bluuebunny/crossref_metadata_2025 huggingface dataset:
Subepidermal moisture detection of pressure induced tissue damage on the trunk: The pressure ulcer detection study outcomes
Authors: Bates‐Jensen Barbara M. , McCreath Heather E. , Patlan Anabel
Published: May 2017

We examined the relationship between subepidermal moisture measured using surface electrical capacitance and visual skin assessment of pressure ulcers at the trunk location (sacral, ischial tuberosities) in 417 nursing home residents residing in 19 facilities. Participants were on average older (mean age of 77 years), 58% were female, over half were ethnic minorities (29% African American, 12% Asian American, and 21% Hispanic), and at risk for pressure ulcers (mean score for Braden Scale for Predicting Pressure Ulcer Risk of 15.6). Concurrent visual assessments and subepidermal moisture were obtained at the sacrum and right and left ischium weekly for 16 weeks. Visual assessment was categorized as normal, erythema, stage 1 pressure ulcer, Deep Tissue Injury or stage 2+ pressure ulcer using the National Pressure Ulcer Advisory Panel 2009 classification system. Incidence of any skin damage was 52%. Subepidermal moisture was measured with a dermal phase meter where higher readings indicate greater moisture (range: 0–70 tissue dielectric constant), with values increasing significantly with the presence of skin damage. Elevated subepidermal moisture values co‐occurred with concurrent skin damage in generalized multinomial logistic models (to control for repeated observations) at the sacrum, adjusting for age and risk. Higher subepidermal moisture values were associated with visual damage 1 week later using similar models. Threshold values for subepidermal moisture were compared to visual ratings to predict skin damage 1 week later. Subepidermal moisture of 39 tissue dielectric constant units predicted 41% of future skin damage while visual ratings predicted 27%. Thus, this method of detecting early skin damage holds promise for clinicians, especially as it is objective and equally valid for all groups of patients.
Oral hygiene in patients with chronic obstructive pulmonary disease: a scoping review protocol
Authors: Pedersen Preben U. , Uhrenfeldt Lisbeth , Larsen Palle
Published: May 2017

Scoping review objective:

It is hypothesized that systematic oral hygiene may reduce airway infections in patients with chronic obstructive pulmonary disease (COPD). Before considering doing a systematic review, a scoping review is necessary to explore and map literature on the subject and identify which interventions have been carried out, if there is relevant literature available for a systematic review, or if further research should be initiated.

The objective of this scoping review is to comprehensively identify and describe qualitative or quantitative literature reporting of non-invasive interventions that have been carried out to improve oral hygiene and relieve and/or reduce respiratory tract infections, exacerbation and/or hospital readmission in patients with diagnosed with COPD. A further objective is to undertake a comprehensive search to identify qualitative literature reporting on the experiences of oral hygiene in people diagnosed with COPD and/or their relatives and/or healthcare providers (HCPs).

Specifically, the scoping review questions are as follows:

What non-invasive interventions have been carried out to improve oral hygiene in patients with COPD in any context?

What have been reported on the experiences of patients, their relatives or their HCP in relation to oral hygiene in patients with COPD?
Fully Developed Laminar Forced Convection in a Circular Duct for Herschel–Bulkley Fluids With Viscous Dissipation and Axial Heat Conduction
Authors: Khatyr Rabha , Khalid-Naciri Jaafar , Il Idrissi Ali
Published: May 2017

The asymptotic behavior of laminar forced convection in a circular duct for a Herschel–Bulkley fluid of constant properties is analyzed. The viscous dissipation and the axial heat conduction effects in the fluid are both considered. The asymptotic bulk and mixing temperature field, and the asymptotic values of the bulk and mixing Nusselt numbers are determined for every boundary condition, enabling a fully developed region. In particular, it is proved that whenever the wall heat flux tends to zero, the asymptotic Nusselt number is zero. The obtained results are compared to other existing solutions in the literature for Newtonian and non-Newtonian cases.
Is Contrast Enhanced Ultrasonography a useful tool in a beginner’s hand? How much can a Computer Assisted Diagnosis prototype help in characterizing the malignancy of focal liver lesions?
Authors: Moga Tudor Voicu , Popescu Alina , Sporea Ioan , Danila Mirela , David Ciprian , Gui Vasile , Iacob Nicoleta , Miclaus Gratian , Sirli Roxana
Published: May 2017

Aim: Contrast enhanced ultrasound (CEUS) improved the characterization of focal liver lesions (FLLs), but is an operatordependent method. The goal of this paper was to test a computer assisted diagnosis (CAD) prototype and to see its benefit in assisting a beginner in the evaluation of FLLs.Material and method: Our cohort included 97 good quality CEUS videos[34% hepatocellular carcinomas (HCC), 12.3% hypervascular metastases (HiperM), 11.3% hypovascular metastases (HipoM), 24.7% hemangiomas (HMG), 17.5% focal nodular hyperplasia (FNH)] that were used to develop a CAD prototype based on an algorithm that tested a binary decision based classifier. Two young medical doctors (1 year CEUS experience), two experts and the CAD prototype, reevaluated 50 FLLs CEUS videos (diagnosis of benign vs. malignant) first blinded to clinical data, in order to evaluate the diagnostic gap beginner vs. expert. Results: The CAD classifier managed a 75.2% overall (benign vs. malignant) correct classification rate. The overall classification rates for the evaluators, before and after clinical data were: first beginner-78%; 94%; second beginner-82%; 96%; first expert-94%; 100%; second expert-96%; 98%. For both beginners, the malignant vs. benign diagnosis significantly improved after knowing the clinical data (p=0.005; p=0,008). The expert was better than the beginner (p=0.04) and better than the CAD (p=0.001). CAD in addition to the beginner can reach the expert diagnosis. Conclusions: The most frequent lesions misdiagnosed at CEUS were FNH and HCC. The CAD prototype is a good comparing tool for a beginner operator that can be developed to assist the diagnosis. In order to increase the classification rate, the CAD system for FLL in CEUS must integrate the clinical data.
The View through the Lens
On Gratitude

