bluuebunny/crossref_metadata_2025 huggingface dataset:
CAN THE '4 P'S OF PN' IMPROVE NEONATAL NUTRIENT INTAKE?
Authors: Lansdowne Zoe , Griffiths Elizabeth
Published: August 2016

Aims

ELBW infants on NICU were found to have poor growth compared to network data. Previous audit work1 showed that the time from birth to PN did not meet unit guideline targets and did not achieve optimal protein intake. Intensive work was done to publicise this and to decrease the time from birth to PN. Stock PN recipes were also reformulated to concentrate nutrition. The aim of audits 2 and 3 was to analyse whether publicising the 4 P's of PN (prompt, protein, protected and peripheral) could improve protein intake and ultimately increase growth velocity.

Methods

The details of all infants born <28 weeks or <1 kg from 1st September to 30th November 2014 (audit 2) and from 1st April to 30th June 2015 (audit 3) were analysed retrospectively. Data was collected from the patients' medical notes, including parenteral nutrition (PN) prescriptions, fluid prescriptions and observation charts.

Results

Over both 3 month audit cycles, data from a further 52 patients were analysed. It was found that the mean time from birth to PN for inborn infants was reduced from 10 hrs 59 mins to 7 hrs 14 mins, and then again further to 4 hrs 16 mins. On average all patients received more protein in the first 24 hrs of life in audit 3 compared to audits 2 and 1, 0.92 g/kg/day, 0.86 g/kg/day and 0.66 g/kg/day respectively. Just under 1/3 of patients achieved the target protein intake of 1.25 g/kg/day for day 1 of life in audit 3. For inborn patients only, protein intake increased from 0.83 g/kg/day to 1.09 g/kg/day to 1.38 g/kg/day over the audit cycle period. Inborn infants <750 g receiving PN within 6 hrs of birth increased from 17%, to 67%, and finally to 83% in audit 3.

Of the infants still on the unit at day 14 of life, the mean daily protein intake increased from 2.15 g/kg/day to 2.35 g/kg/day and then to 2.46 g/kg/day, although the maximum achieved on a single day for a single infant was 3.87 g/kg/day, in audit 2.

Average weight gain was 2.97 g/kg/day in audit 1 but this increased to over 7 g/kg/day in audits 2 and 3. All of the infants exceeded their birth weight by day 14 of life in audits 2 and 3, compared to only 71% in audit 1.

The percentage of PN quantities prescribed but never administered remained constant between 13% and 16%.

Conclusion

Publicising the 4 P's of PN ensured that PN was started promptly after birth resulting in increased protein intake on day 1 of life. Reformulating the stock PN bags to a more concentrated recipe, and protecting the PN volume infused, also increased protein intake. The results of these actions were improved growth velocity and all infants regained at least their birth weight by day 14 of life. Work still needs to be done to increase the mean daily protein intake.

Peripheral PN was not actioned.
MEDICATION MANAGEMENT OF THE EXTREMELY PREMATURE NEONATE – THE IMPACT OF A SPECIALIST PHARMACIST
Authors: Whitfield Karen , Barkeij Claudia , North Angela
Published: August 2016

Aim

To present a case of an extremely premature infant and the role that the specialist neonatal pharmacist has on the quality of care of these patients.

Method

Interventions and recommendations made by the pharmacists over the admission of a triplet born at 23 weeks and 5 days gestation were recorded. The type of interventions were categorised and classified for risk using a consequence/probability matrix.1

Results

The patient required admission to the intensive care unit and subsequently the special care unit for a period of 163 days before discharge home. Over the period of admission the patient had a history of a large patent ductus arteriosus, pulmonary hypertension, bilateral grade two intraventricular haemorrhages, neonatal jaundice, hyponatraemia, hyperglycaemia, anaemia of prematurity, retinopathy of prematurity and chronic neonatal lung disease. A pleural effusion developed at day 10 requiring high frequency ventilation. At the age of 3 weeks a pseudomonas sepsis developed together with feed intolerance and abdominal distention. Milk curd syndrome was diagnosed requiring the removal of 30 cm of bowel and placement of a temporary stoma. Long term Parenteral Nutrition was prescribed

Sixteen interventions were recorded – low risk (3), moderate risk (9) and high risk (4).

Clinical advice was provided regarding appropriate dose, therapeutic drug monitoring and administration of antibiotics including gentamicin, meropenem and flucloxacillin to enhance safety and improve efficacy. Owing to the complexity of the medication regimen at times, drug compatibility queries were common. Close liaison with the neonatal consultant, dietician and gastroenterologists was undertaken during long term Parenteral Nutrition and included discussions relating to, administration of additional electrolytes, trace elements and liver function tests. Advice was sought on the dose and administration of loperamide for short gut syndrome and control of diarrhoea. Pharmaceutical advice was provided to ensure medications were optimised for issues associated with drug administration via transpyloric tube to avoid blockage. Calculation of total daily phosphate was undertaken whilst the patient was receiving fortified feeds, to ensure adequate supplementation, to assist normal bone development. Prior to discharge palivizumab prophylaxis was recommended for respiratory syncytial virus Infection. The pharmacist provided advice on administration to the nursing staff and ensured required documentation was completed.

