bluuebunny/crossref_metadata_2025 huggingface dataset:
Pleistocene climatic changes drive diversification across a tropical savanna
Authors: Potter Sally , Xue Alexander T. , Bragg Jason G. , Rosauer Dan F. , Roycroft Emily J. , Moritz Craig
Published: November 2017

Spatial responses of species to past climate change depend on both intrinsic traits (climatic niche breadth, dispersal rates) and the scale of climatic fluctuations across the landscape. New capabilities in generating and analysing population genomic data, along with spatial modelling, have unleashed our capacity to infer how past climate changes have shaped populations, and by extension, complex communities. Combining these approaches, we uncover lineage diversity across four codistributed lizards from the Australian Monsoonal Tropics and explore how varying climatic tolerances interact with regional climate history to generate common vs. disparate responses to late Pleistocene change. We find more divergent spatial structuring and temporal demographic responses in the drier Kimberley region compared to the more mesic and consistently suitable Top End. We hypothesize that, in general, the effects of species’ traits on sensitivity to climate fluctuation will be more evident in climatically marginal regions. If true, this points to the need in climatically marginal areas to craft more species‐(or trait)‐specific strategies for persistence under future climate change.
Isavuconazole shortens the QTc interval
Authors: Mellinghoff Sibylle C. , Bassetti Matteo , Dörfel Daniela , Hagel Stefan , Lehners Nicola , Plis Andrzej , Schalk Enrico , Vena Antonio , Cornely Oliver A.
Published: November 2017

Isavuconazole is a novel antifungal drug approved for the treatment of adults with invasive aspergillosis and mucormycosis. While azoles as a class effect are known to prolong QTc interval, clinical trials have shown that isavuconazole administration may cause shortening in a dose‐related manner. Here, we assessed the effects of isavuconazole on the length of QTc interval. The objective of the study was to describe changes in the QTc interval induced by isavuconazole treatment. A total of 26 adult patients from 7 hospitals were included. Patients received isavuconazole for the treatment of invasive fungal infection and, in 1 case, for prophylaxis due to QTc prolongation under fluconazole. Twelve‐channel electrocardiograms (ECGs) were performed before and during treatment. Out of 26 patients, 24 showed shortening of QTc interval. In patients with QTc shortening, QTc during isavuconazole treatment showed a mean decrease of 7.4 ± 5.8% (36.5 ± 38.8 ms, range 7‐202; P = .004), compared to pre‐isavuconazole ECG. One patient with available long‐term follow‐up showed further decrease in QTc on days 55 and 110. Apart from 1 case report, these are the first data outside controlled clinical trials showing QTc shortening. Knowledge about cardiac effects of isavuconazole will serve to better manage the use of concomitant medications.
Successful treatment of chromoblastomycosis of 10‐year duration due to Fonsecaea nubica
Authors: He Liya , Ma Jianchi , Mei Xin , Lu Sha , Li Xiqing , Xi Liyan
Published: November 2017

We report a case of chromoblastomycosis due to the presence of large plaque and verrucous hyperplasia lesions on the left upper limb, with elbow abnormal activities, in a 56‐year‐old male. The diagnosis of chromoblastomycosis was based on gross and microscopic morphologies, histopathological examination and clinical manifestation. Molecular tools were applied to identifying the causative agent Fonsecaea nubica, which is rarely reported to be associated with chromoblastomycosis. The patient was initially treated orally with terbinafine (250 mg/day) and itraconazole (200 mg/day), subsequently patient received thermotherapy (45‐50°C, 3 h/day) for 1 month. The patient was successfully cured. A literature review was performed to assess general features, treatment and outcome of chromoblastomycosis due to F.  nubica. All the 5 reviewed patients were male, over 30 years old and their lesions occurred after traumatic inoculation.
Distribution of Medication Considering Information, Transshipment, and Clustering: Malaria in Malawi
Authors: Parvin Hoda , Beygi Shervin , Helm Jonathan E. , Larson Peter S. , Van Oyen Mark P.
Published: November 2017

Malaria is a major health concern for many developing countries. Designing strategies for efficient distribution of malaria medications, such as Artemesinin Combination Therapies, is a key challenge in resource constrained countries. This paper develops a solution methodology that integrates strategic‐level and tactical‐level models to better manage pharmaceutical distribution through a three‐tier centralized health system, which is common to sub‐Saharan African countries. At the strategic level, we develop a two‐stage stochastic programming approach to address the problem of demand uncertainty. In the first stage, an initial round of shipments is sent before the malaria season to each local clinic from district hospitals, which receive medications from regional warehouses. After the malaria season begins, a recourse action is triggered to avoid shortages in the form of (i) lateral transshipment or (ii) delayed shipment. The optimal solutions developed by the strategic model identify small clinic clusters possessing exclusive transshipment policies. Therefore, we decompose the problem at the tactical level, solving each clinic cluster independently using a Markov decision process approach to determine optimal periodic transshipment policies. A case study of our proposed distribution system is performed for 290 facilities controlled by the Malawi Ministry of Health. Numerical analysis of Malawi's distribution system indicates that our proposed cluster‐based decomposition method could near optimally reduce shortage incidents. Moreover, such an approach is robust to challenges of developing countries such as slow paper‐based inventory review, uncertain transportation infrastructure, the need for equitable distribution, and seasonal and correlated demand associated with malaria transmission dynamics.
Latinos and Environmental Justice: Examining the Link between Degenerative Policy, Political Representation, and Environmental Policy Implementation
Authors: Liang Jiaqi
Published: November 2017

