bluuebunny/crossref_metadata_2025 huggingface dataset:
Orbital apex syndrome as a complication of herpes zoster ophthalmicus
Authors: Chandrasekharan Anjali , Gandhi Uppal , Badakere Akshay , Sangwan Virender
Published: February 2017

Orbital apex syndrome is a rare neuro-ophthalmic manifestation of herpes zoster virus infection. We report one such case with favourable outcome in an immunocompetent patient. A 60-year-old woman presented with rash in the dermatome of the left ophthalmic nerve (V1), followed by sudden loss of vision with complete left-sided external and internal ophthalmoplegia. MRI of brain and orbits with contrast revealed optic perineuritis and myositis without intracranial involvement confirming the diagnosis of orbital apex syndrome. Functional visual recovery was achieved after a course of intravenous and oral steroids under antiviral cover over a follow-up period of 3 months.
Hypercalcaemia caused by active pulmonary tuberculosis in an elderly person without fever or pulmonary symptoms
Authors: Hanai Shogo , Shinzato Takashi , Inazu Daiki , Tokuda Yasuharu
Published: February 2017

Many diseases can cause hypercalcaemia, including primary hyperparathyroidism, cancer, drugs and granulomatous diseases. A nursing home resident aged 81 years was admitted because of altered mental status. The patient did not have fever, cough, sputum or night sweat. Hypercalcaemia was identified as a cause of the consciousness disturbance. Chest radiograph showed no acute process. Laboratory workups revealed elevated serum levels of 1,25-(OH)2 vitamin D3and positive T-spot test. Microscopic examination of the suctioned sputum identified acid-fast bacilli, which was confirmed asMycobactrium tuberculsosis. Tuberculosis should be considered as the important cause of hypercalcaemia since early diagnosis and treatment is recommended for preventing its outbreak among people with close contacts with patients.
Over 10 years MRI observation of a patient with neuronal intranuclear inclusion disease
Authors: Abe Kazuo , Fujita Masashi
Published: February 2017

We present a sporadic neuronal intranuclear inclusion disease (NIID) patient with neuropathy followed by cognitive dysfunction along with brain MRIs findings of leucoencephalopathy. Her cognitive impairment gradually progressed along with abnormal intensity lesions in diffusion-weighted images. This pathological and clinical deterioration resemble pathological process in prion diseases.
Emergency cricothyroidotomy following tracheobronchial stenting
Authors: Cavinato Simon Robert , Denning Mike , Madden Brendan P
Published: February 2017

A man aged 51 years was referred for tracheobronchial stenting after a poorly differentiated oesophageal carcinoma had progressed to cause stridor. Bronchoscopy revealed a left vocal cord palsy and tumour infiltration into the trachea. A tracheobronchial stent was placed, and after distal migration was endoscopically resited. Returning from theatre, the patient developed severe upper airway obstruction that progressed to cause CO2narcosis and loss of consciousness. A rapid sequence induction was initiated, and a Glidescope revealed bilateral vocal cord palsy with severe oedema causing an inability to pass a tube or stylet. Tracheostomy was attempted above the suprasternal notch but was obstructed by the stent. Oxygen saturations dropped steadily, reaching as low as 38%. Emergency cricothyroidotomy was performed, compliant with DAS guidelines, that proved successful. The stent was removed, which was blocked with blood and secretions, and tracheostomy was placed 2 days later. The patient made a full neurological recovery.
Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes
Authors: Snorgaard Ole , Poulsen Grith M , Andersen Henning K , Astrup Arne
Published: February 2017

Objective

Nutrition therapy is an integral part of self-management education in patients with type 2 diabetes. Carbohydrates with a low glycemic index are recommended, but the ideal amount of carbohydrate in the diet is unclear. We performed a meta-analysis comparing diets containing low to moderate amounts of carbohydrate (LCD) (energy percentage below 45%) to diets containing high amounts of carbohydrate (HCD) in subjects with type 2 diabetes.

Research design and methods

We systematically reviewed Cochrane library databases, EMBASE, and MEDLINE in the period 2004–2014 for guidelines, meta-analyses, and randomized trials assessing the outcomes HbA1c, BMI, weight, LDL cholesterol, quality of life (QoL), and attrition.

Results

We identified 10 randomized trials comprising 1376 participants in total. In the first year of intervention, LCD was followed by a 0.34% lower HbA1c (3.7 mmol/mol) compared with HCD (95% CI 0.06 (0.7 mmol/mol), 0.63 (6.9 mmol/mol)). The greater the carbohydrate restriction, the greater the glucose-lowering effect (R=−0.85, p<0.01). At 1 year or later, however, HbA1c was similar in the 2 diet groups. The effect of the 2 types of diet on BMI/body weight, LDL cholesterol, QoL, and attrition rate was similar throughout interventions.

Limitations

Glucose-lowering medication, the nutrition therapy, the amount of carbohydrate in the diet, glycemic index, fat and protein intake, baseline HbA1c, and adherence to the prescribed diets could all have affected the outcomes.

