bluuebunny/crossref_metadata_2025 huggingface dataset:
Straight from the Horse’s “Mouth”: Genomic Epidemiology of an Icelandic Equine Epidemic
Authors: Davies Mark R.
Published: October 2017

Despite tight biosecurity measures, an outbreak of respiratory disease rapidly spread across the Icelandic equine population in 2010. Horse transportation was brought to a halt in order to contain the spread of the infectious agent. In a recent article, Björnsdóttir and colleagues (S. Björnsdóttir et al., mBio 8:e00826-17, 2017,
https://doi.org/10.1128/mBio.00826-17
) employ the power and resolution of “genomic epidemiology,” the combination of whole genomic sequencing and epidemiological approaches, to examine the source and spread of the outbreak. Intriguingly, the outbreak was not viral in origin, but linked to a bacterial “commensal”
Streptococcus equi
subsp.
zooepidemicus
infection. A national sampling strategy coupled with population genomics revealed that the outbreak was most likely driven by a
S. equi
subsp.
zooepidemicus
sequence type 209 (ST209) infection that spread nationally from a single source. This retrospective study demonstrates the power of genomics applied on a national scale to unravel the cause of a significant biosecurity threat.
Extensive Core Microbiome in Drone-Captured Whale Blow Supports a Framework for Health Monitoring
Authors: Apprill Amy , Miller Carolyn A. , Moore Michael J. , Durban John W. , Fearnbach Holly , Barrett-Lennard Lance G.
Published: October 2017

The conservation and management of large whales rely in part upon health monitoring of individuals and populations, and methods generally necessitate invasive sampling. Here, we used a small, unmanned hexacopter drone to noninvasively fly above humpback whales from two populations, capture their exhaled breath (blow), and examine the associated microbiome. In the first extensive examination of the large-whale blow microbiome, we present surprising results about the discovery of a large core microbiome that was shared across individual whales from geographically separated populations in two ocean basins. We suggest that this core microbiome, in addition to other microbiome characteristics, could be a useful feature for health monitoring of large whales worldwide.
High-sensitivity C reactive protein as a predictor of inhospital mortality in patients with cardiovascular disease at an emergency department: a retrospective cohort study
Authors: Yoshinaga Ryo , Doi Yasufumi , Ayukawa Katsuhiko , Ishikawa Shizukiyo
Published: October 2017

Objective

We investigated whether serum high-sensitivity C reactive protein (hs-CRP) levels measured in an emergency department (ED) are associated with inhospital mortality in patients with cardiovascular disease (CVD).

Design

A retrospective cohort study.

Setting

ED of a teaching hospital in Japan.

Participants

12 211 patients with CVD aged ≥18 years who presented to the ED by an ambulance between 1 February 2006 and 30 September 2014 were evaluated.

Main outcome measures

Inhospital mortality.

Results

1156 patients had died. The inhospital mortality increased significantly with the hs-CRP levels (<3.0 mg/L: 7.0%, 95% CI 6.4 to 7.6; 3.1–5.4 mg/L: 9.6%, 95% CI 7.9 to 11.3: 5.5–11.5 mg/L: 11.2%, 95% CI 9.4 to 13.0; 11.6–33.2 mg/L: 12.3%, 95% CI 10.5 to 14.1 and ≥33.3 mg/L: 19.9%, 95% CI 17.6 to 22.2). The age-adjusted and sex-adjusted HR for total mortality was increased significantly in the three ≥5.5 mg/L groups compared with the <3.0 mg/L group (5.5–11.5 mg/L: HR=1.32, 95% CI 1.09 to 1.60, p=0.005; 11.6–33.2 mg/L: HR=1.38, 95% CI 1.14 to 1.65, p=0.001 and ≥33.3 mg/L: HR=2.15, 95% CI 1.84 to 2.51, p<0.001). Similar findings were observed for the CVD subtypes of acute myocardial infarction, heart failure, cerebral infarction and intracerebral haemorrhage. This association remained unchanged even after adjustment for age, sex and white cell count and withstood Bonferroni adjustment for multiple testing. When the causes of death were divided into primary CVD and non-CVD deaths, the association between initial hs-CRP levels and mortality remained significant, but the influence of hs-CRP levels was greater in non-CVD deaths than CVD deaths. The percentage of non-CVD deaths increased with hs-CRP levels; among the patients with hs-CRP levels ≥33.3 mg/L, non-CVD deaths accounted for 37.5% of total deaths.

Conclusion

Our findings suggest that increased hs-CRP is a significant risk factor for inhospital mortality among patients with CVD in an ED. Particular attention should be given to our finding that non-CVD death is a major cause of death among patients with CVD with higher hs-CRP levels.
Loneliness and depression among rural empty-nest elderly adults in Liuyang, China: a cross-sectional study
Authors: Wang Guojun , Hu Mi , Xiao Shui-yuan , Zhou Liang
Published: October 2017

Objective

To compare loneliness, depressive symptoms and major depressive episodes between empty-nest and not-empty-nest older adults in rural areas of Liuyang city, Hunan, China.

Methods

A cross-sectional multi-stage random cluster survey was conducted from November 2011 to April 2012 in Liuyang, China. A total of 839 rural older residents aged 60 or above completed the survey (response rate 97.6%). In line with the definition of empty nest, 25 participants who had no children were excluded from the study, while the remaining 814 elderly adults with at least one child were included for analysis. Loneliness and depressive symptoms in rural elderly parents were assessed using the short-form UCLA Loneliness Scale (ULS-6) and the Geriatric Depression Scale (GDS). Major depressive episodes were diagnosed using the Structured Clinical Interview for DSM-IV (SCID-I).