The theory of social construction and policy design is insightful for exploring the circumstances in which the allocation of policy benefits and burdens is attributed to the feed‐forward effect of degenerative policy that institutionalizes bias and reinforces the prevailing categorization and embedded social meaning regarding target populations. However, this theoretical framework has not been broadly adopted to analyze the environment‐related phenomena. With a nationwide, block‐group‐level sample, this study examines the extent to which degenerative policies pertaining to immigrants influence state agencies' environmental regulatory outputs for predominantly Latino communities. Results show that in the states with moderately to most restrictive immigrant policy and high levels of Latino representation in legislatures, the rigorousness of government agencies' compliance monitoring activities decreases for Latino neighborhoods of environmental justice concern, as states' policy stance toward immigrants becomes more unfavorable. More Latino elected officials do not bolster policy implementation efforts for the vulnerable communities or offset the backlash effect of immigrant policy.
Lifelong Maintenance of Oral Tolerance and Immunity Profiles in Mice Depends on Early Exposure to Antigen
Authors: Speziali E. F. , Menezes J. S. , Santiago A. F. , Vaz N. M. , Faria A. M. C.
Published: November 2017

Oral tolerance is defined as a state of systemic hyporesponsiveness to an antigen that has been previously administered by the oral route. Many factors affect oral tolerance induction; some of them related to antigen, and some related to the animal. The age of the animal is one of the most important factors that affect oral tolerance as ageing brings many alterations in immune responses. Herein, we demonstrated that both the oral tolerance and pattern of immune reactivity triggered in early life were kept up to 15 months regarding the magnitude of antibody production, cell proliferation and cytokine profile when compared to immune responses induced in old mice. Therefore, our results corroborate with a promising proposal for prevaccination during childhood and young age, and a booster in older age, to make sure that the primary immunization in early life is not lost in aged individuals.
Detection and clinical impact of human leukocyte antigen antibodies in lung transplantation: A systematic review and meta‐analysis
Authors: Courtwright A. , Diamond J. M. , Wood I. , Guleria I. , Milford E. , El‐Chemaly S. , Goldberg H. J.
Published: November 2017

There is significant variability in lung transplant centers’ approach to HLA antibodies, creating heterogeneity regarding their clinical significance. Some institutions use beads coated with multiple HLA to screen candidate sera and then use single antigen bead (SAB) to determine antibody identity if the pre‐screen is positive. Other centers do not pre‐screen, using SAB alone, which may detect low‐level antibodies of unknown significance. The primary objective of this study was to review the current literature to identify sources of heterogeneity in the identification of pre‐ and post‐lung transplant HLA antibodies, particularly regarding antibody‐detection methods. A random effects model meta‐analysis was used to evaluate the relationship between pre‐transplant HLA antibodies and the development of de novo donor‐specific antibodies (dnDSA) and dnDSA and chronic lung allograft dysfunction (CLAD). Each outcome was stratified by the method of antibody detection (pre‐screen followed by SAB vs SAB alone). We identified 13 cohort studies with a total of 3039 patients. The use of pre‐screening followed by SAB testing and the use of induction immunosuppression were associated with lower prevalence of dnDSA. Patients with pre‐transplant HLA antibodies were more likely to develop dnDSA (hazard ratio [HR] = 1.49, 95% confidence interval [CI]: 1.19‐1.86, P < .001). dnDSA was associated with CLAD (HR = 2.02, 95% CI = 1.37‐2.97, P < .001). When considering studies using SAB alone, however, pre‐transplant antibody status was no longer associated with dnDSA and dnDSA was no longer associated with CLAD. Based on the current literature, SAB‐alone testing may detect less clinically relevant antibodies than pre‐screening followed by SAB.
Quantification of classical HLA class I mRNA by allele‐specific, real‐time polymerase chain reaction for most Han individuals
Authors: Pan N. , Lu S. , Wang W. , Miao F. , Sun H. , Wu S. , Nan D. , Qiu J. , Xu J. , Zhang J.
Published: November 2017

Recent studies have shown that expression levels of different alleles at the same HLA class I locus can vary dramatically, which might have a broad influence on human disease. However, precise quantification of the relative expression level of each HLA allele is challenging, because distinguishing different alleles on the same locus is difficult. Here, we developed a series of allele‐specific, real‐time polymerase chain reaction assays for quantifying HLA class I allele mRNA in most Han individuals. The alleles of almost all heterozygous genotypes with a frequency higher than 0.5% in our population (78 alleles on HLA‐A locus, 124 alleles on HLA‐B locus, and 74 alleles on HLA‐C locus) were specifically amplified. The specificity of the amplification was strictly validated by setting the corresponding negative control for each allele of each genotype. The amplification efficiency of each reaction was determined, and the slopes of the reactions were compared. This study provides a tool for detecting the comprehensive expression profile of HLA class I alleles and will be useful not only for the investigation of the molecular mechanism underlying HLA allele expression regulation but also for exploration of immunological mechanisms involving HLA expression in the fields of tumour immune evasion, viral infection, auto‐immune disorders, and graft vs host disease after haematopoietic stem cell transplantation.
Prevalence, predictors and challenges of gestational diabetes mellitus screening among pregnant women in northern Tanzania
Authors: Njete H. I. , John B. , Mlay P. , Mahande M. J. , Msuya S. E.
Published: November 2017

Objectives

To determine the prevalence and predictors of gestational diabetes mellitus (GDM) as well as acceptability of returning for glucose tolerance testing among pregnant women in Moshi municipality, northern Tanzania.

