the inter-rater and/or intrarater reliability of the SLS, FSD and LSD through observation of movement quality.ResultsThirty-one studies were included. The reliability varied largely between studies (inter-rater: kappa/intraclass correlation coefficients (ICC) = 0.00–0.95; intrarater: kappa/ICC = 0.13–1.00), but most of the studies reached ‘moderate’ measures of agreement. The pooled results of ICC/kappa showed a ‘moderate’ agreement for inter-rater reliability, 0.58 (95% CI 0.50 to 0.65), and a ‘substantial’ agreement for intrarater reliability, 0.68 (95% CI 0.60 to 0.74). Subgroup analyses showed a higher pooled agreement for inter-rater reliability of ≤3-point rating scales while no difference was found for different numbers of segmental assessments.ConclusionOur findings indicate that the SLS test including the FSD and LSD tests can be suitable for clinical use regardless of number of observed segments and particularly with a ≤3-point rating scale. Since most of the included studies were affected with some form of methodological bias, our findings must be interpreted with caution.PROSPERO registration numberCRD42018077822.
Alterations of gut microbiome in autoimmune hepatitis
Authors: Wei Yiran , Li Yanmei , Yan Li , Sun Chunyan , Miao Qi , Wang Qixia , Xiao Xiao , Lian Min , Li Bo , Chen Yong , Zhang Jun , Li You , Huang Bingyuan , Li Yikang , Cao Qin , Fan Zhuping , Chen Xiaoyu , Fang Jing-Yuan , Gershwin Merrill Eric , Tang Ruqi , Ma Xiong 
Published: June 2019

ObjectiveThe significance of the liver-microbiome axis has been increasingly recognised as a major modulator of autoimmunity. The aim of this study was to take advantage of a large well-defined corticosteroids treatment-naïve group of patients with autoimmune hepatitis (AIH) to rigorously characterise gut dysbiosis compared with healthy controls.DesignWe performed a cross-sectional study of individuals with AIH (n=91) and matched healthy controls (n=98) by 16S rRNA gene sequencing. An independent cohort of 28 patients and 34 controls was analysed to validate the results. All the patients were collected before corticosteroids therapy.ResultsThe gut microbiome of steroid treatment-naïve AIH was characterised with lower alpha-diversity (Shannon and observed operational taxonomic units, both p<0.01) and distinct overall microbial composition compared with healthy controls (p=0.002). Depletion of obligate anaerobes and expansion of potential pathobionts includingVeillonellawere associated with disease status. Of note,Veillonella dispar, the most strongly disease-associated taxa (p=8.85E–8), positively correlated with serum level of aspartate aminotransferase and liver inflammation. Furthermore, the combination of four patients with AIH-associated genera distinguished AIH from controls with an area under curves of approximately 0.8 in both exploration and validation cohorts. In addition, multiple predicted functional modules were altered in the AIH gut microbiome, including lipopolysaccharide biosynthesis as well as metabolism of amino acids that can be processed by bacteria to produce immunomodulatory metabolites.ConclusionOur study establishes compositional and functional alterations of gut microbiome in AIH and suggests the potential for using gut microbiota as non-invasive biomarkers to assess disease activity.
Association between physical multimorbidity, body mass index and mental health/disorders in a representative sample of people with obesity
Authors: Romain Ahmed Jérôme , Marleau Jacques , Baillot Aurelie 
Published: June 2019

BackgroundObesity is known to be associated with poor mental health. Studies suggested that multimorbidity might explain the consequences of obesity on mental health. The objective of the present study was to examine to what extent physical multimorbidity and the severity of obesity were associated with mental health and with mental disorders.MethodsCross-sectional study including a weighted representative sample of individuals in obesity from the province of Quebec included in the 2013–2014 Canadian Community Health Survey (N=1315) and test of the replicability of the association in the three previous cycles (2011–2012, N=1180; 2009–2010, N=1166; 2007–2008, N=1298).ResultsAdjusted logistic regressions showed that when obesity classes and physical multimorbidity were considered, the latter was preferentially associated with poor perceived mental health (OR 3.58, 95% CI 2.07 to 6.22), psychological distress (OR 3.71, 95% CI 2.14 to 6.42), major depressive episode (OR 5.16, 95% CI 2.92 to 9.13), mood disorders (OR 2.31, 95% CI 1.41 to 3.78) and anxiety disorders (OR 2.46, 95% CI 1.46 to 4.16). The same associations were confirmed in the previous cycles. Obesity class was only associated with stress (OR 2.05, 95% CI 1.36 to 3.07), but this association was not confirmed in the other cycles. Both physical multimorbidity and severe obesity were associated with mental multimorbidity.ConclusionAmong people with obesity, physical multimorbidity is preferentially associated with poor mental health/disorders. There is an existence of a somatic-mental multimorbidity which should be assessed and prevented in the management of obesity.
Cervical diskospondylitis in a Tennessee walking horse mare
Authors: Olivarez Jeff , Graves Meggan T , Morandi Federica 
Published: June 2019