New Glass Cages

Journey through the Night

A Futile Call

He'll not build now, who has no House awaiting

Authors: -- --
Published: May 2017

Alois Vogel, The Blue House
On the Shunting Track

No Security

On the Edge of the Pond

Ode to Joy

Authors: -- --
Published: May 2017

Alois Vogel, The Blue House
Afterword
Authors: Obermayer,  P. Bond A.
Published: May 2017

Alois Vogel, The Blue House
Pocket-sized sequencers start to pay off big
Authors: Pennisi Elizabeth
Published: May 2017

“Very, very soon,” says one researcher, “anyone could sequence a genome anywhere.”
Where have all the insects gone?
Authors: Vogel Gretchen
Published: May 2017

Surveys in German nature reserves point to a dramatic decline in insect biomass. Key members of ecosystems may be slipping away.
HAT-P-26b: A Neptune-mass exoplanet with a well-constrained heavy element abundance
Authors: Wakeford Hannah R. , Sing David K. , Kataria Tiffany , Deming Drake , Nikolov Nikolay , Lopez Eric D. , Tremblin Pascal , Amundsen David S. , Lewis Nikole K. , Mandell Avi M. , Fortney Jonathan J. , Knutson Heather , Benneke Björn , Evans Thomas M.
Published: May 2017

How much water is in that exoplanet?

Thousands of exoplanets have been identified, but little is known about their atmospheres, especially for bodies smaller than Jupiter. The extent and composition of an atmosphere can provide evidence for how an exoplanet formed. Wakeford
et al.
used the Hubble and Spitzer space telescopes to measure the spectrum of the atmosphere around HAT-P-26b, a Neptune-sized exoplanet discovered in 2011. They detected signatures of water and clouds; this allowed them to constrain the atmospheric composition, which appears not to have been altered substantially since it formed.

Science
, this issue p.
628
Poor human olfaction is a 19th-century myth
Authors: McGann John P.
Published: May 2017

Humans have a good sense of smell

In comparison to that of other animals, the human sense of smell is widely
considered to be weak and underdeveloped. This is, however, an unproven
hypothesis. In a Review, McGann traces the origins of this false belief back to
comparative 19th-century neuroanatomical studies by Broca. A modern look at the
human olfactory bulb shows that it is rather large compared with those of rats
and mice, which are presumed to possess a superior sense of smell. In fact, the
number of olfactory bulb neurons across 24 mammalian species is comparatively
similar, with humans in the middle of the pack, and our sense of smell is
similar to that of other mammals.

Science
, this issue p.
eaam7263
Bifidobacterium Bacteremia: Clinical Characteristics and a Genomic Approach To Assess Pathogenicity
Authors: Esaiassen Eirin , Hjerde Erik , Cavanagh Jorunn Pauline , Simonsen Gunnar Skov , Klingenberg Claus
Published: May 2017

Bifidobacteria are commensals that colonize the orogastrointestinal tract and rarely cause invasive human infections. However, an increasing number of bifidobacterial blood culture isolates has lately been observed in Norway. In order to investigate the pathogenicity of the
Bifidobacterium
species responsible for bacteremia, we studied
Bifidobacterium
isolates from 15 patients for whom cultures of blood obtained from 2013 to 2015 were positive. We collected clinical data and analyzed phenotypic and genotypic antibiotic susceptibility. All isolates (11
Bifidobacterium longum
, 2
B. breve
, and 2
B. animalis
isolates) were subjected to whole-genome sequencing. The 15 patients were predominantly in the extreme lower or upper age spectrum, many were severely immunocompromised, and 11 of 15 had gastrointestinal tract-related conditions. In two elderly patients, the
Bifidobacterium
bacteremia caused a sepsis-like picture, interpreted as the cause of death. Most bifidobacterial isolates had low MICs (≤0.5 mg/liter) to beta-lactam antibiotics, vancomycin, and clindamycin and relatively high MICs to ciprofloxacin and metronidazole. We performed a pangenomic comparison of invasive and noninvasive
B. longum
isolates based on 65 sequences available from GenBank and the sequences of 11 blood culture isolates from this study. Functional annotation identified unique genes among both invasive and noninvasive isolates of
Bifidobacterium
. Phylogenetic clusters of invasive isolates were identified for a subset of the
B. longum
subsp.
longum
isolates. However, there was no difference in the number of putative virulence genes between invasive and noninvasive isolates. In conclusion,
Bifidobacterium
has an invasive potential in the immunocompromised host and may cause a sepsis-like picture. Using comparative genomics, we could not delineate specific pathogenicity traits characterizing invasive isolates.
Meatal Swabs Contain Less Cellular Material and Are Associated with a Decrease in Gram Stain Smear Quality Compared to Urethral Swabs in Men
Authors: Jordan Stephen J. , Schwebke Jane R. , Aaron Kristal J. , Van Der Pol Barbara , Hook Edward W.
Published: May 2017