Conclusions

Low to moderate carbohydrate diets have greater effect on glycemic control in type 2 diabetes compared with high-carbohydrate diets in the first year of intervention. The greater the carbohydrate restriction, the greater glucose lowering, a relationship that has not been demonstrated earlier. Apart from this lowering of HbA1c over the short term, there is no superiority of low-carbohydrate diets in terms of glycemic control, weight, or LDL cholesterol.
Fatigue and its associated factors in liver transplant recipients in Beijing: a cross-sectional study
Authors: Lin Xiao-Hong , Teng Sha , Wang Lu , Zhang Jing , Shang Ya-Bin , Liu Hong-Xia , Zang Yun-Jin
Published: February 2017

Objectives

Fatigue is a highly prevalent symptom experienced by patients who underwent the liver transplantation. However, the influencing factors of fatigue are poorly understood by healthcare professionals. The aim of this study was to examine the intensity, interference, duration and prevalence of fatigue in liver transplantation recipients and to explore the influencing factors of post-transplantation fatigue.

Design

A cross-sectional design was used in this study.

Methods

A convenience sample of liver transplant recipients was recruited at an outpatient transplant clinic of a general hospital in Beijing, China. Self-report survey data were provided by liver transplant recipients using the Fatigue Symptom Inventory (FSI), the Hospital Anxiety and Depression Scale (HADS), the Perceived Social Support Scale (PSSS) and the Athens Insomnia Scale (AIS). Demographic, clinical and psychosocial parameters were evaluated as fatigue influencing factors.

Results

Participants (n=285) included 69 women and 216 men. Fatigue was found in 87.0% of liver transplant recipients. Mean scores of fatigue intensity items were 4.47±2.85, 1.93±1.97, 3.15±2.13 and 2.73±2.42 (most fatigue, least fatigue, average fatigue in the week prior to assessment and fatigue at the point of assessment). The mean score of fatigue interference was 2.27±2.09.The number of days fatigued in the week prior to assessment was 2.26±2.02 and the amount of time fatigued each day was 2.75±2.44. Spearman's correlation analysis showed that fatigue intensity was positively associated with anxiety, depression and insomnia (p<0.001 for all), while fatigue interference was positively associated with gender, anxiety, depression and insomnia (p<0.05 for all). In the multiple linear regression analysis, anxiety and insomnia were positively associated with fatigue intensity (p<0.001), and insomnia, depression and anxiety were positively associated with fatigue interference (p<0.001).

Conclusions

Fatigue is common in liver transplant recipients, and it is strongly associated with insomnia, anxiety and depression.
How does a physical activity programme in elementary school affect fracture risk? A prospective controlled intervention study in Malmo, Sweden
Authors: Cöster Marcus E , Fritz Jesper , Nilsson Jan-Åke , Karlsson Caroline , Rosengren Björn E , Dencker Magnus , Karlsson Magnus K
Published: February 2017

Objectives

Recent evidence from the 7-year follow-up of the Pediatric Osteoporosis Prevention (POP) study indicates an inverse correlation between years of participation in a physical activity (PA) intervention and fracture risk in children. However, we could not see a statistically significant reduction in fracture risk, which urged for an extension of the intervention.

Setting

The study was conducted in 4 neighbouring elementary schools, where 1 school functioned as intervention school.

Participants

We included all children who began first grade in these 4 schools between 1998 and 2012. This resulted in 1339 children in the intervention group and 2195 children in the control group, all aged 6–8 years at the state of the study.

Intervention

We launched an 8-year intervention programme with 40 min of moderate PA per school day, while the controls continued with the Swedish national standard of 60 min of PA per week.

Primary outcome measure

We used the regional radiographic archive to register objectively verified fractures and we estimated annual fracture incidences and incidence rate ratios (IRRs).

Results

During the first year after initiation of the intervention, the fracture IRR was 1.65 (1.05 to 2.08) (mean 95% CI). For each year of the study, the fracture incidence rate in the control group compared with the intervention group increased by 15.7% (5.6% to 26.8%) (mean 95% CI). After 8 years, the IRR of fractures was 52% lower in the intervention group than in the control group (IRR 0.48 (0.25 to 0.91) (mean 95% CI))].

Conclusions

Introduction of the school-based intervention programme is associated with a higher fracture risk in the intervention group during the first year followed by a gradual reduction, so that during the eighth year, the fracture risk was lower in the intervention group.

Trial registration number

NCT00633828.
Electronic nicotine delivery systems and/or electronic non-nicotine delivery systems for tobacco smoking cessation or reduction: a systematic review and meta-analysis
Authors: El Dib Regina , Suzumura Erica A , Akl Elie A , Gomaa Huda , Agarwal Arnav , Chang Yaping , Prasad Manya , Ashoorion Vahid , Heels-Ansdell Diane , Maziak Wasim , Guyatt Gordon
Published: February 2017

Objective

A systematic review and meta-analysis to investigate the impact of electronic nicotine delivery systems (ENDS) and/or electronic non-nicotine delivery systems (ENNDS) versus no smoking cessation aid, or alternative smoking cessation aids, in cigarette smokers on long-term tobacco use.

Data sources

Searches of MEDLINE, EMBASE, PsycInfo, CINAHL, CENTRAL and Web of Science up to December 2015.

Study selection

Randomised controlled trials (RCTs) and prospective cohort studies.

Data extraction

Three pairs of reviewers independently screened potentially eligible articles, extracted data from included studies on populations, interventions and outcomes and assessed their risk of bias. We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate overall certainty of the evidence by outcome.