Methods

Cross‐sectional study from October 2015 to April 2016 among women with gestation age of 24–28 weeks of pregnancy attending at Kilimanjaro Christian Medical Centre (KCMC) referral hospital, Majengo and Pasua Health Centres. Women were interviewed and requested to return the next day (window within a month, depending on gestational age) for fasting plasma glucose (FPG) testing, followed immediately by a 75 g oral glucose tolerance test (OGTT). GDM was diagnosed using the 2013 WHO criteria. Logistic regression was conducted to reveal independent predictors for GDM.

Results

Of 433 interviewed women, 100 (23%) did not return for FPG and OGTT testing. The prevalence of GDM among the 333 screened women was 19.5%, and 3% had diabetes in pregnancy (DIP). GDM was significantly associated with age ≥35 years (adjusted OR 6.75), pre‐pregnancy obesity (AOR 2.22) and history of abortion (AOR 2.36).

Conclusion

Prevalence of GDM is high in Moshi. We recommend introduction of routine screening for hyperglycaemia during pregnancy along with strategies for follow‐up to prevent long‐term effects of GDM and DIP in women and their children.
Daily inspiratory muscle training lowers blood pressure and vascular resistance in healthy men and women
Authors: DeLucia Claire M. , De Asis Roxanne M. , Bailey E. Fiona
Published: November 2017

New Findings

What is the central question of this study?

What impact does inspiratory muscle training have on systemic vascular resistance, cardiac output and baroreflex sensitivity in adult men and women?

What is the main finding and its importance?

Inspiratory muscle training exerts favorable effects on blood pressure, vascular resistance and perception of stress. This exercise format is well‐tolerated and equally effective whether implemented in men or women.

Previous work has shown that inspiratory muscle training (IMT) lowers blood pressure after a mere 6 weeks, identifying IMT as a potential therapeutic intervention to prevent or treat hypertension. Here, we explore the effects of IMT on respiratory muscle strength and select cardiovascular parameters in recreationally active men and women. Subjects were randomly assigned to IMT (n = 12, 75% maximal inspiratory pressure) or sham training (n = 13, 15% maximal inspiratory pressure) groups and underwent a 6‐week intervention comprising 30 breaths day−1, 5 days week−1. Pre‐ and post‐training measures included maximal inspiratory pressure and resting measures of blood pressure, cardiac output, heart rate, spontaneous cardiac baroreflex sensitivity and systemic vascular resistance. We evaluated psychological and sleep status via administration of the Cohen–Hoberman inventory of physical symptoms and the Epworth sleepiness scale. Male and female subjects in the IMT group showed declines in systolic/diastolic blood pressures (−4.3/−3.9 mmHg, P < 0.025) and systemic vascular resistance (−3.5 mmHg min l−1, P = 0.008) at week 6. There was no effect of IMT on cardiac output (P = 0.722), heart rate (P = 0.795) or spontaneous cardiac baroreflex sensitivity (P = 0.776). The IMT subjects also reported fewer stress‐related symptoms (pre‐ versus post‐training, 12.5 ± 8.5 versus 7.2 ± 9.7, P = 0.025). Based on these results, we suggest that a short course of IMT confers significant respiratory and cardiovascular improvements and parallel (modest) psychological benefits in healthy men and women.
Ultrafast dynamics of vibrational symmetry breaking in a charge-ordered nickelate
Authors: Coslovich Giacomo , Kemper Alexander F. , Behl Sascha , Huber Bernhard , Bechtel Hans A. , Sasagawa Takao , Martin Michael C. , Lanzara Alessandra , Kaindl Robert A.
Published: November 2017

Terahertz pulses reveal the multiscale dynamics of the crystal symmetry upon melting and formation of atomic-scale stripes.
Provably secure and high-rate quantum key distribution with time-bin qudits
Authors: Islam Nurul T. , Lim Charles Ci Wen , Cahall Clinton , Kim Jungsang , Gauthier Daniel J.
Published: November 2017

Information encoded in high-dimensional quantum states can achieve ultrahigh rates over metropolitan distances.
Discriminating between natural versus induced seismicity from long-term deformation history of intraplate faults
Authors: Magnani Maria Beatrice , Blanpied Michael L. , DeShon Heather R. , Hornbach Matthew J.
Published: November 2017

Long-term fault slip history can diagnose natural versus induced earthquakes, independent of correlations with fluid injection.
The Spirochete Brachyspira pilosicoli, Enteric Pathogen of Animals and Humans
Authors: Hampson David J.
Published: November 2017

