bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of multi-electrode configuration on sensitivity to interaural timing differences in bilateral cochlear-implant users
Authors: Kan Alan , Jones Heath G. , Litovsky Ruth Y.
Published: December 2015

Recent psychophysical studies in bilateral cochlear implant users have shown that interaural timing difference (ITD) sensitivity with electrical stimulation varies depending on the place of stimulation along the cochlear array. While these studies have measured ITD sensitivity at single electrode places separately, it is important to understand how ITD sensitivity is affected when multiple electrodes are stimulated together because multi-electrode stimulation is required for representation of complex sounds. Multi-electrode stimulation may lead to poorer overall performance due to interference from places with poor ITD sensitivity, or from channel interaction due to electrical current spread. Alternatively, multi-electrode stimulation might result in overall good sensitivity if listeners can extract the most reliable ITD cues available. ITD just noticeable differences (JNDs) were measured for different multi-electrode configurations. Results showed that multi-electrode ITD JNDs were poorer than ITD JNDs for the best single-electrode pair. However, presenting ITD information along the whole array appeared to produce better sensitivity compared with restricting stimulation to the ends of the array, where ITD JNDs were comparable to the poorest single-electrode pair. These findings suggest that presenting ITDs in one cochlear region only may not be optimal for maximizing ITD sensitivity in multi-electrode stimulation.
Low-frequency beamforming for a miniaturized aperture three-by-three uniform rectangular array of acoustic vector sensors
Authors: Guo Xijing , Yang Shi’e , Miron Sebastian
Published: December 2015

This paper proposes a mode domain beamforming method for a 3 × 3 uniform rectangular array of two-dimensional (2D) acoustic vector sensors with inter-sensor spacing much smaller than the wavelengths in the working frequency band. The acoustic modes are extracted from the particle velocity observations in light of the source-sink pictures of the Taylor's series multipoles [Wikswo and Swinney, J. Appl. Phys. 56(11), 3039–3049 (1984)]. Then, similar to other mode domain methods, the modes are synthesized to obtain the desired beam pattern. The proposed method is limited to the cases where five is the maximum order of the modes for pattern synthesis, meaning that the directivity index in the 2D isotropic noise case can reach up to 10.4 dB. The proposed method has been validated by field experiments.
Structural monitoring of a highway bridge using passive noise recordings from street traffic
Authors: Salvermoser Johannes , Hadziioannou Céline , Stähler Simon C.
Published: December 2015

Structural damage on bridges presents a hazard to public safety and can lead to fatalities. This article contributes to the development of an alternative monitoring system for civil structures, based on passive measurements of seismic elastic waves. Cross-correlations of traffic noise recorded at geophone receiver pairs were found to be sufficiently stable for comparison and sensitive to velocity changes in the medium. As such velocity variations could be caused by damage, their detection would be valuable in structural health monitoring systems. A method, originally introduced for seismological applications and named Passive Image Interferometry, was used to quantify small velocity fluctuations in the medium and thereby observe structural changes. Evaluation of more than 2 months of continuous geophone recordings at a reinforced concrete bridge yielded velocity variations Δv/v in the range of −1.5% to +2.1%. The observed fluctuations correlate with associated temperature time series with a striking resemblance which is remarkable for two completely independent data sets. Using a linear regression approach, a relationship between temperature and velocity variations of on average 0.064% °C−1 can be identified. This value corresponds well to other studies on concrete structures.
Evaluation of road traffic noise abatement by vegetation treatment in a 1:10 urban scale model
Authors: Jang Hyung Suk , Lee Sung Chan , Jeon Jin Yong , Kang Jian
Published: December 2015