Data synthesis

Three randomised trials including 1007 participants and nine cohorts including 13 115 participants proved eligible. Results provided by only two RCTs suggest a possible increase in tobacco smoking cessation with ENDS in comparison with ENNDS (RR 2.03, 95% CI 0.94 to 4.38; p=0.07; I2=0%, risk difference (RD) 64/1000 over 6 to 12 months, low-certainty evidence). Results from cohort studies suggested a possible reduction in quit rates with use of ENDS compared with no use of ENDS (OR 0.74, 95% CI 0.55 to 1.00; p=0.051; I2=56%, very low certainty).

Conclusions

There is very limited evidence regarding the impact of ENDS or ENNDS on tobacco smoking cessation, reduction or adverse effects: data from RCTs are of low certainty and observational studies of very low certainty. The limitations of the cohort studies led us to a rating of very low-certainty evidence from which no credible inferences can be drawn. Lack of usefulness with regard to address the question of e-cigarettes' efficacy on smoking reduction and cessation was largely due to poor reporting. This review underlines the need to conduct well-designed trials measuring biochemically validated outcomes and adverse effects.
Inter-rater reliability between nurses for a new paediatric triage system based primarily on vital parameters: the Paediatric Triage Instrument (PETI)
Authors: Karjala Jaana , Eriksson Staffan
Published: February 2017

Introduction

The major paediatric triage systems are primarily based on flow charts involving signs and symptoms for orientation and subjective estimates of the patient's condition. In contrast, the 4-level Paediatric Triage Instrument (PETI) is primarily based on vital parameters and was developed exclusively for paediatric triage in patients with medical symptoms. The aim of this study was to assess the inter-rater reliability of this triage system in children when used by nurses.

Methods

A design was employed in which triage was performed simultaneously and independently by a research nurse and an emergency department (ED) nurse using the PETI. All patients aged ≤12 years who presented at the ED with a medical symptom were considered eligible for participation.

Results

The 89 participants exhibited a median age of 2 years and were triaged by 28 different nurses. The inter-rater reliability between nurses calculated with the quadratic-weighted κ was 0.78 (95% CI 0.67 to 0.89); the linear-weighted κ was 0.67 (95% CI 0.56 to 0.80) and the unweighted κ was 0.59 (95% CI 0.44 to 0.73). For the patients aged <1, 1–3 and >3 years, the quadratic-weighted κ values were 0.67 (95% CI 0.39 to 0.94), 0.86 (95% CI 0.75 to 0.97) and 0.73 (95% CI 0.49 to 0.97), respectively. The median triage duration was 6 min.

Conclusions

The PETI exhibited substantial reliability when used in children aged ≤12 years and almost perfect reliability among children aged 1–3 years. Moreover, rapid application of the PETI was demonstrated. This study has some limitations, including sample size and generalisability, but the PETI exhibited promise regarding reliability, and the next step could be either a larger reliability study or a validation study.
Social disadvantages associated with myasthenia gravis and its treatment: a multicentre cross-sectional study
Authors: Nagane Yuriko , Murai Hiroyuki , Imai Tomihiro , Yamamoto Daisuke , Tsuda Emiko , Minami Naoya , Suzuki Yasushi , Kanai Tetsuya , Uzawa Akiyuki , Kawaguchi Naoki , Masuda Masayuki , Konno Shingo , Suzuki Hidekazu , Aoki Masashi , Utsugisawa Kimiaki
Published: February 2017

Objectives

To clarify the social disadvantages associated with myasthenia gravis (MG) and examine associations with its disease and treatment.

Design

Cross-sectional study.

Setting and participants

We evaluated 917 consecutive cases of established MG seen at 13 neurological centres in Japan over a short duration.

Outcome measures

All patients completed a questionnaire on social disadvantages resulting from MG and its treatment and a 15-item MG-specific quality of life scale at study entry. Clinical severity at the worst condition was graded according to the MG Foundation of America classification, and that at the current condition was determined according to the quantitative MG score and MG composite. Maximum dose and duration of dose ≥20 mg/day of oral prednisolone during the disease course were obtained from the patients' medical records. Achievement of the treatment target (minimal manifestation status with prednisolone at ≤5 mg/day) was determined at 1, 2 and 4 years after starting treatment and at study entry.

Results

We found that 27.2% of the patients had experienced unemployment, 4.1% had been unwillingly transferred and 35.9% had experienced a decrease in income, 47.1% of whom reported that the decrease was ≥50% of their previous total income. In addition, 49.0% of the patients reported feeling reduced social positivity. Factors promoting social disadvantages were severity of illness, dose and duration of prednisolone, long-term treatment, and a depressive state and change in appearance after treatment with oral steroids. Early achievement of the treatment target was a major inhibiting factor.

Conclusions

Patients with MG often experience unemployment, unwilling job transfers and a decrease in income. In addition, many patients report feeling reduced social positivity. To inhibit the social disadvantages associated with MG and its treatment, greater focus needs to be placed on helping patients with MG resume a normal lifestyle as soon as possible by achieving the treatment target.
Advanced Practice Nursing Competency Assessment Instrument (APNCAI): clinimetric validation
Authors: Sastre-Fullana Pedro , Morales-Asencio Jose Miguel , Sesé-Abad Albert , Bennasar-Veny Miquel , Fernández-Domínguez Juan Carlos , De Pedro-Gómez Joan
Published: February 2017

Objective

To describe the development and clinimetric validation of the Advanced Practice Nursing Competency Assessment Instrument (APNCAI) through several evidence sources about reliability and validity in the Spanish context.

