bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of defect depths for sinusoidal and circular perimetric stimuli in patients with glaucoma
Authors: Swanson William H , King Brett J
Published: January 2019

Purpose

Clinical use of perimetric testing in patients with glaucoma typically assumes that perimetric defects will be less deep for larger than smaller stimuli. However, studies have shown that very large sinusoidal stimuli can yield similar defects as small circular stimuli. In order to provide guidelines for new perimetric stimuli, we tested patients with glaucoma using five different stimuli and compared defects to their patterns of retinal nerve fibre layer (RNFL) damage.

Methods

Twenty subjects with glaucoma were imaged with optical coherence tomography (OCT) volume scans to allow for en face RNFL images and were also tested on a custom perimetry station with five stimuli: Goldmann sizes III and V, a two‐dimensional Gaussian blob (standard deviation 0.5°) and a 0.5 cycle degree−1 sinusoidal grating presented two ways: flickered at 5 Hz, and pulsed for 200 ms instead of flickered. En face RNFL images were reviewed with the visual field locations overlaid, and each location was labelled for a patient as either no visible RNFL defect or as wedge, slit, edge, or diffuse defect. Nineteen age‐similar controls were tested with the same stimuli to define depth of defect as difference from mean normal. Bland‐Altman analysis was used to test three predictions of neural modelling by making five comparisons.

Results

Bland‐Altman analysis confirmed the three predictions. The flickered sinusoid gave deeper defects in damaged areas than the pulsed sinusoid (r = 0.25, p < 0.0001). When comparing data for sizes III and V there was increased spread of the data in deeper defects in the direction of size III having deeper defect (r = 0.35, p < 0.0001). The size V stimulus yielded shallower defects than a stimulus of similar size but with blurred edges (r = 0.20, p = 0.0004).

Conclusions

On average, all stimuli produced similar results comparing across type of RNFL damage. However, there were systematic patterns consistent with predictions of neural modelling: in damaged areas, depth of defect tended to be greater for the flickered sinusoid than the pulsed sinusoid, greater for the size III stimulus than the size V stimulus, and greater for the Gaussian blob than for the size V stimulus.
Oral surgery and the critical care department
Authors: McCormick R.S. , Greenwood M. , Francis N.
Published: January 2019

The majority of oral surgery patients do not require the input of a critical care department (CCD). However, oral surgeons working in secondary care may be involved in the management of such patients. This may be due to surgical complications or sequelae (predicted or otherwise) or for medical reasons. Oral Surgery trainees working within Oral and Maxillofacial Surgery departments are likely to be involved in managing patients whose presenting condition necessitates care within a CCD. This article gives an overview of the reasons for use of a CCD and some of its functions.
Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation
Authors: Hollander Seth A. , Schultz Lisa M. , Dennis Katelin , Hollander Amanda M. , Rizzuto Sandra , Murray Jenna M. , Rosenthal David N. , Almond Christopher S.
Published: January 2019

Background

Malnutrition is common in pediatric heart failure and is associated with mortality. The effect of VAD support on malnutrition in children is unknown. We sought to compare the prevalence and severity of malnutrition at HT in children on VAD support vs OMT to inform decisions regarding support strategies.

Methods

Retrospective chart review involving all patients <18 years who underwent HT at Stanford between 1/1/2011 and 3/1/2018. Malnutrition diagnosis and severity were defined by ASPEN guidelines using the lowest age‐adjusted z‐score for weight (WAZ), height (HAZ), and BMI (BMIZ) when the patient was euvolemic. Changes in z‐scores from baseline to HT and across groups were analyzed.

Results

A total of 104 patients (52 in each group) were included. Among all patients, WAZ (−0.9 vs 0.3, P < 0.001) and BMIZ (0 vs 0.6, P < 0.001) improved while HAZ (−0.9 vs −0.9, P = 0.4) did not. Compared to children on OMT, children on VAD experienced greater increases in WAZ (0.8 vs 0.3, P < 0.001) and BMIZ (0.7 vs 0.2, P < 0.003) at HT. The prevalence of moderate‐to‐severe malnutrition decreased in VAD patients (40% to 19%, P < 0.001) and increased in OMT patients (37% to 46%, P < 0.001), leading to a lower prevalence of moderate‐to‐severe malnutrition at HT (19% vs 46%, P = 0.003).

Conclusions

Malnutrition is common in pediatric HT candidates. Compared to children on OMT, children on VAD support had greater improvement in nutritional status while awaiting HT, and a lower prevalence of malnutrition at HT.
Experiences from using eHealth in contact with health care among older adults with cognitive impairment
Authors: Jakobsson Elin , Nygård Louise , Kottorp Anders , Malinowsky Camilla
Published: January 2019

Rationale

Since health care is facing challenges, with fewer caregivers providing care to more clients, eHealth plays a crucial role. Through eHealth, people are expected to be more involved in their own care. On the part of health care users, eHealth requires use of everyday technology such as telephones and computers, and services through the Internet which might be challenging for older adults with cognitive impairment.

Aim

To investigate experiences of using eHealth in contact with health care among older adults with cognitive impairment.

Method

Individual, semi‐structured interviews were conducted with nine participants, aged 65–84 years, with cognitive impairments of varying origins. A constructivist Grounded Theory approach was used. Data collection and analysis were performed simultaneously using a constant comparative method.