Urethral swabs are the samples of choice for point-of-care Gram stain testing to diagnose
Neisseria gonorrhoeae
infection and nongonococcal urethritis (NGU) in men. As an alternative to urethral swabs, meatal swabs have been recommended for the collection of urethral discharge to diagnose
N. gonorrhoeae
and
Chlamydia trachomatis
infection in certain populations by nucleic acid amplification testing (NAAT), as they involve a less invasive collection method. However, as meatal swabs could be sampling a reduced surface area and result in fewer collected epithelial cells compared to urethral swabs, the adequacy of meatal swab specimens to collect sufficient cellular material for Gram stain testing remains unknown. We enrolled 66 men who underwent either urethral or meatal swabbing and compared the cellular content and Gram stain failure rate. We measured the difference in swab cellular content using the Cepheid Xpert CT/NG sample adequacy control crossing threshold (SAC
CT
) and determined the failure rate of Gram stain smears (GSS) due to insufficient cellular material. In the absence of discharge, meatal smears were associated with a significant reduction in cellular content (
P
= 0.0118), which corresponded with a GSS failure rate significantly higher than that for urethral swabs (45% versus 3%, respectively;
P
< 0.0001). When discharge was present, there was no difference among results from urethral and meatal swabs. Therefore, if GSS testing is being considered for point-of-care diagnosis of
N. gonorrhoeae
infection or NGU in men, meatal swabs should be avoided in the absence of a visible discharge.
Evolution and Antiviral Specificities of Interferon-Induced Mx Proteins of Bats against Ebola, Influenza, and Other RNA Viruses
Authors: Fuchs Jonas , Hölzer Martin , Schilling Mirjam , Patzina Corinna , Schoen Andreas , Hoenen Thomas , Zimmer Gert , Marz Manja , Weber Friedemann , Müller Marcel A. , Kochs Georg
Published: May 2017

Bats serve as a reservoir for various, often zoonotic viruses, including significant human pathogens such as Ebola and influenza viruses. However, for unknown reasons, viral infections rarely cause clinical symptoms in bats. A tight control of viral replication by the host innate immune defense might contribute to this phenomenon. Transcriptomic studies revealed the presence of the interferon-induced antiviral myxovirus resistance (Mx) proteins in bats, but detailed functional aspects have not been assessed. To provide evidence that bat Mx proteins might act as key factors to control viral replication we cloned
Mx1
cDNAs from three bat families, Pteropodidae, Phyllostomidae, and Vespertilionidae. Phylogenetically these bat
Mx1
genes cluster closely with their human ortholog MxA. Using transfected cell cultures, minireplicon systems, virus-like particles, and virus infections, we determined the antiviral potential of the bat Mx1 proteins. Bat Mx1 significantly reduced the polymerase activity of viruses circulating in bats, including Ebola and influenza A-like viruses. The related Thogoto virus, however, which is not known to infect bats, was not inhibited by bat Mx1. Further, we provide evidence for positive selection in bat
Mx1
genes that might explain species-specific antiviral activities of these proteins. Together, our data suggest a role for Mx1 in controlling these viruses in their bat hosts.

IMPORTANCE
Bats are a natural reservoir for various viruses that rarely cause clinical symptoms in bats but are dangerous zoonotic pathogens, like Ebola or rabies virus. It has been hypothesized that the interferon system might play a key role in controlling viral replication in bats. We speculate that the interferon-induced Mx proteins might be key antiviral factors of bats and have coevolved with bat-borne viruses. This study evaluated for the first time a large set of bat Mx1 proteins spanning three major bat families for their antiviral potential, including activity against Ebola virus and bat influenza A-like virus, and we describe here their phylogenetic relationship, revealing patterns of positive selection that suggest a coevolution with viral pathogens. By understanding the molecular mechanisms of the innate resistance of bats against viral diseases, we might gain important insights into how to prevent and fight human zoonotic infections caused by bat-borne viruses.
Deletion of the
K1L
Gene Results in a Vaccinia Virus That Is Less Pathogenic Due to Muted Innate Immune Responses, yet Still Elicits Protective Immunity
Authors: Bravo Cruz Ariana G. , Han Aiguo , Roy Edward J. , Guzmán Arielle B. , Miller Rita J. , Driskell Elizabeth A. , O'Brien William D. , Shisler Joanna L.
Published: May 2017

All viruses strategically alter the antiviral immune response to their benefit. The vaccinia virus (VACV) K1 protein has multiple immunomodulatory effects in tissue culture models of infection, including NF-κB antagonism. However, the effect of K1 during animal infection is poorly understood. We determined that a
K1L
-less vaccinia virus (vΔK1L) was less pathogenic than wild-type VACV in intranasal and intradermal models of infection. Decreased pathogenicity was correlated with diminished virus replication in intranasally infected mice. However, in intradermally inoculated ears, vΔK1L replicated to levels nearly identical to those of VACV, implying that the decreased immune response to vΔK1L infection, not virus replication, dictated lesion size. Several lines of evidence support this theory. First, vΔK1L induced slightly less edema than vK1L, as revealed by histopathology and noninvasive quantitative ultrasound technology (QUS). Second, infiltrating immune cell populations were decreased in vΔK1L-infected ears. Third, cytokine and chemokine gene expression was decreased in vΔK1L-infected ears. While these results identified the biological basis for smaller lesions, they remained puzzling; because K1 antagonizes NF-κB
in vitro
, antiviral gene expression was expected to be higher during vΔK1L infection. Despite these diminished innate immune responses, vΔK1L vaccination induced a protective VACV-specific CD8
+
T cell response and protected against a lethal VACV challenge. Thus, vΔK1L is the first vaccinia virus construct reported that caused a muted innate immune gene expression profile and decreased immune cell infiltration in an intradermal model of infection yet still elicited protective immunity.

