bluuebunny/crossref_metadata_2025_split huggingface dataset:
Growth across life course and cardiovascular risk markers in 18-year-old adolescents: the 1993 Pelotas birth cohort
Authors: Buffarini Romina , Restrepo-Méndez María Clara , Silveira Vera Maria , Gonçalves Helen D , Oliveira Isabel O , Menezes Ana Maria , Formoso Assunção Maria Cecília 
Published: January 2018

ObjectiveTo evaluate the association between growth trajectories from birth to adolescence and cardiovascular risk marker levels at age 18 years in a population-based cohort. In order to disentangle the effect of weight gain from that of height gain, growth was analysed using conditional weight relative to linear growth (CWh) and conditional length/height (CH).DesignProspective study.Setting1993 Pelotas birth cohort, Southern Brazil.ParticipantsIndividuals who have been followed up from birth to adolescence (at birth, 1, 4, 11, 15 and 18 years).Primary outcome measuresC-reactive protein (CRP), total cholesterol (TC), LDL cholesterol (LDL-C), HDL-cholesterol (HDL-C), triglycerides (TGL), systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI) and waist circumference (WC).ResultsIn both sexes, greater CWh at 1 year was positively associated with BMI and WC, whereas greater CWh at most age periods in childhood and adolescence predicted higher CRP, TC, LDL-C, TGL, SBP, DBP, BMI and WC levels, as well as lower HDL-C level. Higher CH during infancy and childhood was positively related with SBP in boys and girls, and with BMI and WC only in boys.ConclusionOur study shows that rapid weight gain from 1 year onwards is positively associated with several markers of cardiovascular risk at 18 years. Overall, our results for the first year of life add evidence to the ‘first 1000 days initiative’ suggesting that prevention of excessive weight gain in childhood might be important in reducing subsequent cardiovascular risk.
Breviário de espectrologia e necromancia: uma hipótese referente ao estudo da ficção historiográfica brasileira
Authors: Almeida Marcos Vinícius Lima de 
Published: January 2018

Esse breve ensaio vislumbra a relação da escrita com a morte, na historiografia, mas também na ficção histórica, a partir da questão do espectro enquanto sintoma da barbárie, que assombra o presente. A escrita da história, na esteira de Michel de Certau e Jeanne Marie Gagnebin, seria uma espécie de rito sepultamento, uma espécie de necromancia, portanto, um diálogo com os fantasmas do passado.
Static metrics of impact for a dynamic problem: The need for smarter tools to guide suicide prevention planning and investment
Authors: Page Andrew , Atkinson Jo-An , Heffernan Mark , McDonnell Geoff , Prodan Ante , Osgood Nathaniel , Hickie Ian 
Published: January 2018

Objectives: This study investigates two approaches to estimate the potential impact of a population-level intervention on Australian suicide, to highlight the importance of selecting appropriate analytic approaches for informing evidence-based strategies for suicide prevention. Methods: The potential impact of a psychosocial therapy intervention on the incidence of suicide in Australia over the next 10 years was used as a case study to compare the potential impact on suicides averted using: (1) a traditional epidemiological measure of population attributable risk and (2) a dynamic measure of population impact based on a systems science model of suicide that incorporates changes over time. Results: Based on the population preventive fraction, findings suggest that the psychosocial therapy intervention if implemented among all eligible individuals in the Australian population would prevent 5.4% of suicides (or 1936 suicides) over the next 10 years. In comparison, estimates from the dynamic simulation model which accounts for changes in the effect size of the intervention over time, the time taken for the intervention to have an impact in the population, and likely barriers to the uptake and availability of services suggest that the intervention would avert a lower proportion of suicides (between 0.4% and 0.5%) over the same follow-up period. Conclusion: Traditional epidemiological measures used to estimate population health burden have several limitations that are often understated and can lead to unrealistic expectations of the potential impact of evidence-based interventions in real-world settings. This study highlights these limitations and proposes an alternative analytic approach to guide policy and practice decisions to achieve reductions in Australian suicide.
The impact of health literacy on diabetes self-management education
Authors: Vandenbosch Jessica , Van den Broucke Stephan , Schinckus Louise , Schwarz Peter , Doyle Gerardine , Pelikan Jürgen , Muller Ingrid , Levin-Zamir Diane , Schillinger Dean , Chang Peter , Terkildsen-Maindal Helle 
Published: January 2018