Conclusion

The care of the extremely premature neonate involves numerous medication related challenges. This case not only demonstrates the specialist knowledge, skills and attitudes required by a pharmacist working in this complex field but the impact that can be achieved working closely with the neonatal team.
A NATIONAL SURVEY TO IDENTIFY HOW DISPLACEMENT VALUE INFORMATION IS USED AND PRESENTED TO CLINICAL STAFF IN NHS HOSPITALS
Authors: Christiansen Nanna , Kehk Zinab , Keeling Susan , Dean Bryony
Published: August 2016

Aim

The use of displacement values (DVs) when preparing intravenous (IV) medication for children enables accurate doses to be given1 and is assumed to be common paediatric practice. This survey aimed to assess views of UK paediatric pharmacists on DVs in practice to explore:

▸ How prevalent is DV use in the paediatric hospital setting

▸ Which type of IV administration guidelines were being used

▸ Which form of DV presentation is perceived to be most practical

▸ Which method of calculation is preferred

Method

A national cross-sectional survey study was undertaken. The questionnaire comprised of 13 closed and open questions as well as samples of how DVs are currently displayed on the Medusa Injectable Medicines Guide2. After piloting the questionnaire the survey was sent to 365 paediatric pharmacists across 120 UK hospitals utilising Qualtrics Survey Software.

Results

Fifty-five completed questionnaires covering 52 (43%) United Kingdom (UK) hospital trusts were received. Of 55 respondents, 52 (95%) reported the clinical significance of DVs in paediatric care. This was reflected in the fact that all local guides provided information on DVs. The majority (32;59%) used locally produced guides, while 15 (27%) of respondents used Medusa as a resource. All respondents commented on methods of presentation and calculation of DV information. Of four methods presented, the method involving presentation of reconstitution information in a brand-specific table was ranked as most practical (46;84% respondents). This method was viewed as being clear and concise. Respondents also expressed the importance of having this tabulated method visually embedded in the monograph to allow easy access to information on the wards. This concurs with suggested information presentation to aid error reduction in the literature.3 National standardisation of DV information was viewed as ‘very useful' or ‘preferred' by 52 (95%) of respondents; reasons for this preference were risk reduction due to errors or misinterpretation.

Conclusion

The use of DVs in paediatrics is commonplace in the UK; this is reflected in local IV guides used by the majority of centres. Improving visual presentation of DVs is important and tabulated expression of DVs is preferred by pharmacists and a national standard presentation of DVs is encouraged. The results from the survey will inform the monograph layout for the Medusa. Prior to implementation nurse feedback should also be sought.
BET 1: Utility of ultrasound in the diagnosis of shoulder dislocation
Authors: Gottlieb Michael , Edwards Harriet
Published: August 2016

This short-cut review was carried out to examine the evidence for the use of ultrasound in diagnosing shoulder dislocation in adult patients presenting to EDs. A literature search was carried out that found two relevant papers. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that ultrasound of the shoulder appears to have a very high sensitivity and specificity within this patient group.
IDENTIFYING PRE-HOSPITAL FACTORS WHICH INFLUENCE OUTCOME FOR MAJOR TRAUMA PATIENTS IN A REGIONAL TRAUMA NETWORK: AN EXPLORATORY STUDY
Authors: Thompson Lee , Hill Michael , Davies Caroline , Shaw Gary
Published: August 2016

Background

Major trauma is often life threatening or life changing and is the leading cause of death in the United Kingdom for adults aged≤45 years. The aim of this exploratory study was to identify pre-hospital factors influencing patient outcomes for major trauma within the Northern Trauma Network.

Method

Secondary data analysis of a combined data set of pre-hospital audit data and patient outcome data from the Trauma Audit Research Network (n=1033) was undertaken. Variables included mechanism of injury, age, physiological indices, timings and skill mix. Principle outcome measures included Mortality data and Glasgow Outcome Scales.

Results

Glasgow Coma Scores proved a significant predictor of mortality in major trauma (p<0.00). Amongst other physiological indices, systolic blood pressure ≤90 mm Hg. was associated with both increased mortality (p≤0.004) and poorer morbidity (p≤0.021). Respiration rate <14/minute was also significantly predictive of morbidity (p≤0.03) and mortality (p<0.00). Prolonged response times to the most critically injured patients (p<0.031), and increasing casualty age were significantly associated with poorer outcomes. The attendance of a Doctor was significantly associated with increased mortality (p≤0.036) perhaps validating existing resource despatching practices.

Predictors of positive outcomes included the presence of a Doctor when on-scene time ≤50 minutes (p≤0.015), crew arrival on-scene ≤10 minutes (p<0.046) and on-scene time ≤50 minutes (p<0.015).

Conclusion

These findings validate GCS, BP and Respiratory Rate values as valid triggers for transport to a Major Trauma Centre. Analysis of the interactions between arrival time, time-on-scene, skill mix and age demand further exploration but tentatively validate the concept of a ‘Golden Hour’ and suggest the potential value of a ‘load and go and play on the way’ approach.
REFINING QUESTIONNAIRE ITEMS IN A PATIENT REPORTED EXPERIENCE MEASURE (PREM) DESIGNED FOR USERS OF NHS AMBULANCE SERVICES: QUESTION APPRAISAL STUDY
Authors: Togher Fiona , Siriwardena A Niroshan , Windle Karen
Published: August 2016

Background

Service users' experience of ambulance services is important as a measure of quality in addition to effectiveness and safety of care.