Ethical issues

Ethical approval (Dnr: 2014/906‐32) was obtained from the regional ethical committee, Stockholm.

Results

The core category, the eHealth staircase supported by habits, is presented as a model that visualises the result. The model includes three steps showing different ways of being in contact with health care through the use of technological devices and services that mirrors different levels of complexity of eHealth use as follows: (i) Analogue use, (ii) One‐way‐use and (iii) Interactive use. The participants’ location on the eHealth staircase was affected by several aspects described in three categories united by habits; A stable relationship with technology: a prerequisite for use; The importance of interpersonal relationships within health care and Being supported by significant others: a prerequisite in contact with health care.

Conclusions

Older adults with cognitive impairments seemed to prefer common and less complex eHealth when contacting health care. Therefore, it is necessary that health care providers offer different possibilities for patients to contact them, that is, both through the Internet and by personal telephone service.
Spatial Linkages in FDI Location: Evidence from the Spanish Regions
Authors: Gutiérrez‐Portilla Paula , Maza Adolfo , Villaverde José
Published: January 2019

This paper examines the main factors behind the regional location of foreign direct investment (FDI) in Spain, at both the aggregate and sectoral levels, over the 1996‐2013 period. To do so, a panel spatial Durbin model, which allows us to unveil patterns of substitution or complementarity in FDI across regions, is estimated. Our findings reveal that inward FDI in one region is complementary to that in neighbouring regions, a conclusion that is consistent with a complex vertical FDI strategy. Besides, they tend to confirm the hypotheses that FDI exhibits some inertia and is attracted by regions with: (i) large market size; (ii) large surrounding‐market potential; and (iii) high levels of human capital and wages. However, the results cast some doubts on the role played by infrastructure, R&D and regional differences in taxes as key elements in attracting FDI.
Sex differences in the sympathoexcitatory response to insulin in obese rats: role of neuropeptide Y
Authors: Shi Zhigang , Cassaglia Priscila A. , Pelletier Nicole E. , Brooks Virginia L.
Published: January 2019

Key points

Intracerebroventricular insulin increased sympathetic nerve activity (SNA) and baroreflex control of SNA and heart rate more dramatically in obese male rats; in obese females, the responses were abolished.

In obese males, the enhanced lumbar SNA (LSNA) responses were associated with reduced tonic inhibition of LSNA by neuropeptide Y (NPY) in the PVN. However, PVN NPY injection decreased LSNA similarly in obesity prone/obesity resistant/control rats. Collectively, these results suggest that NPY inputs were decreased. In obese females, NPY inhibition in the PVN was maintained. Moreover, NPY neurons in the arcuate nucleus became resistant to the inhibitory effects of insulin.

A high‐fat diet did not alter arcuate NPY neuronal InsR expression in males or females.

Obesity‐induced ‘selective sensitization’ of the brain to the sympathoexcitatory effects of insulin and leptin may contribute to elevated basal SNA, and therefore hypertension development, in males with obesity.

These data may explain in part why obesity increases SNA less in women compared to men.

Obesity increases sympathetic nerve activity (SNA) in men but not women; however, the mechanisms are unknown. We investigated whether intracerebroventricular insulin infusion increases SNA more in obese male than female rats and if sex differences are mediated by changes in tonic inhibition of SNA by neuropeptide Y (NPY) in the paraventricular nucleus (PVN). When consuming a high‐fat diet, obesity prone (OP) rats accrued excess fat, whereas obesity resistant (OR) rats maintained adiposity as in rats eating a control (CON) diet. Insulin increased lumbar SNA (LSNA) similarly in CON/OR males and females under urethane anaesthesia. The LSNA response was magnified in OP males but abolished in OP females. In males, blockade of PVN NPY Y1 receptors with BIBO3304 increased LSNA in CON/OR rats but not OP rats. Yet, PVN nanoinjections of NPY decreased LSNA similarly between groups. Thus, tonic PVN NPY inhibition of LSNA may be lost in obese males as a result of a decrease in NPY inputs. By contrast, in females, PVN BIBO3304 increased LSNA similarly in OP, OR and CON rats. After insulin, PVN BIBO3304 failed to increase LSNA in CON/OR females but increased LSNA in OP females, suggesting that with obesity NPY neurons become resistant to the inhibitory effects of insulin. These sex differences were not associated with changes in arcuate NPY neuronal insulin receptor expression. Collectively, these data reveal a marked sex difference in the impact of obesity on the sympathoexcitatory actions of insulin and implicate sexually dimorphic changes in NPY inhibition of SNA in the PVN as one mechanism.
New Water Mites of the Genus Neumania (Acari, Hydrachnidia: Unionicolidae) from China
Authors: Ding Zhuhui , Guo Jianjun , Yi Tianci , Jin Daochao
Published: January 2019

This paper describes two new species and one newly recorded species of the genus Neumania, i.e. N. heterocrus Ding & Jin sp. nov., N. absentiuos Ding & Jin, sp. nov., and N. vietnamica Tuzovsky, 2013, from Jiangxi and Hunan provinces, China. Neumania heterocrus can be distinguished by the sexual dimorphism in leg IV. Neumania absentiuos can be distinguished by P-1 without seta and genital plates close to Cx-IV. Neumania vietnamica can be distinguished by the different swimming setae in leg IV. A key to the members of Neumania form China is provided. The examined specimens are kept in Institute of Entomology, Guizhou University, P. R. China (GUGC).
Single-molecule imaging of transcription at damaged chromatin
Authors: Vítor Alexandra C. , Sridhara Sreerama C. , Sabino João C. , Afonso Ana I. , Grosso Ana R. , Martin Robert M. , de Almeida Sérgio F.
Published: January 2019