Design and setting

APNCAI development was based on a multisequential and systematic process: literature review, instrument content consensus through qualitative Delphi method approach (a panel of 51 Advanced Practice in Nursing –APN– experts was selected) and the clinimetric validation process based on a sample of 600 nurses from the Balearic Islands public healthcare setting.

Methods

An initial step for tool's content development process based on Delphi method approach of expert consensus was implemented. A subsequent phase of tool validation started from the analysis of APN core competencies latent measurement model, including exploratory and confirmatory techniques. Reliability evidence for each latent factor was also obtained. Items' scores were submitted to descriptive analysis, plus univariate and multivariate normality tests.

Results

An eight-factor competency assessment latent model obtained adequate fit, and it was composed by ‘Research and Evidence-Based Practice’, ‘Clinical and Professional Leadership’, ‘Interprofessional Relationship and Mentoring’, ‘Professional Autonomy’, ‘Quality Management’, ‘Care Management’, ‘Professional Teaching and Education’ and ‘Health Promotion’.

Conclusions

Adequate empirical evidence of reliability and validity for APNCAI makes it useful for application in healthcare policy programmes for APN competency assessment in Spain.
How do organisational characteristics influence teamwork and service delivery in lung cancer diagnostic assessment programmes? A mixed-methods study
Authors: Honein-AbouHaidar Gladys N , Stuart-McEwan Terri , Waddell Tom , Salvarrey Alexandra , Smylie Jennifer , Dobrow Mark J , Brouwers Melissa C , Gagliardi Anna R
Published: February 2017

Objectives

Diagnostic assessment programmes (DAPs) can reduce wait times for cancer diagnosis, but optimal DAP design is unknown. This study explored how organisational characteristics influenced multidisciplinary teamwork and diagnostic service delivery in lung cancer DAPs.

Design

A mixed-methods approach integrated data from descriptive qualitative interviews and medical record abstraction at 4 lung cancer DAPs. Findings were analysed with the Integrated Team Effectiveness Model.

Setting

4 DAPs at 2 teaching and 2 community hospitals in Canada.

Participants

22 staff were interviewed about organisational characteristics, target service benchmarks, and teamwork processes, determinants and outcomes; 314 medical records were reviewed for actual service benchmarks.

Results

Formal, informal and asynchronous team processes enabled service delivery and yielded many perceived benefits at the patient, staff and service levels. However, several DAP characteristics challenged teamwork and service delivery: referral volume/workload, time since launch, days per week of operation, rural–remote population, number and type of full-time/part-time human resources, staff colocation, information systems. As a result, all sites failed to meet target benchmarks (from referral to consultation median 4.0 visits, median wait time 35.0 days). Recommendations included improved information systems, more staff in all specialties, staff colocation and expanded roles for patient navigators. Findings were captured in a conceptual framework of lung cancer DAP teamwork determinants and outcomes.

Conclusions

This study identified several DAP characteristics that could be improved to facilitate teamwork and enhance service delivery, thereby contributing to knowledge of organisational determinants of teamwork and associated outcomes. Findings can be used to update existing DAP guidelines, and by managers to plan or evaluate lung cancer DAPs. Ongoing research is needed to identify ideal roles for navigators, and staffing models tailored to case volumes.
GAMBLINGLESS: FOR LIFE study protocol: a pragmatic randomised trial of an online cognitive–behavioural programme for disordered gambling
Authors: Merkouris S S , Rodda S N , Austin D , Lubman D I , Harvey P , Battersby M , Cunningham J , Lavis T , Smith D , Dowling N A
Published: February 2017

Introduction

The prevalence of disordered gambling worldwide has been estimated at 2.3%. Only a small minority of disordered gamblers seek specialist face-to-face treatment, and so a need for alternative treatment delivery models that capitalise on advances in communication technology, and use self-directed activity that can complement existing services has been identified. As such, the primary aim of this study is to evaluate an online self-directed cognitive–behavioural programme for disordered gambling (GamblingLess:ForLife).

Methods and analysis

The study will be a 2-arm, parallel group, pragmatic randomised trial. Participants will be randomly allocated to a pure self-directed (PSD) or guided self-directed (GSD) intervention. Participants in both groups will be asked to work through the 4 modules of the GamblingLessprogramme over 8 weeks. Participants in the GSD intervention will also receive weekly emails of guidance and support from a gambling counsellor. A total of 200 participants will be recruited. Participants will be eligible if they reside in Australia, are aged 18 years and over, have access to the internet, have adequate knowledge of the English language, are seeking help for their own gambling problems and are willing to take part in the intervention and associated assessments. Assessments will be conducted at preintervention, and at 2, 3 and 12 months from preintervention. The primary outcome is gambling severity, assessed using the Gambling Symptom Assessment Scale. Secondary outcomes include gambling frequency, gambling expenditure, psychological distress, quality of life and additional help-seeking. Qualitative interviews will also be conducted with a subsample of participants and the Guides (counsellors).

Ethics and dissemination

The study has been approved by the Deakin University Human Research and Eastern Health Human Research Ethics Committees. Findings will be disseminated via report, peer-reviewed publications and conference presentations.

