bluuebunny/crossref_metadata_2025_split huggingface dataset:
North–South divide: Distribution and outcome of respiratory viral infections in paediatric intensive care units in Cape Town (South Africa) and Nottingham (United Kingdom)
Authors: Lonngren Camilla , Morrow Brenda M , Haynes Sarah , Yusri Taha , Vyas Harish , Argent Andrew C 
Published: December 2013

AimThis study aims to describe and compare the spectrum, course, seasonality and outcome of children with virus‐associated respiratory symptoms (VARS) admitted to two paediatric intensive care units (PICUs) in the United Kingdom (UK) and South Africa (SA).MethodsCross‐sectional study of routinely collected data on subjects admitted to PICU with respiratory symptoms and positive respiratory viral polymerase chain reaction between July 2009 and July 2011.ResultsSix hundred forty‐six samples yielding 765 viral isolates (74% from SA) from 599 patients (53% male; median (interquartile range) age 6.0 (2.3–16.5) months) were included. Rhinovirus, respiratory syncytial virus and adenovirus were most commonly isolated. Adenovirus was more prevalent in SA (24.3% vs. 16.8%, P = 0.03). Possible or likely nosocomial viral acquisition occurred in 78% of isolates in SA versus 48% in the UK (P < 0.0001).Total mortality was 13.5%; 17% in SA versus 4% in the UK (P < 0.0001). Mortality for community acquired VARS was 8.4% versus 16.1% in those with possible nosocomial viral acquisition (P = 0.009). Factors independently associated with mortality were: SA study site (adjusted odds ratio (OR) 3.4, 95% confidence interval (CI) 1.4–8.5; P = 0.008); age (months) (OR 1.0, 95% CI 1.0–1.02; P = 0.001); Paediatric Index of Mortality 2 score (%) (OR 1.0, 95% CI 1.01–1.03; P = 0.0002) and isolation of adenovirus (OR 3.0, 95% CI 1.8–5.0; P < 0.0001).ConclusionsThe outcome of children with VARS was worse in SA compared with the UK PICU. Nosocomial VARS was highlighted as an important concern and requires further investigation.
Non‐operative advances: What has happened in the last 50 years in paediatric surgery?
Authors: Holland Andrew JA , McBride Craig A 
Published: December 2013

AbstractPaediatric surgeons remain paediatric clinicians who have the unique skill set to treat children with surgical problems that may require operative intervention. Many of the advances in paediatric surgical care have occurred outside the operating theatre and have involved significant input from medical, nursing and allied health colleagues. The establishment of neonatal intensive care units, especially those focusing on the care of surgical infants, has greatly enhanced the survival rates and long‐term outcomes of those infants with major congenital anomalies requiring surgical repair. Educational initiatives such as the advanced trauma life support and emergency management of severe burns courses have facilitated improved understanding and clinical care. Paediatric surgeons have led with the non‐operative management of solid organ injury following blunt abdominal trauma. Nano‐crystalline burn wound dressings have enabled a reduced frequency of painful dressing changes in addition to effective antimicrobial efficacy and enhanced burn wound healing. Burns care has evolved so that many children may now be treated almost exclusively in an ambulatory care setting or as day case‐only patients, with novel technologies allowing accurate prediction of burn would outcome and planning of elective operative intervention to achieve burn wound closure.
Supported playgroups as a setting for promoting physical activity of young children: Findings from a feasibility study in south‐west Sydney, Australia
Authors: Weber Danielle , Rissel Chris , Hector Debra , Wen Li Ming 
Published: December 2013

