bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum IgE and IgG responses to dietary antigens in dogs with and without cutaneous adverse food reactions
Authors: Pucheu‐Haston Cherie M. , Mougeot Isabelle
Published: November 2019

Background

It is suspected that many canine cutaneous adverse food reactions (CAFR) are true immunological hypersensitivities; however, few specific dietary allergens have been identified.

Objective

To compare serum immunoglobulin (Ig)E and IgG reactivity to specific food antigens in privately owned dogs with and without CAFR.

Animals

Eighteen adult dogs with nonseasonal pruritus recruited from a hospital population.

Methods and materials

Dogs were fed an extensively hydrolysed poultry‐based diet exclusively for 12 weeks. Serum was collected at the beginning of the trial. Canine atopic dermatitis extent and severity index and pruritus Visual Analog Scale scoring were performed at the beginning and end of the trial. Immunoblotting was performed to identify IgE and/or IgG binding to specific proteins in beef, egg, milk, chicken, pork, soy and wheat extracts.

Results

A CAFR (defined as an unequivocal relapse of pruritus after dietary challenge) was diagnosed in 10 dogs, with 60% relapsing when fed chicken‐based diets. Binding of subjects’ IgG to almost all proteins in all extracts was seen regardless of reported dietary history. Few proteins were exclusively or predominantly bound by IgE in CAFR dogs. Exceptions included a 42 kDa band (chicken), a 52 kDa band (beef), a 46 kDa band (beef and milk) and a poorly defined high molecular weight protein or proteins (beef and milk).

Conclusion

This study demonstrated three protein bands and a poorly defined band predominantly recognized by sera from dogs with CAFR relative to non‐CAFR dog sera. Almost all proteins were bound by IgG in all dogs, suggesting prior exposure to unreported foods.
Rabies virus and Histoplasma suramericanum coinfection in a bat from southeastern Brazil
Authors: Menozzi Benedito Donizete , da Paz Giselle Souza , Paiz Laís Moraes , Garces Hans Garcia , Adorno Brunna Mayla Vasconcelos , Almeida‐Silva Fernando , Zancope Oliveira Rosely Maria , Richini‐Pereira Virgínia Bodelão , Chechi Jéssica Luana , Bagagli Eduardo , Bosco Sandra de Moraes Gimenes , Langoni Helio
Published: November 2019

Bats are essential to the global ecosystem, but their ability to harbour a range of pathogens has been widely discussed, as well as their role in the emergence and re‐emergence of infectious diseases. This paper describes the first report of coinfection by two zoonotic agents, rabies virus (RABV) and the fungus Histoplasma suramericanum in a bat. The bat was from the Molossus molossus species, and it was found during the daytime in the hallway of a public psychiatric hospital in a municipality in São Paulo State, southeastern Brazil. RABV infection was diagnosed by the direct fluorescent antibody test and mouse inoculation test. The fungus was isolated by in vitro culture. Both diagnoses were confirmed by molecular techniques. Phylogenetic analysis showed that the fungus isolate had proximity to H. suramericanum in the Lam B clade, while the RABV isolate was characterized in the Lasiurus cinereus lineage. Since the M. molossus bat was found in a peri‐urban transition area (urban/peri‐urban), the possibility of cross‐species transmission of this RABV lineage becomes more plausible, considering that this scenario may provide shelter for both M. molossus and L. cinereus. These are relevant findings since there has been an increase in bat populations in urban and peri‐urban areas, particularly due to environmental modifications and anthropogenic impacts on their habitat. Thus, the detection of two zoonotic agents in a bat found in a public hospital should raise awareness regarding the importance of systematic surveillance actions directed towards bats in urban areas.
The Impact of Fueling Operations on Full Core Uncertainty Analysis in CANDU Reactors
Authors: Tucker M. D. , Novog D. R.
Published: November 2019

Within emerging best-estimate-plus-uncertainty (BEPU) approaches, code output uncertainties can be inferred from the propagation of fundamental or microscopic uncertainties. This paper examines the propagation of fundamental nuclear data uncertainties though the entire analysis framework to predict macroscopic reactor physics phenomena, which can be measured in Canada Deuterium Uranium (CANDU) reactors. In this work, 151 perturbed multigroup cross sections libraries, each based on a set of perturbed microscopic nuclear data, were generated. Subsequently, these data were processed into few-group cross sections and used to generate full-core diffusion models in PARCS. The impact of these nuclear data perturbations leads to changes in core reactivity for a fixed set of fuel compositions of 4.5 mk. The impact of online fueling operations was simulated using a series of fueling rules, which attempted to mimic operator actions during CANDU operations such as studying the assembly powers and selecting fueling sites, which would minimize the deviation in power from some desirable reference condition or increasing or decreasing fueling frequency to manage reactivity. An important feature of this analysis was to perform long-transients (1–3 years) starting with each one of the 151 perturbed full core models. It was found that the operational feedback reduced the standard deviation in core reactivity by 99% from 0.0045 to 2.8 × 10−5. Overall, the conclusions demonstrate that while microscopic nuclear data uncertainties may give rise to large macroscopic variability during simple propagation, when important macrolevel feedback are considered the variability is significantly reduced.
Failure Analysis of Large-Diameter Coiled Tubing Based on Diameter Growth
Authors: Zhao Le , Zhang Hong , Duan Qingquan , Tang Guoping
Published: November 2019

