bluuebunny/crossref_metadata_2025 huggingface dataset:
44 Wirral's Teletriage Service
Authors: Whittle E , James E , Smith A , Highton M , Shaikh S , Stone B , Thompson J , Orr T , Hogan I , Stokes S , Langton J , Chu C , Orr T , Hogan I
Published: February 2020

Introduction

The Wirral Teletriage Service provides non-urgent clinical support to Wirral Care Homes in order to help avoid unnecessary hospital admissions for their residents. It also aims to provide quicker access to clinical assessment than via NHS 111 and to provide this care in the patient’s residence wherever possible.

Methods

Care homes call the Teletriage service when they have concerns about the health of one of their residents. The Teletriage nurse undertakes a clinical assessment of the resident remotely via Skype. Care Homes have been provided with a secure NHS email address to facilitate secure sharing of data. They have also been provided with iPads and training for their staff. After being assessed by Teletriage, residents are signposted to the most appropriate care pathway for their needs.

Results

76 Care Homes have signed up to the service. On average, the Teletriage Service receives 300-400 calls a month. In an 18 month period, the number of calls to NHS 111 have reduced by 76%. Out of all the calls to Teletriage, 22% of patients were managed by the Teletriage team with no onward referral, 57% were managed via community services e.g GPs, Community Geriatricians, and 10% were referred to the ambulance service. Emergency Health Care Plans (EHCPs), Preferred Priorities of Care and EOL (End of Life) wishes are taken into account.

Conclusions

The Teletriage project has reduced the number of phone calls to NHS 111 and the ambulance service, and subsequently has reduced the number of patients conveyed to hospital by 12%. The Teletriage nurses work very closely with various community services as well as GPs, NWAS and Community Geriatricians. The ongoing training and education provided to the Care Home Staff means that overall there has been good engagement with the project from the majority of the Wirral Care Homes.
51 Working Collaboratively: Geriatrician Input in Older Patients Undergoing Emergency Laparotomy Reduces Overall Length of Stay - A Complete Audit Loop
Authors: Khan K A , Richters M , Mubarak A , Thorn C , Chalstrey S , Gunasekera S
Published: February 2020

Background

Great Western Hospital is a busy district general hospital with a catchment population of 340,000. Target population of this study was elderly patients aged >70 undergoing Emergency Laparotomy (EL).

Introduction

Approximately 8% of the population is aged over 75 years and operations in this patient group account for 23% of all surgical procedures. The 2010 National Confidential Enquiry into Patient Outcome and Death report “An Age Old Problem”, suggested routine daily input from Geriatrics should be available to elderly patients undergoing surgery.

This study focuses at the impact of Geriatrician input for EL patients with primary outcome of reduction in Length of Stay (LoS).

Methods

The service was designed with allocation of 4 hours per week of Consultant Geriatrician and 2.5 days per week of a Clinical Innovation Fellow (CIF) time. The existing team of surgical junior doctors, nursing and allied health professionals carried out plans suggested by the geriatrician.

Retrospective data (Prior to service initiation) for the emergency laparotomy patients >70 years, was collected from December 2015-May 2016.

Prospective data collected from February 2018 – July 2018 for EL patients aged > 70, patients with inpatient stay > 7 days, patients with delirium/ inpatient falls.

Length of stay and Inpatient mortality were compared between the two cohorts.

Intervention

Prior to the establishment of this service the medical support was provided on ad-hoc basis. Funding was obtained from local postgraduate medical education for CIF and twice weekly consultant led ward rounds were carried out.

Patients were recruited from hospital database and from a referrals book kept at surgical ward.

Results

45 patients were included in prospective study and Mean LoS was 17.8 days, which was reduced from 22.5 days prior to Geriatrician involvement (N=56).

Average 4.7 days per patient were saved.

IP mortality was 8.8% (2/4 deaths were palliative resections) after geriatrician input compared to 8.9% previously.

6.6% of patients had a new medical diagnosis, 24.4% patients were followed up in prospective cohort.

Conclusions

This study suggests the regular geriatrician input reduces the inpatient LoS. A day stay at surgical ward costs roughly £250, for 45 patients in last six months it saved approximately £52,875.
57 Improving Patient Centred Care On An Acute Older Persons Unit: A Quality Improvement Project
Authors: Meldrum T
Published: February 2020

Topic

Improving patient centred care through the implementation of an occupational therapy assessment that is framed by ‘gold standard’ intervention of comprehensive geriatric assessment (CGA) and Canadian Model of Occupational Performance and Engagement (CMOP-E). Occupational therapy staff had limited knowledge of the CGA process.

Intervention

Implementation of an adapted occupational therapy assessment form that reflects the CMOP-E and addresses the domains of the CGA; using the Plan, Do, Study, Act methodology to support a sequential cycle of change over a three month period (Dec 2019 – Feb 2019). The form also addresses patient centred care and personalised care planning. An education session was undertaken with occupational therapy staff to increase the knowledge and understanding of the CGA process resulting in more effective participation in multidisciplinary team (MDT) meetings.

Improvement

The above intervention resulted in successful implementation of an adapted occupational therapy assessment form for older people addressing the domains of the CGA within the CMOP-E framework and encompassing patient centred care. Occupational therapy staff had increased confidence with their knowledge of the CGA and participation in MDT meetings and patients felt more involved in their care.