This doctoral study focuses on the development of a Patient Reported Experience Measure (PREM), a questionnaire used to assess people's experiences of health care provision.

The draft PREM had been piloted with a sample of patients to explore their views of the content and format of the questionnaire. In this next stage we aimed to use experts (including ambulance care providers and academics) to evaluate the quality of the PREM.

Methods

This evaluation involved the use of the Question Appraisal System (QAS-99), originally developed to assist questionnaire designers identify problems with questionnaire items.

Participants' were asked to review 20 items from a draft PREM of 60 items, completing a QAS-99 coding form for each questionnaire item they were assigned to evaluate. The form directed their attention to the type of flaws that may be found, for example, problems with question instructions, clarity of wording, potential for bias and response options.

Results

Ten participants completed the study. Overall refinements were suggested for 46 of 60 questionnaire items reviewed. Amendments suggested included wording of questionnaire items to improve responders' understanding and interpretation, appropriateness of response options, and decisions on inclusion/exclusion, of specific questionnaire items. The PREM was revised in accordance with these recommendations.

Conclusion

The QAS-99 approach to questionnaire evaluation facilitated refinement of the PREM. The final stage of this doctorate will involve further testing of the PREM using cognitive interviews with patients that have recently used the ambulance service to investigate how they interpret and respond to the refined version of the tool.
PREHOSPITAL USE OF KETAMINE AND MIDAZOLAM IN AN URBAN ADVANCED PARAMEDIC PRACTITIONER SERVICE: A RETROSPECTIVE REVIEW
Authors: Edwards Tim , Shaw Joanna , Gray Danielle , Thomson Neil , Faulkner Mark
Published: August 2016

Background

The use of ketamine and midazolam in physician-led prehospital care teams within the UK is well established. Although both agents are in use by paramedics within emergency medical systems in North America and Australasia, there is a paucity of data relating to administration by UK paramedics.

Methods

A panel of clinicians utilised a standardised data extraction form to review patient report forms for all cases where an Advanced Paramedic Practitioner (APP) administered ketamine or midazolam from 1st May to 30th September 2015. Reviewers assessed indications for and appropriateness of administration, and identification and management of adverse events.

Results

A total of 21 patients received ketamine for analgesia (n=20, 95%) or to facilitate rapid extrication (n=1, 5%). Pain scores were recorded in 18 patients (90%), the majority of whom experienced a reduction in pain post administration (n=17, 94%). No adverse events occurred following ketamine use. Midazolam was administered to a total of 80 cases. The most common indications for administration were maintenance of an advanced airway in patients with return of spontaneous circulation post cardiac arrest (n=37, 46%), management of acute behavioural disturbance (n=28, 35%) and prolonged seizures (n=15, 18%). Transient airway compromise occurred in 10% (n=8) of cases, all of which were managed appropriately. No other adverse events occurred. The administration of ketamine and midazolam was judged to be appropriate in all cases.

Conclusions

The use of ketamine and midazolam in the context of an urban APP service with high levels of additional education, procedural experience and selective targeting to emergency calls appears safe and effective. Further prospective studies are warranted to confirm these findings.
MENTAL HEALTH CRISIS IN THE PRE-HOSPITAL SETTING
Authors: Prothero Larissa S , Cooke Philip
Published: August 2016

Background

The 2014 Mental Health Crisis Care Concordat is a national agreement to ensure people in crisis receive the help they need: integrated multi-agency schemes involving ambulance, police and mental health services are now being developed to provide urgent and emergency care pathways for these vulnerable patients. The aim of this study was to have improved understanding of mental health crisis (MHC) patients requiring ambulance care, to inform the development of new patient care pathways within the East of England.

Methods

A retrospective pilot audit was performed using 291 ‘MHC’ patient care records generated following emergency ‘999’ ambulance and non-emergency ‘111’ calls in a distinct geographical area of the East of England Ambulance Service NHS Trust between 22–29 December 2014. Criteria for record inclusion were presence of the terms ‘mental health’, ‘anxiety’, ‘depression’, ‘self-harm’, ‘self-injury’, ‘abnormal behaviour’, ‘psychosis’, ‘paranoia’, ‘suicide’, ‘suicidal thoughts’, ‘overdose’, ‘dementia’, or ‘Section’.

Results

The cohort age range was 13 to 98 years; 50.5% were male. MHC usually affected people under 65 years. The main reasons for ambulance care were deliberate drug/substance overdose (33.7%) and actions/behaviour associated with suicidal intention (19.2%) – attempted suicide was reported for 14 (4.8%) patients. Anxiety (including ‘panic attacks’/hyperventilation syndrome), depression and behavioural/emotional problems were prevalent. Alcohol consumption was reported for 36.8% patients and police attendance was required for aggressive/threatening behaviour in 22% of incidences. Approximately two-thirds (64.6%) of patients were conveyed to the emergency department; only 12 (4.1%) patients were directly admitted to a mental health facility. The majority of patient contacts occurred ‘out-of-hours’, in particular, between 20:00 and 22:00 hours.