Trial registration number

ACTRN12615000864527; results.
Role of ethnicity in human papillomavirus vaccination uptake: a cross-sectional study of girls from ethnic minority groups attending London schools
Authors: Rockliffe Lauren , Waller Jo , Marlow Laura A V , Forster Alice S
Published: February 2017

Objectives

Research suggests that girls from ethnic minority groups are less likely to receive the human papillomavirus (HPV) vaccination than white British girls; however, the specific ethnic minority groups that have lower uptake have not been identified. This study aimed to examine the relationship between school-level uptake and ethnicity as well as uptake and other ethnicity-related factors, to understand which specific groups are less likely to receive the vaccination.

Methods

Aggregated uptake rates from 195 schools were obtained for each of the three recommended vaccine doses from 2008 to 2010. Census data at the lower super output area (LSOA) level for the postcode of each school were also obtained, describing the ethnic breakdown of the resident population (ethnicity, language spoken, religion, proficiency in English and duration of residency in the UK). These were used as proxy measures of the ethnic make-up of the schools. The most prevalent non-majority group for each ethnicity and ethnicity-related factor was assigned to each school. Analyses explored differences in uptake by ethnicity and ethnicity-related factors.

Results

No significant differences in vaccination uptake were found by ethnicity or ethnicity-related factors, although descriptive differences were apparent. Schools in areas where black ethnicities were the most prevalent non-white British ethnicities had consistently low rates of uptake for all doses. Schools in areas where some Asian ethnicities were the most prevalent non-white British ethnicities had consistently high rates of uptake for all doses. There was evidence of variability in mean uptake rates for ethnicities within ‘black’ and ‘Asian’ ethnic groups.

Conclusions

Future research would benefit from focusing on specific ethnicities rather than broad ethnic categories. Replication of this study with a larger sample and using complete individual-level data, collected on a national level, would provide a clearer indication of where ethnic differences in HPV vaccination uptake exist.
Outcomes associated with prescribed medications in older adults with multimorbidity: protocol for a scoping review
Authors: Watt Jennifer , Tricco Andrea C , Vyas Manav , Kohli Kapil , Soin Sarthak , Abaeian Mitra , Watt Stephanie , Straus Sharon E
Published: February 2017

Introduction

Multimorbidity becomes increasingly prevalent with ageing. Polypharmacy is often associated with multimorbidity because patients accrue medications to treat each individual disease; however, there is uncertainty around the generalisability of disease-specific guidelines. Namely, the extrapolation of results from studies conducted in younger patients to older adults with multimorbidity. The main objective of this scoping review is to explore our current knowledge of the outcomes that older adults with multimorbidity experience from taking prescribed medications.

Methods and analysis

A scoping review will be conducted to explore what is known about the outcomes experienced by older adults with multimorbidity who are taking guideline-recommended medications and to identify areas for future research. In addition to searching the grey literature, the following databases will be searched from 1990 onward: MEDLINE, EMBASE, PsycINFO and the Cochrane Library. Experimental, quasi-experimental and non-experimental studies consisting of patients ≥65 years old who have two or more comorbid conditions (explicitly grouped together for the purpose of analysis) and who are being prescribed a guideline-recommended prescription medication for a chronic condition will be considered for inclusion in our scoping review. We will describe patient (eg, mortality, morbidity, quality of life) and health system (eg, number of emergency department visits or hospitalisations, cost to third-party payer) outcomes associated with the prescription of medications for older adults who have two or more chronic comorbid conditions. Two reviewers will complete all screening and data abstraction independently. Data will be synthesised with descriptive statistics.

Ethics and dissemination

Ethics approval is not required because this is a scoping review of published literature. Results will be disseminated through conference presentations and publication in a peer-reviewed journal.
The National Oesophagogastric Cancer Awareness Campaign: a locality outcome analysis from County Durham
Authors: Koo Sara , Awadelkarim Bidour , Dhar Anjan
Published: February 2017

Introduction

Oesophageal and gastric cancer is common. Despite advances in investigation and treatment, the outcomes from these cancers remain poor. As part of the Be Clear On Cancer Campaign, the Department of Health runs the National Oesophagogastric Cancer Campaign each year, with key messages of (1) ‘Having heartburn most days, for 3 weeks or more could be a sign of cancer’ and (2) ‘if food is sticking when you swallow, tell your doctor’.

Methods

We evaluated the effect of the National Oesophagogastric Cancer Campaign in our locality.

Results

Reviewing new referrals from primary care for upper gastrointestinal symptoms during the campaign period, and a period thereafter, we found that there was no significant impact of the campaign in the diagnosis of oesophagogastric cancers. Furthermore, it increased routine waiting times for elective gastroscopies in our endoscopy units.

Conclusion

We believe that alternative strategies need to be considered for earlier detection of oesophagogastric cancer.
Workplace social capital and the onset of major depressive episode among workers in Japan: a 3-year prospective cohort study
Authors: Sakuraya Asuka , Imamura Kotaro , Inoue Akiomi , Tsutsumi Akizumi , Shimazu Akihito , Takahashi Masaya , Totsuzaki Takafumi , Kawakami Norito
Published: February 2017

Background

This study examined the prospective association of workplace social capital (WSC) with major depressive episode (MDE) among Japanese employees.