DNA damage within active genes drives bidirectional break-induced transcription initiation.
Medieval women’s early involvement in manuscript production suggested by lapis lazuli identification in dental calculus
Authors: Radini A. , Tromp M. , Beach A. , Tong E. , Speller C. , McCormick M. , Dudgeon J. V. , Collins M. J. , Rühli F. , Kröger R. , Warinner C.
Published: January 2019

Lapis lazuli preserved in plaque reveals that medieval women were actively involved in producing richly illustrated manuscripts.
Global patterns and drivers of ecosystem functioning in rivers and riparian zones
Authors: Tiegs Scott D. , Costello David M. , Isken Mark W. , Woodward Guy , McIntyre Peter B. , Gessner Mark O. , Chauvet Eric , Griffiths Natalie A. , Flecker Alex S. , Acuña Vicenç , Albariño Ricardo , Allen Daniel C. , Alonso Cecilia , Andino Patricio , Arango Clay , Aroviita Jukka , Barbosa Marcus V. M. , Barmuta Leon A. , Baxter Colden V. , Bell Thomas D. C. , Bellinger Brent , Boyero Luz , Brown Lee E. , Bruder Andreas , Bruesewitz Denise A. , Burdon Francis J. , Callisto Marcos , Canhoto Cristina , Capps Krista A. , Castillo María M. , Clapcott Joanne , Colas Fanny , Colón-Gaud Checo , Cornut Julien , Crespo-Pérez Verónica , Cross Wyatt F. , Culp Joseph M. , Danger Michael , Dangles Olivier , de Eyto Elvira , Derry Alison M. , Villanueva Veronica Díaz , Douglas Michael M. , Elosegi Arturo , Encalada Andrea C. , Entrekin Sally , Espinosa Rodrigo , Ethaiya Diana , Ferreira Verónica , Ferriol Carmen , Flanagan Kyla M. , Fleituch Tadeusz , Follstad Shah Jennifer J. , Frainer André , Friberg Nikolai , Frost Paul C. , Garcia Erica A. , García Lago Liliana , García Soto Pavel Ernesto , Ghate Sudeep , Giling Darren P. , Gilmer Alan , Gonçalves José Francisco , Gonzales Rosario Karina , Graça Manuel A. S. , Grace Mike , Grossart Hans-Peter , Guérold François , Gulis Vlad , Hepp Luiz U. , Higgins Scott , Hishi Takuo , Huddart Joseph , Hudson John , Imberger Samantha , Iñiguez-Armijos Carlos , Iwata Tomoya , Janetski David J. , Jennings Eleanor , Kirkwood Andrea E. , Koning Aaron A. , Kosten Sarian , Kuehn Kevin A. , Laudon Hjalmar , Leavitt Peter R. , Lemes da Silva Aurea L. , Leroux Shawn J. , LeRoy Carri J. , Lisi Peter J. , MacKenzie Richard , Marcarelli Amy M. , Masese Frank O. , McKie Brendan G. , Oliveira Medeiros Adriana , Meissner Kristian , Miliša Marko , Mishra Shailendra , Miyake Yo , Moerke Ashley , Mombrikotb Shorok , Mooney Rob , Moulton Tim , Muotka Timo , Negishi Junjiro N. , Neres-Lima Vinicius , Nieminen Mika L. , Nimptsch Jorge , Ondruch Jakub , Paavola Riku , Pardo Isabel , Patrick Christopher J. , Peeters Edwin T. H. M. , Pozo Jesus , Pringle Catherine , Prussian Aaron , Quenta Estefania , Quesada Antonio , Reid Brian , Richardson John S. , Rigosi Anna , Rincón José , Rîşnoveanu Geta , Robinson Christopher T. , Rodríguez-Gallego Lorena , Royer Todd V. , Rusak James A. , Santamans Anna C. , Selmeczy Géza B. , Simiyu Gelas , Skuja Agnija , Smykla Jerzy , Sridhar Kandikere R. , Sponseller Ryan , Stoler Aaron , Swan Christopher M. , Szlag David , Teixeira-de Mello Franco , Tonkin Jonathan D. , Uusheimo Sari , Veach Allison M. , Vilbaste Sirje , Vought Lena B. M. , Wang Chiao-Ping , Webster Jackson R. , Wilson Paul B. , Woelfl Stefan , Xenopoulos Marguerite A. , Yates Adam G. , Yoshimura Chihiro , Yule Catherine M. , Zhang Yixin X. , Zwart Jacob A.
Published: January 2019

An experiment in >1000 river and riparian sites found spatial patterns and controls of carbon processing at the global scale.
Turning the Tide against Antibiotic Resistance by Evaluating Novel, Halogenated Phenazine, Quinoline, and NH125 Compounds against
Ureaplasma
Species Clinical Isolates and
Mycoplasma
Type Strains
Authors: Valentine-King Marissa A. , Cisneros Katherine , James Margaret O. , Huigens Robert W. , Brown Mary B.
Published: January 2019

Escalating levels of antibiotic resistance in mycoplasmas, particularly macrolide resistance in
Mycoplasma pneumoniae
and
M. genitalium
, have narrowed our antibiotic arsenal. Further, mycoplasmas lack a cell wall and do not synthesize folic acid, rendering common antibiotics, such as beta-lactams, vancomycin, sulfonamides, and trimethoprim, of no value.
Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases
Authors: Vinogradova Yana , Coupland Carol , Hippisley-Cox Julia
Published: January 2019

Objective

To assess the association between risk of venous thromboembolism and use of different types of hormone replacement therapy.