Fatigue tests were conducted to analyze the fatigue behavior and diameter growth of large-diameter coiled tubing (CT) under the combined loads of bending and internal pressure. The experimental results reveal that mechanical limitations on the allowable diameter growth mean that the effective working life of CT at high pressures is only a fraction of the available fatigue life. The finite element software abaqus is used to further research the changes in diameter growth and to analyze the sensitivity of CT diameter growth to the main influencing factors, including internal pressure, tubing outside diameter (OD), wall thickness, yield strength, and bending radius. For CT with a diameter larger than 2 in., the diameter growth is sensitive to the above factors. As the bending and straightening cycles increase, the OD of the CT increases in association with obvious ovalization deformation, and the increase in the OD is closely related to the internal pressure load. The redistribution of material causes the wall thickness of the CT to become universally thinner. The ovality of the CT and the uneven decrease in wall thickness reduce the resistance to external extrusion. Therefore, it is becoming increasingly necessary to account for diameter growth as one of the key elements when predicting CT life or determining when to retire a string from service.
A New Mistuning Identification Method Based on the Subset of Nominal System Modes Method
Authors: Waldherr Christian U. , Buchwald Patrick , Vogt Damian M.
Published: November 2019

The mistuning problem of quasi-periodic structures has been the subject of numerous scientific investigations for more than 50 years. Researchers developed reduced-order models to reduce the computational costs of mistuning investigations including finite element models. One question which has also high practical relevance is the identification of mistuning based on modal properties. In this work, a new identification method based on the subset of nominal system modes method (SNM) is presented. Different to existing identification methods where usually the blade stiffness of each sector is scaled by a scalar value, N identification parameters are used to adapt the modal blade stiffness of each sector. The input data for the identification procedure consist solely of the mistuned natural frequencies of the investigated mode family as well as of the corresponding mistuned mode shapes in the form of one degree-of-freedom per sector. The reduction basis consists of the tuned mode shapes of the investigated mode family. Furthermore, the proposed identification method allows for the inclusion of centrifugal effects like stress stiffening and spin softening without additional computational effort. From this point of view, the presented method is also appropriate to handle centrifugal effects in reduced-order models using a minimum set of input data compared to existing methods. The power of the new identification method is demonstrated on the example of an axial compressor blisk. Finite element calculations including geometrical mistuning provide the database for the identification procedure. The correct functioning of the identification method including measurement noise is also validated to show the applicability to a case of application where real measurement data are available.
Variable-rate frequency sweeps and their application to the measurement of otoacoustic emissions
Authors: Christensen Anders T. , Abdala Carolina , Shera Christopher A.
Published: November 2019

Swept tones allow the efficient measurement of otoacoustic emissions (OAEs) with fine frequency resolution. Although previous studies have explored the influence of different sweep parameters on the measured OAE, none have directly considered their effects on the measurement noise floor. The present study demonstrates that parameters such as sweep type (e.g., linear or logarithmic), sweep rate, and analysis bandwidth affect the measurement noise and can be manipulated to control the noise floor in individual subjects. Although responses to discrete-tone stimuli can be averaged until the uncertainty of the measurement meets a specified criterion at each frequency, linear or logarithmic sweeps offer no such flexibility. However, measurements of the power spectral density of the ambient noise can be used to construct variable-rate sweeps that yield a prescribed (e.g., constant) noise floor across frequency; in effect, they implement a form of frequency-dependent averaging. The use of noise-compensating frequency sweeps is illustrated by the measurement of distortion-product OAEs at low frequencies, where the ear-canal noise is known to vary significantly.
Differential Sensitivity of Mycobacteria to Isoniazid Is Related to Differences in KatG-Mediated Enzymatic Activation of the Drug
Authors: Reingewertz Tali H. , Meyer Tom , McIntosh Fiona , Sullivan Jaryd , Meir Michal , Chang Yung-Fu , Behr Marcel A. , Barkan Daniel
Published: November 2019

Isoniazid (INH) is a cornerstone of antitubercular therapy.
Mycobacterium tuberculosis
complex bacteria are the only mycobacteria sensitive to clinically relevant concentrations of INH. All other mycobacteria, including
M. marinum
and
M. avium
subsp.
paratuberculosis
are resistant. INH requires activation by bacterial KatG to inhibit mycobacterial growth. We tested the role of the differences between
M. tuberculosis
KatG and that of other mycobacteria in INH sensitivity.
Intact HIV Proviruses Persist in Children Seven to Nine Years after Initiation of Antiretroviral Therapy in the First Year of Life
Authors: Katusiime Mary Grace , Halvas Elias K. , Wright Imogen , Joseph Kevin , Bale Michael J. , Kirby-McCullough Bronwyn , Engelbrecht Susan , Shao Wei , Hu Wei-Shau , Cotton Mark F. , Mellors John W. , Kearney Mary F. , van Zyl Gert U.
Published: November 2019