Results

Significant differences were found between empty-nest and not-empty-nest older adults regarding loneliness (16.19±3.90 vs. 12.87±3.02, Cohen’s d=0.97), depressive symptoms (8.50±6.26 vs. 6.92±5.19, Cohen’s d=0.28) and the prevalence of major depressive episodes (10.1% vs. 4.6%) (all p<0.05). After controlling for demographic characteristics and physical disease, the differences in loneliness, depressive symptoms and major depressive episodes remained significant. Path analysis showed that loneliness mediated the relationship between empty-nest syndrome and depressive symptoms and major depressive episodes.

Conclusion

Loneliness and depression are more severe among empty-nest than not-empty-nest rural elderly adults. Loneliness was a mediating variable between empty-nest syndrome and depression.
The prognostic significance of smoking cessation after acute coronary syndromes: an observational, multicentre study from the Melbourne interventional group registry
Authors: Yudi Matias B , Farouque Omar , Andrianopoulos Nick , Ajani Andrew E , Kalten Katie , Brennan Angela L , Lefkovits Jeffrey , Hiew Chin , Oqueli Ernesto , Reid Christopher M , Duffy Stephen J , Clark David J
Published: October 2017

Objective

We aim to ascertain the prognostic significance of persistent smoking and smoking cessation after an acute coronary syndrome (ACS) in the era of percutaneous coronary intervention (PCI) and optimal secondary prevention pharmacotherapy.

Methods

Consecutive patients from the Melbourne Interventional Group registry (2005–2013) who were alive at 30 days post-ACS presentation were included in our observational cohort study. Patients were divided into four categories based on their smoking status: non-smoker; ex-smoker (quit >1 month before ACS); recent quitter (smoker at presentation but quit by 30 days) and persistent smoker (smoker at presentation and at 30 days). The primary endpoint was survival ascertained through the Australian National Death Index linkage. A Cox-proportional hazards model was used to estimate the adjusted HR and 95% CI for survival.

Results

Of the 9375 patients included, 2728 (29.1%) never smoked, 3712 (39.6%) were ex-smokers, 1612 (17.2%) were recent quitters and 1323 (14.1%) were persistent smokers. Cox-proportional hazard modelling revealed, compared with those who had never smoked, that persistent smoking (HR 1.78, 95% CI 1.36 to 2.32, p<0.001) was an independent predictor of increased hazard (mean follow-up 3.9±2.2 years) while being a recent quitter (HR 1.27, 95% CI 0.96 to 1.68, p=0.10) or an ex-smoker (HR 1.03, 95% CI 0.87 to 1.22, p=0.72) were not.

Conclusions

In a contemporary cohort of patients with ACS, those who continued to smoke had an 80% risk of lower survival while those who quit had comparable survival to lifelong non-smokers. This underscores the importance of smoking cessation in secondary prevention despite the improvement in management of ACS with PCI and pharmacotherapy.
Assessment of the effects of decision aids about breast cancer screening: a systematic review and meta-analysis
Authors: Martínez-Alonso Montserrat , Carles-Lavila Misericòrdia , Pérez-Lacasta Maria José , Pons-Rodríguez Anna , Garcia Montse , Rué Montserrat
Published: October 2017

Objective

The aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) and observational studies is to assess the effect of decision aids (DAs) in women aged 50 and below facing the decision to be screened for breast cancer.

Setting

Screening for breast cancer.

Intervention

DAs aimed to help women make a deliberative choice regarding participation in mammography screening by providing information on the options and outcomes.

Eligible studies

We included published original, non-pilot, studies that assess the effect of DAs for breast cancer screening. We excluded the studies that evaluated only participation intention or actual uptake. The studies’ risk of bias was assessed with the Cochrane Collaboration’s tool for RCTs and the National Institutes of Health Quality Assessment Tool for non-RCTs.

Primary and secondary outcomes

The main outcome measures were informed choice, decisional conflict and/or confidence, and knowledge. Secondary outcomes were values, attitudes, uncertainty and intention to be screened.

Results

A total of 607 studies were identified, but only 3 RCTs and 1 before-after study were selected. The use of DAs increased the proportion of women making an informed decision by 14%, 95% CI (2% to 27%) and the proportion of women with adequate knowledge by 12%, 95% CI (7% to 16%). We observed heterogeneity among the studies in confidence in the decision. The meta-analysis of the RCTs showed a significant decrease in confidence in the decision and in intention to be screened.

Conclusions

Tools to aid decision making in screening for breast cancer improve knowledge and promote informed decision; however, we found divergent results on decisional conflict and confidence in the decision. Under the current paradigm change, which favours informed choice rather than maximising uptake, more research is necessary for the improvement of DAs.
Fabry disease due to D313Y and novel GLA mutations
Authors: Koulousios Konstantinos , Stylianou Konstantinos , Pateinakis Panagiotis , Zamanakou Maria , Loules Gedeon , Manou Eleni , Kyriklidou Parthena , Katsinas Christos , Ouzouni Alexandra , Kyriazis John , Speletas Matthaios , Germenis Anastasios E
Published: October 2017

Objectives

Our aim is to report four novel α-gal A gene (GLA) mutations resulting in Fabry disease (FD) and provide evidence of pathogenicity of the D313Y mutation regarding which contradictory data have been presented in the literature.