IMPORTANCE
The vaccinia virus (VACV) K1 protein inhibits NF-κB activation among its other antagonistic functions. A virus lacking K1 (vΔK1L) was predicted to be less pathogenic because it would trigger a more robust antiviral immune response than VACV. Indeed, vΔK1L was less pathogenic in intradermally infected mouse ear pinnae. However, vΔK1L infection unexpectedly elicited dramatically reduced infiltration of innate immune cells into ears. This was likely due to decreased expression of cytokine and chemokine genes in vΔK1L-infected ears. As such, our finding contradicted observations from cell culture systems. Interestingly, vΔK1L conferred protective immunity against lethal VACV challenge. This suggests that the muted immune response triggered during vΔK1L infection remained sufficient to mount an effective protective response. Our results highlight the complexity and unpredictable nature of virus-host interactions, a relationship that must be understood to better comprehend virus pathogenesis or to manipulate viruses for use as vaccines.
Development of Clade-Specific and Broadly Reactive Live Attenuated Influenza Virus Vaccines against Rapidly Evolving H5 Subtype Viruses
Authors: Boonnak Kobporn , Matsuoka Yumiko , Wang Weijia , Suguitan Amorsolo L. , Chen Zhongying , Paskel Myeisha , Baz Mariana , Moore Ian , Jin Hong , Subbarao Kanta
Published: May 2017

We have developed pandemic live attenuated influenza vaccines (pLAIVs) against clade 1 H5N1 viruses on an Ann Arbor cold-adapted (
ca
) backbone that induced long-term immune memory. In 2015, many human infections caused by a new clade (clade 2.2.1.1) of goose/Guangdong (gs/GD) lineage H5N1 viruses were reported in Egypt, which prompted updating of the H5N1 pLAIV. We explored two strategies to generate suitable pLAIVs. The first approach was to modify the hemagglutinin gene of a highly pathogenic wild-type (
wt
) clade 2.2.1.1 virus, A/Egypt/N03434/2009 (Egy/09) (H5N1), with its unmodified neuraminidase (NA) gene; this virus was designated Egy/09
ca
. The second approach was to select a low-pathogenicity avian influenza H5 virus that elicited antibodies that cross-reacted with a broad range of H5 viruses, including the Egypt H5N1 viruses, and contained a novel NA subtype for humans. We selected the low-pathogenicity A/duck/Hokkaido/69/2000 (H5N3) (dk/Hok/00) virus for this purpose. Both candidate vaccines were attenuated and immunogenic in ferrets, inducing antibodies that neutralized homologous and heterologous H5 viruses with different degrees of cross-reactivity; Egy/09
ca
vaccine antisera were more specific for the gs/GD lineage viruses but did not neutralize recent North American isolates (clade 2.3.4.4), whereas antisera from dk/Hok/69
ca
-vaccinated ferrets cross-reacted with clade 2.3.4.4 and 2.2.1 viruses but not clade 1 or 2.1 viruses. When vaccinated ferrets were challenged with homologous and heterologous H5 viruses, challenge virus replication was reduced in the respiratory tract. Thus, the two H5 pLAIV candidates are suitable for clinical development to protect humans from infection with different clades of H5 viruses.

IMPORTANCE
In response to the continuing evolution of H5N1 avian influenza viruses and human infections, new candidate H5 live attenuated vaccines were developed by using two different approaches: one targeted a specific circulating strain in Egypt, and the other was based on a virus that elicits broadly cross-reactive antibodies against a wide range of H5 viruses. Both candidate vaccines were immunogenic and exhibited protective efficacy in ferrets. Our study permits a comparison of the two approaches, and the data support the further development of both vaccine viruses to optimally prepare for the further spread of clade 2.2.1 or 2.3.4.4 viruses.
The C Terminus of the Herpes Simplex Virus UL25 Protein Is Required for Release of Viral Genomes from Capsids Bound to Nuclear Pores
Authors: Huffman Jamie B. , Daniel Gina R. , Falck-Pedersen Erik , Huet Alexis , Smith Greg A. , Conway James F. , Homa Fred L.
Published: May 2017

The herpes simplex virus (HSV) capsid is released into the cytoplasm after fusion of viral and host membranes, whereupon dynein-dependent trafficking along microtubules targets it to the nuclear envelope. Binding of the capsid to the nuclear pore complex (NPC) is mediated by the capsid protein pUL25 and the capsid-tethered tegument protein pUL36. Temperature-sensitive mutants in both pUL25 and pUL36 dock at the NPC but fail to release DNA. The uncoating reaction has been difficult to study due to the rapid release of the genome once the capsid interacts with the nuclear pore. In this study, we describe the isolation and characterization of a truncation mutant of pUL25. Live-cell imaging and immunofluorescence studies demonstrated that the mutant was not impaired in penetration of the host cell or in trafficking of the capsid to the nuclear membrane. However, expression of viral proteins was absent or significantly delayed in cells infected with the pUL25 mutant virus. Transmission electron microscopy revealed capsids accumulated at nuclear pores that retained the viral genome for at least 4 h postinfection. In addition, cryoelectron microscopy (cryo-EM) reconstructions of virion capsids did not detect any obvious differences in the location or structural organization for the pUL25 or pUL36 proteins on the pUL25 mutant capsids. Further, in contrast to wild-type virus, the antiviral response mediated by the viral DNA-sensing cyclic guanine adenine synthase (cGAS) was severely compromised for the pUL25 mutant. These results demonstrate that the pUL25 capsid protein has a critical role in releasing viral DNA from NPC-bound capsids.

