bluuebunny/crossref_metadata_2025 huggingface dataset:
621 Successfully Advocating to Make Microwave Ovens “child-resistant” to Protect Young Children from Severe Scalds
Authors: Robinson Marla R , Quinlan Kyran , Lowell Gina , Gottlieb Lawrence , O’Connor Annemarie , Cowles Nancy A
Published: March 2020

Introduction

Scald burn injuries are the leading cause of burn-related emergency room visits and hospitalizations for young children. An increasing portion of these injuries occur when children are removing items from microwave ovens. Many of these occur on the face/chest and can have lifelong physical, functional, aesthetic and psychological consequences. Over the past 15 years we have published a series of studies supporting our advocacy for a change in microwave oven design to protect children from severe scalds. Requiring microwave oven doors to be more difficult for a child to open would help to protect young children from these types of burn injuries. Our analysis of the National Electronic Injury Surveillance System found an estimated 7000 young children were treated in US emergency departments over the last decade for burns suffered when the child opened a microwave oven door and spilled the heated contents. This report describes our continued research and advocacy to finally get a regulatory agency to pass a “child-safety” mechanism for opening microwave doors.

Methods

In the United States, microwave ovens must meet the published microwave standard administered by Underwriters Laboratories (UL 923). In 2013, we formally proposed a change in the standard which underwent a voting process by the Standards Technical Panel. Microwave makers are well represented on the panel. This attempt did not pass. We continued to publish focused research, presented at national meetings, enlisted engineering students to design “child-resistant” microwave doors to demonstrate feasibility, and created a video to put a face to the statistics. In 2017, we became active members of a National Task Group convened by UL, and two authors became voting members on the 17 member microwave Standards Technical Panel. A new proposal was introduced by the Association of Home Appliances Manufacturers requiring “two distinct actions” to make it more difficult for a young child to open a microwave oven door. Multiple concerns were addressed including those related to the impact on seniors. We lobbied members who appeared undecided.

Results

On September 17, 2018, the UL 923 STP voted by a narrow margin to pass the measure. In the future, new microwave ovens sold in the United States will be required to be made with “child-resistant doors”.

Conclusions

Research and advocacy work together to protect children. Child scald risk will be reduced as microwaves with child-resistant doors replace current models.

Applicability of Research to Practice

Our research demonstrated that very young children are able to open microwave ovens putting them at risk for burn injuries. We worked diligently through various advocacy channels to actively improve the safety of microwave ovens. With the approved changes for future microwave design requirements, research and advocacy have now resulted in practice changes.
639 Face Masks - The Negative Impression Makes a Positive Impact
Authors: O’Rourke Cassandra
Published: March 2020

Introduction

Providing timely and appropriate pressure to prevent/address hypertrophic scarring for burn survivors is an ongoing challenge. From time of measurement to obtaining a custom compression garment can be several weeks requiring creative solutions to providing interim pressure, particularly in the pediatric population and even more challenging for a facial burn scar. Historically, fabric custom garments were ordered, then with the advancement of silicone lined materials, clear facial masks could be fabricated. This process started with taking a plaster cast of the survivors’ face, frequently using sedation to allow for optimal fitting, but sedation can change the tone of the facial muscles adding to the challenge. With the advancements in technology, less invasive, more accurate, and more timely fabrication of face masks is possible.

Methods

A 3D picture was taken of a 14-month-old pediatric burn survivor with hypertrophic scarring on the face. This image was uploaded to a 3D printer and a positive print (facial surface down) was completed. The positive print was used to make an alginate mask and plaster was poured to create a casting of the positive printed face. A check mask was pulled from this positive plaster cast (+ mask). This check mask was too large for the patient’s face. To have a better fitting mask, another approach to the mask fabrication was completed. From the same 3D picture, a negative print (facial surface up) was completed. Plaster was poured directly into this negative print to create a casting of the negative printed face. A check mask was pulled from this negative plaster cast (- mask). Both check masks were fit to the patient to assess for accuracy of fit and estimation of required adjustments for optimal fit.

Results

There was a significant difference in the fit of the two masks created from the same 3D picture. The mask pulled on the positive casting was too large. The required adjustments to have the mask fit properly to provide appropriate compression to the hypertrophic scarring on the face would have been extremely difficult and time consuming to complete. The mask pulled on the negative casting fit well and only required small adjustments to ensure adequate pressure would be provided to the focused areas of hypertrophic scars on the face.

Conclusions

With advances in technology, 3D photography partnered with 3D printing allow for significant improvement in the accuracy of fitting facial masks, improve timeliness of compression, and improve the patient experience in the process of obtaining a facial mask.