Conclusions

Mental health crisis management is complex and challenging for ambulance clinicians with limited direct access to specialist services. Understanding the nature of crises and patient/public expectations of emergency services will facilitate the development of appropriate pre-hospital mental health pathways.
AMBULANCE RESPONSE TIMES AND MORTALITY IN ELDERLY FALLERS
Authors: Cannon Emily , Shaw Joanna , Fothergill Rachael , Lindridge Jaqualine
Published: August 2016

Background

Worldwide, the number of people aged over 60 is growing faster than any other age group. Increased age is associated with a higher risk of falling and roughly a third of individuals aged 65 and over experience a fall each year. One way in which ambulance services may impact the outcome of patients is the time taken for a response to arrive on scene. Lying on the floor for a long time has been found to be strongly associated with serious injuries, admission to hospital, and mortality. However, previous research has not assessed the impact of ambulance response times on mortality.

Methods

To determine whether there is a relationship between the time elderly fallers (aged 65 and over) spend on the floor and mortality, an observational study was undertaken. A convenience sample of 503 ambulance response times, patient records detailing the amount of time spent on the floor, and patient outcomes at 90 days were analysed using logistic regression.

Results

Eight percent of patients in the sample died within 90 days of their fall (n=38). Patients who were deceased at 90-day follow-up (n=38) did not wait significantly longer for an ambulance than patients who were still alive (n=464) (means= 34 min vs 37 min, p=.678).

Of the patients who were still on the floor upon LAS arrival (n=178), those who had died within 90 days following their fall (n=14) spent less time in total on the floor than patients who were still alive at 90-day follow-up (n=164) (means= 59 min vs 98 min, p=.296).

Conclusions

Increased ambulance response time or prolonged time spent on the floor was not associated with 90-day mortality in elderly fallers who presented to the ambulance service. Whilst any delays in attending elderly fallers require monitoring, we can be reassured that long waits are not leading to mortality in this patient group.
PARAMEDIC ACUTE STROKE TREATMENT ASSESSMENT (PASTA) TRIAL
Authors: Shaw Lisa , Ford Gary A , Exley Catherine , Flynn Darren , McMeekin Peter , Rodgers Helen , Snooks Helen , Tyrell Pippa , Vale Luke , Price Christopher
Published: August 2016

Background

Rapid treatment of stroke can improve the chances of recovery. It is important that patients are assessed quickly to decide if it is appropriate to deliver thrombolysis treatment. This study is evaluating whether an enhanced assessment by paramedics could speed up treatment and improve stroke recovery.

Method

Study design

Multicentre cluster randomised trial with cost-effectiveness analysis and parallel process evaluation.

Setting

NHS ambulance services, emergency departments and stroke units within three geographical regions of England and Wales.

Study intervention

A Paramedic Acute Stroke Treatment Assessment (PASTA) pathway initiated by paramedics and continued initially in hospital to facilitate the speed of brain imaging and delivery of thrombolysis when clinically appropriate.

Study control

Usual care according to national and local guidelines for the pre-hospital and hospital assessment of suspected stroke.

Randomisation

Ambulance stations or paramedic teams within each region randomised to delivering the PASTA pathway or to continue with usual stroke care.

Participants

Intervention paramedics will deliver the PASTA pathway to adults within 4 hours of suspected stroke onset. Participants enrolled in the study will be adults with confirmed stroke who were assessed by a study paramedic within 4 hours of onset.

Primary outcome

Dependency at 90 days after stroke (modified Rankin Scale)

Process evaluation

Semi-structured interviews with a subsample of participants and staff to gain insight into perceptions and experience of the PASTA pathway.

Sample size

Allowing for 3% attrition, 3640 participants are needed to provide 80% power to detect a 3% absolute difference in mRS 3–6 (poor outcome) to mRS 0–2 (good outcome).

Current study status

Opened to recruitment in December 2015.
ADDRESSING THE CHALLENGES OF PARAMEDIC RECRUITMENT AND ENGAGEMENT IN AIRWAYS-2
Authors: Pilbery Richard , Green Jonathan , Hall Helen , Whitley Gregory
Published: August 2016

AIRWAYS-2 is an NIHR-funded study to determine the best initial approach to advanced airway management during out of hospital cardiac arrest (OHCA). Four NHS ambulance trusts are taking part in AIRWAYS-2: East Midlands, South Western, Yorkshire and East of England. One of the key challenges has been the need to recruit approximately 1300 study paramedics for the trial.

The three main challenges in engaging and recruiting paramedics to participate in AIRWAYS-2 have been:

▸ Concerns relating to the potential results of the trial and what this will mean for the continuation of intubation for paramedics

▸ Concerns relating to the restriction on paramedic choice of advanced airway in OHCA and potential skill erosion

▸ Provision of training over large geographical areas at a time when morale is low and many ambulance trusts have recruitment and retention issues.

How have these challenges been overcome?

▸ Communication: Identifying the most appropriate communication methods in each Trust e.g. face to face, email, internal trust operational updates

▸ Delivery of key messages: Emphasising why the trial is important and needed, and that its goal is not to remove intubation from paramedic practice. Obtaining the engagement of senior operational management to allay fears over impacts on service performance

▸ Valuing study paramedics: Paying clinicians overtime to attend training sessions, which contributes to their own continuing professional development

▸ Equity and opportunity: Delivery of multiple training sessions throughout each of the four ambulance trusts.

Key achievements

By November 2015, research paramedics had delivered nearly 350 training sessions and recruited in excess of 1300 paramedics to AIRWAYS-2.