IMPORTANCE
Herpes simplex virus 1 (HSV-1) is the causative agent of several pathologies ranging in severity from the common cold sore to life-threatening encephalitic infection. Early steps in infection include release of the capsid into the cytoplasm, docking of the capsid at a nuclear pore, and release of the viral genome into the nucleus. A key knowledge gap is how the capsid engages the NPC and what triggers release of the viral genome into the nucleus. Here we show that the C-terminal region of the HSV-1 pUL25 protein is required for releasing the viral genome from capsids docked at nuclear pores. The significance of our research is in identifying pUL25 as a key viral factor for genome uncoating. pUL25 is found at each of the capsid vertices as part of the capsid vertex-specific component and implicates the importance of this complex for NPC binding and genome release.
Effect of acute intraocular pressure elevation on the minimum rim width in normal, ocular hypertensive and glaucoma eyes
Authors: Sharma Sourabh , Tun Tin A , Baskaran Mani , Atalay Eray , Thakku Sri Gowtham , Liang Zhang , Milea Dan , Strouthidis Nicholas G , Aung Tin , Girard Michael JA
Published: May 2017

Background

To estimate and compare changes in the Bruch’s membrane opening—minimum rim width (BMO–MRW) and area in normal, ocular hypertensive and glaucoma eyes following acute elevations in intraocular pressure (IOP).

Methods

The optic nerve heads (ONHs) of 104 subjects (31 normals, 20 ocular hypertension (OHT) and 53 with primary glaucoma) were imaged using Spectral-domain optical coherence tomography (OCT; Spectralis, Heidelberg Engineering, Germany). IOP was raised twice by applying a force (0.64 n then 0.9 n) to the anterior sclera using an ophthalmo-dynamometer. After each IOP increment, IOP was held constant, measured with a Tonopen (AVIA applanation tonometer, Reichert, Depew, New York, USA), and ONH was rescanned with OCT. In each OCT volume, BMO–MRW and area were calculated and at each IOP increment.

Results

The baseline MRW was significantly smaller in glaucoma subjects (174.3±54.3 µm) compared with normal (287.4±42.2 µm, p<0.001) and OHT subjects (255.4±45.3 µm, p<0.001). MRW of glaucoma subjects was significantly thinner at the first and second IOP elevations than that at baseline (both p<0.01), but no significant change was noted in normal and OHT subjects. There was no significant change of BMO area at acute IOP elevations from baseline in all diagnoses (all p>0.05).

Conclusion

Acute IOP elevation leads to compression of the nerve fibre layers of neuroretinal rim in glaucoma subjects only without changing ONH size. This suggests that the neural and connective tissues at ONH level in glaucoma subjects are more susceptible to acute IOP episodes than OHT or normal controls.
Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study
Authors: Koelewijn Johanna Maria , Sluijs Anne Marie , Vrijkotte Tanja G M
Published: May 2017

Objectives

The rate of interventions during childbirth has increased dramatically during the last decades. Maternal anxiety might play a role in the progress of the labour process and interventions during labour. This study aimed to identify associations between anxiety in the first half of pregnancy and the birth process, including any interventions required during labour. In addition, differences in the associations by parity and ethnicity were explored.

Design

Prospective cohort study.

Setting

Primary care midwifery practices and secondary/tertiary care obstetric practices in Amsterdam, participating in the multiethnic ABCD (Amsterdam Born Children and their Development) study (participation rate 96%; response 8266/12 373 (67%)).

Participants

Included were women with singletons, alive at labour start, with a gestational age ≥24 weeks (n=6443).

Independent variable

General anxiety (State-Trait Anxiety Inventory state) and pregnancy-related anxiety (Pregnancy-Related Anxieties Questionnaire (PRAQ)) were self-reported in the first half of pregnancy.

Outcomes

Associations between both forms of anxiety and several indicators of the birth process were analysed. Subgroup analyses were performed for parity and ethnicity.

Results

The prevalence of high general anxiety (State-Trait Anxiety Inventory score ≥43) and pregnancy-related anxiety (PRAQ score ≥P90) were 30.9% and 11.0%, respectively. After adjustment, in nulliparae, both general anxiety and pregnancy-related anxiety were associated with pain relief and/or sedation (OR for general anxiety 1.23; 95% CI 1.02 to 1.48; OR for pregnancy-related anxiety 1.45; 95% CI 1.14 to 1.85). In multiparae, general anxiety was associated with induction of labour (OR 1.53; 95% CI 1.16 to 2.03) and pregnancy-related anxiety was associated with primary caesarean section (OR 1.66; 95% CI 1.02 to 2.70). Associations were largely similar for all ethnicities.

Conclusions

High levels of general and pregnancy-related anxiety in early pregnancy contribute modestly to more interventions during the birth process with similar associations between ethnic groups, but with some differences between nulliparae and multiparae.
Feasibility cluster randomised controlled trial of a within-consultation intervention to reduce antibiotic prescribing for children presenting to primary care with acute respiratory tract infection and cough
Authors: Blair Peter S , Turnbull Sophie , Ingram Jenny , Redmond Niamh , Lucas Patricia Jane , Cabral Christie , Hollinghurst Sandra , Dixon Padraig , Peters Tim J , Horwood Jeremy , Little Paul , Francis Nick A , Gilbertson Anna , Jameson Catherine , Hay Alastair D
Published: May 2017

Objective

To investigate recruitment and retention, data collection methods and the acceptability of a ‘within-consultation’ complex intervention designed to reduce antibiotic prescribing.