Applicability of Research to Practice

The availability of technology can allow burn survivors to receive compression for facial scars in a faster, more accurate, and patient friendly manner to allow for early intervention to prevent and/or improve facial hypertrophic scarring. From the 3D picture to mask fitting can be as little as 48–72° as compared to several weeks with historical methods.
711 A Retrospective Review of Enoxaparin Dosing Practices in Burn Patients
Authors: Quan Asia N , Aden Aisha , Islas Claudia , Richey Karen J , Foster Kevin N
Published: March 2020

Introduction

Enoxaparin, a low molecular weight heparin, has been proven to safely and effectively prevent venous thromboembolism (VTE) in acutely ill patients. Burn patients may be particularly vulnerable to the occurrence of a VTE due to prolonged immobility, frequent operating room procedures, and low flow states. Treatment of acute VTE is associated with a direct medical cost of $12000-$15000 and subsequent complications increase costs to $18000 to $23000 per case. Current institutional protocol for initiation of enoxaparin an all burn adult patients is 40 mg administered subcutaneously every 12 hours. Anti-Xa levels are used to monitor anticoagulation prophylaxis, with 0.3–0.5 U/mL recognized as the prophylactic range. Doses are subsequently modified in 10 mg increments to achieve goal prophylaxis anti-Xa levles. The purpose of this study was to evaluate current practice (CP) and assess if the implementation of a published enoxaparin dosing algorithm could minimize delay in achieving anticoagulation prophylaxis.

Methods

A retrospective chart review was performed of 94 adult burn patients. The doses and time required to reach goal prophylaxis anti-Xa levels using current practice (CP) were compared to the predicted algorithm dose (AD). The number of dose adjustments and the number of days needed for adjustments for CP were documented. Charges related for laboratory determinations and medication administration were calculated.

Results

Of the 94 patients reviewed, the average age was 47 years, the majority were male (74%), mean actual weight 92 kilograms and mean TBSA 15.7%. The most common mechanism of injury was flash/flame (63%) with 18% suffering an inhalation injury. On average, using CP, it took 9.3 days to get to goal prophylaxis anti-Xa levels, with a mean of 2.86 anti-Xa lab tests needed and an average prophylactic dose of 55.5 mg. A total of 360 labs draws were performed and 74% were timed correctly. The CP average starting dose was lower than the AD 40 mg versus 45 mg (p < .0001). If the algorithm had been used the number of dosing adjustments would have been 25% less. The algorithm overestimated the starting dose in only 2.1% of the population. The average charges until goal was met for enoxaparin were $2,933 and $787 for anti-Xa levels.

Conclusions

This study demonstrates increased clinical efficacy and cost-effectiveness for an algorithm driven enoxaparin dosing regimen for burn patients. Prospective study with larger patient numbers is warranted.

Applicability of Research to Practice

Increased efficacy combined with decreased cost for an new enoxaparin dosing regimen.
721 Treatment of Hypertrophic Burn and Wound Scars Using a Novel Cold Laser System
Authors: Tsai Jenn , Bendjemil Samy , Dowling Colin , Poulakidas Stathis
Published: March 2020

Introduction

Hypertrophic scars are seen in 70% of individuals after a burn. Survival from acute burns have psychosocial and functional challenges. Hypertrophic scars contain disorganized whorls of collagen, an increase in occluded blood vessels resulting in raised discoloration, inflamed dermis/epidermis and painful sequelae. Management of such scars have been limited to invasive and non-invasive management. One innovative technology is a non-invasive high-intensity laser operating at 1275 nm and 74 Watts, optimizing increased depth of penetration into the tissue utilizing photomechanical effects to biostimulate tissue to heal and regenerate. We present a series of 10 patients.

Methods

10 patients were enrolled with hypertrophic scarring secondary to deep partial or full thickness burns. Hypertrophic areas were identified and numerical pain scale, Vancouver Scar Scale and the World Health Organization Quality of Life score were recorded. The non-contact, high-intensity laser was passed over the hypertrophic scars, continuously moving the laser over the entirety of the scar. Each area of hypertrophic scar tissue was lasered for progressively longer sessions, reaching a therapeutic time of 10 min in each section.

Results

Patients were utilizing previously known non-invasive therapies for scar reduction, such as, compression garments, scar treatment ointments, as well as steroid injection and non-medical therapies such as acupuncture. In our series, 90% of the patients reported decrease in scar pain, inflammation, pigmentation and improved pliability by the second treatment. Decreased scar height was identified by the eighth session, where conventional protocols could require months to years before any changes were observed. Changes in the scars were even identified after the normal time period identified for maximal improvement using conventional burn therapies. In a survey presented to patient, even pain was improved, identified with reduction in narcotic/NSAID use in patients undergoing the therapies.

Conclusions

Non-invasive high-intensity laser therapies are useful adjuncts for reduction of hypertrophic burn scars. Our case series presents a treatment option in patients that have functional, physical and cosmetic challenges. We anticipate broader applications for hypertrophic burn scar reduction utilizing adjunctive non-invasive laser therapy, reducing the need for invasive scar revision and limiting psychosocial strain.

Applicability of Research to Practice

In this case series, non-invasive high-intensity laser therapy provided timely decrease in hypertrophic scar characteristics in an outpatient setting. Thus, leading to decrease in invasive operative therapy and overall improvement in quality of life. Further studies are needed to elucidate other benefits and utility of the laser and possible evaluation of keloid scars.
864 Perioperative Multimodal Analgesia Reduces Opioid Use Following Skin Grafting in Burn Patients
Authors: Gibson Angela , Lennertz Richard C , Zimmerman Haley , McCormick Timothy , Faucher Lee
Published: March 2020

Introduction

Burn injuries cause severe pain and patients often require high doses of opioid medications. Pain management is particularly challenging during dressing changes and following skin grafting procedures. Non-opioid analgesic medications and multimodal analgesic strategies have been promoted to improve pain management and decrease opioid use.