Discussion

It is possible to have both an evidenced MDT model of practice and a uni-professional occupational therapy model working alongside each other to provide patient centred care and effectively address the complex needs of frail, older people.
66 The Use of Proton Pump Inhibitors in An Older Population in A Tertiary Hospital: A Patient Safety Issue?
Authors: Rafee S
Published: February 2020

Background

PPIs form part of the most commonly prescribed medications in Ireland. There has been emerging concern regarding the risks associated with their chronic use. PPI use has been linked with clostridium difficile infection, pneumonia, hypomagnesaemia, nephrotoxicity, hyponatraemia as well as many other GI and non GI pathologies including dementia. Therefore there has been emerging concern regarding their chronic use. The aim of our audit was to identify the spot prevalence and appropriateness of PPI use for gastro-protection in an older population of medical inpatients in accordance with NICE 2014 PPI guidance “Management of dyspepsia in adults in primary care.”

Methods

We audited the prevalence of PPI use in medically admitted patients aged ≥65 years at our institution and the use of PPIs within this population.

Patients' admission proforma, clinical notes, and drug kardex were reviewed. We collected: age, gender, past medical history, drug list, and laboratory results. This data was used to identify the prevalence and appropriateness of PPI use.

Results

The total number of medically admitted patients aged ≥65 years was 107. 52(48.5%) were prescribed PPIs. Of the 52, only 7(13.4%) had an appropriate indication:

Five patients had concomitant prescription of low dose Aspirin ± clopidogrel and a documented history of gastritis/esophagitis/duodenitis.

One patient had a hiatus hernia and gastro-esophageal reflux disease.

One patient had chronic NSAID use due to arthritis.

Subgroup analysis showed 46/52 were prescribed high dose PPI without indication.

Conclusions

Our audit confirms this showing that almost 50% of patients aged ≥ 65y admitted to our hospital have been prescribed PPIs. Furthermore, PPI prescriptions were only appropriate in 13.4%. In line with recent guidelines, NICE PPI guidance 2014 and AGA Best Practice Guidelines, our data shows there is scope to rationalise PPI use in older people with resultant cost savings and reduction in complications.
102 Process Evaluation Exploring the Delivery and Uptake of Posture and Mobility Training for Staff in Care Homes
Authors: Williams R , Clarke D , Graham L , Hawkins R , Cundill B , Ellwood A , Farrin A , Fisher J , Goodwin M , Holland M , Hull K , Hulme C , Kelly C , Forster A
Published: February 2020

Introduction

Provision of care for care home residents with complex needs is challenging. Physiotherapists can play a major role in enhancing the confidence, skills and abilities of care home staff. The Skilful Care Training Package (SCTP) aims to provide staff with an understanding of good posture and training in skilled facilitation of movement. This process evaluation explored barriers and facilitators to delivery and uptake of the SCTP within the context of a feasibility cluster randomised controlled trial (cRCT) in 10 care homes.

Methods

A mixed methods process evaluation, incorporating non-participant observations and interviews, conducted in the five care homes receiving the SCTP intervention. Interviews were audio recorded and transcribed verbatim; resident conversations were captured via a Dictaphone and/or field-notes. Data analysis used the Framework approach.

Results

Fourteen staff training sessions were observed. Interviews with 22 staff and four trainers, and 13 conversations with residents were completed. Five factors influenced delivery and uptake of the SCTP:Organisational factors: strategies to publicise and facilitate access to training improved attendance; a convenient training location and trainer flexibility encouraged attendance and staff engagement.Intervention delivery: a practical participatory element to the training was highly valued; adapting the training to meet the needs of the homes was well-received.Engagement and interaction: relating training to workplace and residents’ experiences engaged staff; high levels of engagement and positive interaction within the training sessions were reported; challenges relating to staff hierarchy affected training delivery in some homes.Intervention content: posture and mobility elements were seen as important; however, some repetition with prior training was highlighted.Training impact: there were indications that staff adopted SCTP techniques. Staff reported an increase in their wellbeing and confidence in movement facilitation; cascade training was reported in some homes.

Conclusions

Training was well-received, and feedback on its impact was largely positive. Practical elements were viewed favourably over classroom-based learning. Intervention content should be revised to optimise focus and avoid overlap with other training.
Individual variation in migratory behavior in a subarctic partial migrant shorebird
Authors: Méndez Verónica , Alves José A , Þórisson Böðvar , Marca Alina , Gunnarsson Tómas G , Gill Jennifer A
Published: February 2020

Migratory behavior can differ markedly amongst individuals within populations or species. Understanding the factors influencing this variation is key to understanding how current environmental changes might influence migratory propensity and the distribution and abundance of migratory species across their range. Here, we investigate variation in migratory behavior of the partially migratory Eurasian oystercatcher (Haematopus ostralegus) population breeding in Iceland. We use the resightings of color-ringed adults and stable isotopes to determine whether individuals migrate or remain in Iceland during winter and test whether individual migratory strategies vary in relation to sex, body size, and breeding location. We also explore individual consistency in migratory strategy and test whether assortative mating with respect to strategy occurs in this population. The proportion of migrants and residents varied greatly across breeding locations but not with respect to sex or body size. Individuals were consistent in migratory strategy between years and there was no evidence of assortative mating by migratory strategy. We use these findings to explore factors underlying the evolution and maintenance of partial migration at high latitudes.
ColocML: machine learning quantifies co-localization between mass spectrometry images
Authors: Ovchinnikova Katja , Stuart Lachlan , Rakhlin Alexander , Nikolenko Sergey , Alexandrov Theodore
Published: February 2020

Motivation

Imaging mass spectrometry (imaging MS) is a prominent technique for capturing distributions of molecules in tissue sections. Various computational methods for imaging MS rely on quantifying spatial correlations between ion images, referred to as co-localization. However, no comprehensive evaluation of co-localization measures has ever been performed; this leads to arbitrary choices and hinders method development.