Setting and participants

Twenty-five family members of nine unrelated patients with definite FD diagnosis, 10 clinically suspected cases and 18 members of their families were included in this polycentric cohort study.

Primary and secondary outcome measures

Genotyping and measurement of lyso-Gb3was performed in all individuals. The α-Gal A activity was measured in all men as well as plasma and urine Gb3concentration in selected cases. Optical and electron microscopy was performed in kidney biopsies of selected patients. All the above were evaluated in parallel with the clinical data of the patients.

Results

Fourteen new cases of FD were recognised, four of which were carrying already describedGLAmutations. Four novelGLAmutations, namely c.835C>T, c.280T>A, c.924A>C and c.511G>A, resulting in a classic FD phenotype were identified. Moreover, FD was definitely diagnosed in five patients carrying the D313Y mutation. Eight D313Y carriers were presenting signs of FD despite not fulfilling the criteria of the disease, two had no FD signs and two others were apparently healthy.

Conclusions

Four novelGLApathogenic mutations are reported and evidence of pathogenicity of the D313Y mutation is provided. It seems that the D313Y mutation is related to a later-onset milder phenotype than the typical phenotype with normal lysoGb3concentration. Our study underlines the significance of family member genotyping and newborn screening to avoid misdiagnoses and crucial delays in diagnosis and treatment of the disease.
Hypothermic oxygenated machine perfusion (HOPE) for orthotopic liver transplantation of human liver allografts from extended criteria donors (ECD) in donation after brain death (DBD): a prospective multicentre randomised controlled trial (HOPE ECD-DBD)
Authors: Czigany Zoltan , Schöning Wenzel , Ulmer Tom Florian , Bednarsch Jan , Amygdalos Iakovos , Cramer Thorsten , Rogiers Xavier , Popescu Irinel , Botea Florin , Froněk Jiří , Kroy Daniela , Koch Alexander , Tacke Frank , Trautwein Christian , Tolba Rene H , Hein Marc , Koek Ger H , Dejong Cornelis H C , Neumann Ulf Peter , Lurje Georg
Published: October 2017

Introduction

Orthotopic liver transplantation (OLT) has emerged as the mainstay of treatment for end-stage liver disease. In an attempt to improve the availability of donor allografts and reduce waiting list mortality, graft acceptance criteria were extended increasingly over the decades. The use of extended criteria donor (ECD) allografts is associated with a higher incidence of primary graft non-function and/or delayed graft function. As such, several strategies have been developed aiming at reconditioning poor quality ECD liver allografts. Hypothermic oxygenated machine perfusion (HOPE) has been successfully tested in preclinical experiments and in few clinical series of donation after cardiac death OLT.

Methods and analysis

HOPE ECD-DBD is an investigator-initiated, open-label, phase-II, prospective multicentre randomised controlled trial on the effects of HOPE on ECD allografts in donation after brain death (DBD) OLT. Human whole organ liver grafts will be submitted to 1–2 hours of HOPE (n=23) via the portal vein before implantation and are going to be compared with a control group (n=23) of patients transplanted after conventional cold storage. Primary (peak and Δ peak alanine aminotransferase within 7 days) and secondary (aspartate aminotransferase, bilirubin and international normalised ratio, postoperative complications, early allograft dysfunction, duration of hospital and intensive care unit stay, 1-year patient and graft survival) endpoints will be analysed within a 12-month follow-up. Extent of ischaemia–reperfusion (I/R) injury will be assessed using liver tissue, perfusate, bile and serum samples taken during the perioperative phase of OLT.

Ethics and dissemination

The study was approved by the institutional review board of the RWTH Aachen University, Aachen, Germany (EK 049/17). The current paper represent the pre-results phase. First results are expected in 2018.

Trial registration number

NCT03124641.
Effects of family planning factors on the awareness of sexual and reproductive healthcare rights among married women of reproductive age in China: a cross sectional study
Authors: Junqing Wu , Chuanning Yu , Yuyan Li
Published: October 2017

Objectives

Although family planning in China has changed gradually since 1994, there are few studies about family planning and women’s reproductive rights. The main objective of this study was to examine awareness of sexual and reproductive healthcare rights (SRHCRs), and learn how factors related to family planning influence awareness of SRHCRs among married women of reproductive age in China.

Methods and participants

Inner Mongolia, Chongqing, Guangdong and Henan were selected for the study, and a total of 2504 married women of reproductive age were recruited. A self-administered anonymous questionnaire was used to collect information on participants’ awareness of SRHCRs.

Results

There were a total of 10 843 (≤6×2504) responses, with a response rate of 72.17% (10 843/15 024) on average among participants regarding SRHCRs (a multiple response set). The highest response rate was for choice (Right 3) (90.64%, 95% CI 89.47%, 91.81%), followed by privacy (Right 5) (86.11%, 95% CI 84.72%, 87.50%) and information (Right 1) (84.47%, 95% CI 83.02%, 85.93%). Only 43.39% (95% CI 41.40%, 45.38%) of participants gave responses to safety (Right 4). Participants without children showed more interest in Right 1, in access (Right 2) and in Right 4. Those who utilised tests for fetal sex determination paid more attention to Rights 2 and 4. Women who accepted informed choice were more likely to be aware of all six rights except for Right 3 and dignity (Right 6). Those individuals who were satisfied or very satisfied with comprehensive sexual and reproductive health counselling services were more likely to show interest in all six rights.