Methods

We performed a retrospective chart review to identify burn patients who underwent autologous skin grafting procedures between January 2011 and June 2018. We included patients who underwent were 18–80 years old and were inpatients for at least 24 hours before and after their procedure. We excluded patients who remained intubated in PACU, had surgery the day prior or had active opioid prescriptions prior to their hospitalization. We evaluated the effect of different non-opioid analgesic medications on opioid use following a skin grafting procedure. The primary outcome measure of this study compared opioid use 24 hours before skin grafting to 24 hours after skin grafting.

Results

We found that most patients (69%) reported severe pain (NRS ≥7) immediately after autologous skin grafting. On average, patients required an additional 54 mg of oral morphine equivalents (ME) in the 24 hours after the procedure compared to the 24 hours before. The use of perioperative non-opioid analgesia varied between patients (Acetaminophen 29%, gabapentin 29%, ketamine 33% and all three 8%). Patients who received either gabapentin or a combination of acetaminophen, gabapentin and ketamine had a smaller increase in their opioid use than patients who did not receive the medications (-24 ME, CI -46, -3 and -40 ME, CI -75, -5 respectively).

Conclusions

Burn patients who received perioperative acetaminophen, gabapentin and ketamine required relatively less opioid following their skin grafting procedure.

Applicability of Research to Practice

These results support the use of multimodal analgesia for perioperative analgesia in burn patients.
867 The Effect of Financial Reward on Opioid Use After Thermal Injury to the Upper Extremity
Authors: Coffey Rebecca , Schubauer Kathryn , Xiang Henry , Bailey John Kevin
Published: March 2020

Introduction

The widespread use of opioids for the treatment of pain has come under progressive scrutiny in an attempt to address multiple unintended consequences. Despite multiple psychological, social, biological, and legal factors that contribute to pain management strategies, narcotics remain a mainstay for the treatment of burn-pain. As efforts are underway to test novel methods for mitigating pain, it is essential to clearly define models for testing these tools and strategies. This study examines the impact of financial incentives alone on the use of opioids at a single center.

Methods

Patients with thermal injury to the upper extremity, managed as outpatients, no more than three days from the date of injury and were prescribed the state-encouraged narcotic dosage of no more than 4 tablets (oxycodone, 5mg) per day for no more than 7 days were included. Enrolled patients (n=33) then answered a series of descriptive questions, completed the QuickDASH and had grip strength measurements of each hand. Patients were randomized to one of two groups. Both groups were offered a financial incentive to return a completed pill diary. One group (Incentivized- IC) was offered the possibility of additional financial incentive for each unused oxycodone tablet returned at one week follow up. Only patients who presented a completed pill diary were included in analysis (n=23).

Results

The Unincentivized (UIC)(n=13) and IC (n=10) were similar age, gender race, ethnicity, mean burn size (1.72% TBSA) and completed level of education. Mechanism of injury was predominantly scald burns (17 scalds, 5 flame injuries, 1 contact injury). Mean difference in grip strength between hands was similar between study groups at enrollment for both UIC and IC patients (-16.60 ±15.92lbs p=0.32,-16.45 ± 12.681lbs p=0.21). The initial QuickDASH scores (15.6lbs, SD 24.6 vs. 7.3lbs SD±10.4 p=0.01) were significant between groups. At one week follow up the difference between grip strength in each hand had improved similarly in each group (-13.16 ±19.71lbs p = 0.51vs. 3.07 ±19.44 lbs, p=0.87 and the increase in QuickDASH score was similar (34.83 SD 23.90 vs.46.09 SD 30.67 p=0.33). The UIC group used a mean of 2.5 tablets/day (±1.5 tab/day) versus the IC group used 2.1 tablets/day (±1.5 tab/day), p=0.46.

Conclusions

Modest financial incentives do not appear to alter opioid use for acute pain from thermal injury involving the upper extremity. These results support the use of financial rewards, which may encourage participation in future studies without independently affecting opioid use. Finally, it also appears that our state’s encouragement of more stringent prescription practices is appropriate for this mechanism of injury.

Applicability of Research to Practice

Ongoing research is needed to identify the best tools to decrease use of opioids in acute injury.
Updating the Burn Center Referral Criteria: Results From the 2018 eDelphi Consensus Study
Authors: Bettencourt Amanda P , Romanowski Kathleen S , Joe Victor , Jeng James , Carter Jeffrey E , Cartotto Robert , Craig Christopher K , Fabia Renata , Vercruysse Gary A , Hickerson William L , Liu Yuk , Ryan Colleen M , Schulz John T
Published: March 2020

Existing burn center referral criteria were developed several years ago, and subsequent innovations in burn care have occurred. Coupled with frequent errors in the estimation of extent of burn injury and depth by referring providers, patients are both over and under-triaged when the existing criteria are used to support patient care decisions. In the absence of compelling clinical trial data on appropriate burn patient triage, we convened a multidisciplinary panel of experts to execute an iterative eDelphi consensus process to facilitate a revision. The eDelphi process panel consisted of n = 61 burn stakeholders and experts and progressed through four rounds before reaching consensus on key clinical domains. The major findings are that 1) burn center consultation is strongly recommended for all patients with deep partial-thickness or deeper burns ≥ 10% TBSA burned, for full-thickness burns ≥ 5% TBSA burned, for children and older adults with specific dressing and medical needs, and for special burn circumstances including electrical, chemical, and radiation injuries; 2) smaller burns are ideally followed in burn center outpatient settings as soon as possible after injury, preferably without delays of a week or more; 3) frostbite, Stevens–Johnson syndrome/TENS, and necrotizing soft-tissue infection patients benefit from burn center treatment; and 4) telemedicine and technological solutions are of likely benefit in achieving this standard. Unlike the original criteria, the revised consensus-based guidelines create a framework promoting communication so that triage and treatment are specifically tailored to individual patient characteristics, injury severity, geography, and the capabilities of referring institutions.
Insects Associated to Crime Scenes in the Northeast of Brazil: Consolidation of Collaboration Between Entomologists and Criminal Investigation Institutes
Authors: Meira L M R , Barbosa T M , Jales J T , Santos A N , Gama R A
Published: March 2020