There are limited data about the proviral landscape in children exhibiting long-term suppression after early treatment, particularly in Sub-Saharan Africa where HIV-1 subtype C predominates. Investigating the sequence-intact reservoir could provide insight on the mechanisms by which intact proviruses persist and inform ongoing cure efforts. Through nearly full-length proviral amplification and sequencing (NFL-PAS), we generated 733 NFL-PAS amplicons from eight children. We showed that rare, genetically intact proviruses could be detected in children who initiated ART after 2.3 months of age. The frequency of intact proviruses was lower (
P
 < 0.05) than that reported for HIV subtype B-infected adults treated during early HIV infection. We show that cells harboring genetically intact HIV proviruses are rare in children exhibiting long-term suppression after early treatment and may require the processing of a large number of cells to assess reservoir size. This points to the need for efficient methods to accurately quantify latent reservoirs, particularly in pediatric studies where sample availability is limited.
Salt tectonics in the Eastern Mediterranean Sea: Where a giant delta meets a salt giant
Authors: Zucker Elchanan , Gvirtzman Zohar , Steinberg Josh , Enzel Yehouda
Published: November 2019

The circum-Nile deformation belt (CNDB) demonstrates the interaction between a giant delta and a giant salt body. The semi-radial shape of the CNDB is commonly interpreted as the product of salt squeezing out from under the Nile Delta. We demonstrate, however, that this is not the dominant process, because the delta and its deep-sea fan do not reach the deep-basin salt. The distal part of the deep-sea fan overlies the edge of the salt giant, but squeezing this edge (<150 m thickness) should have had only little effect on the regional salt tectonics. Only on the easternmost side of the deep-sea fan, toward the Levant Basin, does the squeeze-out model work. Here, the delta front reaches the thick salt layer and differential loading promotes basinward salt flow, even upslope. On the western side of the delta, downslope gliding of the sediment-salt sequence toward the Herodotus Basin is driven by the elevation gradient toward the deepest part of the basin. Our analysis shows that salt squeezing by differential loading was previously overestimated in the Eastern Mediterranean and raises the need to carefully map the boundary of salt basins prior to any interpretation. This conclusion is especially relevant in young basins where deltas and shelves have not propagated far enough into the basin.
Controls on the structural and stratigraphic evolution of the megaflap-bearing Sinbad Valley salt wall, NE Paradox Basin, SW Colorado
Authors: Thompson Jobe Jessica Ann , Giles Katherine A. , Hearon Thomas E. , Rowan Mark G. , Trudgill Bruce , Gannaway Dalton C. Evelyn , Jobe Zane R.
Published: November 2019

The interplay between sedimentation and salt rise around a diapir results in distinct geometries that can be used to determine the structural and stratigraphic history within a basin. Using new geologic mapping, measured stratigraphic sections, and subsurface interpretations of seismic and well logs, we describe circum-diapir stratal geometries and deformation at the Sinbad Valley salt wall in the proximal, northeastern Paradox Basin, southwest Colorado (USA). We interpret these geometries in the context of newly recognized halokinetic features and salt-associated deformation (megaflaps, counterregional faults, intrasalt inclusions), present a revised stratigraphic and salt tectonic history of Sinbad Valley diapir, and compare these proximal features to those at the distal Gypsum Valley diapir and infer local versus regional controls on their formation. The deposition of conglomerates within the Paradox Formation, now preserved as intrasalt inclusions in the center of Sinbad Valley, record early elevation of the Uncompahgre Uplift. Subsequent differential sedimentary loading resulted in initiation of passive diapirism during the late Pennsylvanian through the latest Triassic/Early Jurassic, facilitated by movement on a NE-dipping, listric, counterregional fault that extends for >22 km southeast of the diapir. Exposures of a steeply dipping stratal panel of late Pennsylvanian-aged Honaker Trail Formation along the southwestern flank of Sinbad Valley are interpreted as a megaflap, a preserved remnant of the diapir roof that was folded into a vertical position by drape-folding during passive salt rise. Significant lateral changes in the surface geometry and depositional facies of the megaflap define four structural domains that may result from a combination of radial faulting and varying degrees of folding via limb rotation or limb rotation with minor hinge migration. Using key differences between Sinbad Valley and Gypsum Valley salt walls in regard to the megaflap facies, timing of megaflap formation, and the presence of a Paradox Formation conglomeratic intrasalt inclusion, we conclude that salt wall position (i.e., proximal versus distal) within a basin influences the characteristics of some of these features, whereas the timing of other features (e.g., megaflap formation) appears to be similar throughout the basin suggesting a more regional control.
Structure and metamorphism of a subducted seamount (Zagros suture, Southern Iran)
Authors: Bonnet G. , Agard P. , Angiboust S. , Monié P. , Fournier M. , Caron B. , Omrani J.
Published: November 2019