Conclusions

Awareness of SRHCRs among reproductive aged women in China is still inadequate. Family planning service providers might strengthen the service awareness of sex and reproductive health rights according to the different needs of women.
Search for unpublished data by systematic reviewers: an audit
Authors: Ziai Hedyeh , Zhang Rujun , Chan An-Wen , Persaud Nav
Published: October 2017

Objectives

We audited a selection of systematic reviews published in 2013 and reported on the proportion of reviews that researched for unpublished data, included unpublished data in analysis and assessed for publication bias.

Design

Audit of systematic reviews.

Data sources

We searched PubMed and Ovid MEDLINE In-Process & Other Non-Indexed Citations between 1 January 2013 and 31 December 2013 for the following journals:Journal of the American Medical Association,The British Medical Journal,Lancet,Annals of Internal Medicineand theCochrane Database of Systematic Reviews. We also searched the Cochrane Library and included 100 randomly selected Cochrane reviews.

Eligibility criteria

Systematic reviews published in 2013 in the selected journals were included. Methodological reviews were excluded.

Data extraction and synthesis

Two reviewers independently reviewed each included systematic review. The following data were extracted: whether the review searched for grey literature or unpublished data, the sources searched, whether unpublished data were included in analysis, whether publication bias was assessed and whether there was evidence of publication bias.

Main findings

203 reviews were included for analysis. 36% (73/203) of studies did not describe any attempt to obtain unpublished studies or to search grey literature. 89% (116/130) of studies that sought unpublished data found them. 33% (68/203) of studies included an assessment of publication bias, and 40% (27/68) of these found evidence of publication bias.

Conclusion

A significant fraction of systematic reviews included in our study did not search for unpublished data. Publication bias may be present in almost half the published systematic reviews that assessed for it. Exclusion of unpublished data may lead to biased estimates of efficacy or safety in systematic reviews.
Neurological outcome after minimal invasive coronary artery surgery (NOMICS): protocol for an observational prospective cohort study
Authors: Nijs Kristof , Vandenbrande Jeroen , Vaqueriza Fidel , Ory Jean-Paul , Yilmaz Alaaddin , Starinieri Pascal , Dubois Jasperina , Jamaer Luc , Arijs Ingrid , Stessel Björn
Published: October 2017

Introduction

Adverse neurocognitive outcomes are still an important cause of morbidity and mortality after cardiac surgery. The most common neurocognitive disorders after conventional cardiac surgery are postoperative cognitive dysfunction (POCD), stroke and delirium. Minimal invasive cardiac procedures have recently been introduced into practice. Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimal invasive cardiac procedure based on the conventional CABG procedure. Neurocognitive outcome after minimal invasive cardiac surgery, including Endo-CABG, has never been studied. Therefore, the main objective of this study is to examine neurocognitive outcome after Endo-CABG.

Methods and analysis

We will perform a prospective observational cohort study including 150 patients. Patients are categorised into three groups: (1) patients undergoing Endo-CABG, (2) patients undergoing a percutaneous coronary intervention and (3) a healthy volunteer group. All patients in the Endo-CABG group will be treated following a uniform, standardised protocol. To assess neurocognitive outcome after surgery, a battery of six neurocognitive tests will be administered at baseline and at 3-month follow-up. In the Endo-CABG group, a neurological examination will be performed at baseline and postoperatively and delirium will be scored at the intensive care unit. Quality of life (QOL), anxiety and depression will be assessed at baseline and at 3-month follow-up. Satisfaction with Endo-CABG will be assessed at 3-month follow-up. Primary endpoints are the incidence of POCD, stroke and delirium after Endo-CABG. Secondary endpoints are QOL after Endo-CABG, patient satisfaction with Endo-CABG and the incidence of anxiety and depression after Endo-CABG.

Ethics and dissemination

The neurological outcome after minimal invasive coronary artery surgery study has received approval of the Jessa Hospital ethics board. It is estimated that the trial will be executed from December 2016 to January 2018, including enrolment and follow-up. Analysis of data, followed by publication of the results, is expected in 2018.

Trial registration number

NCT02979782.
Longer-term needs of stroke survivors with communication difficulties living in the community: a systematic review and thematic synthesis of qualitative studies
Authors: Wray Faye , Clarke David
Published: October 2017

Objective

To review and synthesise qualitative literature relating to the longer-term needs of community dwelling stroke survivors with communication difficulties including aphasia, dysarthria and apraxia of speech.

Design

Systematic review and thematic synthesis.

Method

We included studies employing qualitative methodology which focused on the perceived or expressed needs, views or experiences of stroke survivors with communication difficulties in relation to the day-to-day management of their condition following hospital discharge. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, The Cochrane Library, International Bibliography of the Social Sciences and AMED and undertook grey literature searches. Studies were assessed for methodological quality by two researchers independently and the findings were combined using thematic synthesis.

Results

Thirty-two studies were included in the thematic synthesis. The synthesis reveals the ongoing difficulties stroke survivors can experience in coming to terms with the loss of communication and in adapting to life with a communication difficulty. While some were able to adjust, others struggled to maintain their social networks and to participate in activities which were meaningful to them. The challenges experienced by stroke survivors with communication difficulties persisted for many years poststroke. Four themes relating to longer-term need were developed: managing communication outside of the home, creating a meaningful role, creating or maintaining a support network and taking control and actively moving forward with life.