In Brazil, many studies on Forensic Entomology analyze the activity and succession of flies in animal models. Data on human corpses are always collected and evaluated in isolated cases. This study aimed to list the insect species associated with crime scenes investigated by the Technical-Scientific Institute of criminal expertise of the State of Rio Grande do Norte (ITEP-RN), in the Northeast of Brazil, a region exposed to high homicide rates. In total, 10 cases were investigated, of which 50% were in the initial stage of decomposition. The examined bodies were colonized by species of three orders of insects, Diptera, Coleoptera and Hymenoptera. The order Diptera represented 96% of the total insects, being represented by the following species: Chrysomya albiceps (Wiedemann) (Diptera: Calliphoridae), Chrysomya megacephala (Fabricius) (Diptera: Calliphoridae), Chrysomya putoria (Wiedemann) (Diptera: Calliphoridae), and Cochliomyia macellaria, (Fabricius) (Diptera: Calliphoridae); Musca domestica (Linnaeus) (Diptera: Muscidae); and unidentified females of the Sarcophagidae family. Among beetles, the occurrence of Dermestes maculatus (DeGeer) (Coleoptera: Dermestidae), Necrobia rufipes (De Geer) (Coleoptera: Cleridae), and Onthophagus sp. (Scarabaeidae), as well as unidentified specimens of the families Tenebrionidae and Histeridae were recorded. In addition, specimens of Ectatomma sp. (Formicidae) were also recorded. Considering that the Rio Grande do Norte state presents a high homicide rate and the last cadaver study was conducted over a decade ago, these records update the list of species associated with cadaveric decomposition and contribute to consolidate forensic entomology in the Northeast region.
Meningococcal and pneumococcal carriage in Hajj pilgrims: findings of a randomized controlled trial
Authors: Badahdah Al-Mamoon , Bakarman Marwan A , Khatami Ameneh , Tashani Mohamed , Barasheed Osamah , Alfelali Mohammad , Azeem Mohammad I , Bokhary Hamid , Soltan Osama , Lahra Monica M , Jeoffreys Neisha , Kok Jen , Dwyer Dominic E , Booy Robert , Rashid Harunor ,   the Hajj Research Team
Published: March 2020

Background

Intense congestion during the Hajj pilgrimage amplifies the risk of meningococcal carriage and disease, and there have been many meningococcal outbreaks reported amongst pilgrims. Thus, a strict vaccination policy is enforced by the host country and either polysaccharide or conjugate quadrivalent meningococcal vaccines are mandatory. However, unlike conjugate vaccines, the polysaccharide vaccine is not thought to reduce pharyngeal carriage of meningococci.

Methods

A single-blinded, randomized, controlled trial amongst pilgrims from Saudi Arabia and Australia during the Hajj seasons of 2016–2017 was conducted to compare MenACWY-Conjugate vaccine with MenACWY-Polysaccharide vaccine, to determine if the conjugate vaccine is more effective in reducing asymptomatic carriage of meningococci, and whether the effect may be long-standing. Oropharyngeal swabs were obtained pre-, immediately post- and 6–11 months following completion of Hajj and tested for the presence of meningococci.

Results

Amongst 2000 individuals approached, only 1146 participants aged 18–91 (mean 37.6) years agreed to participate and were randomized to receive either the polysaccharide (n = 561) or the conjugate (n = 561) vaccine, 60.8% were male, and 93.5% were from Saudi Arabia. Amongst oropharyngeal swabs obtained before Hajj, only two (0.2%) tested positive for Neisseria meningitidis. Similarly, meningococci were identified in only one sample at each of the post-Hajj and late follow-up visits. None of the carriage isolates were amongst the serogroups covered by the vaccines. A post hoc analysis of the third swabs revealed that 22.4% of all participants (50/223) were positive for Streptococcus pneumoniae nucleic acid.