Design

Primary care feasibility cluster randomised controlled trial.

Setting

32 general practices in South West England recruiting children from October 2014 to April 2015.

Participants

Children (aged 3 months to <12 years) with acute cough and respiratory tract infection (RTI).

Intervention

A web-based clinician-focussed clinical rule to predict risk of future hospitalisation and a printed leaflet with individualised child health information for carers, safety-netting advice and a treatment decision record.

Controls

Usual practice, with clinicians recording data on symptoms, signs and treatment decisions.

Results

Of 542 children invited, 501 (92.4%) consented to participate, a month ahead of schedule. Antibiotic prescribing data were collected for all children, follow-up data for 495 (98.8%) and the National Health Service resource use data for 494 (98.6%). The overall antibiotic prescribing rates for children’s RTIs were 25% and 15.8% (p=0.018) in intervention and control groups, respectively. We found evidence of postrandomisation differential recruitment: the number of children recruited to the intervention arm was higher (292 vs 209); over half were recruited by prescribing nurses compared with less than a third in the control arm; children in the intervention arm were younger (median age 2 vs 3 years controls, p=0.03) and appeared to be more unwell than those in the control arm with higher respiratory rates (p<0.0001), wheeze prevalence (p=0.007) and global illness severity scores assessed by carers (p=0.045) and clinicians (p=0.01). Interviews with clinicians confirmed preferential recruitment of less unwell children to the trial, more so in the control arm.

Conclusion

Differential recruitment may explain the paradoxical antibiotic prescribing rates. Future cluster level studies should consider designs which remove the need for individual consent postrandomisation and embed the intervention within electronic primary care records.

Trial registration number

ISRCTN 23547970

UKCRN study ID

16891
Maternal alcohol disorders and school achievement: a population cohort record linkage study in Western Australia
Authors: Johnson Sarah E , O’Leary Colleen , Bower Carol , Lawrence David , Cunningham Nadia , Semmens James , Zubrick Stephen R
Published: May 2017

Objective

Maternal alcohol use disorder is a risk factor for a range of developmental outcomes in children. This study examines school achievement in children of Indigenous and non-Indigenous mothers with an alcohol-related diagnosis.

Design, setting and participants

This is a Western Australian population cohort study of mothers with a record of an alcohol-related diagnosis classified by the International Classification of Diseases Revisions 9/10 codes as recorded on administrative databases, and of their offspring born between 1989 and 2007 (n=18 486 exposed children), with a frequency matched comparison cohort of mothers with no record of alcohol diagnosis and their offspring (n=48 262 comparison children).

Outcomes

Records were linked with school achievement data for numeracy and literacy from Years 3, 5, 7 and 9 (age range: ~8–14 years) based on statewide and national testing. Mixed multivariate models with a random intercept per child were used to assess the relationship between exposure and the timing of exposure with failure to meet minimum standardised benchmarks.

Results

Academic achievement was lower in all testing domains (reading, writing, spelling and numeracy) among children of mothers with an alcohol diagnosis and persisted across all year groups examined. The highest ORs at Year 9 for non-Indigenous children were in reading (adjusted OR (aOR) 1.6, 95% CI 1.4 to 1.8) and in writing for Indigenous children (aOR 2.0, 95% CI 1.8 to 2.3).

Conclusion

Children of mothers with alcohol use disorders are at risk of not meeting minimum educational benchmarks in numeracy and literacy, with the risk highest among Indigenous children.
Screening for coronary artery disease in patients with type 2 diabetes: a meta-analysis and trial sequential analysis
Authors: Rados Dimitris V , Pinto Lana C , Leitão Cristiane B , Gross Jorge L
Published: May 2017

Objective

To evaluate the efficacy of coronary artery disease screening in asymptomatic patients with type 2 diabetes and assess the statistical reliability of the findings.

Methods

Electronic databases (MEDLINE, EMBASE, Cochrane Library and clinicaltrials.org) were reviewed up to July 2016. Randomised controlled trials evaluating coronary artery disease screening in asymptomatic patients with type 2 diabetes and reporting cardiovascular events and/or mortality were included. Data were summarised with Mantel-Haenszel relative risk. Trial sequential analysis (TSA) was used to evaluate the optimal sample size to detect a 40% reduction in outcomes. Main outcomes were all-cause mortality and cardiac events (non-fatal myocardial infarction and cardiovascular death); secondary outcomes were non-fatal myocardial infarction, myocardial revascularisations and heart failure.

Results

One hundred thirty-five references were identified and 5 studies fulfilled the inclusion criteria and totalised 3315 patients, 117 all-cause deaths and 100 cardiac events. Screening for coronary artery disease was not associated with decrease in risk for all-cause deaths (RR 0.95(95% CI 0.66 to 1.35)) or cardiac events (RR 0.72(95% CI 0.49 to 1.06)). TSA shows that futility boundaries were reached for all-cause mortality and a relative risk reduction of 40% between treatments could be discarded. However, there is not enough information for firm conclusions for cardiac events. For secondary outcomes no benefit or harm was identified; optimal sample sizes were not reached.