Results

We present ColocML, a machine learning approach addressing this gap. With the help of 42 imaging MS experts from nine laboratories, we created a gold standard of 2210 pairs of ion images ranked by their co-localization. We evaluated existing co-localization measures and developed novel measures using term frequency–inverse document frequency and deep neural networks. The semi-supervised deep learning Pi model and the cosine score applied after median thresholding performed the best (Spearman 0.797 and 0.794 with expert rankings, respectively). We illustrate these measures by inferring co-localization properties of 10 273 molecules from 3685 public METASPACE datasets.

Availability and implementation

https://github.com/metaspace2020/coloc.

Supplementary information

Supplementary data are available at Bioinformatics online.
Critical Comments on “Assessment of the Thermodynamic Properties of DL-p-Mentha-1,8-diene, 4-Isopropyl-1-Methylcyclohexene (DL-Limonene) by Inverse Gas Chromatography (IGC)”
Authors: Acree William E
Published: February 2020

A polemic is given regarding the calculated thermodynamic quantities reported in the published paper by Farschi and coworkers. The graph used to calculate the molar heat of sorption of organic probe molecules onto the liquid DL-limonene stationary phase erroneously plots the reciprocal of the centigrade temperatures, rather than the reciprocal of the Kelvin temperatures. Molar heats of vaporization of the organic probe molecules reported in the paper are abnormally small and are not in accord with published values determined from calorimetric and vapor pressure measurements.
Hand Hygiene Compliance at Critical Points of Care
Authors: Chang Nai-Chung Nelson , Reisinger Heather Schacht , Schweizer Marin L , Jones ichael , Chrischilles Elizabeth , Chorazy Margaret , Huskins Charles , Herwaldt Loreen
Published: February 2020

Background

Most articles on hand hygiene report either overall compliance or compliance with specific hand hygiene moments. These moments vary in the level of risk to patients if healthcare workers (HCWs) are noncompliant. We assessed how task type affected HCWs’ hand hygiene compliance.

Methods

We linked consecutive tasks individual HCWs performed during the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study into care sequences and identified task pairs—2 consecutive tasks and the intervening hand hygiene opportunity. We defined tasks as critical and/or contaminating. We determined the odds of critical and contaminating tasks occurring, and the odds of hand hygiene compliance using logistic regression for transition with a random effect adjusting for isolation precautions, glove use, HCW type, and compliance at prior opportunities.

Results

Healthcare workers were less likely to do hand hygiene before critical tasks than before other tasks (adjusted odds ratio [aOR], 0.97 [95% confidence interval {CI}, .95–.98]) and more likely to do hand hygiene after contaminating tasks than after other tasks (aOR, 1.12 [95% CI, 1.10–1.13]). Nurses were more likely to perform both critical and contaminating tasks, but nurses’ hand hygiene compliance was better than physicians’ (aOR, 0.94 [95% CI, .91–.97]) and other HCWs’ compliance (aOR, 0.87 [95% CI, .87–.94]).

Conclusions

Healthcare workers were more likely to do hand hygiene after contaminating tasks than before critical tasks, suggesting that habits and a feeling of disgust may influence hand hygiene compliance. This information could be incorporated into interventions to improve hand hygiene practices, particularly before critical tasks and after contaminating tasks.
A Modified Semi-automated Resorcinol Method for the Determination of Inulin
Authors: Steele Thomas H
Published: February 2020

A semi-automated resorcinol method for the determination of inulin in plasma and urine specimens, using standard AutoAnalyzer modules, is described. Plasma and other protein-containing fluids undergo a preliminary manual protein precipitation procedure. The deproteinized specimens are processed at a rate of 50/hr, with a high degree of accuracy and precision. The superiority of the present method is largely due to the elimination of small acid-resistant pump tubes from the manifold. This is possible because reagents are premixed prior to aspiration into the system, allowing simplification of manifold design over other automated methods.
Measurement of sodium valproate in serum by direct-insertion chemical-ionization/mass spectrometry.
Authors: Schier G M , Gan I E , Halpern B , Korth J
Published: February 2020

To quantitatively determine sodium valproate, we use a stable isotope-labeled internal standard and chemical-ionization/mass spectrometry, without prior chromatographic separation. The technique is rapid, simple, sensitive, and provides for the routine analysis of 100 microL of serum with good within-day and day-to-day precision. The technique also allows for the simultaneous determination of phenobarbital, mephobarbital, carbamazepine, primidone, and phenytoin.
"High-pressure" liquid chromatography of sulfisoxazole and N4-acetylsulfisoxazole in body fluids.
Authors: Jung D , Oie S
Published: February 2020