Brachyspira pilosicoliis a slow-growing anaerobic spirochete that colonizes the large intestine. Colonization occurs commonly in pigs and adult chickens, causing colitis/typhlitis, diarrhea, poor growth rates, and reduced production. Colonization of humans also is common in some populations (individuals living in village and peri-urban settings in developing countries, recent immigrants from developing countries, homosexual males, and HIV-positive patients), but the spirochete rarely is investigated as a potential human enteric pathogen. In part this is due to its slow growth and specialized growth requirements, meaning that it is not detectable in human fecal samples using routine diagnostic methods. Nevertheless, it has been identified histologically attached to the colon and rectum in patients with conditions such as chronic diarrhea, rectal bleeding, and/or nonspecific abdominal discomfort, and one survey of Australian Aboriginal children showed that colonization was significantly associated with failure to thrive.B. pilosicolihas been detected in the bloodstream of elderly patients or individuals with chronic conditions such as alcoholism and malignancies. This review describes the spirochete and associated diseases. It aims to encourage clinicians and clinical microbiologists to considerB. pilosicoliin their differential diagnoses and to develop and use appropriate diagnostic protocols to identify the spirochete in clinical specimens.
Major bleeding disorders: diagnosis, classification, management and recent developments in haemophilia
Authors: Bhatnagar Neha , Hall Georgina W
Published: November 2017

In this review, we outline the standard of care for children in the UK with the most common major bleeding disorder, haemophilia, and how exciting new developments in therapy have the potential for further improvements in quality of life and clinical outcome. The combination of comprehensive specialist medical care, safer factor concentrates, earlier introduction of prophylaxis and patient-specific education has allowed the current generation of patients with haemophilia to grow into adulthood with excellent joint function, pursuing full-time employment with a good quality of life. We are entering an exciting new phase in paediatric haemophilia as potentially life-changing products appear on the scene taking a step towards achieving better, easier and personalised prophylaxis.
Patterns of pain over time among children with juvenile idiopathic arthritis
Authors: Rashid Amir , Cordingley Lis , Carrasco Roberto , Foster Helen E , Baildam Eileen M , Chieng Alice , Davidson Joyce E , Wedderburn Lucy R , Ioannou Yiannis , McErlane Flora , Verstappen Suzanne M M , Hyrich Kimme L , Thomson Wendy
Published: November 2017

Objectives

Pain is a very common symptom of juvenile idiopathic arthritis (JIA). Disease activity alone cannot explain symptoms of pain in all children, suggesting other factors may be relevant. The objectives of this study were to describe the different patterns of pain experienced over time in children with JIA and to identify predictors of which children are likely to experience ongoing pain.

Methods

This study used longitudinal-data from patients (aged 1–16 years) with new-onset JIA. Baseline and up to 5-year follow-up pain data from the Childhood Arthritis Prospective Study (CAPS) were used. A two-step approach was adopted. First, pain trajectories were modelled using a discrete mixture model. Second, multinomial logistic regression was used to determine the association between variables and trajectories.

Results

Data from 851 individuals were included (4 years, median follow-up). A three-group trajectory model was identified: consistently low pain (n=453), improved pain (n=254) and consistently high pain (n=144). Children with improved pain or consistently high pain differed on average at baseline from consistently low pain. Older age at onset, poor function/disability and longer disease duration at baseline were associated with consistently high pain compared with consistently low pain. Early increases in pain and poor function/disability were also associated with consistently high pain compared with consistently low pain.

Conclusions

This study has identified routinely collected clinical factors, which may indicate those individuals with JIA at risk of poor pain outcomes earlier in disease. Identifying those at highest risk of poor pain outcomes at disease onset may enable targeted pain management strategies to be implemented early in disease thus reducing the risk of poor pain outcomes.
Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis
Authors: Payne Victoria , Hall Mike , Prieto Jacqui , Johnson Mark
Published: November 2017

Background

Central line-associated bloodstream infections (CLABSIs) are associated with increased mortality, prolonged hospitalisation and increased healthcare costs. Care bundles have reduced CLABSIs in adult intensive care units (ICUs) but replication in paediatric ICUs has had inconsistent outcomes. A systematic review was performed to assess the evidence for the efficacy of care bundles in reducing CLABSIs in the neonatal unit (NNU).

Methods

MEDLINE, CINAHL and EMBASE were searched from January 2010 up to January 2017. The Cochrane Library, Web of Science, Zetoc and Ethos were searched for additional studies. Randomised controlled trials (RCTs), quasi-experimental and observational studies were eligible. The primary outcome measure was CLABSI rates per 1000 central line, or patient, days. A meta-analysis was performed using random effects modelling.

Results

Twenty-four studies were eligible for inclusion: six were performed in Europe, 12 were in North America, two in Australia and four were in low/middle-income countries. Five were observational studies and 19 were before and after quality improvement studies. No RCTs were found. Meta-analysis revealed a statistically significant reduction in CLABSIs following the introduction of care bundles (rate ratio=0.40 (CI 0.31 to 0.51), p<0.00001), which equates to a 60% reduction in CLABSI rate.