Design

Two nested case-control studies.

Setting

UK general practices contributing to the QResearch or Clinical Practice Research Datalink (CPRD) databases, and linked to hospital, mortality, and social deprivation data.

Participants

80 396 women aged 40-79 with a primary diagnosis of venous thromboembolism between 1998 and 2017, matched by age, general practice, and index date to 391 494 female controls.

Main outcome measures

Venous thromboembolism recorded on general practice, mortality, or hospital records. Odds ratios were adjusted for demographics, smoking status, alcohol consumption, comorbidities, recent medical events, and other prescribed drugs.

Results

Overall, 5795 (7.2%) women who had venous thromboembolism and 21 670 (5.5%) controls had been exposed to hormone replacement therapy within 90 days before the index date. Of these two groups, 4915 (85%)and 16 938 (78%) women used oral therapy, respectively, which was associated with a significantly increased risk of venous thromboembolism compared with no exposure (adjusted odds ratio 1.58, 95% confidence interval 1.52 to 1.64), for both oestrogen only preparations (1.40, 1.32 to 1.48) and combined preparations (1.73, 1.65 to 1.81). Estradiolhad a lower risk than conjugated equine oestrogen for oestrogen only preparations (0.85, 0.76 to 0.95) and combined preparations (0.83, 0.76 to 0.91). Compared with no exposure, conjugated equine oestrogen with medroxyprogesterone acetate had the highest risk (2.10, 1.92 to 2.31), and estradiol with dydrogesterone had the lowest risk (1.18, 0.98 to 1.42). Transdermal preparations were not associated with risk of venous thromboembolism, which was consistent for different regimens (overall adjusted odds ratio 0.93, 95% confidence interval 0.87 to 1.01).

Conclusions

In the present study, transdermal treatment was the safest type of hormone replacement therapy when risk of venous thromboembolism was assessed. Transdermal treatment appears to be underused, with the overwhelming preference still for oral preparations.
A pilot randomised controlled trial of metacognitive therapy for prolonged grief
Authors: Wenn Jenine Anne , O’Connor Moira , Kane Robert T , Rees Clare Samantha , Breen Lauren J
Published: January 2019

Objectives

Prolonged grief disorder is associated with significant distress and impairment and thus efforts to improve treatments are essential. The present pilot study tested the efficacy and feasibility of group Metacognitive Grief Therapy (MCGT) designed specifically for prolonged grief symptomatology to reduce the psychological distress and impaired function resulting from bereavement.

Design/participants

Twenty-two bereaved adult participants with prolonged grief symptomatology were randomised to a wait-list control (n=10) or an intervention condition (n=12) with a 3-month and 6-month follow-up. The wait-list control group was offered treatment after the post-test assessment.

Intervention

Participants attended six group MCGT sessions that ran for 2 hours per week.

Outcome measures

A primary outcome measure of prolonged grief symptomatology and secondary outcome measures of depression, anxiety, rumination, metacognitive beliefs and quality of life were taken pretreatment and post-treatment for both groups and at the 3-month and 6-month follow-up for the intervention group. A Generalised Linear Mixed Model was used to assess treatment efficacy.

Results

Post-treatment intent-to-treat analyses showed MCGT reduced prolonged grief symptomatology (Cohen’s d=1.7), depression (d=1.3), anxiety (d=0.8), stress (d=1.0), rumination (d=0.9) and increased quality of life (d=0.6), and these effects were maintained at the 3-month and 6-month follow-ups. No prepost between-group differences were found in metacognitive beliefs. However, a large significant effect was identified at the 3-month and 6-month follow-ups (d=1.0).

Conclusion

The results show promise for the utility of group MCGT for reducing psychological distress and promoting quality of life. Additionally, the results underscore the need for a full randomised controlled trial of group MCGT, which may be an important addition to the treatment armamentarium available to support people with prolonged grief.

Trial registration number

ACTRN12613001270707; Results.

Original protocol

BMJ Open2015;5:e007221. doi:10.1136/bmjopen-2014-007221
Non-Invasive Positive airway Pressure thErapy to Reduce Postoperative Lung complications following Upper abdominal Surgery (NIPPER PLUS): protocol for a single-centre, pilot, randomised controlled trial
Authors: Lockstone Jane , Boden Ianthe , Robertson Iain K , Story David , Denehy Linda , Parry Selina M
Published: January 2019

Introduction

Postoperative pulmonary complications (PPCs) are a common serious complication following upper abdominal surgery leading to significant consequences including increased mortality, hospital costs and prolonged hospitalisation. The primary objective of this study is to detect whether there is a possible signal towards PPC reduction with the use of additional intermittent non-invasive ventilation (NIV) compared with continuous high-flow nasal oxygen therapy alone following high-risk elective upper abdominal surgery. Secondary objectives are to measure feasibility of: (1) trial conduct and design and (2) physiotherapy-led NIV and a high-flow nasal oxygen therapy protocol, safety of NIV and to provide preliminary costs of care information of NIV and high-flow nasal oxygen therapy.