We describe a simple, rapid chromatographic method for separating and quantitatively determining sulfisoxazole and its N4-acetyl metabolite in plasma and urine. A 100-micro L sample of plasma or urine is combined with 200 micro L of a solution containing 12 mg/L of the internal standard, N4-acetylsulfamethoxazole, in absolute methanol and centrifuged to obtain a clear supernatant solution. This solution is then eluted through a 10-micron microparticulate column with a mobile phase of 32/68 (by vol) methanol/sodium acetate buffer (0.01 mol/L, pH 4.7), at a flow rate of 1.2 mL/min. The eluted sompounds are detected by their absorption at 254 nm. We calculated concentration from the peak-height ratios of sulfisoxazole or N4-acetylsulfisoxazole to N4-acetylsulfamethoxazole. The peak-height ratio was linear with concentration in the range 0.05--200 mg/L for both drug and metabolite in plasma and urine. Because this assay can be completed within 30 min of obtaining a blood or urine sample, it should be a valuable tool in clinical drug monitoring and pharmacokinetic studies.
Immobilized-enzyme rate-determination method for glucose analysis.
Authors: Sokol L , Garber C , Shults M , Updike S
Published: February 2020

We present a rate-determination method for analyzing glucose. A glucose enzyme electrode serves as the sensor and is made by placing a gel-immobilized layer of glucose oxidase over the tip of a Clark-type O2 electrode. The electrode membrane is made of Teflon and is derivatized by etching with a suspension of colloidal sodium metal in organic solvent. The enzyme is coupled to the membrane surface by use of paraformaldehyde. The immobilized-enzyme method is compared with a similar solution-enzyme method and with the National Glucose Reference method. The immobilized enzyme method compares favorably with the solution-enzyme method and offers the advantages of simplicity, economy of enzyme, and linearity over a greater range of concentration.
Simultaneous liquid-chromatographic determination of zinc protoporphyrin IX, protoporphyrin IX, and coproporphyrin in whole blood.
Authors: Gotelli G R , Wall J H , Kabra P M , Marton L J
Published: February 2020

We describe a method for simultaneously measuring concentrations of coproporphyrin, zinc protoporphyrin IX, and protoporphyrin IX in whole blood by liquid chromatography, with use of reversed-phase ion-pair system, fluorometric detection, and internal standardization. Each analysis requires 10 microL of whole blood and 15 min total analysis time. Analytical recovery ranged from 84 to 92%, day-to-day precision (CV) from 5 to 12%. Uroporphyrin, though not studied in detail, can also be detected by this method.
Automated multiple flow-injection analysis in clinical chemistry: determination of albumin with bromcresol green.
Authors: Renoe B W , Stewart K K , Beecher G R , Wills M R , Savory J
Published: February 2020

We describe an adaptation of automated multiple flow-injection analysis instrumentation to an analysis for albumin in serum. The bromcresol green reaction was used to test the utility of the system. The approach yielded albumin results with excellent sensitivity, no measurable carryover, a relative standard deviation of less than 1%, good correlations with published procedures, and no measurable interferences. The simplicity and flexibility of the instrumentation and its performance integrity, as indicated by the analytical results, make this a viable clinical chemical tool.
Amniotic fluid phospholipids measured by continuous-development thin-layer chromatography.
Authors: Kolins M D , Epstein E , Civin W H , Weiner S
Published: February 2020

We describe a one-dimensional thin-layer chromatographic system for separation of amniotic fluid phosphatidylcholine, sphingomyelin, phosphatidylglycerol, phosphatidylinositol, phosphatidylserine, and phosphatidylethanolamine in amniotic fluid. We utilize short-bed continuous development and "high performance" thin-layer chromatography. Phospholipids are detected with an antimony molybdate staining reagent and quantitated by transmittance densitometry. This system is more sensitive to changes in lecithin/sphingomyelin ratios than are planimetric evaluations.
Continuous-flow (Autoanalyzer I) analysis for plasma thiocyanate as an index to tobacco smoking.
Authors: Dalferes E R , Webber L S , Radhakrishnamurthy B , Berenson G S
Published: February 2020

We describe a procedure for determining thiocyanate in plasma with a Technicon AutoAnalyzer I, modified with a 50-mm tubular flow cell to increase the sensitivity of thiocyanate detection. The procedure is suitable for distinguishing cigarette smokers from non-smokers, the mean for smokers being 151 (SD 43) micromol/L and for non-smokers 62 (SD 19) micromol/L.
Measurement of anticonvulsants in serum by reversed-phase ion-pair liquid chromatography.
Authors: Christofides J A , Fry D E
Published: February 2020