AimThis study examined the feasibility of the supported playgroups (SPGs) setting to promote physical activity among young children and increase staff and parental knowledge of the physical activity recommendations for young children.MethodsA 10‐week Active Play@Playgroup intervention was conducted with 28 co‐ordinators and 174 parents attending SPGs located in south‐west Sydney. The intervention involved training and providing support to SPG co‐ordinators to help promote active play and reduce screen time for young children. The effectiveness of the intervention was evaluated using pre‐ and post‐intervention surveys. The main outcomes included changes in parents' knowledge of physical activity recommendations for 0‐ to 5‐year‐olds, and children's physical activity and sedentary behaviours outside of playgroup.ResultsThe mean time children spent playing actively outdoors during the week increased (pre: 1.48 h/day vs. post: 1.95 h/day, P = 0.02), and the time parents spent playing actively with their children increased both during weekdays (pre: 1.57 h/day vs. post: 2.42 h/day, P = 0.01) and on the weekend (pre: 2.95 h/day vs. post: 3.83 h/day, P = 0.02). There was also a significant increase in the proportion of parents with correct knowledge of recommended screen time for 0‐ to <2‐year‐olds (pre: 7.9% vs. post: 23.4%, P = 0.02).ConclusionsIt is feasible and potentially effective to use the SPG setting to promote active play among young children and increase parents' knowledge of physical activity recommendations for young children.
Retrospective review of 200 children hospitalised with acute asthma. Identification of intervention points: A single centre study
Authors: Giarola Blake F , McCallum Gabrielle B , Bailey Emily J , Morris Peter S , Maclennan Carolyn , Chang Anne B 
Published: December 2013

AimIndigenous Australians with asthma have higher morbidity and mortality compared with non‐Indigenous Australians. In children hospitalised with acute asthma, we aimed to (i) determine if acute severity, risk factors and management differed between Indigenous and non‐Indigenous children; and (ii) identify intervention points to reduce morbidity and mortality of asthma.MethodsRetrospective review of 200 children hospitalised to Royal Darwin Hospital with asthma. We compared admission characteristics, severity indices, treatment, discharge plans and readmissions in Indigenous and non‐Indigenous children.ResultsMedian age was 3.6 years (interquartile range 2.2, 6.8). A significantly higher proportion of Indigenous children (95.2%) were exposed to tobacco smoke compared with non‐Indigenous children (45.7%). The difference in proportions was −0.41 (95% confidence interval (CI) −0.60, −0.22). Other risk factors, asthma severity (moderate 83.9% vs. 83.3%; severe 16% vs. 16.1%), length of stay (1.9 vs. 1.3 days) and readmission rate (27.4% vs. 27.5%) were similar between Indigenous and non‐Indigenous children. Indigenous children were significantly more likely to be followed up in a community clinic (difference in proportions = 0.10, 95% CI 0.1, 0.17) and less likely by a paediatrician. Only 62.5% of all children had an asthma action plan on discharge.ConclusionUnlike other common respiratory diseases requiring hospitalisation, biological factors are unlikely major contributors to the known gap in asthma outcomes between Indigenous and non‐Indigenous children. Intervention points include better identification, documentation and management of tobacco smoke exposure, delivery of salbutamol and discharge planning (including education and utilisation of asthma action plans).
Insult to injury: Transient encephalopathy in a brain‐injured adolescent
Authors: Peters Jurriaan M , Fernández Iván Sánchez 
Published: December 2013

AbstractWe report on an adolescent with prior brain injury who responded to abrupt drug changes and an electrolyte imbalance with a significant alteration in the level of consciousness. In children with prior brain injury, paediatricians should consider the concept of a ‘fragile brain’ with limited ‘cognitive reserve’ and increased susceptibility to relatively minor toxic‐metabolic insults. Psychoactive and central nervous system drugs should be managed with prudence in these patients.
Epidermal nevus syndrome with hypophosphatemic rickets in a young girl
Authors: Sukkhojaiwaratkul Dabuswinee , Mahachoklertwattana Pat , Poomthavorn Preamrudee 
Published: December 2013

AbstractEpidermal nevus syndrome (ENS) is a rare congenital disorder. It is characterised by epidermal nevi and abnormalities of multiple organs, including central nervous system, skeleton, cardiovascular and genitourinary systems and eyes. Hypophosphatemic rickets‐associated ENS has rarely been reported. We report a 46‐month‐old girl who presented with a classical feature of hypophosphatemic rickets. Examination of skin revealed multiple melanocytic nevi at her trunk, face and both arms with verrucous plaques at both axillae and neck, and yellow plaques at the back along Blaschko's lines. Histopathology of the skin lesions was compatible with epidermal nevi and nevus sebaceous. Therefore, the diagnosis of ENS was made. Apart from typical rickets, the skeletal X‐rays interestingly displayed fibrous dysplasia‐like lesions along right femur, tibia and fibula. Hypophosphatemic rickets was treated with alfacalcidol and phosphate solution. After 3 months of treatment, clinical improvement of hypophosphatemic rickets was clearly demonstrated. Her blood chemistries were normalised at 5 months following the treatment. In conclusion, hypophosphatemic rickets is a rare presentation of ENS. Our patient also demonstrated an additional abnormal bone finding, fibrous dysplasia‐like lesions, associated with rachitic changes. This highlights heterogeneity of this condition and importance of thorough evaluation of patients with ENS.
Implementation of written consent for newborn screening in Victoria, Australia
Authors: Charles Taryn , Pitt James , Halliday Jane , Amor David J 
Published: December 2013