Methods and analysis

This is a single-centre, parallel group, assessor blinded, pilot, randomised trial, with 130 high-risk upper abdominal surgery patients randomly assigned via concealed allocation to either (1) usual care of continuous high-flow nasal oxygen therapy for 48 hours following extubation or (2) usual care plus five additional 30 min physiotherapy-led NIV sessions within the first two postoperative days. Both groups receive standardised preoperative physiotherapy and postoperative early ambulation. No additional respiratory physiotherapy is provided to either group. Outcome measures will assess incidence of PPC within the first 14 postoperative days, recruitment ability, physiotherapy-led NIV and high-flow nasal oxygen therapy protocol adherence, adverse events relating to NIV delivery and costs of providing a physiotherapy-led NIV and a high-flow nasal oxygen therapy service following upper abdominal surgery.

Ethics and dissemination

Ethics approval has been obtained from the relevant institution and results will be published to inform future multicentre trials.

Trial registration number

ACTRN12617000269336; Pre-results.
Values-based and acceptance-based intervention to promote adoption and maintenance of habitual physical activity among inactive adults with overweight/obesity: a study protocol for an open trial
Authors: Lillis Jason , Bond Dale S
Published: January 2019

Introduction

Despite the importance of regular moderate-intensity to vigorous-intensity physical activity (MVPA) for health benefits and long-term weight management, current comprehensive lifestyle interventions have focused on providing MVPA prescriptions and goals but with only minimal and intermittent focus on psychosocial theoretical constructs and novel strategies, perhaps explaining the often modest impact on adoption and maintenance of higher levels of MVPA. An intervention based on acceptance and commitment therapy (ACT) targeting the increase of values-based autonomous motivation could improve the adoption and maintenance of habitual MVPA among insufficiently active overweight or obese adults in a brief intervention format.

Methods and analysis

The overall aim of this study is to develop and test the feasibility, acceptability and preliminary efficacy of an ACT-based brief workshop intervention for increasing bouted MVPA for inactive adults with overweight/obesity using a single-arm design. A total of 48 inactive adults with overweight/obesity will be recruited and attend a 4-hour, ACT-based workshop followed by weekly emails and monthly phone calls for 3 months. The workshop will teach values clarification and acceptance-based skills to increase values-based autonomous motivation and bouted MVPA. Participants will self-monitor minutes of MVPA and personal values and report on progress via weekly emails and monthly phone calls. Assessments will be conducted at baseline and at 3 and 6 months.

Ethics and dissemination

Study procedures have been approved by the Institutional Review Board. Consent is given in writing and in person. Data collection and storage separates study data from personally identifying information. Two safety officers who are not connected to the study monitor study progress and participant safety.

Trial registration number

NCT03565731; Pre-results.
Did expansion of health insurance coverage reduce horizontal inequity in healthcare finance? A decomposition analysis for China
Authors: Wang Zhonghua , Zhou Xue , Gao Yukuan , Chen Mingsheng , Palmer Andrew J , Si Lei
Published: January 2019

Objectives

‘Horizontal inequity’ in healthcare finance occurs when people with equal income contribute unequally to healthcare payments. Prior research is lacking on horizontal inequity in China. Accordingly, this study set out to examine horizontal inequity in the Chinese healthcare financing system in 2002 and 2007 through two rounds of national household health surveys.

Design

Two rounds of cross-sectional study.

Setting

Heilongjiang Province, China.

Participants

Adopting a multistage stratified random sampling, 3841 households with 11 572 individuals in 2003 and 5530 households with 15 817 individuals in 2008 were selected.

Methods

The decomposition method of Aronsonet alwas used in the present study to measure the redistributive effects and horizontal inequity in healthcare finance.

Findings

Over the period 2002–2007, the absolute value of horizontal inequity in total healthcare payments decreased from 93.85 percentage points to 35.50 percentage points in urban areas, and from 113.19 percentage points to 37.12 percentage points in rural areas. For public health insurance, it increased from 17.84 percentage points to 28.02 percentage points in urban areas, and decreased from 127.93 percentage points to 0.36 percentage points in rural areas. Horizontal inequity in out-of-pocket payments decreased from 79.92 percentage points to 24.83 percentage points in urban areas, and from 127.71 percentage points to 53.10 percentage points in rural areas.

Conclusions

Our results show that horizontal inequity in total healthcare financing decreased over the period 2002–2007 in China. In addition, out-of-pocket payments contributed most to the extent of horizontal inequity, which were reduced both in urban and rural areas over the period 2002–2007.
Taking the stage: a development programme for women speakers in emergency medicine
Authors: Sunga Kharmene L , Kass Dara
Published: January 2019

Female physicians in the USA achieve associate and full professor rank at numbers disparate to their representation within emergency medicine (EM). The authors describe a novel curriculum aimed at developing women speakers as a step on the journey towards academic recognition. In this pilot programme, four female physicians at a single academic emergency department participated in a year-long Speaker Development Programme (SDP), and all presented in at least one national EM conference at SDP completion. Participants reported improved speaking skills, confidence and drive to present externally. Elements to success were mentor engagement, encouragement by the departmental chair and creation of a growth and belonging mindset within the cohort. Future steps include creating a framework for maintaining the SDP beyond the pilot phase, such as ensuring access to curriculum materials, and retaining an experienced external mentor over time.
Combined nitrous oxide 70% with intranasal fentanyl for procedural analgosedation in children: a prospective, randomised, double-blind, placebo-controlled trial
Authors: Seiler Michelle , Staubli Georg , Landolt Markus A.
Published: January 2019

Objective

Nitrous oxide 70% (N2O 70%) is an excellent medication for procedural analgosedation (PAS), yet the limit of its analgesic power remains uncertain; therefore, a combination with intranasal fentanyl (INF) was suggested. However, this combination seems to result in a higher rate of vomiting and deeper sedation. This study aimed at assessing the analgesic efficacy, sedation depth and rate of adverse events of PAS with N2O 70% with and without INF.