Millions of seamounts on modern and past seafloor end up being subducted, and only small pieces are recovered in suture zones. How they are metamorphosed and deformed is, however, critical to understand how seamount subduction can impact subduction zone geometry, fluid circulation or seismogenic conditions, and more generally to trace physical conditions along the subduction boundary. Since geophysical studies mostly reach the shallowest subducted seamounts and miss internal structures due to low resolution, there is a high need for fossil seamount exposures. We herein report on a fully exposed, 3D example of seamount that we discovered in the Siah Kuh massif, Southern Iran. Through a series of sections across the whole massif and the combination of magmatic-metamorphic-sedimentary petrological data, we document several distinct stages associated with seamount build-up on the seafloor and with subduction. In particular, we constrain different stages of metamorphism and associated mineralogy, with precise conditions for subduction-related metamorphism around 250 °C and 0.7 GPa, in the middle of the seismogenic zone. Extensive examination of the seismogenic potential of the Siah Kuh seamount reveals that it was not a large earthquake asperity (despite the report of a rare example of cm-scale, high-pressure pseudotachylyte in this study), and that it possibly behaved as a barrier to earthquake propagation. Finally, we discuss the nature of high-pressure fluid circulation preserved in this seamount.
Association of troponin level and age with mortality in 250 000 patients: cohort study across five UK acute care centres
Authors: Kaura Amit , Panoulas Vasileios , Glampson Benjamin , Davies Jim , Mulla Abdulrahim , Woods Kerrie , Omigie Joe , Shah Anoop D , Channon Keith M , Weber Jonathan N , Thursz Mark R , Elliott Paul , Hemingway Harry , Williams Bryan , Asselbergs Folkert W , O’Sullivan Michael , Kharbanda Rajesh , Lord Graham M , Melikian Narbeh , Patel Riyaz S , Perera Divaka , Shah Ajay M , Francis Darrel P , Mayet Jamil
Published: November 2019

Objective

To determine the relation between age and troponin level and its prognostic implication.

Design

Retrospective cohort study.

Setting

Five cardiovascular centres in the UK National Institute for Health Research Health Informatics Collaborative (UK-NIHR HIC).

Participants

257 948 consecutive patients undergoing troponin testing for any clinical reason between 2010 and 2017.

Main outcome measure

All cause mortality.

Results

257 948 patients had troponin measured during the study period. Analyses on troponin were performed using the peak troponin level, which was the highest troponin level measured during the patient’s hospital stay. Troponin levels were standardised as a multiple of each laboratory’s 99th centile of the upper limit of normal (ULN). During a median follow-up of 1198 days (interquartile range 514-1866 days), 55 850 (21.7%) deaths occurred. A positive troponin result (that is, higher than the upper limit of normal) signified a 3.2 higher mortality hazard (95% confidence interval 3.1 to 3.2) over three years. Mortality varied noticeably with age, with a hazard ratio of 10.6 (8.5 to 13.3) in 18-29 year olds and 1.5 (1.4 to 1.6) in those older than 90. A positive troponin result was associated with an approximately 15 percentage points higher absolute three year mortality across all age groups. The excess mortality with a positive troponin result was heavily concentrated in the first few weeks. Results were analysed using multivariable adjusted restricted cubic spline Cox regression. A direct relation was seen between troponin level and mortality in patients without acute coronary syndrome (ACS, n=120 049), whereas an inverted U shaped relation was found in patients with ACS (n=14 468), with a paradoxical decline in mortality at peak troponin levels >70×ULN. In the group with ACS, the inverted U shaped relation persisted after multivariable adjustment in those who were managed invasively; however, a direct positive relation was found between troponin level and mortality in patients managed non-invasively.

Conclusions

A positive troponin result was associated with a clinically important increased mortality, regardless of age, even if the level was only slightly above normal. The excess mortality with a raised troponin was heavily concentrated in the first few weeks.

Study registration

ClinicalTrials.gov
NCT03507309
.
Arts for ageing well: a propensity score matching analysis of the effects of arts engagements on holistic well-being among older Asian adults above 50 years of age
Authors: Ho Andy Hau Yan , Ma Stephanie Hilary Xinyi , Ho Moon-Ho Ringo , Pang Joyce Shu Min , Ortega Emily , Bajpai Ram
Published: November 2019

Objective

To assess the frequency and intensity of arts engagement inclusive of active and passive engagements in arts, culture and heritage activities among Singaporean adults aged 50 and above, and examine the relationships between participatory art and holistic well-being.

Design

Cross-sectional stratified household survey.

Setting

All residential areas across Singapore’s Central, East, North, North-East and West Regions.

Participants

1067 community-dwelling, Singaporean older adults between the ages of 50 and 95 years were recruited.

Primary and secondary outcome measures

Respondents completed a self-reported questionnaire, consisting of standardised ad hoc items assessing the frequencies and durations of active and passive participatory arts engagement, as well as validated psychometric assessments on psychosociospiritual health including the primary outcome measure on quality of life, and the secondary outcome measures on physical, psychological, emotional, spiritual, and social well-being. sociodemographic information, as well as frequency and intensity of physical activity were also collected.