Methods

A 3-year prospective cohort study was conducted among 1058 employees from a private think-tank company who participated in a baseline survey; after excluding those with MDE in the past 12 months, 929 were followed up. WSC at baseline was measured using a 3-item scale. MDE was assessed at baseline and at follow-up every year, by using a web-based, self-administered version of the WHO Composite International Diagnostic Interview (WHO-CIDI) 3.0 depression section, based on the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition: Text Revision (DSM-IV-TR)/DSM-5 criteria. Cox discrete-time hazards analyses were used to estimate HRs and 95% CIs, adjusting for covariates.

Results

A group with middle-level WSC scores had the lowest risk of MDE after being fully adjusted (HR 0.34, 95% CI 0.14 to 0.84, p=0.02). The relationship between WSC and MDE was U-shaped, although a non-linear model fit better than a linear model, with only marginally statistical significance (p=0.06). Dichotomised and continuous variables of WSC scores were significantly and negatively associated with MDE (p=0.03 and p<0.01, respectively).

Conclusions

The current study replicated a previous finding from Finland that WSC was a protective factor of the onset of MDE in Japan. The slightly U-shaped relationship, that is, the group with high WSC having a small elevated risk of MDE, may reflect a dark side of WSC in a country with collectivity-oriented and hierarchy-oriented culture, such as Japan.
Republished: A case of right middle cerebral artery ‘tendonectomy’ following mitral valve replacement surgery
Authors: Thomas Mary C , Delgado Almandoz Josser E , Todd Adam J , Young Mark L , Fease Jennifer L , Scholz Jill Marie , Milner Anna M , Mulder Maximilian , Kayan Yasha
Published: February 2017

Following mechanical mitral valve replacement surgery, a 69-year-old woman had an ischemic stroke in the right middle cerebral artery territory. Mechanical thrombectomy showed the embolus to be a piece of chordae tendineae excised during the valve replacement surgery.
Analysis of weekend effect on 30-day mortality among patients with acute myocardial infarction
Authors: Noad Rebecca , Stevenson Michael , Herity Niall A
Published: February 2017

Objectives

Several publications have demonstrated increased 30-day mortality in patients admitted on Saturdays or Sundays compared with weekdays. We sought to determine whether this was true for two different cohorts of patients admitted with acute myocardial infarction (MI).

Methods and results

Thirty-day mortality data were obtained for 3757 patients who had been admitted to the Belfast Health and Social Care Trust with acute MI between 2009 and 2015. They were subdivided into those presenting with ST elevation MI (n=2240) and non-ST elevation MI (n= 1517). We observed no excess 30-day mortality in those admitted over weekends.

Conclusion

Excess mortality in patients admitted at weekends is not a universal finding. This may mean that that there are patient subgroups with proportionately greater weekend hazard and points to the need for more detailed understanding of the weekend effect.
On-X versus St Jude Medical Regent mechanical aortic valve prostheses: early haemodynamics
Authors: Xu Robert , Rahnavardi Mohammad , Pitman Bradley , Shirazi Masoumeh , Stuklis Robert , Edwards James , Worthington Michael
Published: February 2017

Objective

We aimed to compare the early haemodynamic data of the On-X and St Jude Medical (SJM) Regent bileaflet mechanical prostheses in the aortic position.

Methods

A retrospective study was performed using data collected prospectively for a national database. Thirty-three patients who had aortic On-X valve (On-X group) and 33 matched patients who had aortic SJM Regent valve (SJM group) were included. The intraoperative and early postoperative data were collected. The same echocardiographer reviewed all the echocardiograms and obtained the required parameters.

Results

The peak gradient across the prosthetic valve was comparable between the two groups except for the labelled valve size of 25 mm for which the On-X group had lower peak gradient when compared with the SJM group. Mean gradients and effective orifice area indices of the two valve types within each valve size subgroup were comparable.

Conclusions

The current study confirms that in the early postoperative period, the two valve types had comparable haemodynamic outcomes.
Utility of T-wave amplitude as a non-invasive risk marker of sudden cardiac death in hypertrophic cardiomyopathy
Authors: Sugrue Alan , Killu Ammar M , DeSimone Christopher V , Chahal Anwar A , Vogt Josh C , Kremen Vaclav , Hai JoJo , Hodge David O , Acker Nancy G , Geske Jeffrey B , Ackerman Michael J , Ommen Steve R , Lin Grace , Noseworthy Peter A , Brady Peter A
Published: February 2017

Objective

Sudden cardiac arrest (SCA) is the most devastating outcome in hypertrophic cardiomyopathy (HCM). We evaluated repolarisation features on the surface electrocardiogram (ECG) to identify the potential risk factors for SCA.

Methods

Data was collected from 52 patients with HCM who underwent implantable cardioverter defibrillator (ICD) implantation. Leads V2 and V5 from the ECG closest to the time of ICD implant were utilised for measuring the Tpeak-Tend interval (Tpe), QTc, Tpe/QTc, T-wave duration and T-wave amplitude. The presence of the five traditional SCA-associated risk factors was assessed, as well as the HCM risk-SCD score.