Conclusion

The research paramedics leading AIRWAYS-2 have collaboratively, and successfully, overcome the main challenges relating to recruiting and engaging the paramedics in their Trusts. This should contribute to achieving the target patient sample size for the trial.
UTILITY OF PRE-HOSPITAL LACTATE MEASUREMENT FOR TRAUMA PATIENTS: A SYSTEMATIC REVIEW
Authors: Lewis Christopher TM , Naumann David N , Midwinter Mark J , Crombie Nicholas
Published: August 2016

Background

Serum lactate serves as a surrogate marker for tissue hypoxia following traumatic injury, and may be used to guide resuscitation. The portable, lightweight nature of handheld point-of-care monitoring devices enables lactate values to be readily available in the pre-hospital environment, whether in land or air based evacuation modalities. The current review evaluates the utility of pre-hospital lactate measurement in the management of trauma patients.

Methods

The published literature up to 06 August 2015 was searched using Medline and EMBASE using pre-defined criteria (English language, pre-hospital lactate measurement, trauma patients; excluding non-trauma/mixed patient groups). The Newcastle-Ottawa Scale was used to assess risk of bias of individual studies.

Results

Of 857 non-duplicate articles of interest, 5 articles met the inclusion criteria, and included four cohort studies and one cross-sectional study. There were 2049 patients included in all studies.

Key findings

▸ Pre-hospital lactate may be an independent prognostic marker of in-hospital mortality, multiple organ dysfunction, and requirement for transfusion or surgical intervention in trauma patients, particularly in blunt trauma.

▸ Pre-hospital lactate measurement may be more sensitive than systolic blood pressure in determining need for resuscitative care.

▸ Early lactate measurement may be particularly useful in the detection of occult hypotension, with elevated levels detectable within 30 minutes of injury.

▸ All current studies that investigate pre-hospital lactate were assessed as being at risk of bias.

Conclusions

There is a paucity of evidence relating to pre-hospital lactate-guided management in trauma. From the limited literature, it seems that pre-hospital lactate may be a useful early tool in guiding the management of trauma patient resuscitation. Further prospective studies are required to elucidate the sensitivity and specificity of abnormal pre-hospital lactate values.
AN ANALYSIS OF THE IDENTIFICATION AND MANAGEMENT OF FREQUENT USERS OF URGENT AND EMERGENCY HEALTHCARE
Authors: Worrillow Nicola , Briggs Michelle , South Jane
Published: August 2016

Abstracts selected through the 999 EMS Research Forum peer review process and presented orally and by poster at the ‘Making it Happen: Delivering Research in Pre-hospital Care’ Conference 2016.

Background

There is a dearth of literature available that examines the characteristics of frequent users of urgent and emergency healthcare. Most research and literature explores this population by focusing within one clinical service rather than throughout the whole urgent and emergency healthcare system in England.

The aim was to examine how frequent users of: Out of Hours General Practitioners; NHS 111; Ambulance Services; and Emergency Departments are defined, what thresholds are used to categorise and what approaches are used to manage this population.

Method

A systemic mapping exercise was undertaken to capture a wide range of data to gain a comprehensive understanding of how these services are currently working with regard to frequent users.

The search provided 5094 articles which were screened against the inclusion criteria leaving 156 articles to be analysed. Data was extracted and thematic synthesis created four main themes: typology with regard to definitions assigned; threshold variance; separation of the main population into subgroups; and case management approaches.

Results

The systematic mapping exercise revealed that diverse definitions and thresholds were being employed by all services. The language used to describe these individuals was often negative and subjective. A single definition of High Intensity User (HIUs) has been selected and advocated for the standardisation within all services. This transposable terminology and identification process will aid in supporting and managing patients within all these services.

A taxonomy of HIUs has been developed from this research to sub-divide the main heterogeneous group into the 5 main classification groups. This meets a gap in current knowledge.

Conclusions

The standardised identification process and taxonomy will facilitate interoperability and clarity between clinicians thus benefitting patient and their outcome. The support and management of HIUs will be more comparable between all urgent and emergency services and within the research community.
The presence of fructosamine in human aortic valves is associated with valve stiffness
Authors: Kishabongo Antoine S , Katchunga Philippe , Cikomola Justin C , De Somer Filip M , De Buyzere Marc L , Speeckaert Marijn M , Delanghe Joris R
Published: August 2016

Aims

Human heart valves are prone to glycation, a fundamental process of ageing. The aim of this study was to establish the relationship between fructosamine formation and the mechanical properties of human aortic valves.

Methods

67 patients (age: 76±8 years) diagnosed with an aortic valve stenosis, who underwent an aortic valve replacement were enrolled. Fructosamine and calcium concentrations in aortic valves were determined. Using a transthoracic Doppler echocardiography, aortic valve orifice area and transvalvular pressure gradients were measured. In a subgroup of 32 patients, the aortic valve orifice area was sufficient to carry out mechanical testing on a LFPlus Universal material tester. An in vitro removal of fructosamine of the valve was initiated using ATP-dependent fructosamine 3-kinase (FN3K).

Results

A significant correlation was found between the aortic valve fructosamine concentration and the calculated aortic valve orifice area: Y (aortic valve orifice area, mm2)=1.050−0.228X (aortic valve fructosamine concentration, µmol/g valve) (r=−0.38). A significantly higher calcium concentration was measured in the aortic valves of diabetics in comparison with those of non-diabetics. A multiple regression analysis revealed that the presence of diabetes mellitus and aortic valve fructosamine concentration were the main predictors of the extensibility of the aortic valves. In the in vitro deglycation study, a significant lower aortic valve fructosamine concentration was detected after treatment with FN3K. This resulted in an increased flexibility of the aortic valves.