We describe a method for the simultaneous liquid-chromatographic determination of ethosuximide, ethylphenacemide, primidone, phenobarbital, carbamazepine, and phenytoin in serum. The drugs, together with an internal standard, are extracted into ethyl acetate at pH 7.0. The extract is analyzed isocratically at ambient temperature on a reversed-phase column of "SAS Hypersil" with a mobile phase of acetonitrile/tetrabutyl ammonium phosphate solution (2/8 by volume). The eluted drugs are detected by their absorption at 200 nm, and quantitated from their peak heights as compared with those of extracted standards. The day-to-day CV of the method varied between 5.1 and 9.6% for concentrations ranging from less than therapeutic to toxic. The results, when compared with those by gas chromatography, gave correlation coefficients of 0.936 for phenytoin, 0.977 for phenobarbital, and 0.939 for primidone. No drug interference was found except that amobarbital and ethylphenacemide co-chromatographed.
Kinetic serum creatinine assays. II. A critical evaluation and review.
Authors: Bowers L D , Wong E T
Published: February 2020

We have evaluated the Technicon AutoAnalyzer method, the Beckman Creatinine Analyzer II, DuPont aca, Electro-Nucleonics GEMSAEC, and Instrumentation Laboratory Model 916 kinetic methods for determination of serum creatinine. These methods, which involve the Jaffé reaction, all showed a statistically significant proportional error relative to an ion-exchange pretreatment method for creatinine in 92 serum samples; the GEMSAEC method also showed a bias. The positive interference of several acid metabolites was quantitated in each of the methods. The evidence indicates that bilirubin, although associated with a negative creatinine interference, is not the sole interferent. We determined the magnitude of this interference and studied several methods for minimizing it.
Liquid-chromatographic separation and on-line bioluminescence detection of creatine kinase isoenzymes.
Authors: Bostick W D , Denton M S , Dinsmore S R
Published: February 2020

We separated isoenzymes of creatine kinase by anion-exchange chromatography, with use of an elution of gradient containing lithium acetate (0.1 to 0.6 mol/L). A stream splitter was used to divert a 5% side stream of column effluent, which was subsequently mixed with the reagents necessary for bioluminescence assay of the separated isoenzymes. The use of the stream splitter greatly decreased the rate of consumption of reagent and, when combined with a peristaltic pumping system, permitted independent control of the side-stream flow rate. Thus both the residence interval in a delay coil in which the ATP reaction product is formed and the bioluminescence response could be increased. Bioluminescence emission was monitored in a flow-through fluorometer without use of an external light source or filters. Separation and detection of the isoenzymes of creative kinase were rapid, sensitive, and highly selective. The incremental decrease of bioluminescence response owing to inhibition by the ions in the eluent was less than 31% across the entire gradient.
Lamellar body phospholipid content of amniotic fluid and L/S ratio compared in assessing fetal lung maturity.
Authors: Duck-Chong C G , Gupta J M , Storey G N , Houghton C R
Published: February 2020

A micro-method has been devised for isolating a lung-derived membranous fraction from human amniotic fluid. The phospholipid content of this fraction, known as lamellar body phospholipid, provides an indication of fetal lung maturity (Ann. Clin. Biochem 16: 191, 1979). This method has now been applied to 479 samples of amniotic fluid from 330 pregnancies. The lecithin/sphingomyelin ratio has also been determined for each of the samples by the routine method currently in use in the hospitals providing the samples. Hyaline membrane disease was associated with a low concentration of lamellar body phospholipid (< 35 mg/L) in all eight cases encountered in this study. In contrast, in 182 of the 185 cases where the lamellar body content of the amniotic fluid, collected within two days of delivery, exceeded 35 mg/L, the infants were free from serious respiratory problems. Data are presented which suggests that the lecithin/sphingomyelin ratio falsely indicated lung immaturity in many cases, amounting to 44% or more of all values indicating immaturity that were reported.
ESC Working Group on Coronary Pathophysiology and Microcirculation position paper on ‘coronary microvascular dysfunction in cardiovascular disease’
Authors: Padro Teresa , Manfrini Olivia , Bugiardini Raffaele , Canty John , Cenko Edina , De Luca Giuseppe , Duncker Dirk J , Eringa Etto C , Koller Akos , Tousoulis Dimitris , Trifunovic Danijela , Vavlukis Marija , de Wit Cor , Badimon Lina
Published: February 2020

Although myocardial ischaemia usually manifests as a consequence of atherosclerosis-dependent obstructive epicardial coronary artery disease, a significant percentage of patients suffer ischaemic events in the absence of epicardial coronary artery obstruction. Experimental and clinical evidence highlight the abnormalities of the coronary microcirculation as a main cause of myocardial ischaemia in patients with ‘normal or near normal’ coronary arteries on angiography. Coronary microvascular disturbances have been associated with early stages of atherosclerosis even prior to any angiographic evidence of epicardial coronary stenosis, as well as to other cardiac pathologies such as myocardial hypertrophy and heart failure. The main objectives of the manuscript are (i) to provide updated evidence in our current understanding of the pathophysiological consequences of microvascular dysfunction in the heart; (ii) to report on the current knowledge on the relevance of cardiovascular risk factors and comorbid conditions for microcirculatory dysfunction; and (iii) to evidence the relevance of the clinical consequences of microvascular dysfunction. Highlighting the clinical importance of coronary microvascular dysfunction will open the field for research and the development of novel strategies for intervention will encourage early detection of subclinical disease and will help in the stratification of cardiovascular risk in agreement with the new concept of precision medicine.
Social interactions in striped hyena inferred from camera trap data: is it more social than previously thought?
Authors: Tichon Jonathan , Gilchrist Jason S , Rotem Guy , Ward Paul , Spiegel Orr
Published: February 2020