Conclusion

There is a substantial body of quasi-experimental evidence to suggest that care bundles may reduce CLABSI rates in the NNU, though it is not clear which bundle elements are effective in specific settings. Future research should focus on determining what processes promote the effective implementation of infection prevention recommendations, and which elements represent essential components of such care bundles.
Post-traumatic stress after PICU and corticosteroid use
Authors: Corbet Burcher Georgina , Picouto Maria D , Als Lorraine C , Cooper Mehrengise , Pierce Christine M , Nadel Simon , Garralda M Elena
Published: November 2017

Aim

To examine the association between corticosteroid use in paediatric intensive care units (PICU) and subsequent symptoms of post-traumatic stress disorder (PTSD).

Methods

The subjects were children aged 8–16 years admitted to PICU with sepsis, meningoencephalitis (ME) and other disorders. Illness information was extracted from case notes; 3–6 months post discharge children completed a PTSD symptom questionnaire (eight-item Impact of Events Scale (IES-8)) assessing intrusion and avoidance symptoms. Saliva samples were also collected for cortisol profile analysis.

Results

53 children completed the IES-8 questionnaires. 33 provided saliva samples. 19 (36%) received corticosteroids. In children with sepsis (n=15), corticosteroid use was associated with significantly lower PTSD intrusion symptom scores. There was a trend towards an association between corticosteroid use and lower evening cortisol levels. There was a comparable but weaker trend in children with ME.

Discussion

Corticosteroid use may be associated with fewer PTSD symptoms and lower evening cortisol levels following PICU admission in children with sepsis.
Decreased oxygen exposure during transportation of newborns
Authors: Ruangkit Chayatat , Soonsawad Sasivimon , Tutchamnong Thavatchai , Swatesutipun Buranee
Published: November 2017

Oxygen is the most common treatment for newborns in need of respiratory support. However, oxygen can cause tissue injury through reactive oxygen species formation, especially in premature infants with reduced antioxidant defences, and may result in short-term and long-term toxic effects in multiple organ systems. Although most hospitals have the capability to tightly control oxygen delivery to hospitalised neonates, in many circumstances, the need is overlooked during infant transport. Lack of awareness of harm or appropriate medical equipment invariably results in excessive oxygen exposure. We developed a quality improvement programme to decrease oxygen exposure to newborns during their transportation, thus improving patient safety and quality of care.
Traumatic pneumocephaly: trapped air from where?
Authors: Basheer Azam , Macki Mohamed , Mahmood Asim
Published: November 2017

Traumatic pneumocephaly is literally defined as ‘air in the head’ after trauma. While this phenomenon has been well described in the literature, our case report is unique in describing diffuse pneumocephalus in the subaponeurotic space, subdural space, subarachnoid space, brain and ventricles without a break in the cranial vault: a 26-year-old man fell from a =9 meter scaffolding in a water tower. Following an arduous and delayed extrication, the patient was unresponsive with loss of pulse requiring intubation, cardiopulmonary resuscitation and release of tension pneumothorax with bilateral thoracostomy tubes. Examination remained poor with a Glasgow Coma Scale of 3. Immediate exploratory laparotomy was performed for a small right retroperitoneal haematoma on Focused Assessment with Sonography for Trauma. Postoperative imaging revealed diffuse pneumocephaly without facial fractures. This case presentation explores unusual causes of fistulous connections with the atmosphere that may lead to air trapped in and around the cranial vault.
What is the cause of this fever? Malaria with concomitant pneumonia
Authors: Sanford Blake Sterling , Potrous Laith , Castillo MacKenzie Maricela
Published: November 2017

A 43-year-old Hispanic woman presented to the clinic complaining of fever, chills and cough for 14 days. The patient reported a recent trip to Asia 12 days prior to presenting symptoms. Given her physical examination findings, she was treated empirically for community acquired pneumonia. Since her symptoms worsened despite the antibiotic, she was referred to the Emergency Department for further evaluation. The patient was ultimately diagnosed with pneumonia and malaria. When evaluating patients with history of recent travel, it is important to consider communicable diseases that are endemic to the areas visited, as well as multiple disease aetiologies for complicated and refractory cases.
Cluster analysis of novel isometric strength measures produces a valid and evidence-based classification structure for wheelchair track racing
Authors: Connick Mark J , Beckman Emma , Vanlandewijck Yves , Malone Laurie A , Blomqvist Sven , Tweedy Sean M
Published: November 2017

Background

The Para athletics wheelchair-racing classification system employs best practice to ensure that classes comprise athletes whose impairments cause a comparable degree of activity limitation. However, decision-making is largely subjective and scientific evidence which reduces this subjectivity is required.

Aim

To evaluate whether isometric strength tests were valid for the purposes of classifying wheelchair racers and whether cluster analysis of the strength measures produced a valid classification structure.

Methods

Thirty-two international level, male wheelchair racers from classes T51–54 completed six isometric strength tests evaluating elbow extensors, shoulder flexors, trunk flexors and forearm pronators and two wheelchair performance tests–Top-Speed (0–15 m) and Top-Speed (absolute). Strength tests significantly correlated with wheelchair performance were included in a cluster analysis and the validity of the resulting clusters was assessed.