Results

Passive engagement (60%) and active engagement (17%) in the arts were associated with better holistic wellness and social support. Specifically, findings from the propensity score matching and independent t-test analyses revealed that adults aged 50 and above who passively engaged in arts and culture-related events experienced higher quality of life (t(728)=3.35, p=0.0008,d=0.25), perceived health (t(728)=2.21, p=0.0277,d=0.16) and sense of belonging (t(728)=2.17, p=0.03,d=0.16), as compared with those who did not. Moreover, those who actively engaged in participatory arts experienced greater quality of life (t(442)=3.68, p=0.0003,d=0.36), self-rated health (t(442)=2.59, p=0.0099,d=0.25), spiritual well-being (t(442)=3.75, p=0.0002,d=0.37), meaning in life (t(442)=5.03, p<0.0001,d=0.50) and sense of peace (t(442)=3.72, p=0.0002,d=0.36), as compared with those who did not actively engaged in the arts.

Conclusion

This study provided robust evidence to support a significant causal relationship between arts engagements and holistic well-being. Recommendations for art-based public health and elderly care research, practice and policy are discussed.
Effects of physical activity interventions on the body mass index of children and adolescents in Latin America: a protocol for a systematic review and meta-analysis
Authors: Godoy-Cumillaf Andrés , Diaz Armando , Álvarez-Bueno Celia , Martinez-Vizcaino Vicente , Cavero-Redondo Iván
Published: November 2019

Introduction

In Latin America, the number of children and adolescents who are overweight or obese has significantly increased in recent decades, and this situation has become a major public health concern. To address this problem, several intervention programmes, based on factors such as physical activity and nutrition, have been implemented, and body mass index (BMI) has been widely used as a means of measuring the impact of such interventions. Although some Latin America-based systematic reviews have been performed, there have been no previous meta-analyses of findings regarding the effect of physical activity interventions on BMI. Thus, the objective of the systematic review and meta-analysis will be to provide an up-to-date synthesis of the effects of physical activity interventions on BMI of Latin American children and adolescents aged 4–18 years.

Methods and analysis

This systematic review and meta-analysis protocol is based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. The literature search will involve MEDLINE, EMBASE, Cochrane Library, Web of Science and Scielo for articles published up to July 2019. This search will include randomised controlled trials (RCTs), non-randomised experimental studies and single-arm pre–post studies. Further, the Cochrane Collaboration’s tool for RCT studies and the Quality Assessment Tool for Quantitative Studies for non-randomised experimental and single-arm pre–post studies will be used to assess the risk of bias among the studies included in the systematic review. For the meta-analysis, the statistical program STATA V.14 will be used, and standardised mean differences are calculated as the primary outcomes. Subgroup analyses will then be performed based on the characteristics of the interventions and populations included in the studies examined.

Ethics and dissemination

This systematic review protocol is designed to provide updated evidence regarding the effects of physical activity interventions on the Latin American population; such evidence may be useful for institutions responsible for the development of public health policies and for those tasked with implementing such interventions among children and adolescents in Latin America. The results should be disseminated through publication in a peer-reviewed journal. Since the data used in systematic reviews of this type will be extracted exclusively from published studies, approval from an ethics committee will not be required.

PROSPERO registration number

CRD42019077702.
The Incentives to Quit tobacco in Pregnancy (IQuiP) protocol: piloting a financial incentive-based smoking treatment for women attending substance use in pregnancy antenatal services
Authors: Jackson Melissa A , Brown Amanda L , Baker Amanda L , Gould Gillian S , Dunlop Adrian J
Published: November 2019

Introduction

While tobacco smoking prevalence is falling in many western societies, it remains elevated among high-priority cohorts. Rates up to 95% have been reported in women whose pregnancy is complicated by other substance use. In this group, the potential for poor pregnancy outcomes and adverse physical and neurobiological fetal development are elevated by tobacco smoking. Unfortunately, few targeted and effective tobacco dependence treatments exist to assist cessation in this population. The study will trial an evidence-based, multicomponent tobacco smoking treatment tailored to pregnant women who use other substances. The intervention comprises financial incentives for biochemically verified abstinence, psychotherapy delivered by drug and alcohol counsellors, and nicotine replacement therapy. It will be piloted at three government-based, primary healthcare facilities in New South Wales (NSW) and Victoria, Australia. The study will assess the feasibility and acceptability of the treatment when integrated into routine antenatal care offered by substance use in pregnancy antenatal services.

Methods and analysis

The study will use a single-arm design with pre–post comparisons. One hundred clients will be recruited from antenatal clinics with a substance use in pregnancy service. Women must be <33 weeks’ gestation, ≥16 years old and a current tobacco smoker. The primary outcomes are feasibility, assessed by recruitment and retention and the acceptability of addressing smoking among this population. Secondary outcomes include changes in smoking behaviours, the comparison of adverse maternal outcomes and neonatal characteristics to those of a historical control group, and a cost-consequence analysis of the intervention implementation.

Ethics and dissemination

Protocol approval was granted by Hunter New England Human Research Ethics Committee (Reference 17/04/12/4.05), with additional ethical approval sought from the Aboriginal Health and Medical Research Council of NSW (Reference 1249/17). Findings will be disseminated via academic conferences, peer-reviewed publications and social media.