Understanding the drivers promoting sociality over solitariness in animal species is imperative for predicting future population trends and informing conservation and management. In this study we investigate the social structure of a desert dwelling population of striped hyena Hyaena hyaena. This species is historically regarded as strictly solitary albeit being the least studied of the extant Hyaenids. Accumulating evidence regarding the frequency of social interactions suggests a revision of striped hyena social structure is required. We hypothesized that striped hyena has a social structure that is more complex than expected for a strictly solitary species. For that end, we deployed an array of camera-traps in a remote desert region in Israel, and compared observed frequencies of striped hyena co-occurrence against null models to test whether hyena co-occurred more than expected by chance. Seven adults were (re)captured by our camera-traps in 49 different instances over 83 tracking days. Of these, 6 exhibited shared space-use around a scarce, isolated perennial water source. Five of them, co-occurred with other hyena (in 3 instances) significantly more frequent than expected by chance (and that timing suggests reproduction is unlikely to be the driving factor). Our findings substantiate evidence of complex social structure in striped hyena, highlight the importance of a scarce resource in space-use and sociality, and provide a baseline for future research of striped hyena social structure. We suggest that similar methods be employed to evaluate social structure in other “solitary species” to better understand their social dynamics.
Inter-clinician eConsults without programmatic incentives or requirements: a qualitative study of primary care provider perspectives
Authors: Zallman Leah , Fisher Carolyn F , Ladner Sofia , Mengistu Kira , Rapaport Alison B , Bor David , He Zhiheng , Sawady Joel , Stavert Robert , Nardin Rachel , Bajracharya Adarsha , Pels Richard , Sayah Assaad
Published: February 2020

Background

Inter-clinician electronic consultation (eConsult) programmes are becoming more widespread in the USA as health care systems seek innovative ways of improving specialty access. Existing studies examine models with programmatic incentives or requirements for primary care providers (PCPs) to participate.

Objective

We aimed to examine PCP perspectives on eConsults in a system with no programmatic incentive or requirement for PCPs to use eConsults.

Methods

We conducted seven focus groups with 41 PCPs at a safety-net community teaching health care system in Eastern Massachusetts, USA.

Results

Focus groups revealed that eConsults improved PCP experience by enabling patient-centred care and enhanced PCP education. However, increased workload and variations in communication patterns added challenges for PCPs. Patients were perceived as receiving timelier and more convenient care. Timelier care combined with direct documentation in the patient record was perceived as improving patient safety. Although cost implications were less clear, PCPs perceived costs as being lowered through fewer unnecessary visits and laboratories.

Conclusions

Our findings suggest that eConsult systems with no programmatic incentives or requirements for PCPs have the potential to improve care.
Finite-frequency traveltime tomography using the Generalized Rytov approximation
Authors: Feng B , Xu W , Wu R S , Xie X B , Wang H
Published: February 2020

Wave-equation-based traveltime tomography has been extensively applied in both global tomography and seismic exploration. Typically, the traveltime Fréchet derivative is obtained using the first-order Born approximation, which is only satisfied for weak velocity perturbations and small phase shifts (i.e. the weak-scattering assumption). Although the small phase-shift restriction can be handled with the Rytov approximation, the weak velocity-perturbation assumption is still a major limitation. The recently developed generalized Rytov approximation (GRA) method can achieve an improved phase accuracy of the forward-scattered wavefield, in the presence of large-scale and strong velocity perturbations. In this paper, we combine GRA with the classical finite-frequency theory and propose a GRA-based traveltime sensitivity kernel (GRA-TSK), which overcomes the weak-scattering limitation of the conventional finite-frequency methods. Numerical examples demonstrate that the accumulated time delay of forward-scattered waves caused by large-scale smooth perturbations can be correctly handled by the GRA-TSK, regardless of the magnitude of the velocity perturbations. Then, we apply the new sensitivity kernel to solve the traveltime inverse problem, and we propose a matrix-free Gauss–Newton method that has a faster convergence rate compared with the gradient-based method. Numerical tests show that, compared with the conventional adjoint traveltime tomography, the proposed GRA-based traveltime tomography can obtain a more accurate model with a faster convergence rate, making it more suited for recovering the large-intermediate scale of the velocity model, even for strong-perturbation and complex subsurface structures.
Correction of ATM mutations in iPS cells from two ataxia-telangiectasia patients restores DNA damage and oxidative stress responses
Authors: Ovchinnikov Dmitry A , Withey Sarah L , Leeson Hannah C , Lei U Wang , Sundarrajan Ashmitha , Junday Keerat , Pewarchuk Michelle , Yeo Abrey J , Kijas Amanda W , Lavin Martin F , Wolvetang Ernst J
Published: February 2020