Conclusions

Although no direct causativeness is proven with the presented results, which just show an association between fructosamine, the effect of FN3K and aortic valve stiffness, the present study points for the first time towards a possible additional role of the Amadori products in the biomechanical properties of ageing aortic valves.
Dogs attending primary‐care practice in England with clinical signs suggestive of Chiari‐like malformation/syringomyelia
Authors: Sanchis‐Mora S. , Pelligand L. , Thomas C. L. , Volk H. A. , Abeyesinghe S. M. , Brodbelt D. C. , Church D. B. , Thomson P. C. , McGreevy P. D. , O'Neill D. G.
Published: August 2016

Chiari‐like malformation/syringomyelia (CM/SM) in dogs describes a developmental disorder that can cause pain and reduced quality of life. This retrospective study aimed to report the period prevalence, clinical signs and risk factors for diagnosis of symptomatic CM/SM in the veterinary primary‐care setting using a cross‐sectional design. The study population included all dogs within the VetCompass Programme (September 1, 2009–June 13, 2014). Overall, the period prevalence of symptomatic CM/SM was 0.05 per cent (95 per cent CI 0.04 per cent to 0.06 per cent) for all breeds. The period prevalence in the Cavalier King Charles Spaniel (CKCS) was 1.6 per cent (95 per cent CI 1.2 to 2.06). Other breeds at increased odds included the King Charles Spaniel (KCS), Affenpinscher, Chihuahua and Pomeranian. Insured dogs had 4.6 times the odds (95 per cent CI 2.95 to 7.17) of having a diagnosis of CM/SM compared with uninsured dogs. Pain was the most commonly associated clinical sign (67 dogs, 72 per cent). Analgesics were prescribed to 72 (77.4 per cent) of the symptomatic dogs. Despite its low overall period prevalence, the high proportion of affected dogs identified with chronic pain suggests a significant welfare issue. Financial implications could impede the diagnostic process and lead to underestimation of the true prevalence. This study may help to inform clinicians about the clinical relevance and the need for improved awareness of clinical signs, particularly in high‐risk breeds, to optimise the management of CM/SM in primary‐care practice.
A Computational Method for Enforcing Knowledge that Cannot be Subsumed
Authors: Grégoire Éric , Lagniez Jean-Marie
Published: August 2016

We introduce a practical computational method that enforces some incoming piece of information [Formula: see text] in a clausal Boolean logic knowledge base [Formula: see text] in such a way that [Formula: see text] is not strictly subsumed by the resulting knowledge base. [Formula: see text] is not strictly subsumed by [Formula: see text] iff for every piece of information [Formula: see text] that is entailed by [Formula: see text] and that is such that [Formula: see text] entails [Formula: see text], we have that [Formula: see text] entails [Formula: see text], too. We claim that this paradigm is a useful form of reasoning for both human and artificial intelligence systems. Under a usual minimal change policy, it amounts to computing one cardinality-maximal satisfiable subset of [Formula: see text] that contains [Formula: see text] but that does not strictly subsume [Formula: see text]. Although this task is intractable in the worst case, we provide a practical method that appears experimentally efficient very often, even for large and complex knowledge bases.
Probabilistic Roadmaps with Higher Expressive Power
Authors: Mali Amol D.
Published: August 2016

Sampling-based motion planning had an enormous impact on robot motion planning because of its efficiency and scalability. Many sampling-based motion planners construct a probabilistic roadmap (PRM) that captures the connectivity of the robot's free configuration space. A valid node of a PRM contains a collision-free robot configuration (also known as a sample) and a valid edge of a PRM connects two valid nodes with a collision-free path. Nodes connected by an edge are usually also required to satisfy additional requirements based on the distance between them. PRM planners use PRMs. Increasing the expressive power will allow PRMs to be used for a wider set of motion planning problems. In this paper we report on increasing the expressive power of PRMs by including the following five features in PRMs-nodes with multiple samples that need not be organized as a graph, temporal intervals of validity of nodes and edges, nodes with samples of multiple robots, special edges for the state transitions performed by humans sharing a workspace with robots, and conditional validity of samples and edges. We report on motion planning problems solvable using these new features.
Path-Cost Bounds for Parameterized Centralized Variants of A* for Static and Certain Environments
Authors: Mali Amol D. , Tang Minh
Published: August 2016

A* search and its variants have been used in various fields for solving problems with large search spaces where state transitions occur because of application of operators. The key values in A* search are g(n) and h(n), where g(n) is the cost of the path from root (or start) node to node n, and h(n) is the estimated cost of cheapest path from n to goal. In this paper, we report on a space of variants of A* based on the following ideas: (i) using weighting functions for g(n) and h(n), (ii) evaluating different nodes with different heuristics, (iii) evaluating nodes with computationally cheap heuristics and re-evaluating some nodes with computationally expensive heuristics, and (iv) changing the size of the set of nodes from which the node to be expanded next is selected. We report on the bounds on the costs of solutions found by these variants of A*. We also report on the bounds for meta-variants of A* that invoke these variants sequentially. We show how the results can be used to obtain a more flexible search control without increasing the bound on the cost of the solution found by a variant or a meta-variant.
Link and knot invariants from non-abelian Yang–Baxter 2-cocycles
Authors: Farinati Marco A. , García Galofre Juliana
Published: August 2016