Trial registration number

Australia New Zealand Clinical Trial Registry (Ref: ACTRN12618000576224).
Transcultural mediation programme in a paediatric hospital in France: qualitative and quantitative study of participants’ experience and impact on hospital costs
Authors: Lachal Jonathan , Escaich Mélanie , Bouznah Serge , Rousselle Clémence , De Lonlay Pascale , Canoui Pierre , Moro Marie-Rose , Durand-Zaleski Isabelle
Published: November 2019

Objective

In France, immigrants with chronic diseases encounter numerous difficulties in gaining access to care and then in its initiation and organisation, difficulties only partly explained by socioeconomic factors. Atranscultural mediationconsultation programme has been set up in Necker Hospital in Paris to help families and professionals deal with these situations. The objective of this study was to assess the economic impact and the experience of this consultation.

Design

Qualitative and quantitative descriptive study.

Setting

This study of inpatients treated at Necker Hospital included those whose families participated in transcultural mediation in 2014 through 2016.

Participants

The first portion of the study applied quantitative methods and compared hospital costs before and after the mediation from the patients' records and accounting data for 15 cases. The qualitative portion analysed 15 semistructured interviews of physicians and families after the mediation, and a focus group of three psychologists.

Results

The results show a systematic reduction in costs after mediation, associated with fewer emergency hospitalisations and the shift of care toward less specialised facilities, calmer relationships between families and professionals, improved mutual understanding and increased confidence by the professionals in the families' ability to manage the treatment.

Conclusion

Transcultural mediation can benefit both patients and the healthcare system and may be useful for other hospitals that care for socially and culturally diverse patients.
Benefits of not smoking during pregnancy for Australian Aboriginal and Torres Strait Islander women and their babies: a retrospective cohort study using linked data
Authors: McInerney Carol , Ibiebele Ibinabo , Ford Jane B , Randall Deborah , Morris Jonathan M , Meharg David , Mitchell Jo , Milat Andrew , Torvaldsen Siranda
Published: November 2019

Objectives

To provide evidence for targeted smoking cessation policy, the aim of this study was to compare pregnancy outcomes of Aboriginal mothers who reported not smoking during pregnancy with Aboriginal mothers who reported smoking during pregnancy.

Design

Population based retrospective cohort study using linked data.

Setting

New South Wales, the most populous Australian state.

Population

18 154 singleton babies born to 13 477 Aboriginal mothers between 2010 and 2014 were identified from routinely collected New South Wales datasets. Aboriginality was determined from birth records and from four linked datasets through an Enhanced Reporting of Aboriginality algorithm.

Exposure

Not smoking at any time during pregnancy.

Main outcome measures

Unadjusted and adjusted relative risks (aRR) and 95% CIs from modified Poisson regression were used to examine associations between not smoking during pregnancy and maternal and perinatal outcomes including severe morbidity, inter-hospital transfer, perinatal death, preterm birth and small-for-gestational age. Population attributable fractions (PAFs) were calculated using adjusted relative risks.

Results

Compared with babies born to mothers who smoked during pregnancy, babies born to non-smoking mothers had a lower risk of all adverse perinatal outcomes including perinatal death (aRR=0.58, 95% CI 0.44 to 0.76), preterm birth (aRR=0.58, 95% CI 0.53 to 0.64) and small-for-gestational age (aRR=0.35, 95% CI 0.32 to 0.39). PAFs (%) were 27% for perinatal death, 26% for preterm birth and 48% for small-for-gestational-age. Compared with women who smoked during pregnancy (n=8919), those who did not smoke (n=9235) had a lower risk of being transferred to another hospital (aRR=0.76, 95% CI 0.66 to 0.89).

Conclusions

Babies born to women who did not smoke during pregnancy had a lower risk of adverse perinatal outcomes. Rates of adverse outcomes among Aboriginal non-smokers were similar to those among the general population. These results quantify the proportion of adverse perinatal outcomes due to smoking and highlight why effective smoking cessation programme are urgently required for this population.
Renin–angiotensin system blocker use and the risk of acute kidney injury after colorectal cancer surgery: a population-based cohort study
Authors: Slagelse Charlotte , Gammelager H , Iversen Lene Hjerrild , Liu Kathleen D , Sørensen Henrik T Toft , Christiansen Christian F
Published: November 2019

Objectives

It is unknown whether preoperative use of ACE inhibitors (ACE-I) or angiotensin receptor blockers (ARBs) affects the risk of acute kidney injury (AKI) after colorectal cancer (CRC) surgery. We assessed the impact of preoperative ACE-I/ARB use on risk of AKI after CRC surgery.

Design

Observational cohort study. Patients were divided into three exposure groups—current, former and non-users—through reimbursed prescriptions within 365 days before the surgery. AKI within 7 days after surgery was defined according to the current Kidney Disease Improving Global Outcome consensus criteria.

Setting

Population-based Danish medical databases.

Participants

A total of 9932 patients undergoing incident CRC surgery during 2005–2014 in northern Denmark were included through the Danish Colorectal Cancer Group Database.

Outcome measure

We computed cumulative incidence proportions (risk) of AKI with 95% CIs for current, former and non-users of ACE-I/ARB, including death as a competing risk. We compared current and former users with non-users by computing adjusted risk ratios (aRRs) using log-binomial regression adjusted for demographics, comorbidities and CRC-related characteristics. We stratified the analyses of ACE-I/ARB users to address any difference in impact within relevant subgroups.