Methods

Patients aged 2–16 years who qualified for PAS with N2O 70% were randomly assigned to receive either INF or placebo prior to N2O inhalation in this randomised, double-blind study, which was performed in a tertiary children’s hospital ED between September 2015 and October 2017. Behaviour during the procedure was evaluated using the Face, Leg, Activity, Cry and Consolability (FLACC) scale and the Modified Behavioural Pain Scale (MBPS); analgesic efficacy was assessed with a self-reported pain scale. Sedation depth using the validated University of Michigan Sedation Scale and adverse events in the ED and during the following 12 hours were documented.

Results

A total of 402 patients were included; 3 did not tolerate N2O and therefore had to be excluded. Overall, 399 patients were analysed, of whom 201 (50.4%) received INF. No significant group differences with regard to FLACC scale score, self-reported pain, MBPS score and sedation depth were found. In addition, the two groups did not differ with regard to all types of adverse events.

Conclusion

Combining N2O 70% with INF resulted in no differences with regard to FLACC scale score, self-reported pain, MBPS score, patient and parental satisfaction rate, sedation depth, and adverse events.

Trial registration number

NCT02533908
Management of acute retrobulbar haemorrhage: a survey of non-ophthalmic emergency department physicians
Authors: Edmunds Matthew R , Haridas Anjana S , Morris Daniel S , Jamalapuram Kasyap
Published: January 2019

Introduction

Acute retrobulbar haemorrhage (RBH) with orbital compartment syndrome is a sight-threatening ophthalmic emergency requiring treatment with lateral canthotomy and cantholysis (LC/C). However, such cases may present to non-ophthalmic emergency departments (ED) out-of-hours, when specialist intervention is not readily available. We completed a survey of ED physicians to explore experiences of RBH and confidence in undertaking LC/C.

Methods

From February to April 2018, an online survey was sent to ED physicians of all training grades in seven UK locations. The survey comprised a case vignette of a patient presenting with clinical features of RBH with orbital compartment syndrome, with multiple choice questions on the diagnosis, management and onward referral of such cases. Additional questions explored the experience of RBH, LC/C and perspectives on current and future training of ED physicians in this area.

Results

190 ED doctors completed the survey (response rate 70%). While 82.8% correctly diagnosed RBH and 95.7% recognised irreversible visual loss as a consequence of untreated RBH with orbital compartment syndrome, 78.7% indicated that they would initially undertake CT imaging rather than performing LC/C. Only 38.9% had previously encountered a case of RBH and only 37.1% would perform LC/C themselves, with 91.4% indicating that this was due to lack of training. 92.2% felt that more training was required for ED physicians in RBH management and performing LC/C.

Conclusion

While cases of RBH with orbital compartment syndrome are infrequent, it is important that RBH management with the vital, sight-saving skill of LC/C is added to the United Kingdom Royal College of Emergency Medicine training curriculum. At present, though the majority of ED physicians can identify RBH, the minority are willing or able to undertake LC/C, potentially risking irreversible but avoidable visual loss.
Low levels of ideal cardiovascular health in a semi-urban population of Western Nepal: a population-based, cross-sectional study
Authors: Gyawali Bishal , Mishra Shiva Raj , Virani Salim S , Kallestrup Per
Published: January 2019

Background

The aim of this study was to assess the status of cardiovascular health among a semi-urban population of Nepal, and determine factors associated with ideal cardiovascular health.

Methods

A population-based, cross-sectional study using a systematic random sample was conducted among 2310 adults aged ≥ 25 years in a semi-urban area of the Pokhara Metropolitan City previously named Lekthnath in Nepal. The ideal, intermediate and poor cardiovascular health were defined as the presence of 6–7, 4–5 or 1–3 health metrics, among a list of 7 health behaviours and healthfactors, namely smoking, body mass index, physical activity, fruits and vegetables intakes, harmful alcohol consumption, blood pressure, and fasting blood glucose. We used univariate and multivariate Poisson regression models adjusting for sex, age groups, ethnicity, educational level and socioeconomic status, and calculated the prevalence ratios with 95% CIs.

Results

Only 14.3 % of the participants had ideal cardiovascular health, whereas 67.0% and 18.7% of the participants had intermediate and poor cardiovascular health, respectively. Age groups 45–54 years (prevalence ratio 0.88, 95% CI: 0.83 to 0.94, p<0.001) and 55–64 years (prevalence ratio 0.84, 95% CI: 0.79 to 0.90, p<0.001) were significantly associated with low prevalence of ideal cardiovascular health compared with the age group 35–44 years. Ethnic groups, including Janajati (prevalence ratio 0.89, 95% CI: 0.85 to 0.93, p<0.001) and Dalit (prevalence ratio 0.9, 95% CI: 0.84 to 0.95, p=0.001), were significantly associated with low prevalence of ideal cardiovascular health.