Conclusion

The low overall carriage rate of meningococci found amongst Hajj pilgrims in 2016 and 2017 demonstrates a successful vaccination policy, but neither supports nor refutes the superiority of meningococcal conjugate ACWY vaccine over the polysaccharide vaccine against carriage. Although an association could not be established in this study, molecular epidemiology would help to establish the role of Hajj in facilitating transmission of pneumococci and inform vaccination policy.
The stellar variability noise floor for transiting exoplanet photometry with PLATO
Authors: Morris Brett M , Bobra Monica G , Agol Eric , Lee Yu Jin , Hawley Suzanne L
Published: March 2020

One of the main science motivations for the ESA PLAnetary Transit and Oscillations (PLATO) mission is to measure exoplanet transit radii with 3 per cent precision. In addition to flares and starspots, stellar oscillations and granulation will enforce fundamental noise floors for transiting exoplanet radius measurements. We simulate light curves of Earth-sized exoplanets transiting continuum intensity images of the Sun taken by the Helioseismic and Magnetic Imager (HMI) instrument aboard the Solar Dynamics Observatory (SDO) to investigate the uncertainties introduced on the exoplanet radius measurements by stellar granulation and oscillations. After modelling the solar variability with a Gaussian process, we find that the amplitude of solar oscillations and granulation is of order 100 ppm – similar to the depth of an Earth transit – and introduces a fractional uncertainty on the depth of transit of 0.73 per cent assuming four transits are observed over the mission duration. However, when we translate the depth measurement into a radius measurement of the planet, we find a much larger radius uncertainty of 3.6 per cent. This is due to a degeneracy between the transit radius ratio, the limb darkening, and the impact parameter caused by the inability to constrain the transit impact parameter in the presence of stellar variability. We find that surface brightness inhomogeneity due to photospheric granulation contributes a lower limit of only 2 ppm to the photometry in-transit. The radius uncertainty due to granulation and oscillations, combined with the degeneracy with the transit impact parameter, accounts for a significant fraction of the error budget of the PLATO mission, before detector or observational noise is introduced to the light curve. If it is possible to constrain the impact parameter or to obtain follow-up observations at longer wavelengths where limb darkening is less significant, this may enable higher precision radius measurements.
Simulated synchrotron emission for the Tycho’s supernova remnants: an asymmetric initial mass model
Authors: Moranchel-Basurto A , Velázquez P F , Ares de Parga G , Reynoso E M , Schneiter E M , Esquivel A
Published: March 2020

We have performed 3D magnetohydrodynamics (MHD) numerical simulations with the aim of exploring the scenario in which the initial mass distribution of a supernova (SN) explosion is anisotropic. The purpose is to analyse if this scenario can also explain the radio-continuum emission and the expansion observed in young supernova remnants (SNRs). To study the expansion, synthetic polarized synchrotron emission maps were computed from the MHD simulations. We found a good agreement (under a number of assumptions) between this expansion study and previous observational results applied to Tycho’s SNR, which represents a good example of asymmetric young SNRs. Additionally, both the observed morphology and the brightness distribution are qualitatively reproduced.
Surface brightness fluctuation spectra to constrain stellar population properties
Authors: Vazdekis A , Cerviño M , Montes M , Martín-Navarro I , Beasley M A
Published: March 2020

We present a new set of surface brightness fluctuation (SBF) spectra computed with the E-MILES stellar population synthesis models. The model SBF spectra cover the range λλ1680–50 000 at moderately high resolution, all based on extensive empirical stellar libraries. The models span the metallicity range $-2.3\le \mbox{$\mbox{[M/H]}$}\le +0.26$ for a suite of intial mass function types with varying slopes. These predictions can complement and aid fluctuation magnitude studies, permitting a first-order approximation by applying filter responses to the SBF spectra to obtain spectroscopic SBF magnitudes. We provide a recipe for obtaining the latter and discuss their uncertainties and limitations. We compare our spectroscopic SBF magnitudes to photometric data of a sample of early-type galaxies. We also show that the SBF spectra can be very useful for constraining relevant stellar population parameters. We find small (<5 per cent) mass fractions of extremely metal-poor components ($\mbox{$\mbox{[M/H]}$}\lt -1$) on the top of the dominant, old, and metal-rich stellar population. These results put stringent constraints on the early stages of galaxy formation in massive elliptical galaxies. This is remarkable given the high degree of degeneracy of the standard spectral analysis to such metal-poor stellar populations in the visible and in the near-infrared. The new SBF models show great potential for exploiting ongoing surveys, particularly those based on narrow-band filters.
Statistical separation of weak gravitational lensing and intrinsic ellipticities based on galaxy colour information
Authors: Tugendhat Tim M , Reischke Robert , Schäfer Björn Malte
Published: March 2020

Intrinsic alignments of galaxies are recognized as one of the most important systematic in weak lensing surveys on small angular scales. In this paper, we investigate ellipticity correlation functions that are measured separately on elliptical and spiral galaxies, for which we assume the generic alignment mechanisms based on tidal shearing and tidal torquing, respectively. Including morphological information allows to find linear combinations of measured ellipticity correlation functions that suppress the gravitational lensing signal completely or which show a strongly boosted gravitational lensing signal relative to intrinsic alignments. Specifically, we find that (i) intrinsic alignment spectra can be measured in a model-independent way at a significance of Σ ≃ 60 with a wide-angle tomographic survey such as Euclid’s, (ii) the underlying intrinsic alignment model parameters can be determined at per cent-level precision, (iii) this measurement is not impeded by misclassifying galaxies and assuming a wrong alignment model, (iv) parameter estimation from a cleaned weak lensing spectrum is possible with almost no bias, and (v) the misclassification would not strongly impact parameter estimation from the boosted weak lensing spectrum.
The Myrosinases TGG1 and TGG2 Function Redundantly in Reactive Carbonyl Species Signaling in Arabidopsis Guard Cells
Authors: Rhaman Mohammad Saidur , Nakamura Toshiyuki , Nakamura Yoshimasa , Munemasa Shintaro , Murata Yoshiyuki
Published: March 2020