Patients with ataxia-telangiectasia (A-T) lack a functional ATM kinase protein and exhibit defective repair of DNA double-stranded breaks and response to oxidative stress. We show that CRISPR/Cas9-assisted gene correction combined with piggyBac (PB) transposon-mediated excision of the selection cassette enables seamless restoration of functional ATM alleles in induced pluripotent stem cells from an A-T patient carrying compound heterozygous exonic missense/frameshift mutations, and from a patient with a homozygous splicing acceptor mutation of an internal coding exon. We show that the correction of one allele restores expression of ~ 50% of full-length ATM protein and ameliorates DNA damage-induced activation (auto-phosphorylation) of ATM and phosphorylation of its downstream targets, KAP-1 and H2AX. Restoration of ATM function also normalizes radiosensitivity, mitochondrial ROS production and oxidative-stress-induced apoptosis levels in A-T iPSC lines, demonstrating that restoration of a single ATM allele is sufficient to rescue key ATM functions. Our data further show that despite the absence of a functional ATM kinase, homology-directed repair and seamless correction of a pathogenic ATM mutation is possible. The isogenic pairs of A-T and gene-corrected iPSCs described here constitute valuable tools for elucidating the role of ATM in ageing and A-T pathogenesis.
Validation of a Method for Quantification of Lutein in Spinach Using High-Performance Liquid Chromatography: Interlaboratory Study
Authors: Sonoda Takefumi , Hiejima *Yusuke , Koiwa Tomohiro , Asano Masahiro , Kotake Eiichi , Yasui Akemi ,   Collaborators, Iwamaru K , Kumagai M , Maeda H , Manabe Y , Miyamoto M , Mizuta K , Morioka M , Sugawara T , Takahashi F , Ueda H , Watanabe E , Yamoto R , Yonekura L
Published: February 2020

Background

Lutein is gaining attention as a strong antioxidant contained in foods. It accumulates in the human blood and retina, and is considered to play an important role in the body, especially in the eyes.

Objective

A method to determine the lutein content of raw spinach (Spinacia oleracea L.) was developed with the aim of its enactment as a Japanese agricultural standard (JAS) measurement method for components beneficial to human health.

Methods

An interlaboratory study was conducted to evaluate an analytical method for the determination of lutein in spinach. The detection limit and quantification limit of lutein for this method were 0.2 and 0.7 mg/kg, respectively. Twelve participating laboratories independently analyzed test samples (five pairs of blind duplicates) using high-performance liquid chromatography (HPLC).

Results

After removal of a few outliers, the repeatability relative standard deviation (RSDr), reproducibility (RSDR), and predicted RSDR of the evaluated method were 3.4–7.5, 4.6–13, and 7.5–8.5%, respectively, in a concentration range from 64.9–150 mg/kg.

Conclusions

The HorRat values (RSDR/predicted RSDR) of the lutein concentration were calculated to be 0.61–1.6.

Highlights

The study results indicate the acceptable precision of this method.
Comparison of Different Culture Methods for the Detection of Bacillus cereus Group in Cosmetics
Authors: Yossa Nadine , Hoang Son T , Canida Travis , Bell Rebecca , Tallent Sandra , Brown Eric , Hammack Thomas
Published: February 2020

Background

The U.S. Food and Drug Administration (FDA) Bacteriological Analytical Manual (BAM) reference culture method uses Modified Letheen Broth (MLB) for microbiological analyses for all types of cosmetic products.

Objective

This study evaluated the effectiveness of MLB and Tryptone Azolectin Tween (TAT) broths using BAM reference culture method for cosmetics.

Methods

Pure spore suspensions of B. cereus group members were experimentally spiked (McF: 0.5) into cosmetic products. After an aging period of 72 h, the products were analyzed using MLB and TAT broth. The enumeration of the cells was performed on B. cereus group selective plates Bacillus cereus rapid agar (BACARA) and Mannitol Yolk Polymyxin (MYP) plates.

Results

No statistical difference (p > 0.05) was found for the recovery of cells from the liquid products using either medium (MLB or TAT broth) and the selective plates. In solid/powder products, a combination of Tween 80 and MLB detected significantly more cells (p < 0.05) than combination of Tween 80 and TAT broth. The microbial counts on BACARA showed no significant differences (p > 0.05). However, when assessing cream/oil-based products, the number of cells detected by use of Tween 80/TAT broth was significantly higher than Tween 80/MLB, and MYP showed significantly higher counts than BACARA.

Conclusions

This study showed that relative effectiveness of MLB vs. TAT for recovering of B. cereus group cells varied depending on the variety of formulation, and combination of preservatives of the tested cosmetic products. The findings suggest additional studies are needed to explore recovery of other relevant microorganisms that may contaminate cream/oil-based cosmetics.
Real-World Use of Azathioprine Metabolites Changes Clinical Management of Inflammatory Bowel Disease
Authors: Wilson Laura , Tuson Stephanie , Yang Lufang , Loomes Dustin
Published: February 2020

Background

Thiopurines such as 6-mercaptopurine and azathioprine have complex metabolism, resulting in significant inter-individual differences in clinical efficacy and risk of drug toxicity, making conventional weight-based dosing inaccurate and potentially unsafe. Therapeutic drug monitoring (TDM) of thiopurine metabolites improves clinical outcomes through dose optimization and toxicity monitoring. Despite evidence for TDM, use is limited, due in part to test availability and awareness. The objectives of this study were twofold: (1) to investigate how thiopurine TDM impacts clinical management of IBD patients and (2) to evaluate proportion of patients outside therapeutic 6TGN levels or exhibiting signs of toxicity

Methods

Patients who received thiopurine TDM as part of routine care underwent chart review of demographics, disease activity, medication dosing, metabolite levels, and adverse events. Changes in clinical management following TDM were measured. Additionally, we conducted a retrospective review of clinical decision making blinded and unblinded to TDM result.