AimsThere has been increasing evidence of a lack of public awareness of newborn screening and concern about inadequate consent being obtained from parents. Apprehension also exists in relation to storage and secondary use of screening samples. Our objective was to introduce a written consent process across Victoria as a means of strengthening programme transparency, quality and supporting parental choice. In addition, more comprehensive information covering all aspects of the programme was developed.MethodsA ‘two‐stage’ written consent protocol allowed parents to give separate consent for (i) their baby to be screened and (ii) secondary use of the sample in de‐identified health research. At the time of sample collection, parents were asked to complete the consent form, included as part of the screening card. The protocol was piloted in four public hospitals and subsequently implemented statewide.ResultsTwelve months of laboratory data showed that although refusals for screening increased, overall participation remained above 99%. The percentage of parents opting out of research use was 6.5%. Provider compliance with the new protocol was high, with only 1.4% of cards received without a completed consent form.ConclusionThis quality improvement project has demonstrated that parents can participate more fully in newborn screening without jeopardising high uptake. As a secondary benefit, the public health resource of stored cards can be maintained with parental support. Future work needs to examine the quality of consent being given by parents and investigation of the reasons why some choose to decline.
Standardising paediatric resuscitation training in New South Wales, Australia: RESUS4KIDS
Authors: O'Leary Fenton , Allwood Margaret , McGarvey Kathryn , Howse Julie , Fahy Karyn 
Published: December 2013

AimA key competency for all health‐care workers (HCWs) who care for children is the ability to respond to a child in respiratory or cardiorespiratory arrest. However, evidence suggests that medical and nursing staff may not have the knowledge and clinical skills to respond to these emergencies. The aim of this project was to create a standardised, evidence‐based, paediatric life support course that would be available free to all HCWs in New South Wales (NSW), including NSW Ambulance.MethodsA paediatric life support course was designed along current education principles. It used e‐learning as pre‐learning and a face‐to‐face short practical course, combining team work and communication with practical paediatric resuscitation skills training. The programme was designed to empower local trainers to deliver a standardised course to local participants.ResultsA total of 14 000 participants have completed the mandatory e‐learning component, and over 8600 participants have completed the short practical course, across all NSW Local Health Districts, including NSW Ambulance. RESUS4KIDS has also been adopted by the universities of Sydney and Newcastle undergraduate medical and nursing programmes. Outside of NSW and ACT, over 400 participants have completed the course in facilities in Queensland, South Australia, Victoria and the Northern Territory.ConclusionWe have developed a course that is available, at no cost to individuals or facilities, to all HCWs in NSW, including students, paramedics and general practitioners. We would encourage all other jurisdictions to consider adopting the programme.
Reasons for the overly optimistic beliefs of parents of children with diabetes
Authors: Freckleton Evril , Sharpe Louise , Mullan Barbara 
Published: December 2013

AimsThe purposes of this study are to investigate parents' beliefs about the likelihood of diabetes outcomes for their child, the reasons that they give for these beliefs and the relationship between the beliefs and parental psychopathology.MethodsSeventy‐one mothers of children with diabetes completed a questionnaire about the likelihood of certain diabetes outcomes and measures of psychopathology. Both qualitative and quantitative data were collected at a single time point.ResultsMothers generally held very optimistic views about their children's future, and this was associated with less maternal depressive symptoms. Mothers typically used their previous experiences and belief that diabetes is controllable to justify optimistic beliefs about short‐term consequences. In contrast, formation of mothers' views on long‐term consequences generally relied on information from a variety of sources.ConclusionThe results suggest that it is usual and helpful for mothers of children with diabetes to hold overly optimistic views about their children's futures. Medical evidence appears to have little influence on mothers' beliefs about likely outcomes for their children.
Natural polymer-stabilized multiple water-in-oil-in-water emulsions: a novel dermal drug delivery system for 5-fluorouracil
Authors: Hoppel Magdalena , Mahrhauser Denise , Stallinger Christina , Wagner Florian , Wirth Michael , Valenta Claudia 
Published: December 2013

Abstract

Objectives
The aim of this study was to create multiple water-in-oil-in-water (W/O/W) emulsions with an increased long-term stability as skin delivery systems for the hydrophilic model drug 5-fluorouracil.