Conclusions

Prevalence of ideal cardiovascular health is low in the semi-urban population in Nepal. Concerted efforts are needed to develop a population-based intervention to improve cardiovascular health in Nepal.
Molecular characterisation of haemoglobin E-Udon Thani (HBB:c.[79G>A;92+7A>G]): a novel form of Hb E-β-thalassaemia syndrome
Authors: Singha Kritsada , Fucharoen Goonnapa , Fucharoen Supan
Published: January 2019

Interaction of βE-globin gene with an in trans β-thalassaemia gene leads to thalassaemia syndrome, known as haemoglobin (Hb) E-β-thalassaemia disease, with variable clinical and haematological severity. Here, we reported for the first time the Hb E-β-thalassaemia syndrome caused alternatively by an in cis interaction of βEand a novel IVSI#7;A>G mutation, namely the Hb E-Udon Thani (HBB:c.[79G>A;92+7 A>G]). The syndrome was found in an adult Thai man (32) who was generally healthy but had an unexplained hypochromic microcytosis. Hb analysis identified heterozygous Hb E with very low Hb E expression (3.1%) and elevated Hb A2(5.7%). Final diagnosis was made on DNA analysis, which confirmed a double mutation in a single β-globin gene of the patient. A multiplex allele-specific PCR assay was developed for use in the screening of this novel form of Hb E-β-thalassaemia in the population.
Effects of onabotulinumtoxinA treatment for chronic migraine on common comorbidities including depression and anxiety
Authors: Blumenfeld Andrew M , Tepper Stewart J , Robbins Lawrence D , Manack Adams Aubrey , Buse Dawn C , Orejudos Amelia , D Silberstein Stephen
Published: January 2019

Objective

To assess the effects of onabotulinumtoxinA treatment for chronic migraine (CM) on comorbid symptoms of depression, anxiety, fatigue and poor sleep quality.

Methods

The Chronic Migraine OnabotulinuMtoxinA Prolonged Efficacy open-Label (COMPEL) study is a multicentre, open-label, prospective study assessing the long-term safety and efficacy of onabotulinumtoxinA 155 U over nine treatments (108 weeks) in adults with CM. The Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder (GAD-7) scales were used to assess the effects of onabotulinumtoxinA on comorbid symptoms of depression and anxiety, respectively. A clinically meaningful improvement was assessed by the percentage of patients experiencing a ≥1 severity category reduction in PHQ-9 and GAD-7. The effects of onabotulinumtoxinA on associated sleep quality and fatigue were assessed using the Pittsburgh Sleep Quality Index and Fatigue Severity Scale, respectively.

Results

OnabotulinumtoxinA treatment was associated with sustained reduction in headache days and PHQ-9 and GAD-7 scores in the analysis population (n=715) over 108 weeks. PHQ-9 and GAD-7 scores were significantly reduced at all time points in patients with clinically significant symptoms of depression and/or anxiety at baseline. By week 108, 78.0% and 81.5% had clinically meaningful improvement in depression and anxiety symptoms, respectively. Sleep quality and symptoms of fatigue also improved; however, less is understood about clinically meaningful changes in these measures. No new safety concerns were identified.

Conclusion

In addition to reducing headache frequency, onabotulinumtoxinA treatment for CM was associated with clinically meaningful reduction in symptoms of depression and anxiety, and improved associated symptoms of poor sleep quality and fatigue.

Trial registration number

NCT01516892.
Impact of frontal round jet on vortex synchronization control around a cylinder: a turbulence perspective
Authors: Roy Sayahnya , Debnath Koustuv
Published: January 2019

The present study demonstrates that a round turbulent jet issued from a cylinder surface towards the upstream against the current can be a controlling parameter for vortex synchronization (VSC) in the wake region (WR) of the vertical cylinder. The results depict that the VSC state can be reached when the jet excitation frequency and the natural shedding frequency (NSF) are almost equal, or the jet excitation frequency is double that of the NSF. Precisely for VSC case, the turbulent production and dissipation terms of the turbulent kinetic energy budget equation contribute majorly to the total energy at the reattachment region with shifting of energy from the pressure and the turbulent diffusion terms. The enhancement of intermittency in turbulence for the VSC cases is also pertinent.
Insight into late Iapetus tectonics from new U–Pb zircon and micropalaeontological data from the Navan area, eastern Ireland
Authors: McConnell B. , Riggs N. , Sevastopulo G.
Published: January 2019

The Ordovician peri-Laurentian Grangegeeth Terrane in eastern Ireland and the adjacent Katian to Wenlock Rathkenny Tract are together a relict of the closing Iapetus Ocean. The Rathkenny Tract succession is part of the Laurentian Southern Uplands–Down–Longford Terrane accretionary prism, but the contact between the Rathkenny and Grangegeeth terranes is cryptic. Two cores of Lower Paleozoic strata along a buried projection of the Rathkenny–Grangegeeth outcrops contain volcaniclastic units within a succession of mudstone and siltstone. Laser ablation inductively coupled plasma mass spectrometry U–Pb dating of zircons from volcanogenic horizons yielded a maximum depositional age of
c.
450 Ma. Nearly 98% of the zircon ages are 480–445 Ma, indicating a proximal volcanic source. The trace element geochemistry of the Ordovician zircons indicates a host magma sourced from continental crust. A diverse ostracod fauna in the mudstones suggests a Katian age and includes species with Baltic, Laurentian and Avalonian affinities. We propose a paired subduction zone model for the emplacement of the Grangegeeth–Rathkenny succession, with the Rathkenny strata deposited on an oceanic plate between the Laurentian margin accretionary prism and the 480–450 Ma Grangegeeth peri-Laurentian microcontinental arc. Volcaniclastic detritus fed into the Rathkenny basin was then incorporated into the accretionary prism. The mixed fauna indicates that the Iapetus Ocean was narrow by Katian time.