Myrosinase (β-thioglucoside glucohydrolase, enzyme nomenclature, EC 3.2.1.147, TGG) is a highly abundant protein in Arabidopsis guard cells, of which TGG1 and TGG2 function redundantly in abscisic acid (ABA)- and methyl jasmonate-induced stomatal closure. Reactive carbonyl species (RCS) are α,β-unsaturated aldehydes and ketones, which function downstream of reactive oxygen species (ROS) production in the ABA signalling pathway in guard cells. Among the RCS, acrolein is the most highly reactive, which is significantly produced in ABA-treated guard cells. To clarify the ABA signal pathway downstream of ROS production, we investigated the responses of tgg mutants (tgg1-3, tgg2-1 and tgg1-3 tgg2-1) to acrolein. Acrolein induced stomatal closure and triggered cytosolic alkalization in wild type (WT), tgg1-3 single mutants and in tgg2-1 single mutants, but not in tgg1-3 tgg2-1 double mutants. Exogenous Ca2+ induced stomatal closure and cytosolic alkalization not only in WT but also in all of the mutants. Acrolein- and Ca2+-induced stomatal closures were inhibited by an intracellular acidifying agent, butyrate, a Ca2+ chelator, ethylene glycol tetraacetic acid (EGTA) and a Ca2+ channel blocker, LaCl3. Acrolein induced cytosolic free calcium concentration ([Ca2+]cyt) elevation in guard cells of WT plants but not in the tgg1-3 tgg2-1 double mutants. Exogenous Ca2+ elicited [Ca2+]cyt elevation in guard cells of WT and tgg1-3 tgg2-1. Our results suggest that TGG1 and TGG2 function redundantly, not between ROS production and RCS production, but downstream of RCS production in the ABA signal pathway in Arabidopsis guard cells.
The contribution of age and obesity to the number of painful joint sites in individuals reporting osteoarthritis: a population-based study
Authors: Badley Elizabeth M , Wilfong Jessica M , Yip Calvin , Millstone Dov B , Perruccio Anthony V
Published: March 2020

Objective

To investigate the association of OA risk factors with number of painful joint sites in a representative population sample.

Methods

Analysis of the 2009 Survey on Living with Chronic Diseases in Canada – Arthritis Component (n = 1614) for respondents reporting symptomatic OA. Variables: painful joints sites (hands, wrists, elbows, shoulders, hips, knees, ankles, feet, back, neck), joint symptom duration, sociodemographic characteristics, smoking, comorbidities and BMI. Zero-truncated negative binomial regressions were used to investigate the association between number of painful joint sites and the variables. Generalizability of findings was assessed by a similar analysis in a clinical hip/knee OA sample.

Results

The sample comprised 73% women and 56% were aged <65 years. The mean number of painful joint sites was 3.8: 84% reported pain at ≥2 sites, and 45% at ≥4 sites. Age, BMI, education and smoking were not associated with the number of joint sites. Significant associations were found with being female [rate ratio (RR) = 1.23, 95% CI 1.09, 1.39], having more comorbidities (RR = 1.11, 95% CI 1.07, 1.15) and longer symptom duration (RR = 1.16, 95% CI 1.09, 1.24), although the increase in joint sites with duration was small. Similar regression results were found with the clinical OA sample.

Conclusion

The lack of an association of age and BMI (obesity) with number of painful joint sites in OA raises questions about the role of these risk factors and our understanding of OA as a multi-joint disease. Filling this knowledge gap is critical to making progress with defining OA phenotypes and identifying potential aetiological mechanisms.
An Emerging Strawberry Fungal Disease Associated with Root Rot, Crown Rot and Leaf Spot Caused by Neopestalotiopsis rosae in Mexico
Authors: Rebollar-Alviter Angel , Silva-Rojas Hilda Victoria , Fuentes-Aragón Dionicio , Acosta-González Uriel , Martínez-Ruiz Merari , Parra-Robles Brenda Estefanía
Published: March 2020

In the 2017 strawberry season, several transplant losses reaching 50% were observed in Zamora, Michoacán Valley, Mexico, due to a new fungal disease associated with root rot, crown rot, and leaf spot. In this year the disease appeared consistently and increased in the following seasons, becoming a concern among strawberry growers. Thus, the aim of this research was to determine the etiology of the disease and to determine the in vitro effect of fungicides on mycelial growth of the pathogen. Fungal isolates were obtained from symptomatic strawberry plants of the cultivars ‘Albion’ and ‘Festival’ and were processed to obtain monoconidial isolates. Detailed morphological analysis was conducted. Concatenated phylogenetic reconstruction was conducted by amplifying and sequencing the translation elongation factor 1 α, β-tubulin partial gene, and the internal transcribed spacer region of rDNA. Pathogenicity tests involving inoculation of leaves and crowns reproduced the same symptoms as those observed in the field, fulfilling Koch’s postulates. Morphology and phylogenetic reconstruction indicated that the causal agent of the described symptoms was Neopestalotiopsis rosae, marking the first report anywhere in the world of this species infecting strawberry. N. rosae was sensitive to cyprodinil + fludioxonil, captan, iprodione, difenoconazole, and prochloraz.
Mobile Phone Contamination in Clinical Environments ‘The True Extent’
Authors: Simmonds Rebecca , Hayhust Emma
Published: March 2020

Smart phones are integral , especially within healthcare. However, there are increasing concerns regarding their contamination and potential infection control risk. Bacteria under selective pressure can rapidly acquire resistant mechanisms leading to the assumption; mobile phones used within clinical environment may harbour bacteria associated with a higher infection mortality rate.