Conclusions

Understanding the experiences of stroke survivors with communication difficulties is vital for ensuring that longer-term care is designed according to their needs. Wider psychosocial factors must be considered in the rehabilitation of people with poststroke communication difficulties. Self-management interventions may be appropriate to help this subgroup of stroke survivors manage their condition in the longer-term; however, such approaches must be designed to help survivors to manage the unique psychosocial consequences of poststroke communication difficulties.
Prospective Investigation of Pesticide Applicators’ Health (PIPAH) study: a cohort study of professional pesticide users in Great Britain
Authors: Harding Anne-Helen , Fox David , Chen Yiqun , Pearce Neil , Fishwick David , Frost Gillian
Published: October 2017

Purpose

The purpose of the study is to monitor the exposure and health of workers in Great Britain who use pesticides as a part of their job, and to gain a better understanding of the relationship between long-term exposure to pesticides and health.

Participants

Study participants are professional pesticide users who are certified in the safe use of pesticides or who were born before 1965 and apply pesticides under ‘grandfather rights’. Overall response rate was 20%; participants are mostly male (98%) and the average age is 54 years, ranging from 17 to over 80 years.

Findings to date

Participants have completed a baseline general questionnaire and three follow-up questionnaires on the use of pesticides. These data will enable investigations into the relationship between occupational pesticide exposure and health outcomes taking into account non-occupational confounding factors.

Future plans

There is no set end date for data collection. Recruitment into the cohort will continue, and for the foreseeable future there will be annual pesticide use questionnaires and five yearly follow-up general questionnaires.

The intention is to validate the pesticide use questionnaire, and to develop a crop/job exposure matrix (C/JEM) which can be updated regularly. This C/JEM will be able to look at general categories of pesticide, such as insecticides, structurally related pesticides, such as organochlorines, or individual active ingredients. Data collected on use of personal protective equipment and method of application will provide information on how potential exposure to pesticide during application may have been modified. The study will be able to estimate changes in individual pesticide use over time, and to examine the associations between pesticide use and both baseline and long-term health outcomes.

The cohort members will be linked to national databases for notification of hospital episode statistics, cancer incidence and mortality for follow-up of health outcomes.
Impact of an inpatient electronic prescribing system on prescribing error causation: a qualitative evaluation in an English hospital
Authors: Puaar Seetal Jheeta , Franklin Bryony Dean
Published: October 2017

Background

Few studies have applied a systems approach to understanding the causes of specific prescribing errors in the context of hospital electronic prescribing (EP). A comprehensive understanding of underlying causes is essential for developing effective interventions to improve prescribing safety. Our objectives were to explore prescribers’ perspectives of the causes of errors occurring with EP and to make recommendations to maximise benefits and minimise risks.

Methods

We studied a large hospital using inpatient EP. From April to June 2016, semistructured interviews were conducted with purposively sampled prescribers involved with a prescribing error. Interviews explored prescribers’ perceived causes of the error and views about EP; they were audio-recorded and transcribed verbatim. Data were thematically analysed against a framework based on Reason’s accident causation model, with a focus on identifying latent conditions.

Results

Twenty-five interviews explored causes of 32 errors. Slips and rule-based mistakes were the most common active failures. Error causation was multifactorial; environmental, individual, team, task and technology error-producing conditions were all influenced by EP. There were three broad groups of latent conditions: the EP system’s functionality and design; the organisation’s decisions around EP implementation and use; and prescribing behaviours in the context of EP.

Conclusions

Errors were associated with the design of EP itself and its integration within the healthcare environment. Findings suggest that EP vendors should focus on revolutionising interface design and usability issues, bearing in mind the wider healthcare context in which such software is used. Healthcare organisations should draw upon human factors principles when implementing EP. Consideration of work environment, infrastructure, training, prescribing responsibilities and behaviours should be considered to address local issues identified.
Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis
Authors: Bahin Farzan F , Heitman Steven J , Rasouli Khalid N , Mahajan Hema , McLeod Duncan , Lee Eric Y T , Williams Stephen J , Bourke Michael J
Published: October 2017

Objective

To compare the cost-effectiveness of endoscopic submucosal dissection (ESD) and wide-field endoscopic mucosal resection (WF-EMR) for removing large sessile and laterally spreading colorectal lesions (LSLs) >20 mm.

Design

An incremental cost-effectiveness analysis using a decision tree model was performed over an 18-month time horizon. The following strategies were compared: WF-EMR, universal ESD (U-ESD) and selective ESD (S-ESD) for lesions highly suspicious for containing submucosal invasive cancer (SMIC), with WF-EMR used for the remainder. Data from a large Western cohort and the literature were used to inform the model. Effectiveness was defined as the number of surgeries avoided per 1000 cases. Incremental costs per surgery avoided are presented. Sensitivity and scenario analyses were performed.

Results

1723 lesions among 1765 patients were analysed. The prevalence of SMIC and low-risk-SMIC was 8.2% and 3.1%, respectively. Endoscopic lesion assessment for SMIC had a sensitivity and specificity of 34.9% and 98.4%, respectively. S-ESD was the least expensive strategy and was also more effective than WF-EMR by preventing 19 additional surgeries per 1000 cases. 43 ESD procedures would be required in an S-ESD strategy. U-ESD would prevent another 13 surgeries compared with S-ESD, at an incremental cost per surgery avoided of US$210 112. U-ESD was only cost-effective among higher risk rectal lesions.