Results

16 (30%) patients experienced aborted cardiac arrest over 8.5±4.1 years, with 9 receiving an ICD shock and 7 receiving ATP. On univariate analysis, T-wave amplitude was associated with appropriate ICD therapy (HR per 0.1 mV 0.79, 95% CI 0.56 to 0.96, p=0.02). Aborted SCA was not associated with a greater mean QTc duration, Tpeak-Tend interval, T-wave duration, or Tpe/QT ratio. Multivariate analysis (adjusting for cardinal HCM SCA-risk factors) showed T-wave amplitude in Lead V2 was an independent predictor of risk (adjusted HR per 0.1 mV 0.74, 95% CI 0.57 to 0.97, p=0.03). Addition of T-wave amplitude in Lead V2 to the traditional risk factors resulted in significant improvement in risk stratification (C-statistic from 0.65 to 0.75) but did not improve the performance of the HCM SCD-risk score.

Conclusions

T-wave amplitude is a novel marker of SCA in this high risk HCM population and may provide incremental predictive value to established risk factors. Further work is needed to define the role of repolarisation abnormalities in predicting SCA in HCM.
A mixed method, multiperspective evaluation of a near peer teaching programme
Authors: Lydon Sinéad , O’Connor Paul , Mongan Orla , Gorecka Miroslawa , McVicker Lyle , Stankard Aiden , Byrne Dara
Published: February 2017

Purpose of study

Peer teaching (PT) has become increasingly popular. PT may offer benefits for students, tutors and institutions. Although resistance to PT has been identified among faculty, research has typically focused on students’ experiences and perceptions, rather than those of the peer tutors or senior doctors/medical faculty. The current study comprised of a comprehensive, multiperspective evaluation of a near PT programme delivered by interns to final-year medical students in the Republic of Ireland.

Study design

This study employed a mixed methods design, using both interviews and questionnaires to assess students’ (n=130), interns’ (n=49) and medical faculty’s or senior doctors’ (n=29) perceptions of the programme.

Results

All three groups were emphatic about the programme’s benefits, although senior doctors and faculty reported significantly more positive attitudes than the others. Mean ratings of the programme’s value, out of 10, were 8.2 among students, 8.2 among interns and 9.1 among senior doctors and faculty. Challenges identified were largely organisational in nature. Perceived benefits for students included the informality of teaching sessions, increased opportunities in the clinical environment and improvements in exam preparedness. Perceived benefits for the interns included improvements in knowledge and teaching ability and experience as a role model.

Conclusions

PT programmes have been posited as an ‘easy fix’ to growing numbers of students. However, it is apparent that PT has substantial value outside of this. Future research that conducts economic evaluations of such programmes and that collects objective data on teaching quality and student learning would be of much interest.
Systematic account of animal poisonings in Germany, 2012–2015
Authors: McFarland S. E. , Mischke R. H. , Hopster‐Iversen C. , von Krueger X. , Ammer H. , Potschka H. , Stürer A. , Begemann K. , Desel H. , Greiner M.
Published: February 2017

A systematic retrospective study on animal poisonings in Germany (wildlife excluded) between January 2012 and December 2015 was conducted. Data were collected on animal exposure calls to German poison centres, poisoning cases presenting to the University of Veterinary Medicine, Hannover Small Animal and Equine Clinics, cases involving off‐label use of veterinary medicinal products reported to the Federal Office of Consumer Protection and Food Safety and toxicological submissions to the Institute of Pharmacology, Toxicology, and Pharmacy, Faculty of Veterinary Medicine, Ludwig‐Maximilians‐University, Munich. Descriptive statistics were used to characterise animal type, exposure reason, type and substance, year/month of exposure, case severity and outcome. An evaluation of the data and data sources was also carried out. Variation in poisoning patterns was seen. However, dogs and cats were the most frequently reported species and medicinal products, pesticides and plants were consistently implicated as top causes of poisoning. Advantages and disadvantages were associated with each data source; bias was found to be an important consideration when evaluating poisoning data. This study provided useful information on animal poisonings in Germany and highlights the need for standardised approaches for the collection, evaluation and integration of poisoning data from multiple sources.
Evaluation of a rapid IgM detection test for diagnosis of acute leptospirosis in dogs
Authors: Lizer J. , Grahlmann M. , Hapke H. , Velineni S. , Lin D. , Kohn B.
Published: February 2017

Recently, a lateral flow assay (LFA) for detection of Leptospira‐specific IgM in canine sera became commercially available in Europe. The present study aims to evaluate the diagnostic performance of this assay using canine sera from a collection of diagnostic accessions. Diagnostic sensitivity was assessed by testing 37 acute‐phase and 9 corresponding convalescent‐phase sera from dogs with a confirmed diagnosis of leptospirosis. Specificity was determined by testing sera from sick dogs with non‐leptospiral infections (n=15) and healthy dogs with incomplete history of vaccination (n=45). During acute phase of illness, LFA scored positive for 28/37 sera with a sensitivity of 75.7 per cent while only 9/37 (24.3 per cent) samples were positive on microscopic agglutination test. The specificity of the LFA was 98.3 per cent (59/60). This test showed 89.7 and 100 per cent overall agreements with clinical diagnosis for acute‐phase and convalescent‐phase sera, respectively. The impact of vaccination on the LFA was also determined and vaccine‐stimulated IgM responses were negative in 19/25 (76 per cent) dogs at 12 weeks post vaccination. In conclusion, the LFA is a rapid and reliable test for early detection of Leptospira‐specific IgM during acute phase of canine leptospirosis. However, interpretation of a positive result must be made in the context of clinical signs and vaccination history.
Primary human monocytes differentiate into M2 macrophages and involve Notch-1 pathway
Authors: Singla Dinender K. , Wang Jing , Singla Reetu
Published: February 2017