Results

All six strength tests correlated with performance (r=0.54–0.88). Cluster analysis yielded four clusters with reasonable overall structure (mean silhouette coefficient=0.58) and large intercluster strength differences. Six athletes (19%) were allocated to clusters that did not align with their current class. While the mean wheelchair racing performance of the resulting clusters was unequivocally hierarchical, the mean performance of current classes was not, with no difference between current classes T53 and T54.

Conclusions

Cluster analysis of isometric strength tests produced classes comprising athletes who experienced a similar degree of activity limitation. The strength tests reported can provide the basis for a new, more transparent, less subjective wheelchair racing classification system, pending replication of these findings in a larger, representative sample. This paper also provides guidance for development of evidence-based systems in other Para sports.
Reconstruction of head impacts in FIS World Cup alpine skiing
Authors: Steenstrup Sophie Elspeth , Mok Kam-Ming , McIntosh Andrew S , Bahr Roald , Krosshaug Tron
Published: November 2017

Introduction

Prior to the 2013/2014 season, the International Ski Federation (FIS) increased the helmet testing speed from 5.4 to 6.8 m/s for alpine downhill, super-G and giant slalom. Whether this increased testing speed reflects head impact velocities in real head injury situations on snow is unclear. We therefore investigated the injury mechanisms and gross head impact biomechanics in seven real head injury situations among World Cup (WC) alpine skiers.

Methods

We analysed nine head impacts from seven head injury videos from the FIS Injury Surveillance System, throughout nine WC seasons (2006–2015) in detail. We used commercial video-based motion analysis software to estimate head impact kinematics in two dimensions, including directly preimpact and postimpact, from broadcast video. The sagittal plane angular movement of the head was also measured using angle measurement software.

Results

In seven of nine head impacts, the estimated normal to slope preimpact velocity was higher than the current FIS helmet rule of 6.8 m/s (mean 8.1 (±SD 0.6) m/s, range 1.9±0.8 to 12.1±0.4 m/s). The nine head impacts had a mean normal to slope velocity change of 9.3±1.0 m/s, range 5.2±1.1 to 13.5±1.3 m/s. There was a large change in sagittal plane angular velocity (mean 43.3±2.9 rad/s (range 21.2±1.5 to 64.2±3.0 rad/s)) during impact.

Conclusion

The estimated normal to slope preimpact velocity was higher than the current FIS helmet rule of 6.8 m/s in seven of nine head impacts.
Poor overall quality of clinical practice guidelines for musculoskeletal pain: a systematic review
Authors: Lin Ivan , Wiles Louise K , Waller Robert , Goucke Roger , Nagree Yusuf , Gibberd Michael , Straker Leon , Maher Christopher G , O’Sullivan Peter P B
Published: November 2017

Objectives

Undertake a systematic critical appraisal of contemporary clinical practice guidelines (CPGs) for common musculoskeletal (MSK) pain conditions: spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis) and shoulder.

Design

Systematic review of CPGs (PROSPERO number: CRD42016051653).

Included CPGs were written in English, developed within the last 5 years, focused on adults and described development processes. Excluded CPGs were for: traumatic MSK pain, single modalities (eg, surgery), traditional healing/medicine, specific disease processes (eg, inflammatory arthropathies) or those that required payment.

Data sources and method of appraisal

Four scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used for critical appraisal.

Results

4664 records were identified, and 34 CPGs were included. Most were for osteoarthritis (n=12) or low back pain (n=11), most commonly from the USA (n=12). The mean overall AGREE II score was 45% (SD=19.7). Lowest mean domain scores were forapplicability(26%, SD=19.5) andeditorial independence(33%, SD=27.5). The highest score was forscopeandpurpose(72%, SD=14.3). Only 8 of 34 CPGS were high quality: for osteoarthritis (n=4), low back pain (n=2), neck (n=1) and shoulder pain (n=1).
Usage-driven problem design for radical innovation in healthcare
Authors: Lamé Guillaume , Yannou Bernard , Cluzel François
Published: November 2017

While the diffusion and evaluation of healthcare innovations receive a lot of attention, the early design stages are less studied and potential innovators lack methods to identify where new innovations are necessary and to propose concepts relevant to users. To change this, we propose a structured methodology, Radical Innovation Design (RID), which supports designers who want to work on the unstated needs of potential end users in order to create superior value. In this article, the first part of RID is introduced with its two subprocesses: Problem Design and Knowledge Design. In this first period, RID guides innovators to systematically explore users’ problems and evaluate which ones are most pressing in terms of innovation, taking into account existing solutions. The result is an ambition perimeter, composed of a set of value buckets, that is, important usage situations where major problems are experienced and the current solutions provide little or no relief. The methodology then moves on to Solution Design and Business Design (which are not detailed in this article) to address the value buckets identified. With its emphasis on problem exploration, RID differs from methods based on early prototyping. The RID methodology has been validated in various industrial sectors and is well-adapted for healthcare innovation. To exemplify the methodology, we present a case study in dental imagery performed by 10 students in 8 weeks. This example demonstrates how RID favours efficiency in Problem Design and allows designers to explore unaddressed and sometimes undeclared user needs.
Innovation for the future of Irish MedTech industry: retrospective qualitative review of impact of BioInnovate Ireland’s clinical fellows
Authors: McGloughlin Elizabeth Kate , Anglim Paul , Keogh Ivan , Sharif Faisal
Published: November 2017