Conclusion

S-ESD is the preferred treatment strategy. However, only 43 ESDs are required per 1000 LSLs. U-ESD cannot be justified beyond high-risk rectal lesions. WF-EMR remains an effective and safe treatment option for most LSLs.

Trial registration number

NCT02000141.
Firearms training: what is actually taught?
Authors: Hemenway David , Rausher Steven , Violano Pina , Raybould Toby A , Barber Catherine W
Published: October 2017

Introduction

Firearm safety instructors and public health professionals are natural allies in the quest to prevent firearm injuries. We audited basic firearm classes to provide information that can help familiarise public health professionals and others with the content covered.

Methods

With the advice of expert instructors, we created an audit form. Volunteers audited 20 basic firearm classes in seven north-eastern states.

Results

All trainers covered a wide variety of safety issues. Some specific basics were covered in 90+% of the classes, including how to safely load/unload a gun, keeping your finger off the trigger until ready to shoot, and being aware of your target and what is behind it. In 50%–75% of the classes, the trainer covered topics such as operating a safety, clearing jams and cartridge malfunctions, and recommended storing guns unloaded and locked when not in use. Few instructors covered firearm suicide prevention (10%) or domestic violence (10%). Most encouraged gun ownership, gun carrying, gun use in self-defence and membership in a gun rights group.

Discussion

From a public health standpoint, we would like to see more instructors covering topics such as firearm suicide and alternatives to gun use in self-defence, and to recommend safer storage of firearms.
A systematic review of interventions to foster physician resilience
Authors: Fox Susan , Lydon Sinéad , Byrne Dara , Madden Caoimhe , Connolly Fergal , O’Connor Paul
Published: October 2017

This review aimed to synthesise the literature describing interventions to improve resilience among physicians, to evaluate the quality of this research and to outline the type and efficacy of interventions implemented. Searches were conducted in April 2017 using five electronic databases. Reference lists of included studies and existing review papers were screened. English language, peer-reviewed studies evaluating interventions to improve physician resilience were included. Data were extracted on setting, design, participant and intervention characteristics and outcomes. Methodological quality was assessed using the Downs and Black checklist. Twenty-two studies were included. Methodological quality was low to moderate. The most frequently employed interventional strategies were psychosocial skills training and mindfulness training. Effect sizes were heterogeneous. Methodologically rigorous research is required to establish best practice in improving resilience among physicians and to better consider how healthcare settings should be considered within interventions.
Spatially overlapping episodes of deformation, metamorphism, and magmatism in the southern Omineca Belt, southeastern British Columbia
Authors: Webster Ewan Russell , Pattison David R.M.
Published: October 2017

The southeastern Omineca Belt of the Canadian Cordillera preserves a record of overlapping Barrovian and Buchan metamorphism spanning 180–50 Ma. This paper documents the timing, character, and spatial relationships that define separate domains of Middle Jurassic, Early Cretaceous, and Late Cretaceous deformation and metamorphism, and the nature of the geological interfaces that exist between them. A domain of Early Jurassic deformation (D1) and regional greenschist-facies metamorphism (M1) is cross-cut by Middle Jurassic (174–161 Ma) intrusions. Associated contact aureoles are divided into lower pressure (cordierite-dominated; ∼2.5–3.3 kbar; 1 kbar = 100 MPa) and higher pressure (staurolite-bearing; 3.5–4.2 kbar) subtypes; contact metamorphic kyanite occurs rarely in some staurolite-bearing aureoles. Jurassic structures are progressively overprinted northwards by Early Cretaceous deformation and metamorphism (D2M2), manifested in a tightening of Jurassic structures, development of more pervasive ductile fabrics, and Barrovian metamorphism. The D2M2 domain is the southerly continuation of the 600 km long Selkirk–Monashee–Cariboo metamorphic belt. Mid-Cretaceous intrusions (118–90 Ma) were emplaced throughout the D2M2 domain, the earliest of which contain D2 fabrics, but cut M2 isograds. The D2M2 domain makes a continuous, southeasterly transition into a domain of Late Cretaceous regional Barrovian metamorphism and deformation (D3M3; 94–76 Ma). The interface between these two domains is obscured by the coaxial nature of the deformation and the apparent continuity of the metamorphic zones, resulting in a complex and cryptic interface. Similarities between the D3M3 domain and the Selkirk Crest of Idaho and Washington suggest that this domain is the northerly continuation of the northward-plunging Priest River Complex.
Syk inhibitor R406 downregulates inflammation in an in vitro model ofPseudomonas aeruginosainfection
Authors: Alhazmi Alaa , Choi Joshua , Ulanova Marina
Published: October 2017