Using next generation sequencing technology, characterise the true extent of bacterial contamination on mobile phones of hospital staff and determine the presence of multi-drug resistant bacteria associated with hospital acquired infections.

DNA was extracted from the swab tips of 450 Particpant’s mobile phones. 16S rRNA primers were used to characterise and compare the microbiome on devices from the hospital staff and a control group. Staphylococcus aureus and Enterococcus faecalis underwent Kirby Baur disc diffusion.

Results The microbiome revealed the extent of contamination far exceeds anything previously reported. In particular, gram-negative bacteria (including several important potential pathogens) were grossly under detected. 198 bacteria genus were discovered on mobile phones of which 34 were unique to the hospital. Differences were also detected between hospital departments. MRSA, VRSA and VRE were only detected within the hospital group.

Our results indicate traditional culture-dependent swabbing methods don’t provide an accurate account of mobile phone contamination. This may also be true in other areas relevant to infection control. Used within clinical environments could expose patients to unknown levels of multi drug resistant bacteria. Decontamination between patient contact should be a necessity to prevent the undermining of hand hygiene and the transmission of MDR bacteria.
Antimicrobial stewardship ward rounds led by junior members of the healthcare team improve patient care
Authors: Hamilton Ashley Ryan , Rogers Benedict
Published: March 2020

Background

Reported Antimicrobial Stewardship (AMS) ward rounds and review initiatives utilise consultant microbiologists or consultant ID physicians with or without senior antimicrobial pharmacists (AMP). There is sparse evidence regarding AMS ward rounds led by more junior members of staff.

Methods

AMS ward rounds were launched on the acute medical unit at Leicester Royal Infirmary, attended by a band 7 AMP and an Infectious Diseases registrar (ST3-5). Patient details and recommendations were recorded for each patient seen and followed-up to determine if recommendations were followed and the impact on treatment duration (TD), length of stay (LOS), and 28-day readmission rate (RR).

Results

104 patient reviews were recorded, of which 87% received at least one recommendation regarding their care (median 2, SD±1.4, Range 0-6), totalling 224 recommendations. Change of antimicrobial was advised for 35 patients (33.7%), whereas stopping antimicrobials was recommended for 18 patients (17.3%). Parenteral to enteral switch was recommended for 12.5% of patients. Although all contributions supported AMS, 41.2% also supported medicines optimisation. An alternative diagnosis was also suggested in 15 patients (14.4%).

All patients were followed-up. Ward clinicians changed treatment in line with recommendations in 70.6% of instances. There was no difference in TD, median LOS was 12-hours shorter for patients whose treatment was changed in line with recommendations, and RR was 9.5% lower for those whose treatment changed in line with recommendations.

Conclusion

Junior staff provide valuable input regarding patient care and optimising antimicrobial therapy. There was a trend towards shorter LOS and reduced RR.
The link between ocular infection with non-chlamydial bacteria and trachomatous eye changes
Authors: Walker-Jacobs Abigail , Derrick Tamsyn , Ramadhani Athumani , Mafuru Elias , Massae Patrick , Malisa Aiweda , Mtuy Tara , Burton Matthew , Holland Martin
Published: March 2020

Introduction Globally, C. trachomatis is the leading infectious cause of blindness. There is evidence to suggest that trachomatous inflammation may be linked to ocular infection with other pathogenic organisms.

Methods Conjunctival swab samples from 472 Tanzanian children who participated in a 4-year longitudinal study were analysed using optimised duplex qPCR assays to assess carriage of H. influenzae, CNS, S. pneumoniae and Adenovirus spp. in each sample. The presence of C. trachomatis (Ct) in the conjunctiva had previously been recorded. Logistic regression analysis, adjusted for age and sex, was performed to identify associations between the prevalence of bacterial infection and (1) progressive scarring trachoma, and (2) active trachoma (defined as the presence of follicular trachoma (TF) or trachomatous inflammation (TI)).

Results Logistic regression identified no significant associations between (1) progressive scarring trachoma and Ct;and (2) progressive scarring trachoma and non-chlamydial bacterial infection. Active trachoma was only associated with conjunctival infection with H. influenzae. Logistic regression found that patients with ocular H. influenzae infection were more likely to demonstrate clinically-graded active trachoma (TF + TI) (OR = 1.96, 95% CI: 1.11 – 3.56, p = 0.023). Individual analyses of TF or TI and their associations with H. influenzae found (1) a strong association between ocular H. influenzae infection and TF (OR = 2.21, p = 0.0095); (2) no association between ocular H. influenzae infection and TI (OR = 2.19, p = 0.19).

Conclusion These results indicate that H. influenzae might contribute to the TF phenotype. TF is widely used to assess population levels of trachoma.
Campylobacter lari associated Prosthetic Joint Infection
Authors: Taynton Thomas , Beard Chris , Hamilton David
Published: March 2020

Campylobacter lariis a rare cause of extraintestinal infection in humans. There has only been one prior case report of prosthetic joint infection in an immunocompetent adult, which was rapidly fatal. We can identify no previous case reports of successful management of this condition.