Conclusion

Current available data do not support screening for coronary artery disease in patients with type 2 diabetes for preventing fatal events. Further studies are needed to assess the effects on cardiac events.

PROSPERO

CRD42015026627.
Are medical outliers associated with worse patient outcomes? A retrospective study within a regional NHS hospital using routine data
Authors: Stylianou Neophytos , Fackrell Robin , Vasilakis Christos
Published: May 2017

Objective

To explore the quality and safety of patients’ healthcare provision by identifying whether being a medical outlier is associated with worse patient outcomes. A medical outlier is a hospital inpatient who is classified as a medical patient for an episode within a spell of care and has at least one non-medical ward placement within that spell.

Data sources

Secondary data from the Patient Administration System of a district general hospital were provided for the financial years 2013/2014–2015/2016. The data included 71 038 medical patient spells for the 3-year period.

Study design

This research was based on a retrospective, cross-sectional observational study design. Multivariate logistic regression and zero-truncated negative binomial regression were used to explore patient outcomes (in-hospital mortality, 30-day mortality, readmissions and length of stay (LOS)) while adjusting for several confounding factors.

Principal findings

Univariate analysis indicated that an outlying medical in-hospital patient has higher odds for readmission, double the odds of staying longer in the hospital but no significant difference in the odds of in-hospital and 30-day mortality. Multivariable analysis indicates that being a medical outlier does not affect mortality outcomes or readmission, but it does prolong LOS in the hospital.

Conclusions

After adjusting for other factors, medical outliers are associated with an increased LOS while mortality or readmissions are not worse than patients treated in appropriate specialty wards. This is in line with existing but limited literature that such patients experience worse patient outcomes. Hospitals may need to revisit their policies regarding outlying patients as increased LOS is associated with an increased likelihood of harm events, worse quality of care and increased healthcare costs.
A retrospective cohort study of the utility of the modified early warning score for interfacility transfer of patients with traumatic injury
Authors: Salottolo Kristin , Carrick Matthew , Johnson Jacob , Gamber Mark , Bar-Or David
Published: May 2017

Objective

The modified early warning score (MEWS) is a ‘track and trigger’ score using routine physiological vital signs. The objective is to determine if the pretransfer MEWS can be used for predicting outcomes in trauma patients requiring interfacility transfer to higher levels of care.

Design, setting and participants

Retrospective study of consecutively transferred trauma patients into a level-II trauma centre from 2013 to 2014.

Interventions

None.

Outcome measures

Mortality, intensive care unit (ICU) admission, operative procedure, MEWS deterioration in-transit, air transport interfacility, secondary overtriage (low injury severity score (ISS) <10, LOS<1 day, discharged home) and severe injury (ISS ≥16). The association between the pretransfer MEWS and outcomes were analysed with Cochran-Armitage trend tests, receiver operator characteristic (ROC) curves and univariate logistic regression.

Results

There were 587 transferred patients; outcomes were reported in 339 patients with complete data on all five vital signs used to calculate the MEWS. The MEWS ranged from 0 to 9 (median of 1). There was a significant linear relationship between MEWS and study outcomes, especially mortality, ICU admission, air medical transport and severe injury (p<0.001 for all). A threshold score ≥4 was identified by ROC analysis; 11.2% of patients had MEWS ≥4. Outcomes were significantly worse in patients with MEWS ≥4 versus <4: mortality (26.2% vs 3.0%, OR=11.59, p<0.001); ICU admission (73.7% vs 47.2%, OR=3.14, p=0.003); air transfer (42.1% vs 15.6%, OR=3.93, p<0.001) and severe injury (59.5% vs 27.2%, OR=3.9, p<0.001). The MEWS was not associated with surgery, in-transit MEWS deterioration or secondary overtriage.

Conclusion

Pretransfer MEWS ≥4 may be used by the receiving facility for predicting injury severity, mortality, air transport and ICU resource use. In the interfacility transport setting, the MEWS may be useful for identifying patients with less obvious need for transfer or requiring more expeditious transfer.
Validity and reliability of the Patient Centred Assessment Method for patient complexity and relationship with hospital length of stay: a prospective cohort study
Authors: Yoshida Shuhei , Matsushima Masato , Wakabayashi Hidetaka , Mutai Rieko , Murayama Shinichi , Hayashi Tetsuro , Ichikawa Hiroko , Nakano Yuko , Watanabe Takamasa , Fujinuma Yasuki
Published: May 2017

Objectives

Several instruments for evaluating patient complexity have been developed from a biopsychosocial perspective. Although relationships between the results obtained by these instruments and the length of stay in hospital have been examined, many instruments are complicated and not easy to use. The Patient Centred Assessment Method (PCAM) is a candidate for practical use. This study aimed to test the validity and reliability of the PCAM and examine the correlations between length of hospital stay and PCAM scores in a regional secondary care hospital in Japan.

Design

Prospective cohort study.

Participants and setting

Two hundred and one patients admitted to Ouji Coop Hospital between July 2014 and September 2014.

Main predictor

PCAM total score in initial phase of hospital admission.

Main outcome

Length of stay in hospital.