As Pseudomonas aeruginosa infections are characterized by strong inflammation of infected tissues, anti-inflammatory therapies in combination with antibiotics have been considered for the treatment of associated diseases. Syk tyrosine kinase is an important regulator of inflammatory responses, and its specific inhibition was explored as a therapeutic option in several inflammatory conditions; however, this has not been studied in bacterial infections. We used a model of in vitro infection of human monocytic cell line THP-1 and lung epithelial cell line H292 with both wild-type and flagella-deficient mutant of P. aeruginosa strain K, as well as with clinical isolates from cystic fibrosis patients, to study the effect of a small molecule Syk inhibitor R406 on inflammatory responses induced by this pathogen. One-hour pretreatment of THP-1 cells with 10 μmol/L R406 resulted in a significant downregulation of the expression of the adhesion molecule ICAM-1, pro-inflammatory cytokines TNF-α and IL-1β, and phosphorylated signaling proteins ERK2, JNK, p-38, and IκBα, as well as significantly decreased TNF-α release by infected H292 cells. The results suggest that Syk is involved in the regulation of inflammatory responses to P. aeruginosa, and R406 may potentially be useful in dampening the damage caused by severe inflammation associated with this infection.
Exploring the diet of arctic wolves (Canislupusarctos) at their northern range limit
Authors: Dalerum F. , Freire S. , Angerbjörn A. , Lecomte N. , Lindgren Å. , Meijer T. , Pečnerová P. , Dalén L.
Published: October 2017

The grey wolf (Canis lupus Linnaeus, 1758) is one of the most widespread large carnivores on Earth, and occurs throughout the Arctic. Although wolf diet is well studied, we have scant information from high Arctic areas. Global warming is expected to increase the importance of predation for ecosystem regulation in Arctic environments. To improve our ability to manage Arctic ecosystems under environmental change, we therefore need knowledge about Arctic predator diets. Prey remains in 54 wolf scats collected at three sites in the high Arctic region surrounding the Hall Basin (Judge Daly Promontory, Ellesmere Island, Canada, and Washington Land and Hall Land, both in northwestern Greenland) pointed to a dietary importance of arctic hare (Lepus arcticus Ross, 1819; 55% frequency of occurrence) and muskoxen (Ovibos moschatus (Zimmermann, 1780); 39% frequency of occurrence), although we observed diet variation among the sites. A literature compilation suggested that arctic wolves (Canis lupus arctos Pocock, 1935) preferentially feed on caribou (Rangifer tarandus (Linnaeus, 1758)) and muskoxen, but can sustain themselves on arctic hares and Greenland collared lemmings (Dicrostonyx groenlandicus (Traill, 1823)) in areas with limited or no ungulate populations. We suggest that climate change may alter the dynamics among wolves, arctic hare, muskoxen, and caribou, and we encourage further studies evaluating how climate change influences predator–prey interactions in high Arctic environments.
Dispersion relations and wave propagation in photonic hypercrystals
Authors: Ali Munazza Zulfiqar
Published: October 2017

A photonic hypercrystal is a subwavelength periodic structure consisting of alternate layers of hyperbolic metamaterial and dielectric material. The structure can be treated as an effective medium as well as a periodic medium. Since two length scales are involved, the better treatment is to treat the hyperbolic metamaterial as an effective medium and the overall structure as a periodic medium. The dispersion relations are derived and plotted to show the appearance of propagating bands and gaps in the frequency and wave vector domains. Then using the transfer matrix approach, the transmissivity versus the frequency plot for propagating waves and grayscale plot of the transmission coefficient in the frequency versus wave vector plane for the evanescent waves are plotted and analyzed.
Dynamic Analysis of an Integrated Train–Bridge–Foundation–Soil System by the Substructure Method
Authors: Qiao Hong , Xia He , Du Xianting
Published: October 2017

The substructure method is applied to the dynamic analysis of a train–bridge system considering the soil–structure interaction. With this method, the integrated train–bridge–foundation–soil system is divided into the train–bridge subsystem and the soil–foundation subsystem. Further, the train–bridge subsystem is divided into the train and bridge components. The frequency-dependent impedance function of the soil–foundation subsystem is transformed into time domain by rational approximation and simulated by a high-order lumped-parameter model with masses. The equations of motion of the train and bridge components are established by the rigid-body dynamics method and the modal superposition method, respectively. Finally, the dynamic responses of the two subsystems are obtained by iterative procedures, with the influence of the soil shear velocity studied. The case study reveals that it is important to consider the effect of soil–foundation interaction in the dynamic analysis of train–bridge systems, but with the increase of the shear velocity of the soil, such influence becomes weaker.
Passive Winglet Control of Flutter and Buffeting Responses of Suspension Bridges
Authors: Phan Duc-Huynh
Published: October 2017

The passive control using winglets has been considered to be an alternative solution for control of flutter and buffeting responses of long suspension bridges. This method is aimed at not only developing lightweight, reduced-cost stiffening girders without adding stiffness for aerodynamic stability, but also avoiding problems from malfunctions caused by the control and energy supply systems of active control devices by winglets. This paper presented a mechanically controlled approach using the winglets, for which a two-dimensional bridge deck model was numerically and experimentally studied. In addition, numerical research on the flutter and buffeting passive control of a 3000[Formula: see text]m span suspension bridge was carried out. The result showed that the flutter speed of the suspension bridge increases, whereas the buffeting response decreases, through the implementation of the winglets.
AUTOMATED DETECTION OF ATRIAL FIBRILLATION ECG SIGNALS USING TWO STAGE VMD AND ATRIAL FIBRILLATION DIAGNOSIS INDEX
Authors: TRIPATHY R. K. , PATERNINA MARIO R. ARRIETA , ARRIETA JUAN G. , PATTANAIK P.
Published: October 2017