Methods
Multiple W/O/W emulsions were prepared in a one-step emulsification process, and were characterized regarding particle size, microstructure and viscosity. In-vitro studies on porcine skin with Franz-type diffusion cells, tape stripping experiments and attenuated total reflectance-fourier transform infrared spectroscopy (ATR-FTIR) were performed.

Key findings
The addition of Solagum AX, a natural polymer mixture of acacia and xanthan gum, led to multiple W/O/W emulsions with a remarkably increased long-term stability in comparison to formulations without a thickener. The higher skin diffusion of 5-fluorouracil from the multiple emulsions compared with an O/W-macroemulsion could be explained by ATR-FTIR. Shifts to higher wave numbers and increase of peak areas of the asymmetric and symmetric CH2 stretching vibrations confirmed a transition of parts of the skin lipids from an ordered to a disordered state after impregnation of porcine skin with the multiple emulsions.

Conclusions
Solagum AX is highly suitable for stabilization of the created multiple emulsions. Moreover, these formulations showed superiority over a simple O/W-macroemulsion regarding skin permeation and penetration of 5-fluorouracil.
Ascorbic acid 6-palmitate: a potent inhibitor of human and soybean lipoxygenase-dependent lipid peroxidation
Authors: Mohamed Riyaz , Tarannum Shaista , Yariswamy Manjunath , Vivek Hamse K , Siddesha Jalahalli M , Angaswamy Nataraju , Vishwanath Bannikuppe S 
Published: December 2013

Abstract

Objectives
Lipoxygenases (LOX) are the key enzymes involved in the biosynthesis of leukotrienes and reactive oxygen species, which are implicated in pathophysiology of inflammatory disorders. This study was conducted to evaluate the inhibitory effect of water-soluble antioxidant ascorbic acid and its lipophilic derivative, ascorbic acid 6-palmitate (Vcpal) on polymorphonuclear lymphocyte 5-LOX and soybean 15-LOX (sLOX) in vitro.

Methods
LOX activity was determined by measuring the end products, 5-hydroperoxy eicosatetraenoic acid (5-HETE) and lipid hydroperoxides, by spectrophotometric and high performance liquid chromatography methods. The substrate-dependent enzyme kinetics and docking studies were carried out to understand the nature of inhibition.

Key findings
Vcpal potently inhibited 5-LOX when compared with its inhibitory effect on sLOX (IC50; 2.5 and 10.3 μm respectively, P = 0.003). Further, Vcpal inhibited 5-LOX more strongly than the known synthetic drugs: phenidone and nordihydroguaiaretic acid (P = 0.0007). Enzyme kinetic studies demonstrated Vcpal as a non-competitive reversible inhibitor of 5-LOX. In-silico molecular docking revealed high MolDock and Rerank score for Vcpal than ascorbic acid, complementing in-vitro results.

Conclusion
Both in-vitro and docking studies demonstrated Vcpal but not ascorbic acid as a non-competitive inhibitor of 5-LOX- and sLOX-induced lipid peroxidation, suggesting a key role for lipophilic nature in bringing about inhibition.
Do Antarctic lichens modify microclimate and facilitate vascular plants in the maritime Antarctic? A comment to Molina‐Montenegro et al. ()
Authors: Casanova‐Katny Angélica , Palfner Götz , Torres‐Mellado Gustavo A. , Cavieres Lohengrin A. 
Published: December 2013