Clinicians have historically been integral in innovating and developing technology in medicine and surgery. In recent years, however, in an increasingly complex healthcare system, a doctor with innovative ideas is often left behind. Transition from idea to bedside now entails significant hurdles, which often go unrecognised at the outset, particularly for first-time innovators. The BioInnnovate Ireland process, based on the Stanford Biodesign Programme (Identify, Invent and Implement), aims to streamline the process of innovation within the MedTech sector. These programmes focus on needs-based innovation and enable multidisciplinary teams to innovate and collaborate more succinctly. In this preliminary study, the authors aimed to examine the impact of BioInnovate Ireland has had on the clinicians involved and validate the collaborative process. To date, 13 fellows with backgrounds in clinical medicine have participated in the BioInnovate programme. Ten of these clinicians remain involved in clinical innovation projects with four of these working on Enterprise Ireland funded commercialisation grants and one working as chief executive officer of a service-led start-up, Strive. Of these, five also remain engaged in clinical practice on a full or part-time basis. The clinicians who have returned to full-time clinical practice have used the process and learning of the programme to influence their individual clinical areas and actively seek innovative solutions to meet clinical challenges. Clinicians, in particular, describe gaining value from the BioInnovate programme in areas of ‘Understanding Entrepreneurship’ and ‘Business Strategy’. Further study is needed into the quantitative impact on the ecosystem and impact to other stakeholders.
Smoking prevalence and attitudes towards smoking among Estonian physicians: results from cross-sectional studies in 2002 and 2014
Authors: Põld Mariliis , Pärna Kersti
Published: November 2017

Objectives

To explore smoking prevalence and attitudes towards smoking among Estonian physicians in 2002 and 2014.

Design

Two self-administered cross-sectional postal surveys were conducted among practising physicians in Estonia.

Participants

Initial sample consisted of all practising physicians in Estonia. The corrected response rate was 67.8% in 2002 and 53.1% in 2014. Present study sample was restricted to physicians younger than 65 years (n=2549 in 2002, n=2339 in 2014).

Methods

Age-standardised prevalence of smoking and prevalence of agreement with seven statements concerning attitudes towards smoking was determined. To analyse association of physicians’ attitudes towards smoking with study year and smoking status, logistic regression analysis was used. Adjusted ORs of agreement with the seven statements were determined. Corresponding 95% CIs were calculated.

Results

The age-standardised prevalence of current smoking among men was 26.8% in 2002 and 15.3% in 2014, among women 10.4% and 5.8%, respectively. Compared with the year 2002, in 2014, prevalence of agreement with statements declaring harmfulness of smoking was higher and prevalence of agreement with statements approving smoking was lower. Adjusted ORs showed that compared with 2002, physicians’ attitudes towards smoking were less favourable in 2014, and physicians’ attitudes towards smoking were associated with their smoking status.

Conclusions

Compared with 2002, the age-standardised smoking prevalence among male and female physicians was lower, and attitudes towards smoking were less approving in 2014. The smoking physicians had more approving attitudes towards smoking than their non-smoking colleagues.
Epidemiology of obesity and overweight in sub-Saharan Africa: a protocol for a systematic review and meta-analysis
Authors: Biadgilign Sibhatu , Mgutshini Tennyson , Haile Demewoz , Gebremichael Bereket , Moges Yonatan , Tilahun Kelemu
Published: November 2017

Introduction

Globally, overweight and obesity were estimated to cause 3.4 million deaths, 3.9% of years of life lost and 3.8% of disability-adjusted life years in 2010. Despite the fact that obesity and overweight is a problem of high-income countries, low- and middle-income countries (LMICs), in particular urban settings of sub-Saharan African countries, face the challenge of an increasing trend. The aim of this systematic review and meta-analysis will be to determine the prevalence of obesity and overweight individuals in sub-Saharan Africa and to help guide policy planners in the decision-making process for the increase in non-communicable diseases in Africa.

Methods and analyses

A comprehensive systematic review and meta-analysis of published studies on the prevalence of obesity and overweight in sub-Saharan Africa will be conducted. A computerised internet search using Medline/PubMed, Google Scholar and EMBASE databases and reference lists of previous prevalence studies and detailed search strategy and cross-checking of reference lists of published peer-reviewed articles will be conducted to identify all epidemiological and/or clinical studies published in English and French. We will use the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement for reporting. The overall effect (pooled estimated effect size) of the prevalence of obesity and overweight will be analysed using the Der Simonian–Laird random effects meta-analysis (random effects model) and the obesity proportion (with 95% CI) will be measured.

Ethics and dissemination

The underlying work is based on systematic reviews of published data and thus doed not require ethical review approval. The findings of the systematic review will be disseminated in different conferences and seminars and will be published in a reputable and refereed international peer-reviewed journal.