Results

A total of 92 IBD patients were included. Levels of 6TGN were therapeutic in 29% of patients. 6TGN levels correlated weakly with weight-based dosing (r2 = 0.057, P = 0.02). Adverse reactions were observed in 6.5%. TDM informed clinical management in 64%. Significantly more changes to clinical management occurred in those with active disease than in remission (73% versus 48%; P = 0.02) and in those on mono- versus combination therapy (48% versus 27.5%; P = 0.03).

Conclusions

TDM informs clinical decision making in over two-thirds of patients. The demonstrated poor efficacy of weight-based dosing and impact of TDM on clinical management contributes to the evidence supporting the need for greater availability and uptake of thiopurine TDM.
An approach to automatic boundary segmentation of solid models using virtual topology: toward reconstruction of design features
Authors: Zhang Yingzhong , Fu Yufei , Jia Jia , Luo Xiaofang
Published: February 2020

Boundary segmentation of solid models is the geometric foundation to reconstruct design features. In this paper, based on the shape evolution analysis for the feature-based modeling process, a novel approach to the automatic boundary segmentation of solid models for reconstructing design features is proposed. The presented approach simulates the designer’s decomposing thinking on how to decompose an existing boundary representation model into a set of design features. First, the modeling traces of design features are formally represented as a set of feature vertex adjacent graphs that use low-dimensional vertex entities and their connection relations. Then, a set of Boolean segmentation loops is searched and extracted from the constructed feature vertex adjacent graphs, which segment the boundary of a solid model into a set of regions with different design feature semantics. In the search process, virtual topology operations are employed to simulate the topological changes resulting from Boolean operations in feature modeling processes. In addition, to realize effective search, search strategies and search algorithms are presented. The segmentation experiments and case study show that the presented approach is feasible and effective for the boundary segmentation of medium-level complex part models. The presented approach lays the foundation for the later reconstruction of design features.
Can Workfare Programs Moderate Conflict? Evidence from India
Authors: Fetzer Thiemo
Published: February 2020

Can public interventions persistently reduce conflict? Adverse weather shocks, through their impact on incomes, have been identified as robust drivers of conflict in many contexts. An effective social insurance system moderates the impact of adverse shocks on household incomes, and hence, could attenuate the link between these shocks and conflict. This paper shows that a public employment program in India, by providing an alternative source of income through a guarantee of 100 days of employment at minimum wages, effectively provides insurance. This has an indirect pacifying effect. By weakening the link between productivity shocks and incomes, the program uncouples productivity shocks from conflict, leading persistently lower conflict levels.
Seismic pre-stack AVA inversion scheme based on lithology constraints
Authors: Xiao Shuang , Ba Jing , Guo Qiang , Carcione J M , Zhang Lin , Luo Cong
Published: February 2020

Seismic pre-stack AVA inversion using the Zoeppritz equation and its approximations as a forward engine yields P- and S-wave velocities and density. Due to the presence of seismic noise and other factors, the solution to seismic inversion is generally ill-posed and it is necessary to add constraints to regularize the algorithm. Moreover, since pre-stack inversion is a nonlinear problem, linearized optimization algorithms may fall into false local minima. The simulated annealing (SA) algorithm, on the other hand, is capable of finding the global optimal solution regardless of the initial model. However, when applied to multi-parameter pre-stack inversion, standard SA suffers from instability. Thus, a nonlinear pre-stack inversion method is proposed based on lithology constraints. Specifically, correlations among the elastic parameters are introduced to establish constraints based on a Bayesian framework, with special intention of mitigating the ill-posedness of the inversion problem as well as addressing the lithological characteristics of the formations. In particular, to improve the stability, a multivariate Gaussian distribution of elastic parameters is incorporated into the model updating the SA algorithm. We apply the algorithm to synthetic and field seismic data, indicating that the proposed method has a good resolution and stability performance.
A metal interference correction method of tunnel transient electromagnetic advanced detection
Authors: Zhou Guanqun , Yue Mingxin , Yang Xiaodong , Liu Shengdong , Wu Zhao , Cao Yu , Wu Xiaoping
Published: February 2020

Water inrush during tunnel excavation severally threatens the mining safety as blind water-bearing structures may develop in front of the working face. The transient electromagnetic method (TEM) has been widely applied in the advanced detection of tunnel water-bearing structures. However, the metal interference of both supports and tools in the tunnel has become a bottleneck that reduces the forecast accuracy of this method. In this paper, we analyse the effect of metal interference on TEM data and propose a novel set of an observation and correction method under metal interference based on the ratio of anomalous and background apparent resistivity. Flume model experiments both with and without metal interference are carried out, showing that this interference can affect TEM measurements significantly and result in false anomalies, and that our proposed method can remove this ambient noise caused by metal interference appropriately. The practical application further proves that this method can effectively reduce low-resistivity interference introduced by the support and other metal tools inside the tunnel. By applying this correction method, the location of water-rich anomalies can be detected more precisely during the excavation process of the same tunnel, which is of high application value of reducing exploration difficulty and tunneling risk.