AbstractA recent article published by Molina‐Montenegro et al. (Journal of Vegetation Science24: 463) examines the association of Antarctic native plant and lichen species to the lichen Usnea antarctica on Fildes Peninsula, King George Island, maritime Antarctica. The authors report that on two sites, five out of 13 and four out of 11 species of lichens and mosses were spatially associated with U. antarctica, suggesting positive interactions between them. Although Deschampsia antarctica does not grow naturally associated with U. antarctica, Molina‐Montenegro et al. carried out a transplantation experiment to demonstrate that the macrolichen acts as a nurse plant, improving the survival of the grass. Serious conceptual and methodological discrepancies emerge from a critical evaluation of this study, challenging their conclusions. First, we suspect that the author confused some lichen taxa, and we also disagree with macrolichens being treated as cushion plants, because rootless, poikilohydric and poikilothermic thallophytes such as lichens are unable to create a stable, enclave‐like microhabitat as vascular cushion plants do. Indeed, a critical evaluation of some of the micro‐environmental parameters measured indicates that there are no biologically meaningful differences between the U. antarctica thalli and surrounding open areas. Second, the lack of consideration of the life history of the species under study leads to confusion when (a) referring to the succession sequence of species that colonize the studied area and (b) interpreting the putative distribution patterns promoted by Usnea versus the substrate preferences of associated species. Third, the authors intend to demonstrate experimentally that Usnea can facilitate the survival of D. antarctica plants, transplanting adult plants and not seedlings between the lichen thalli, and it is not clear how the grass was planted – between or within the lichens – as at both experimental sites the lichens grow on stones or rocks. Facilitative interactions are present in the Antarctic and may play a pivotal role in the structure and functioning of the fragile Antarctic ecosystems. However, more rigorous and well‐planned research is needed to assess its presence, importance and involved mechanisms.
How to optimize current therapy of HCV genotype 1 infection with boceprevir
Authors: Bourlière Marc , Adhoute Xavier , Wendt Astrid , Ansaldi Christelle , Oules Valérie , Castellani Paul 
Published: December 2013

AbstractTreatment with first generation protease inhibitors (PIs) is a milestone in the history of HCV therapy. Triple therapy with boceprevir (BOC) improves sustained virological response (SVR) by 30% in treatment naïve genotype 1 patients and by 50–60% in relapsers, 40–45% in partial responders and 25% in null responders compared with the Pegylated Interferon (PEG‐IFN) and ribavirin regimen. To optimize BOC treatment, screening and access to treatment must be improved in genotype 1 patients. To select the ideal candidate for immediate treatment with triple therapy, an individual risk/benefit ratio must be assessed. Recent data have shown that patients with compensated cirrhosis and more advanced disease may also benefit from this regimen. Moreover, in HCV patients with extrahepatic manifestations, patients with HCV recurrence after liver transplantation and HIV‐HCV co‐infected patients, immediate treatment with triple therapy should be discussed. There is growing evidence that triple therapy with BOC is cost‐effective in genotype 1 patients. Finally, the treatment design of BOC must be optimized in relation to baseline characteristics, so that optimal stopping rules can be followed, Drug‐drug interactions (DDIs) can be prevented and AEs can be accurately prevented and managed.
Impact of HBV therapy on the incidence of hepatocellular carcinoma
Authors: Triolo Michela , Corte Cristina Della , Colombo Massimo 
Published: December 2013

AbstractHepatocellular carcinoma (HCC) is a frequent, long term complication of chronic infection with hepatitis B virus (HBV) with an annual incidence ranging from 2 to 5%, often independent from the histological stage of underlying liver disease and serological status. Nevertheless, HCC is more often seen in older patients in whom HBV has been asserting its pro‐oncogenic properties through both indirect and direct mechanisms. In Europe, HBV‐related HCC is associated with cirrhosis in most patients, whereas this is not true in Asia and Africa where the tumour is also common among carriers with mild hepatic fibrosis, probably because of the coexistence of environmental co‐carcinogens (aflatoxin) and long standing infection that is often acquired perinatally. Since hepatitis B‐related carcinogenesis develops independently of the onset of cirrhosis, antiviral treatments such as nucleo(t)side analogues (NAs) that may result in the regression of fibrosis, prevent clinical decompensation and variceal bleeding, often fail to prevent HCC.Studies enrolling patients treated with lamivudine or rescued with adefovir, i.e. regimens characterized by limited potency and a low to moderate genetic barrier, have clearly been shown to help prevent HCC in patients with chronic hepatitis but not in those with cirrhosis, and in general not in patients that cannot achieve a sustained virological response.More potent anti‐HBV drugs, such as entecavir and tenofovir, have been shown to improve the prevention of HCC in responders with cirrhosis, although HCC may still occur even in low risk patients. To attenuate HCC related outcomes, HBV replication must permanently be suppressed and HCC surveillance by abdominal ultrasound should be maintained even in responder patients.