Results

Twenty-one per cent were ACE-I/ARB current users, 6.4% former users and 72.3% non-users. The 7-day postoperative AKI risk for current, former and non-users was 26.4% (95% CI 24.6% to 28.3%), 25.2% (21.9% to 28.6%) and 17.8% (17.0% to 18.7%), respectively. The aRRs of AKI were 1.20 (1.09 to 1.32) and 1.16 (1.01 to 1.34) for current and former users, compared with non-users. The relative risk of AKI in current compared with non-users was consistent in all subgroups, except for higher aRR in patients with a history of hypertension.

Conclusions

Being a current or former user of ACE-I/ARBs is associated with an increased risk of postoperative AKI compared with non-users. Although it may not be a drug effect, users of ACE-I/ARBs should be considered a risk group for postoperative AKI.
Does gender equality and availability of contraception influence maternal and child mortality? A systematic review
Authors: Bagade Tanmay , Chojenta Catherine , Harris Melissa L , Nepal Smriti , Loxton Deborah
Published: November 2019

Background

Current global maternal and child health policies rarely value gender equality or women’s rights and are restricted to policies addressing clinical interventions and family planning. Gender equality influences the knowledge, autonomy and utilisation of contraception and healthcare, thereby affecting maternal and child health. This systematic review aims to analyse the concurrent effect of gender equality and contraception on maternal and under-5 child mortality.

Methods

A systematic review was conducted to investigate the current evidence. Studies were eligible if three themes—namely, indicators of gender equality (such as female education, labour force participation, gender-based violence), contraception, and maternal or child mortality—were present together in a single article analysing the same sample at the same time.

Results

Even though extensive literature on this topic exists, only three studies managed to fit the selection criteria. Findings of two studies indicated an association between intimate partner violence (IPV) and infant mortality, and also reported that women’s contraceptive use increased the risk of IPV. The third study found that the mother’s secondary education attainment significantly reduced child mortality, while the mother’s working status increased the odds of child mortality. The researchers of all included studies specified that contraceptive use significantly reduced the risk of child mortality.

Conclusion

Improvement in gender equality and contraception concurrently affect the reduction in child mortality. These findings provide strong support to address the research gaps and to include a gender equality approach towards maternal and child health policies.
3 Advances in treating heart failure
Authors: Cowie Martin
Published: November 2019

The average age of a person with a new diagnosis of heart failure in the UK is now 80, and such a person is as likely to be female as male, to have 5–6 co-morbidities, and to be frail.1 Delivering appropriate care is a challenge, particularly where the evidence from clinical trials may be in patients who are typically 20 years younger and with less complex medical and social needs. Increased awareness of the need for a more holistic approach, with shared decision making, and advance care planning, is improving the experience and outcome of care, but there is marked variation across the NHS.2 3

This talk will briefly summarise some of the recent advances in treating heart failure – particularly for those with systolic impairment of the left ventricle, and for those with valve disease. Mechanical circulatory support has improved greatly in recent years but is only ever an option for a tiny minority of patients. Treatment of co-morbidities, such as atrial fibrillation and diabetes, have also improved the outcome for those with heart failure. Despite much effort, cellular and genetic therapies remain a distant prospect. Digital approaches to care, and self-management, show considerable promise but integrating such approaches into a traditional healthcare system has proven challenging.

The prognosis of heart failure has improved dramatically for many patients over the past 30 years –but the residual risk of mortality and urgent hospitalisation means that there is much work to be done.

References
6 Translating genomics for clinical benefit
Authors: Caulfield Mark
Published: November 2019

The UK 100,000 Genomes Project has focussed on transforming genomic medicine in the National Health Service using whole genome sequencing in rare disease, cancer and infection. Genomics England partnering with the NHS established 13 Genomic Medicine Centres, the NHS whole genome sequencing centre and the Genomics England Clinical Interpretation Partnership (3337 researchers from 24 countries). We sequenced the 100,000th genome on the 5th December 2019 and completed an initial analysis for participants in July 2019. Alongside these genomes we have assembled a longitudinal life course dataset for research and diagnosis including 2.6 billion clinical data points for the 3000 plus researchers to work on to drive up the value of the genomes for direct healthcare. In parallel we have partnered the NHS to establish one of the world’s most advanced Genomic Medicine Service where we re-evaluated 300,000 genomic tests and upgraded 25% of tests to newer technologies with an annual review. The Department of Health have announced the ambition to undertake 5 million genome analyses over the next 5 years focused on new areas tractable to health gain.
9 Low fidelity simulation in a high fidelity world
Authors: Scott A , Gartner A
Published: November 2019

Introduction

All aspects of medical training have experienced an exponential acceleration in the application of technology for learning needs.1 Research promotes the use of high fidelity models and ever more complex training methods with organisations keen to adopt and implement new technology. Models are utilised to minimise potential risks to patients through bedside learning and refine established technique.2 Simulation practice can also be used to develop non-technical skills pertinent to safe clinical practice.2–4 Simulation training can be employed from early stages of undergraduate education through to use in professional postgraduate exams giving a large scope of use in a multiplicity of environments.1 4 5

Methods

Forty Foundation Year 1 Doctors were taught clinical skills utilising Low fidelity part task training models. Four clinical skills were selected from pre-determined postgraduate curricula. Self assessment pre and post procedure were recorded with qualitative feedback sought as a secondary measure.