Atrial fibrillation (AF) is a common atrial arrhythmia occurring in clinical practice and can be diagnosed using electrocardiogram (ECG) signal. The conventional diagnostic features of ECG signal are not enough to quantify the pathological variations during AF. Therefore, an automated detection of AF pathology using the new diagnostic features of ECG signal is required. This paper proposes a novel method for the detection of AF using ECG signals. In this work, we are using a novel nonlinear method namely, the two-stage variational mode decomposition (VMD) to analyze ECG and deep belief network (DBN) for automated AF detection. First, the ECG signals of both normal sinus rhythm (NSR) and AF classes are decomposed into different modes using VMD. The first mode of VMD is decomposed in the second stage as this mode captures the atrial activity (AA) information during AF. The remaining modes of ECG captures the ventricular activity information. The sample entropy (SE) and the VMD estimated center frequency features are extracted from the sub-modes of AA mode and ventricular activity modes. These extracted features coupled with DBN classifier is able to classify normal and AF ECG signals with an accuracy, sensitivity and specificity values of 98.27%, 97.77% and 98.67%, respectively. We have developed an atrial fibrillation diagnosis index (AFDI) using selected SE and center frequency features to detect AF with a single number. The system is ready to be tested on huge database and can be used in main hospitals to detect AF ECG classes.
P4 Medicine and Scientific Wellness: Catalyzing a Revolution in 21st Century Medicine
Authors: Hood Lee
Published: October 2017

Dr. Lee Hood and researchers at Institute for Systems Biology pioneered the concept of medicine that is predictive, preventive, personal and participatory (P4). ISB’s exploration of scientific wellness and a systems approach to disease, along with its affiliation with Providence St. Joseph Health, one of the largest not-for-profit healthcare systems in the U.S., is accelerating momentum to transform the structure of modern healthcare, shifting from an almost complete focus on disease to a major focus on wellness.
Blocking AGE-RAGE Signaling Improved Functional Disorders of Macrophages in Diabetic Wound
Authors: Wang Qi , Zhu Guanya , Cao Xiaozan , Dong Jiaoyun , Song Fei , Niu Yiwen
Published: October 2017

Advanced glycosylation end products (AGEs) accumulate in diabetic wounds. Interactions between AGEs and their receptor (RAGE) leads to dermatologic problems in diabetes. Macrophage, which plays important roles in wound healing, highly expresses RAGE. Therefore, we investigated whether RAGE-expressing macrophages might be responsible for impaired wound healing on diabetes. We used anti-RAGE antibody applied topically on diabetic wounds. After confirming that wound healing was improved in anti-RAGE antibody group compared with normal mice, our results showed that macrophages appeared insufficient in the early stage and fading away slowly in the later proliferative phase compared with the control group, which was ameliorated in anti-RAGE antibody-applied wounds. Blocking AGE-RAGE signaling also increased neutrophils phagocytized by macrophages and promoted the phenotypic switch of macrophages from proinflammatory to prohealing activities. In vitro, phagocytosis of THP-1 (M0) and lipopolysaccharide- (LPS-) induced (M1) macrophages was impaired by treatment with AGEs, while IL-4- and IL-13-induced (M2) macrophages was not. Finally, AGEs increased the proinflammatory response of M1 macrophages, while inhibiting the polarization and anti-inflammatory functions of M2 macrophages. In conclusion, inhibition of AGE-RAGE signaling improved functional disorders of macrophages in the early inflammatory phase, which promoted the healing of wounds in diabetic mice.
Erosive Pustular Dermatosis of the Scalp with Urate-Like Crystals
Authors: Emanuel Patrick O. , Paul Sharad P.
Published: October 2017

Follicular urate-like crystals were first described in Necrotizing Infundibular Crystalline Folliculitis (NICF), a rare cutaneous disorder with multiple waxy folliculocentric papules. Similar crystal accumulation may be seen within follicular infundibulae as an incidental finding. We describe a case showing identical crystals occurring within the horn-like crusts of a patient with erosive pustular dermatosis of the scalp (EPDS), a condition which due to its presentation can often be mistaken for nonmelanoma skin cancer. A brief overview of erosive pustular dermatosis of the scalp (EPDS) is presented in this paper.
Effect of (0001) Strain on the Electronic and Magnetic Properties of the Half-Metallic Ferromagnet Fe2Si
Authors: Chen Wang , Li Ruijie , Liu Yanhui
Published: October 2017

The electronic and magnetic properties of the half-metallic ferromagnet Fe2Si under (0001) strain have been evaluated by the first-principles density functional theory method. The spin-up band structure shows that bulk Fe2Si has metallic character, whereas the spin-down band structure shows that bulk Fe2Si is an S-L indirect band gap of 0.518 eV in the vicinity of Fermi surface. Indirect-to-direct band gaps and an unstable-to-stable transition are observed in bulk Fe2Si as strain is applied. In the range −11% to 11% (excluding zero strain), bulk Fe2Si has stable half-metallic ferromagnetism, the spin polarization at the Fermi surface is 100%, and the magnetic moment of the Fe2Si unit cell is 4.0 μB. The density distribution shows that the spin states of bulk Fe2Si mainly come from the Fe1-3d and Fe3-3d states, indicating that bulk Fe2Si has spin-polarized ferromagnetism. The half-metallic ferromagnetism of bulk Fe2Si is mainly caused by d–d exchange and p–d hybridization, which are not sensitive to strain. It is very important to investigate the effect of changes in the lattice constant on the half-metallic ferromagnetic properties of bulk Fe2Si.