Results

Among 201 patients (Female/Male=98/103) with mean (SD) age of 77.4±11.9 years, the mean PCAM score was 25±7.3 and mean (SD) length of stay in hospital (LOS) 34.1±40.9 days. Using exploratory factor analysis to examine construct validity, PCAM evidently has a two-factor structure, comprising medicine-oriented and patient-oriented complexity. The Spearman rank correlation coefficient for evaluating criterion-based validity between PCAM and INTERMED was 0.90. For reliability, Cronbach’s alpha was 0.85. According to negative binomial regression analyses, PCAM scores are a statistically significant predictor (p<0.001) of LOS after adjusting for age, gender, Mini Nutritional Assessment Short-Form, Charlson Comorbidity Index, serum sodium concentration, total number of medications and whether public assistance was required. In another model, each factor in PCAM was independently correlated with length of stay in hospital after adjustment (medicine-oriented complexity: p=0.001, patient-oriented complexity: p=0.014).

Conclusion

PCAM is a reliable and valid measurement of patient complexity and PCAM scores have a significant correlation with hospital length of stay.
Scanning transmission X-ray microscopy studies of chromium hydroxide hollow spheres and nanoparticles formed by gamma radiation
Authors: Wang Zhiqiang , Alrehaily Leena , Joseph Jiju , Wren Jungsook Clara , Wang Jian , Sham Tsun-Kong
Published: May 2017

Amorphous chromium-containing solid nanoparticles and hollow spheres were formed as the intermediate product during the synthesis of Cr2O3 by gamma radiolysis of dichromate solution. Scanning transmission X-ray microscopy (STXM) is applied to investigate the electronic structure and chemical composition of this intermediate product (solid nanoparticles and hollow spheres). The STXM result obtained at O K-edge and Cr L3,2-edge confirms that chromium in the sample exists as Cr3+ and that the solid nanoparticles and hollow spheres are both Cr(OH)3. Combined with other techniques, a mechanism for gamma radiation induced formation of Cr2O3 nanoparticles via Cr(OH)3 intermediates from dissolved dichromate is proposed.
Simple inheritance of a complex trait: figured wood in curly birch is caused by one semi-dominant and lethal Mendelian factor?
Authors: Kärkkäinen K. , Viherä-Aarnio A. , Vakkari P. , Hagqvist R. , Nieminen K.
Published: May 2017

Even though individuals with a deviant morphology have been elemental in genetics of model species, they have thus far been largely ignored in the studies of forest trees. Here we studied the inheritance of curly-grained and brown-figured wood phenotype in curly birch (Betula pendula var. carelica (Mercklin) Hämet-Ahti). In addition of the figured wood, curly birches display reduced and aberrant growth, indicating that the causative locus (loci) is (are) vital for normal tree development. To explore the genetic basis of this mutation, we studied the inheritance of the curly birch phenotype in a progeny trial (crosses between curly birch parent trees, between curly and normal phenotypes, and from selfings of curly trees). Based on the external morphology, the phenotypes of 11-year-old progeny trees were scored as either curly or wild. Based on the phenotypic segregation ratios, we postulate a simple Mendelian inheritance model for curliness: (i) a one-locus, two-allele model in which the allele coding for curly phenotype is dominant over the allele coding for normal phenotype and (ii) the semi-dominant curly allele is lethal when homozygous. We expect that further studies on the molecular genetic basis of the curly birch phenotype will provide valuable information on the developmental pathways involved in wood formation.
Salixspecies variation in leaf gas exchange, sodium, and nutrient parameters at three levels of salinity
Authors: Major John E. , Mosseler Alex , Malcolm John W.
Published: May 2017

Leaf gas exchange, Na+, and nutrient parameters were quantified under control (CTL), medium (MST), and high (HST) saline treatments for Salix discolor Muhl. (DIS), Salix eriocephala Michx. (ERI), and Salix interior Rowlee (INT). Net photosynthesis (Pn) increased from CTL to MST for all species but remained unchanged between MST and HST for surviving INT plants in HST. Salix interior had greater water-use efficiency (WUE) than DIS and ERI. Under CTL, INT had 13× the leaf Na+concentration of DIS and ERI, but INT Na+only increased by 17% across each saline treatment, whereas DIS and ERI leaf Na+increased 6.0× from CTL to MST. Salix discolor and ERI had greater cation to Na+ratios than INT; however, INT ratios were stable across saline treatments, whereas the DIS and ERI ratios dropped precipitously. Across species and treatments, Pnhad a significant positive relationship to total aboveground dry mass, supporting the sink regulation of Pntheory. Also, Pnshowed a significant positive relationship to WUE and leaf N and to leaf Na+, which probably reflects greater energy expenditure required to mitigate the higher levels of Na+. The saline tolerance of INT may be due to natural selection pressure in the arid regions of the southwestern United States, where it is believed to have its evolutionary origins.
Oxidation behavior of HVOF-sprayed nanostructured and CeO2-modified WC–12Co coatings
Authors: Xi Naiyuan , Hang Zongqiu , Liu Yan , Chen Hui , Zhang Mingyue , Gao Wei
Published: May 2017

Two types of WC–12Co coatings with different modifications were deposited on steel substrates using high velocity oxygen fuel (HVOF) spraying. The coated samples were oxidized at 550[Formula: see text]C and 650[Formula: see text]C in ambient atmosphere. Oxidation mass gain was measured by electronic balance. Phase composition and microstructure evolution of both coatings after oxidation were conducted by X-ray diffraction (XRD) and scanning electron microscopy (SEM). Microhardness testing was performed before and after oxidation testing. The results showed that at 550[Formula: see text]C and 650[Formula: see text]C, the rare-earth modified WC–12Co coating has lower oxidation rates compared with the nanostructured WC–12Co coating. This might be due to the rare-earth modification coating reducing the porosity and oxygen diffusion in the coatings, therefore delaying the crack formation and propagation.