We define a knot/link invariant using set theoretical solutions [Formula: see text] of the Yang–Baxter equation and non-commutative 2-cocycles. We also define, for a given [Formula: see text], a universal group [Formula: see text] governing all 2-cocycles in [Formula: see text], and we exhibit examples of computations.
Evolution of the Robertson–Walker metric under 2-loop renormalization group flow
Authors: Hesamifard F. , Rezaii M. M.
Published: August 2016

Here, we study the evolution of a Robertson–Walker (RW) metric under the Ricci flow and 2-loop renormalization group flow (RG-2 flow). We show that a RW metric is a fixed point of the Ricci flow and it is not a solution of the RG-2 flow. RG-2 flow is considered on a doubly twisted product metric with further assumptions and also we introduce a necessary condition for existence of the solution of RG-2 flow.
Stable phantom-energy wormholes admitting conformal motions
Authors: Kuhfittig Peter K. F.
Published: August 2016

It has been argued that wormholes are as good a prediction of Einstein’s theory as black holes but the theoretical construction requires a reverse strategy, specifying the desired geometric properties of the wormhole and leaving open the determination of the stress–energy tensor. We begin by confirming an earlier result by the author showing that a complete wormhole solution can be obtained by adopting the equation of state [Formula: see text] and assuming that the wormhole admits a one-parameter group of conformal motions. The main purpose of this paper is to use the assumption of conformal symmetry to show that the wormhole is stable to linearized radial perturbations whenever [Formula: see text].
Back shifted Fermi gas model with temperature dependent pairing energy: Thermal properties of 98Mo
Authors: Alavi S. A. , Dehghani V.
Published: August 2016

The effect of using a temperature dependent pairing term in back-shifted Fermi-gas (BSFG) formula of nuclear level density has been studied. We have used the mean order parameter formula of modified Ginzburg–Landau (MGL) theory as a simple possible choice for temperature dependency of the pairing term. The level density and heat capacity of [Formula: see text]Mo have been calculated with this formalism and compared with the experimental data. We observed good agreement between the heat capacity of this model and the experimental data.
SCALING OF THE AVERAGE RECEIVING TIME ON A FAMILY OF WEIGHTED HIERARCHICAL NETWORKS
Authors: SUN YU , DAI MEIFENG , SUN YANQIU , SHAO SHUXIANG
Published: August 2016

In this paper, based on the un-weight hierarchical networks, a family of weighted hierarchical networks are introduced, the weight factor is denoted by [Formula: see text]. The weighted hierarchical networks depend on the number of nodes in complete bipartite graph, denoted by [Formula: see text], [Formula: see text] and [Formula: see text]. Assume that the walker, at each step, starting from its current node, moves to any of its neighbors with probability proportional to the weight of edge linking them. We deduce the analytical expression of the average receiving time (ART). The obtained remarkable results display two conditions. In the large network, when [Formula: see text], the ART grows as a power-law function of the network size [Formula: see text] with the exponent, represented by [Formula: see text], [Formula: see text]. This means that the smaller the value of [Formula: see text], the more efficient the process of receiving information. When [Formula: see text], the ART grows with increasing order [Formula: see text] as [Formula: see text] or [Formula: see text].
Existence and nonexistence of limit cycles for Liénard-type equations with bounded nonlinearities and φ-Laplacian
Authors: Fujimoto Kōdai , Yamaoka Naoto
Published: August 2016

This paper deals with an equivalent system to the nonlinear differential equation of Liénard type [Formula: see text], where the range of the function [Formula: see text] is bounded. Sufficient conditions are obtained for the system to have at least one limit cycle. The proofs of our results are based on phase plane analysis of the system with the Poincaré–Bendixon theorem. Moreover, to show that these sufficient conditions are suitable in some sense, we also establish the results that the system has no limit cycles. Finally, some examples are given to illustrate our results.
An integral formula in Kähler geometry with applications
Authors: Wang Xiaodong
Published: August 2016

We establish an integral formula on a smooth, precompact domain in a Kähler manifold. We apply this formula to study holomorphic extension of CR functions. Using this formula, we also prove some geometric inequalities when the boundary has positive Hermitian mean curvature.
On a ring structure related to annihilators
Authors: Hong Chan Yong , Huh Chan , Kim Hong Kee , Kim Nam Kyun , Lee Yang , Park Jeong Sook , Ryu Sung Ju , Yun Sang Jo
Published: August 2016

In this note, we focus our attention on a new ring structure related to annihilators, and consider a ring property that contains many kinds of ring classes, introducing right ZAFS. This property is shown to be not left-right symmetric but left-right symmetric for left or right Artinian rings. The left (right) ZAFS property is shown to pass to Ore extensions with automorphisms. The left (respectively, right) ZAFS property is shown to pass also to classical left (respectively, right) quotient rings, yielding that semiprime right Goldie rings are ZAFS.
On a theorem of Gagola and Lewis
Authors: Lu Jiakuan
Published: August 2016