Results

Global increases are seen across 4 sampled clinical skills. Participants self-reported increased confidence and competence. A high value was placed upon trainees perceived value in training.

Conclusion

Fidelity has been shown to play an integral role in simulation.4 The authors conclude that simple part task trainers, low fidelity models, still have a valuable part to play in medical education. They remain cost effective, adaptable and accessible training tools in the era of increasing complexity.1 5 Simulation provides a safe space to develop both technical and non-technical aspects.3 4 Low fidelity simulation can be used to underpin the learning objectives of trainees through effective feedback in real time, access to repetitive practice and remain a feasible training tool for trainers and trainees alike.2 4 High fidelity simulation should not be excluded completely however appears to be best suited to defined roles in more complex moulage.1 4

Take home message

Technology has the ability to improve and evolve medical education. With the potential for increased feedback, self and peer assessment along with pragmatic assessment, simulation has firmly entrenched itself in medical education. Care should be taken however not to disregard lower fidelity models as they still provide proven effective learning, enable the teaching of non-technical skills and facilitate knowledge delivery.

References
Occupational exposure to organic dusts and risk of developing rheumatoid arthritis: findings from a Swedish population-based case–control study
Authors: Ilar Anna , Gustavsson Per , Wiebert Pernilla , Alfredsson Lars
Published: November 2019

Objectives

We estimated the association between occupational exposures to five different organic dusts: wood, animal, paper, textile and flour dust and the risk of developing rheumatoid arthritis (RA).

Methods

This population-based case–control study analysed 12 582 incident cases and 129 335 controls. Participants were identified from national public authority and quality registers. Census data on occupations were collected 1960–2010 and we estimated the exposure to organic dust with the help of job-exposure matrices. We used logistic regression to assess the OR of seropositive or seronegative RA. Estimates were adjusted for the matching variables (sex, county, age and index year), education and occupational silica exposure.

Results

Exposure to animal dust was associated with an increased risk of RA among both men and women. The OR was 1.2 (95% CI=1.1 to 1.4) for seropositive RA and 1.3 (95% CI=1.1 to 1.5) for seronegative RA among ever exposed participants compared with unexposed. The risk increased with duration of exposure for seropositive RA, and participants who had been exposed in five or more censuses had an OR of 1.6 (95% CI=1.1 to 2.2, p for trend=0.003). Exposure to textile dust also generated a significant dose–response relationship for seropositive RA (p for trend=0.014). We detected no association between exposure to wood, paper or flour dust and risk of RA.

Conclusions

Overall, exposure to animal dust and textile dust was associated with an increased risk of developing RA. These observations give further support to the notion that airborne exposures are involved in the aetiology of RA.
Water pipe failure prediction and risk models: state-of-the-art review
Authors: Dawood Thikra , Elwakil Emad , Novoa Hector Mayol , Gárate Delgado José Fernando
Published: November 2019

This review paper presents the current state-of-the-art pertains to water pipe failure prediction and risk assessment, published in the last ten years (2009–2019). This paper has been motivated by the lack of comprehensive review articles that integrates water network failure and risk modeling. Some of the current practices reviewed the pipe condition and its failure. Others focused on the statistical prediction models, whereas the rest outlined failure prediction models of large diameter mains only. The mainstream of the current practice, highlighted in this paper characterizes the structural deterioration and failure rates using various statistical techniques, whereas the remainder of research covers a proliferation of machine learning and soft computing applications to forecast and model the pipeline risk of failure. The review offers descriptions of the models together with their proposed methodologies, algorithms and equations, contributions and drawbacks, comparisons and critiques, and types of data used to develop the models using the bibliographic review method. Finally, future work and research challenges are recommended to assist the civil engineering research community in setting a clear agenda for the upcoming research.
Climate-sensitive height–age models for top height trees in natural and reclaimed oil sands stands in Alberta, Canada
Authors: Yang Yuqing , Huang Shongming , Vassov Robert , Pinno Brad , Chhin Sophan
Published: November 2019

Climate-sensitive height–age models were developed for top height trees of trembling aspen (Populus tremuloides Michx.), jack pine (Pinus banksiana Lamb.), and white spruce (Picea glauca (Moench) Voss) in natural and reclaimed oil sands stands. We used stem analysis data collected from the Athabasca oil sands region in northern Alberta, Canada, and climate data generated by the ClimateWNA model. Height–age trajectories differed between top height trees in natural and reclaimed stands for jack pine and white spruce, but not for trembling aspen. At a given age, white spruce top height trees were taller and jack pine top height trees were shorter in reclaimed stands than those in natural stands, suggesting that it is easier to achieve similar forest productivity for oil sands sites reclaimed with white spruce stands than for sites reclaimed with jack pine stands. The principal climate variables were growing season (May to September) precipitation averaged over the previous 10 years for trembling aspen and jack pine and summer (June to August) precipitation averaged over the previous 10 years for white spruce. These variables had positive effects on the height–age trajectories.