Background: Diabetes self-management education (DSME) is generally considered to be a key determinant of the treatment outcomes and related costs of diabetes mellitus. While DSME programmes generally have positive outcomes, their effects may depend on certain factors, such as the type of programmes provided and patients’ level of health literacy (HL). Low HL has been associated with poorer self-management behaviours and poor medication adherence in diabetic patients, but its impact on the effects of DSME has not yet been systematically investigated. This study aimed to investigate the influence of HL on the self-reported effects of DSME programmes while taking the type of programme into consideration. Method: A total of 366 diabetic patients from nine countries completed a questionnaire measuring HL, self-management behaviours, problem perception, coping, perceived general health and well-being, before and after participating in a DSME programme. Results: DSME programmes were found to have positive effects on self-reported self-management behaviours and almost all psychological and health outcomes, regardless of HL level. Patients with high HL scored better on several diabetes outcomes than those with low HL, but all patients described benefiting from DSME. Individual and group-based programmes resulted in more positive effects on several diabetes outcomes than self-help groups, but no interaction with HL was found. Conclusion: Our findings confirm those of previous studies showing that DSME programmes have positive effects and that low HL is associated with lower diabetes outcomes but do not support the assumption that the effects of DSME programmes are influenced by the patient’s HL. However, due to the limitations of this study, further investigation is necessary to support these findings and improve our understanding about the impact of HL on DSME programmes’ effectiveness.
Low-energy housing retrofit in North England: Overheating risks and possible mitigation strategies
Authors: Ibrahim Azlizawati , Pelsmakers Sofie LJ 
Published: January 2018

In the drive to reduce space-heating demand and associated CO2 emissions as well as tackle fuel poverty, dwelling overheating and summer-time occupant thermal discomfort might be the unintended consequences of low-energy building retrofits. This paper presents the findings of a steady-state modelled low-energy retrofit dwelling in northern England and its potential current and future climate overheating risks using UK Climate Projections 2009 (UKCP09) scenarios (2050 and 2080 High Emission Scenarios). Predictive findings highlight that retrofitting to low-energy standards increases overheating risk over time, unless passive prevention measures are included in the retrofit design. In addition, the steady-state nature of the model might not fully capture the occupants’ exposure to actual future overheating risks. Among the most effective individual passive overheating mitigation strategies are temporary internal shading, permanent external shading and night-time ventilation. Most effective is a combination of these adaptation measures, so that predictive overheating is minimised in a future changing climate, reducing the uptake of active cooling in retrofitted dwellings. Practical application: Much research focuses on building overheating risks in the warmer South-east of England. However, this paper highlights how dwelling retrofit in north England (Sheffield) also can lead to increased dwelling overheating risk, unless passive design measures are included in the retrofit design. Among the most effective individual passive overheating mitigation strategies are solar shading devices and increased night-time ventilation, though ideally different measures are combined. Using future climate scenarios highlights that retrofits designed today might not be able to provide occupant thermal comfort in a future warming world.
In-stent restenosis: surgical and histopathological perspective
Authors: Srimurugan Balaji , Sigler Matthias , Sankar Nainar Madhu , Cherian Kotturathu Mammen 
Published: January 2018

Background In-stent restenosis has been recognized as a distinct clinical entity that warrants a repeat procedure either in the form of percutaneous reintervention or coronary artery bypass grafting. Multivessel grafting with endarterectomy and explantation of the stent is rarely performed, with few cases reported in the literature. We aim to study the pathomorphology of the stent-vascular interface in coronary vessels undergoing in-stent restenosis. Methods Over a period of 3 years, 3 patients who had undergone angioplasty for diffuse coronary artery disease developed in-stent restenosis and were advised coronary artery bypass. The mean age was 53 years, the average time from the previous intervention was 77 months. Coronary endarterectomy with stent removal and concomitant multivessel coronary artery bypass was performed. Results Histology showed significant proliferation of the well-endothelialized intima as the reason for in-stent restenosis. There were no signs of local thrombus formation or increased inflammatory activity in any of the specimens. After coronary artery bypass, all patients were asymptomatic at a mean follow-up of 32 months. Conclusion Coronary endarterectomy with stent explantation and multivessel coronary artery bypass is a procedure that requires attention because the need is increasing due to the rise in the number of angioplasties. The complexity of this procedure increases to the extent that the adventitia is involved during stent explantation.
Outcomes and Costs of Patients Admitted to the Intensive Care Unit Due to Accidental or Intentional Poisoning
Authors: Fernando Shannon M. , Reardon Peter M. , Ball Ian M. , van Katwyk Sasha , Thavorn Kednapa , Tanuseputro Peter , Rosenberg Erin , Kyeremanteng Kwadwo 
Published: January 2018