The current study investigates whether inhibiting the Notch-1 signaling pathway in primary human monocytes enhances M2 macrophage differentiation. We generated a primary human monocyte cell culture model to understand the effect of the Notch-1 signaling pathway. Monocytes were treated with Notch-1 inhibitors DAPT or siRNA. Our data show that there was a significant increase in the M1 macrophage population demonstrated by iNOS marker in the primary human monocytes treated with apoptotic-conditioned medium (ACM). Next, the levels of pro-inflammatory cytokines IL-6 and MCP-1, as well as TNF-α, increased in ACM media (p < 0.05). Furthermore, M1 macrophages and pro-inflammatory cytokines were reduced following DAPT or siRNA treatment. Comparatively, there was a significant increase in M2 macrophages, as demonstrated by an increase in CD206 and arginase-1 positive cells treated with DAPT or siRNA (p < 0.05). Furthermore, a significant increase in the associated anti-inflammatory cytokines IL-10 and IL-1RA was also observed with respect to control groups (p < 0.05). We conclude that blocking the Notch-1 pathway with DAPT or siRNA attenuates pro-inflammatory cytokines, enhances M2 macrophage differentiation, and increases anti-inflammatory cytokines in primary human monocytes. As a result, Notch-1 pathway inhibition has potential therapeutic applications of inflammatory disease.
Simulation of SiO2 etching in an inductively coupled CF4 plasma
Authors: Xu Qing , Li Yu-Xing , Li Xiao-Ning , Wang Jia-Bin , Yang Fan , Yang Yi , Ren Tian-Ling
Published: March 2017

Plasma etching technology is an indispensable processing method in the manufacturing process of semiconductor devices. Because of the high fluorine/carbon ratio of CF4, the CF4 gas is often used for etching SiO2. A commercial software ESI-CFD is used to simulate the process of plasma etching with an inductively coupled plasma model. For the simulation part, CFD-ACE is used to simulate the chamber, and CFD-TOPO is used to simulate the surface of the sample. The effects of chamber pressure, bias voltage and ICP power on the reactant particles were investigated, and the etching profiles of SiO2 were obtained. Simulation can be used to predict the effects of reaction conditions on the density, energy and angular distributions of reactant particles, which can play a good role in guiding the etching process.
CASE REPORT: THE EARLY ABORTION IN SOWS CAUSED BYE. RHUSIOPATHIAEFROM THE SEMEN
Authors: Lo Dan-Yuan , Yeh Jih-Ching , Hu De-Hua , Chen Chiou-Lin , Chang Ming-Huang , Kuo Hung-Chih
Published: March 2017

This case report describes a mini-outbreak of early abortion in sows caused by Erysipelothrix rhusiopathiae that is transmitted from the semen of an asymptomatic boar. Six sows that were all impregnated with the semen from the asymptomatic boar aborted at 25 days after fecundation. Three aborted embryos and the attached placentas were submitted for diagnostic investigation. The histopathology revealed edematous chorioallantoic membrane containing mononuclear cells with leukocytic debris in the vessel wall, accompanied with clumps of Gram-positive bacteria elsewhere in the chorioallantois. In situ hybridization revealed some positive signals of E. rhusiopathiae in the chorioallantois. The semen of the asymptomatic boar was cultured positive for E. rhusiopathiae. Taken all results together, it was concluded that the early abortion in sows was caused by the semen from the asymptomatic boar infected by E. rhusiopathiae.
Strategies and Challenges to Facilitate Situated Learning in Virtual Worlds Post-Second Life
Authors: Conrad Marc , Hassan Adil , Koshy Lyzgeo , Kanamgotov Aslan , Christopoulos Athanasios
Published: March 2017

Virtual worlds can establish a stimulating environment to support a situated learning approach in which students simulate a task within a safe environment. While in previous years Second Life played a major role in providing such a virtual environment, there are now more and more alternative—often OpenSim-based—solutions deployed within the educational community. By drawing parallels to social networks, we discuss two aspects: how to link individually hosted virtual worlds together in order to implement context for immersion and how to identify and avoid “fake” avatars so people behind these avatars can be held accountable for their actions.
Classical and novel pharmacological insights offered by the simple chick cardiomyocyte cell culture model: a valuable teaching aid and a primer for “real” research
Authors: Freestone N. S. , Sam C. L. S.
Published: February 2017

The chick embryo cardiomyocyte model of cell culture is a staple technique in many physiology and pharmacology laboratories. Despite the relative simplicity, robustness, and reproducibility inherent in this model, it can be used in a variety of ways to yield important new insights that help facilitate student understanding of underlying physiological and pharmacological concepts as well as, more generally, the scientific method. Using this model, this paper will show real data obtained by undergraduate students in the authors’ laboratories. It will first demonstrate classical pharmacological concepts such as full and partial agonism, inverse agonism, and competitive reversible antagonism and then move on to more complex pharmacology involving the characterization of novel receptors in these cells.