We discuss our management of a 63 year old stable manager that presented with 1 week history of right prosthetic knee pain and swelling. Following two washouts the patient underwent a first-stage revision of his knee. Post-operative antibiotic choice was empirical, and 28-day outcome has been promising, with complete resolution of inflammatory markers and resolution of symptoms. Outcome following planned second-stage revision will be discussed at FIS 2019.
Investigating the role of the gut microbiome as a trigger for arthritis development in individuals at risk of rheumatoid arthritis
Authors: Rooney Christopher , Mankia Kulveer , Mitra Suparna , Moura Ines , Chilton Caroline , Emery Paul , Wilcox Mark
Published: March 2020

Background:

Rheumatoid arthritis (RA) is now recognised as the end point of a disease continuum. Anti-citrullinated peptide antibodies (ACPA) mark the presence of RA-related systemic autoimmunity, but the production of auto-antibodies alone is not sufficient to develop disease. Data on progression between the stages of RA disease are limited, but accumulating evidence suggests a microbial dysbiosis in the gut may trigger RA development. Using a prospective ‘at-risk’ cohort of ACPA positive individuals without arthritis, we investigated for the presence of a gut dysbiosis before the onset of RA.

Materials/methods:

Faecal samples from 25 ACPA-positive individuals, with non-specific musculoskeletal pain, were sequenced using16S rRNA gene. A control population was selected from publicly available data on the NCBI database, matched for rRNA V4 amplification region, sequencing technique, and approximately for age, gender, diet and ethnicity. Taxonomic analysis was performed using QIIME and MEGAN, and statistical analysis using R software.

Results:

Comparison of the ACPA-positive and control populations shows large clustering at bacterial family level. The ACPA population has an abundance of Lachnospiraceae, Helicobacteraceae, Ruminococcaceae, Erysipelotrichaceae and Bifidobacteriaceae, and a lower abundance of Bacteroidaceae, Barnesiellaceae, Methanobacteriaceae amongst others. The relative abundance of bacterial taxa between the ACPA positive and control population was significantly different (P value 0.01, permutation MANOVA).

Conclusions:

The gut microbiome of individuals ‘at-risk’ of developing RA is distinct from heathy controls. These pilot data can inform further studies, and are an important step in the attribution of causality to the gut microbiome in the development of RA.
Encouraging Day Three Reviews via a Pharmacist-led Antimicrobial Stewardship Ward Round
Authors: Atack Kelly , Olusoga Abimbola , Howard Philip
Published: March 2020

Background

Intravenous antibiotics should be reviewed at day three and a decision made whether to continue, stop, switch to oral or refer to OPAT. Clinicians struggle to undertake this review due to the demands of the daily ward round and patients are inappropriately left on broad spectrum intravenous antibiotics, which can cause harm and increase antimicrobial resistance. A pharmacist-led virtual ward round was initiated to review these patients to decrease the number of patients on broad-spectrum IV antibiotics and support regular review of these.

Methods

Patients on day three or more of intravenous antibiotics were identified using an electronic prescribing report and reviewed using an electronic antimicrobial review tool by a pharmacist on a weekly basis.

Recommendations were made via the tool and added to the patient’s electronic record and then followed up after 24 hours to review the prescription and identify whether advice had been followed.

Results

Over eight weeks, 75 patients had their IV antibiotics reviewed by the pharmacist. 20 recommendations were made to continue, 15 to stop, 33 for IVOS and 10 for OPAT referral. After 24 hours, 80% of patients were continued, 47% were stopped, 61% of patients were switched to oral, and 40% of patients were referred to OPAT as per the recommendations.

Discussion

The pharmacist-led virtual ward round appeared to have a positive impact on the reduction of IV antibiotics being continued after day three. Additionally, reviewing patients virtually allowed for more patients to be reviewed, increasing the impact of the stewardship round.
Missed opportunities for HIV testing in a Scottish Health Board
Authors: Davies Melanie , Kennedy Nicholas , McGoldrick Claire
Published: March 2020

Background

Early diagnosis of HIV allows commencement of combination antiretroviral therapy, reducing morbidity and mortality, as well as transmission. In 2010, 64.3% of new patients diagnosed with HIV in Lanarkshire had missed opportunities for earlier diagnosis, leading to various educational initiatives. Their success in reducing missed opportunities is examined here.

Methods

People who were newly diagnosed with HIV in 2017 were identified. For each person, NHS Lanarkshire hospital records, dating back ten years, were analysed to identify missed opportunities for testing. These were defined as episodes of care with potential HIV indicator conditions (shown in the British HIV Association testing guideline), that did not lead to an HIV test. Comparisons were made to 2010 data.

Results

16 patients who were newly diagnosed with HIV in 2017 were identified. 43.8% (7/16) had missed opportunities for earlier diagnosis compared to 64.3% (9/14) in 2010. One presented with an AIDS-defining illness, compared with 3 in 2010. Blood dyscrasia was the most common clinical indicator that failed to prompt testing, although other commonly missed indicators were pneumonia and mononucleosis-like syndrome.

Conclusion

Educational initiatives are effective in improving appropriate HIV testing, however are not enough in isolation. Quality improvement strategies to increase testing, that are applicable to any Health Board/Trust, are currently being used. These include engagement with haematologists to provide testing prompts in reports, and opt-out testing in presumed high-prevalence clinical areas.