Gagola and Lewis proved that a finite group [Formula: see text] is nilpotent if and only if [Formula: see text] divides [Formula: see text] [Formula: see text] [Formula: see text] for all irreducible characters [Formula: see text] of [Formula: see text]. In this paper, we prove that a finite soluble group [Formula: see text] is nilpotent if and only if [Formula: see text] divides [Formula: see text] [Formula: see text] [Formula: see text] for all irreducible monomial characters [Formula: see text] of [Formula: see text].
Property RD and the classification of traces on reduced group C∗-algebras of hyperbolic groups
Authors: Gong Sherry
Published: August 2016

In this paper, we show that if [Formula: see text] is a non-elementary word hyperbolic group, [Formula: see text] is an element, and the conjugacy class of [Formula: see text] is infinite, then all traces [Formula: see text] vanish on [Formula: see text]. Moreover, we completely classify all traces by showing that traces [Formula: see text] are linear combinations of traces [Formula: see text] given by [Formula: see text] where [Formula: see text] is an element with finite conjugacy class, denoted [Formula: see text]. We demonstrate these two statements by introducing a new method to study traces that uses Sobolev norms and the rapid decay property.
Exaggerated IL-15 and Altered Expression of foxp3+ Cell-Derived Cytokines Contribute to Enhanced Colitis in Nlrp3−/− Mice
Authors: Hirota Simon A. , Ueno Aito , Tulk Sarah E. , Becker Helen M. , Schenck L. Patrick , Potentier Mireille S. , Li Yan , Ghosh Subrata , Muruve Daniel A. , MacDonald Justin A. , Beck Paul L.
Published: August 2016

The pathogenesis of Crohn’s disease (CD) involves defects in the innate immune system, impairing responses to microbes. Studies have revealed that mutations NLRP3 are associated with CD. We reported previously that Nlrp3−/− mice were more susceptible to colitis and exhibited reduced colonic IL-10 expression. In the current study, we sought to determine how the loss of NLRP3 might be altering the function of regulatory T cells, a major source of IL-10. Colitis was induced in wild-type (WT) and Nlrp3−/− mice by treatment with dextran sulphate sodium (DSS). Lamina propria (LP) cells were assessed by flow cytometry and cytokine expression was assessed. DSS-treated Nlrp3−/− mice exhibited increased numbers of colonic foxp3+ T cells that expressed significantly lower levels of IL-10 but increased IL-17. This was associated with increased expression of colonic IL-15 and increased surface expression of IL-15 on LP dendritic cells. Neutralizing IL-15 in Nlrp3−/− mice attenuated the severity of colitis, decreased the number of colonic foxp3+ cells, and reduced the colonic expression of IL-12p40 and IL-17. These data suggest that the NLRP3 inflammasome can regulate intestinal inflammation through noncanonical mechanisms, providing additional insight as to how NLRP3 variants may contribute to the pathogenesis of CD.
Apresentação do Núcleo Temático
Authors: Anelli Renato Luiz Sobral
Published: August 2016

Apresentação do Núcleo Temático.
Museu de Arte de São Paulo no Brasil
Authors: Bardi Lina Bo
Published: August 2016

Lina Bo Bardi (documento). Tradução realizada por Renato Anelli do original publicado em revista L’Architettura, Cronache e Storia, n. 210, vol XVIII, n. 12, abril, 1973.
No avesso dos cartazes, a cidade perversa
Authors: Pechman Robert Moses
Published: August 2016

Parto da hipótese que uma das explicações possíveis para se entender as “jornadas de junho” de 2013, jogadas nas ruas brasileiras é a compreensão do papel das cidades na percepção que o cidadão tem, seja dos mistérios do laço social, seja da dramatização da sociabilidade encenada no espaço público ou no espaço privado e/ou íntimo. Na medida em que a vida privada tragou toda a luz da esfera pública que iluminava a cena urbana, muito da experiência urbana reduziu-se diante do espetáculo de uma história, tributária, muito mais das estratégias do sujeito do que da cooperação coletiva, o que abriria caminho para novas formas de individualização, a partir do desenho de um modelo de homem psicológico e não mais social.
Synoptic-Scale Waves in Sheared Background Flow over the Western North Pacific
Authors: Feng Tao , Yang Xiu-Qun , Zhou Wen , Huang Ronghui , Wu Liang , Yang Dejian
Published: August 2016

Tropical depression (TD)-type waves are the dominant mode of synoptic-scale fluctuations over the western North Pacific. By applying spatiotemporal filters to the observed OLR data and the NCEP–DOE AMIP-II reanalysis data for 1979–2013, this study reveals the characteristics and energetics of convectively coupled TD-type waves under the effects of different circulation patterns in association with vertical wind shear. Results exhibit that different ambient sheared flows significantly affect the vertical structure of westward-propagating TD-type waves, with a lower-tropospheric mode in an easterly sheared background and an upper-tropospheric mode in a westerly sheared background. Energetic diagnoses demonstrate that when the disturbance is trapped in the lower (upper) level by easterly (westerly) shear, the horizontal mean flow in the lower (upper) level favors wave growth by converting energy from the shear of the zonal mean flow (from the convergence of the meridional mean flow). During the penetration of a westward-propagating synoptic-scale disturbance from a westerly sheared flow into an easterly sheared flow, the upper-level disturbance decays, and the lower-level disturbance intensifies. Meanwhile, the upper-level kinetic energy is transferred downward, but the effect induces the wave growth only confined to the midlevels. Consequently, the low-level growth of the westward-propagating upper-level synoptic-scale disturbance is mainly attributed to the barotropic conversion of horizontal mean flow in the lower troposphere.