A 17‐year‐old Tennessee Walking Horse mare presented for an approximate four‐week history of hindlimb weakness and suspect laminitis, as perceived by the owner. When examined by a veterinarian, no lameness was found; rather significant cervical pain was detected. Cervical radiographs revealed abnormalities consistent with diskospondylitis at C5‐C6. The patient was placed on oral trimethoprim‐sulfamethoxazole (20 mg/kg orally twice a day) to be continued for two to three months, as well as firocoxib (0.3 mg/kg orally once a day). After two days of treatment, gabapentin (10 mg/kg orally twice a day) was added for pain management. Two days following, fentanyl patches (100 mcg/hour every 36 hours) were placed to further alleviate pain. Acupuncture was also used for pain management. The patient was released two weeks after initial presentation, with marked improvement. At the time of this report, two months after admission, the mare continues to show marked improvement in mobility and range of motion.
Comparing the randomized benchmarking figure with the average infidelity of a quantum gate-set
Authors: Qi Jiaan , Ng Hui Khoon 
Published: June 2019

Randomized benchmarking (RB) is a popular procedure used to gauge the performance of a set of gates useful for quantum information processing (QIP). Recently, Proctor et al. [Phys. Rev. Lett. 119 (2017) 130502] demonstrated a practically relevant example where the RB measurements give a number [Formula: see text], very different from the actual average gate-set infidelity [Formula: see text], despite past theoretical assurances that the two should be equal. Here, we derive formulas for [Formula: see text], and for [Formula: see text] from the RB protocol, in a manner permitting easy comparison of the two. We show in general that, indeed, [Formula: see text], i.e. RB does not measure average infidelity, and, in fact, neither one bounds the other. We give several examples, all plausible in real experiments, to illustrate the differences in [Formula: see text] and [Formula: see text]. Many recent papers on experimental implementations of QIP have claimed the ability to perform high-fidelity gates because they demonstrated small [Formula: see text] values using RB. Our analysis shows that such a statement from RB alone has to be interpreted with caution.
Is Chronic Kidney Disease Progression Influenced by the Type of Renin-Angiotensin-System Blocker Used?
Authors: Silvariño Ricardo , Rios Pablo , Baldovinos Graciela , Chichet María Alejandra , Perg Nancy , Sola Laura , Saona Gustavo , De Souza Nancy , Lamadrid Verónica , Gadola Liliana 
Published: June 2019

<b><i>Introduction:</i></b> Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce proteinuria and slow renal disease progression more effectively than other therapies in patients with chronic kidney disease (CKD). However, differences regarding efficacy and safety between these therapies remain controversial. <b><i>Objectives:</i></b> Aim of this study was to analyze the different treatment effect of ACEI, ARB, and non-ACEI/ARB in CKD progression. The primary outcome was survival to end-stage renal disease (ESRD) and/or death and to ESRD censored by all-cause death, secondary outcomes were proteinuria reduction and hyperkalemia. <b><i>Methods:</i></b> We analyzed data from 1,120 patients extracted from the National Renal Healthcare Program cohort, which included 17,238 CKD nondialysis subjects who were successively monitored between ­September 1, 2004 and August 31, 2016. Inclusion criteria were at least a 1-year follow-up, 3 clinical visits, and no previous treatment with ACEI or ARB. From the baseline visit onward, patients continued with 3 different treatment schemes: no ACEI/ARB, started on ACEI or ARB, but while avoiding both treatments in combination. Chi<sup>2</sup>, <i>t</i> test, binary logistic regression, and multivariate regression models (Cox proportional Hazard model and competing risk Fine and Gray model were used for statistical analysis. <b><i>Results:</i></b> Mean age and follow-up were 67.9 (± 15) and 3.8 (± 2) years, respectively. Estimated glomerular filtration rate averaged 42.1 ± 23 mL/min/1.73 m<sup>2</sup> and 300 (27%) patients were diabetics. Progression to ESRD was significantly worse in the no ACEI/ARB group (hazard ratio [HR] 4.23, 95% CI 1.28–13.92) versus ACEI (reference group; <i>p</i> = 0.01). The analysis by competing-risks’ regression showed significantly higher risk of ESRD in the no ACEI/ARB group (HR 3.63, 95% CI 1.34–9.85) versus ACEI (<i>p</i> = 0.01). There were no significant differences between ACEI and ARB groups (HR 1.31, 95% CI 0.37–4.66) regarding the risk of progression to ESRD. Survival was similar in all 3 groups (<i>p</i> = 0.051). Statistically significantly more patients experienced reductions in proteinuria/albuminuria in ACEI and ARB groups (together) versus no ACEI/ARB group (<i>p</i> = 0.016, OR 1.82, 95% CI 1.12–2.94). No difference in hyperkalemia frequency was found between them (<i>p</i> = 0.17). <b><i>Conclusions:</i></b> In patients with CKD, treatment with ACEI or ARB had a superior effect than no ACEI or ARB treatment on slowing kidney disease progression and on proteinuria reduction. Efficacy of ACEI and ARB was comparable.