Introduction: Acute poisoning represents a major cause of morbidity and mortality, and many of these patients are admitted to the intensive care unit (ICU). However, little is known regarding ICU costs of acute poisoning. Methods: This was a retrospective matched database analysis of patients admitted to the ICU with acute poisoning from 2011 to 2014. It was performed in 2 ICUs within a single tertiary care hospital system. All patient information, outcomes, and costs were stored in the hospital data warehouse. Control patients were defined as randomly selected age-, sex-, severity index-, and comorbidity index-matched nonpoisoned ICU patients (1:4 matching ratio). Results: A total of 8452 critically ill patients were admitted during the study period, of whom 277 had a diagnosis of acute poisoning. The mean age was 44.5 years, and the most common xenobiotics implicated were sedative hypnotics (20.2%), antidepressants (15.2%), and opioids (10.5%). Of these, 73.6% of poisonings were deemed intentional. In-hospital mortality of poisoned patients was 5.1%, compared to 11.1% for control patients ( P < .01). The median ICU length of stay (LOS) for poisoned patients was 3.0 days, compared with 4.0 days for control patients ( P < .01). The mean total cost for poisoned patients was CAD$18 958. Control patients had a significantly higher mean total cost of CAD$60 628 ( P < .01). The xenobiotics associated with the highest costs were acetaminophen (CAD$18 585), toxic alcohols (CAD$16 771), and opioids (CAD$12 967). Conclusions: In our cohort, we confirmed the long-held belief that patients admitted to the ICU with a primary diagnosis of poisoning have a lower mortality rate, ICU LOS, and overall cost per ICU admission than nonpoisoned patients. However, poisoned patients still accrue significant daily costs, with the highest costs attributed to xenobiotics with known antidotes, such as acetaminophen, toxic alcohols, and opioids.
Normal Baseline Function Is Associated With Delayed Rehabilitation in Critically Ill Children
Authors: Miura Shinya , Wieczorek Beth , Lenker Hallie , Kudchadkar Sapna R. 
Published: January 2018

Background: Early mobilization of patients in the adult intensive care unit (ICU) is associated with improved functional outcomes and shorter ICU stay. Although emerging evidence suggests that early mobilization in pediatric ICUs (PICUs) is safe and feasible, physical therapist (PT) consultation may be delayed because of perceptions that patient acuity precludes mobilization activities. Factors that influence timely involvement of PTs to facilitate acute rehabilitation in critically ill children have not been characterized. The aim of this study was to identify patient-level factors for early PT consultation in a tertiary care PICU before large-scale implementation of a multicomponent early mobilization program. Methods: We conducted a retrospective analysis of data from the PICU Up! Quality Improvement Initiative. The primary outcome was early rehabilitation, defined as PT consultation within the first 3 days of PICU admission. Patients (n = 100) were divided into 2 groups by outcome, and predictive factors for early rehabilitation were analyzed with logistic regression. Results: Of 100 children, 54% received early rehabilitation. In univariate analyses, higher pediatric risk of mortality (PRISM) score ( P < .001), baseline motor impairment ( P < .01), developmental delay ( P = .04), mechanical ventilation ( P = .1), and number of devices ( P = .01) were associated with early rehabilitation. In a logistic regression model, predictive factors for early rehabilitation included baseline motor impairment (adjusted odds ratio = 5.36, 95% confidence interval [CI] = 1.3-22.0) and higher PRISM score (adjusted odds ratio = 1.17, 95% CI = 1.02-1.34). Conclusions: Critically ill children with normal baseline function or lower acuity of illness are less likely to have initiation of early rehabilitation with PT prior to implementation of a unit-wide early mobilization program. Baseline motor impairment and higher PRISM scores were independently associated with early rehabilitation. These findings highlight the need for streamlined criteria for PT consultation to meet the rehabilitation needs of all critically ill patients.
Transforming an idea into a scholarly project
Authors: Ng Lillian , Cullum Sarah , Cheung Gary , Friedman Susan Hatters 
Published: January 2018

Objectives: This article describes components of a workshop designed to orientate psychiatric trainees to the task of conducting a scholarly project. The aims are: to promote an approach that incorporates principles of adult learning to guide trainees who are undertaking research; to allow trainees to transform their ideas into more tangible research questions; and to enable supervisors to reflect on delivering similar content in scholarly project workshops. Methods: The workshop comprised: creating a safe space to explore ideas; discussing the process of posing a question or hypothesis; using group interactions to generate concepts; and considering personal values that influence the choice of research methodology to answer a question. Results: Examples are provided from the workshop. The process enabled trainees to generate and distil ideas into more concrete questions and methods in three phases: introductory, exploratory and tangible. Conclusions: Adult learning principles may assist trainees to develop their ideas for a scholarly project into research questions that are relevant to clinical practice. Harnessing the creative potential of a peer collective may encourage deeper inquiry, shifts to a tangible output and a sustained interest in research.
Paliperidone palmitate three-month depot formulation: a helpful innovation with practical pitfalls
Authors: Hope Judith D , Keks Nicholas A 
Published: January 2018