Supplementary material:
Navan zircon U–Pb geochronology and geochemistry data are available at
https://doi.org/10.6084/m9.figshare.c.4358243
Adaptation of fluid inclusion techniques for investigating gas charge – examples from the Caswell Sub-basin, Browse Basin, Australia
Authors: Bourdet Julien F. R. , Heath Charles H. , Kempton Richard H.
Published: January 2019

Palaeoformation water trapped in quartz cements in sandstone during diagenesis is typically of interest for constraining the temperature history, cementation and timing of hydrocarbon charge. Recent progresses in developing methods for salinity measurement, gas detection (CH
4
, CO
2
, N
2
, H
2
S) and fluid modelling of the CH
4
–H
2
O–NaCl system by combining conventional microthermometry techniques with Raman spectroscopy provide powerful tools for investigating formation water and its evolution in gas-bearing basins. Samples from the aquifer, in the Plover Formation and in the Brewster Member in the Upper Vulcan Formation, underlying large gas accumulations in the Caswell Sub-basin provided an opportunity to test these new techniques and generate data on formation water evolution. Temperature of homogenization, salinity and gas content of water inclusions show that the salinity of the palaeoformation waters decreased with increasing methane content and temperature. Detection of CO
2
shows, however, that water inclusions with dissolved CO
2
, often in association with CH
4
, do not follow the same salinity trend. These inclusions are often associated with higher trapping temperatures. The salinities associated with water reaching methane saturation (coeval with free gas) are between 8500 and 24 000 ppm eq. NaCl (0.8–2.4 wt%). An influx of meteoric water from the Ashmore Platform in the north is presented as a hypothesis on the origin of the low salinities of the formation water in the Plover Formation in the Browse Basin, supported by the distribution of the lowest palaeowater salinities, but still remains problematic.
Probabilistic Evaluation of Hardware Security Vulnerabilities
Authors: Gong Yanping , Qian Fengyu , Wang Lei
Published: January 2019

Various design techniques can be applied to implement the finite state machine (FSM) functions in order to optimize timing, performance, power, and to reduce overhead. Recently, malicious attacks to hardware systems have emerged as a critical problem. Fault injection attacks, in particular, alter the function or reveal the critical information of a hardware system through precisely controlled fault injection processes. Attackers can utilize the loopholes and vulnerabilities of FSM functions to access the states that are under protection. A probabilistic model is developed in this article to evaluate the potential vulnerabilities of FSM circuits at the design stage. Analysis based on the statistical behaviors of FSM also shows that the induced circuit errors can be exploited to access the protected states. An effective solution based on state re-encoding is proposed to minimize the risk of unauthorized transitions. Simulation results demonstrate that vulnerable transition paths can be protected with small hardware overheads.
Bee Viruses: Ecology, Pathogenicity, and Impacts
Authors: Grozinger Christina M. , Flenniken Michelle L.
Published: January 2019

Bees—including solitary, social, wild, and managed species—are key pollinators of flowering plant species, including nearly three-quarters of global food crops. Their ecological importance, coupled with increased annual losses of managed honey bees and declines in populations of key wild species, has focused attention on the factors that adversely affect bee health, including viral pathogens. Genomic approaches have dramatically expanded understanding of the diversity of viruses that infect bees, the complexity of their transmission routes—including intergenus transmission—and the diversity of strategies bees have evolved to combat virus infections, with RNA-mediated responses playing a prominent role. Moreover, the impacts of viruses on their hosts are exacerbated by the other major stressors bee populations face, including parasites, poor nutrition, and exposure to chemicals. Unraveling the complex relationships between viruses and their bee hosts will lead to improved understanding of viral ecology and management strategies that support better bee health.
Life and Death at the Voltage-Sensitive Sodium Channel: Evolution in Response to Insecticide Use
Authors: Scott Jeffrey G.
Published: January 2019

The voltage-sensitive sodium channel (VSSC) is a critical component of the insect nervous system. Pyrethroids and DDT are insecticides that have been widely used, and they kill insects by perturbations of the VSSC. Decades of insecticide use selected for mutations in Vssc that give rise to resistance in almost all pest insects. However, the mutations responsible for the resistance are not always the same, and some unusual patterns have emerged. This review focuses on what pyrethroid/DDT selection has done, in terms of Vssc changes that have occurred, using four well-studied species as examples of the differences that have evolved. Information is provided about the mutations that occur, potential pathways by which alleles with multiple mutations arose, the relative fitness of the alleles, the levels of resistance conferred, and the geographic distribution of the mutations. The lessons learned and exciting new areas of research are discussed.