PROSPERO registration number

CRD42017064942.
Monitoring of clinical strains and environmental fungal aerocontamination to prevent invasive aspergillosis infections in hospital during large deconstruction work: a protocol study
Authors: Loeffert Sophie Tiphaine , Melloul Elise , Dananché Cédric , Hénaff Laetitia , Bénet Thomas , Cassier Pierre , Dupont Damien , Guillot Jacques , Botterel Françoise , Wallon Martine , Gustin Marie-Paule , Vanhems Philippe
Published: November 2017

Introduction

Monitoring fungal aerocontamination is an essential measure to prevent severe invasive aspergillosis (IA) infections in hospitals. One central block among 32 blocks of Edouard Herriot Hospital (EHH) was entirely demolished in 2015, while care activities continued in surrounding blocks. The main objective was to undertake broad environmental monitoring and clinical surveillance of IA cases to document fungal dispersion during major deconstruction work and to assess clinical risk.

Methods and analysis

A daily environmental survey of fungal loads was conducted in eight wards located near the demolition site. Air was collected inside and outside selected wards by agar impact samplers. Daily spore concentrations were monitored continuously by volumetric samplers at a flow rate of 10 L.min-1. Daily temperature, wind direction and speed as well as relative humidity were recorded by the French meteorological station Meteociel.Aspergillus fumigatusstrains stored will be genotyped by multiple-locus, variable-number, tandem-repeat analysis. Antifungal susceptibility will be assessed by E-test strips on Roswell Park Memorial Institute medium supplemented with agar. Ascertaining the adequacy of current environmental monitoring techniques in hospital is of growing importance, considering the rising impact of fungal infections and of curative antifungal costs. The present study could improve the daily management of IA risk during major deconstruction work and generate new data to ameliorate and redefine current guidelines.

Ethics and dissemination

This study was approved by the clinical research and ethics committees of EHH.
Impact of US smoke-free air laws on restaurants and bars by employer size: a panel study
Authors: Shafer Paul
Published: November 2017

Objectives

Thirty states have smoke-free air laws that ban smoking in restaurants and bars, covering nearly two-thirds of the US population. It is well established that these laws generally have a null or positive economic impact on restaurants and bars. However, all establishments in a geographic area are usually treated as a homogeneous group without considering the potential for differential effects by establishment characteristics. This study uses variation in smoke-free air laws over time to estimate their impact on employment in restaurants and bars with a focus on potential differences by employer size (number of employees). A two-pronged approach with a national-level and state-level analysis is used to take advantage of more granular data availability for a single state (North Carolina).

Design

Observational study using panel data.

Setting

1) US, 2) North Carolina

Interventions

Smoke-free air laws.

Outcome measures

State-level accommodation and food services employment for all 50 states and District of Columbia from 1990 through 2014 (Quarterly Census of Employment and Wages); county-level restaurant and bar employment in North Carolina from 2001 through 2014 (North Carolina Department of Commerce).

Results

There is no evidence of a redistributive effect of smoke-free air laws on restaurant and bar employment by employer size.

Conclusion

The lack of a redistributive effect is an important finding for policy-makers considering implementation or expansion of a smoke-free air law to protect employees and patrons from the dangers of exposure to secondhand smoke.
When has service provision for transient ischaemic attack improved enough? A discrete event simulation economic modelling study
Authors: Barton Pelham , Sheppard James P , Penaloza-Ramos Cristina M , Jowett Sue , Ford Gary A , Lasserson Daniel , Mant Jonathan , Mellor Ruth M , Quinn Tom , Rothwell Peter M , Sandler David , Sims Don , McManus Richard J
Published: November 2017

Objectives

The aim of this study was to examine the impact of transient ischaemic attack (TIA) service modification in two hospitals on costs and clinical outcomes.

Design

Discrete event simulation model using data from routine electronic health records from 2011.

Participants

Patients with suspected TIA were followed from symptom onset to presentation, referral to specialist clinics, treatment and subsequent stroke.

Interventions

Included existing versus previous (less same day clinics) and hypothetical service reconfiguration (7-day service with less availability of clinics per day).

Outcome measures

The primary outcome of the model was the prevalence of major stroke after TIA. Secondary outcomes included service costs (including those of treating subsequent stroke) and time to treatment and attainment of national targets for service provision (proportion of high-risk patients (according to ABCD2score) seen within 24 hours).

Results

The estimated costs of previous service provision for 490 patients (aged 74±12 years, 48.9% female and 23.6% high risk) per year at each site were £340 000 and £368 000, respectively. This resulted in 31% of high-risk patients seen within 24 hours of referral (47/150) with a median time from referral to clinic attendance/treatment of 1.15 days (IQR 0.93–2.88). The costs associated with the existing and hypothetical services decreased by £5000 at one site and increased £21 000 at the other site. Target attainment was improved to 79% (118/150). However, the median time to clinic attendance was only reduced to 0.85 days (IQR 0.17–0.99) and thus no appreciable impact on the modelled incidence of major stroke was observed (10.7 per year, 99% CI 10.5 to 10.9 (previous service) vs 10.6 per year, 99% CI 10.4 to 10.8 (existing service)).

Conclusions

Reconfiguration of services for TIA is effective at increasing target attainment, but in services which are already working efficiently (treating patients within 1–2 days), it has little estimated impact on clinical outcomes and increased investment may not be worthwhile.