Objective: Paliperidone palmitate is now available as a three-month depot injection. This paper will review the pharmacokinetics, pharmacodynamics, efficacy and tolerability, as well as practical issues and pitfalls for clinicians with this innovative treatment for schizophrenia. Conclusion: The three-month depot formulation of paliperidone for the treatment of schizophrenia is not a new compound. The nanocrystalline structure of the three-month formulation is larger and takes longer to disperse than the one-month formulation, hence its extended depot action. As expected, it is non-inferior to one-month depot paliperidone, and superior to placebo, for the treatment of schizophrenia. The side effect profile of three-month paliperidone is identical to the one-month formulation. The relapse rate on treatment is low, and the median time to relapse after ceasing the drug is 395 days. An understanding of half-life and kinetics is crucial for clinicians using this compound, and the loading strategy is important to ensure effectiveness. There are significant challenges: ensuring timely administration and switching a three-month depot treatment to another antipsychotic may be problematic. Paliperidone palmitate three-month depot injection represents an advance for both convenience and effectiveness in the long term psychopharmacological treatment of schizophrenia.
Aplastic anemia secondary to propylthiouracil: A rare and life-threatening adverse effect
Authors: Shaikh Hira , Kamran Amir , Shaikh Soorih , Mewawalla Prerna 
Published: January 2018

Background Propylthiouracil has been in use for more than half a century for the treatment of hyperthyroidism. While it is largely known to cause agranulocytosis, its association with aplastic anemia is rarely heard of. Our case will be the third in literature to suggest aplastic anemia as a manifestation of propylthiouracil, which unfortunately culminated in the death of the patient. Case A 67-year-old female, with recently diagnosed metastatic adenocarcinoma of the lung, developed hyperthyroidism after being started on Nivolumab and Iplimumab. After she developed atrial fibrillation, she was started on propylthiouracil to control the thyroid activity. Soon after that, she was admitted with severe neutropenia, which progressed to pancytopenia confirmed as aplastic anemia on a bone marrow biopsy. Despite discontinuation of propylthiouracil and aggressive treatment, she developed septic shock and multi-organ failure, leading to her death. Conclusion Aplastic anemia has been sparingly reported as an extremely rare complication of propylthiouracil. Further adding to the ambiguity is the unknown etiology and lack of specific therapy for the complication when attributed to propylthiouracil. The disease can carry an extremely poor prognosis if untreated, as proven by our case. Due to the same reasons, we recommend that further investigations be done to elucidate the pathogenesis and assist with treatment of the disease when caused by propylthiouracil.
Simultaneous early-onset severe autoimmune hemolytic anemia and albuminuria during alemtuzumab treatment for multiple sclerosis
Authors: di Ioia Maria , Farina Deborah , di Tommaso Valeria , Travaglini Daniela , Pietrolongo Erika , Onofrj Marco , de Luca Giovanna 
Published: January 2018

Background: Alemtuzumab, approved for multiple sclerosis (MS), can cause secondary autoimmune adverse events including thyroid disorders, immune thrombocytopenia (ITP), and glomerular nephropathies. Non-ITP autoimmune cytopenias are rarely reported. Objective: To report a case of autoimmune hemolytic anemia (AIHA) and nephropathy in a MS patient treated with alemtuzumab. Case report: A 34-year-old man with MS developed albuminuria and AIHA after the first and only alemtuzumab treatment, with positive Coombs’ direct and indirect tests and IgG autoantibodies. Both AIHA and nephropathy resolved 1 month after treatment with steroids and intravenous immunoglobulins. Conclusion: Our report adds to literature on AIHA and nephropathy after alemtuzumab treatment and suggests to add Coombs’ tests to the screening panel required for alemtuzumab treatment.
No place like home: A case study of a patient discharged from an Intensive Care Unit for end of life care at home
Authors: Smith David , Hall Donna , Parke Geraldine , Lane Rebecca , Gray Alison 
Published: January 2018

Introduction Both in the UK and internationally, discharge from an intensive care unit to home for end of life care is a rare and challenging occurrence. These challenges include clinicians’ ability to identify appropriate patients in whom it is possible to communicate with about their wishes and preferences, the critical nature of their condition and the interface between hospital and community services. Method We present a case report of a patient who had been admitted to hospital with a myocardial infarction and subsequently suffered a cardiac arrest, from which he was successfully resuscitated. Subsequently, he suffered multi-organ failure, but despite treatments, the ceiling of care was reached. With a poor prognosis, medical and nursing staff engaged in advance care planning to determine his wishes and preferences at the end of life and to facilitate his discharge from the intensive care unit to his home. Conclusion This case study has highlighted that through good communication amongst patients, families and professionals and collaborative working across boundaries and organisations, appropriate patients in the critical care setting can have a real choice regarding where they wish to be cared for and die at the end of their life.