A 1:10 scale of a street canyon and courtyard was constructed to evaluate sound propagation when various vegetation treatments including trees, shrubs, vegetated facades, and green roofs were installed in the urban environment. Noise reductions in the street canyon and courtyard were measured for both single and combined vegetation treatments. Vegetated facades mitigated the overall noise level up to 1.6 dBA in the street canyon, and greening facades were effective to reduce low frequency noise levels below 1 kHz. Trees increased the noise level at high frequency bands to some extent in the street canyon, while the noise level over 1 kHz decreased in the courtyard after installing the street trees. This is because tree crowns diffused and reflected high frequency sounds into the street canyon. Green roofs offered significant noise abatement over 1 kHz in the courtyard, while the vegetated facade was effective to reduce noise levels at low frequencies. In terms of the integrated effects of vegetation treatments, a combined vegetation treatment was less effective than the sum of single treatments in the street canyon. The maximum noise reduction observed for all combinations of vegetation treatments provided 3.4 dBA of insertion loss in the courtyard.
Sound source localization in a randomly inhomogeneous medium using matched statistical moment method
Authors: Wang Xun , Khazaie Shahram , Sagaut Pierre
Published: December 2015

This paper investigates the problem of sound source localization from acoustical measurements obtained by an array of microphones. The sound propagation medium is assumed to be randomly inhomogeneous, being modelled by a random function of space. In this case, classical source localization methods (e.g., beamforming, near-field acoustical holography, and time reversal) cannot be used anymore. Therefore, an approach based on the statistical moments of acoustical measurement is proposed to solve the aforementioned problem. In this work, a Karhunen–Loève expansion is used so that the random medium can be represented by a small number of uncorrelated and identically distributed random variables. The statistical characteristics of the measurements in terms of probability density function and statistical moments are also studied. Then, the sound source is localized by minimizing the error of statistical moments between the real measurements obtained from the microphone array and the measurements simulated from an assumed source. Finally, a numerical example is introduced to justify the proposed method. This experiment shows that the random field can be replicated by a very small number of random variables, the statistical moments of measurements guarantee the convergence, and the source location can be accurately estimated using the proposed source localization method.
Complete Genome Sequence of a Hepatitis D Virus Genotype 1 Strain Isolated in Guangdong, China
Authors: Liao Baolin , Chen Weilie , Ping Qu , Shi Haiyan , He Haolan , Liu Huiyuan , Tan Yizhou , Lei Chunliang , Cai Weiping
Published: December 2015

Here, we report the first complete genome sequence of a hepatitis D virus genotype 1 strain, GZ37, isolated in Guangzhou, Guangdong Province, China, in 2014. The sequence information provided here will help us understand the molecular epidemiology of hepatitis D virus and contribute to disease control in mainland China.
Draft Genome Sequence of “
Candidatus
Liberibacter asiaticus” from a Citrus Tree in San Gabriel, California
Authors: Wu F. , Kumagai L. , Liang G. , Deng X. , Zheng Z. , Keremane M. , Chen J.
Published: December 2015

The draft genome sequence of “
Candidatus
Liberibacter asiaticus” strain SGCA5 from an orange citrus tree in San Gabriel, California, is reported here. SGCA5 has a genome size of 1,201,445 bp, a G+C content of 36.4%, 1,152 predicted open reading frames (ORFs), and 42 RNA genes.
Complete Genome Sequence of Bovine Viral Diarrhea Virus-1 Strain Egy/Ismailia/2014, Subtype 1b
Authors: Soltan Mohamed A. , Wilkes Rebecca P. , Elsheery Mohamed N. , Elhaig Mahmoud M. , Riley Matthew C. , Kennedy Melissa A.
Published: December 2015

Here, we report the complete genome sequence of bovine viral diarrhea virus-1b (BVDV-1b), strain Egy/Ismailia/2014. The virus genome is composed of 12,217 nucleotides organized as one open reading frame encoding 3,898 amino acids. This report will assist efforts in diagnostics, studying molecular epidemiology, and control of BVDV in Egypt.
A Pan-HIV Strategy for Complete Genome Sequencing
Authors: Berg Michael G. , Yamaguchi Julie , Alessandri-Gradt Elodie , Tell Robert W. , Plantier Jean-Christophe , Brennan Catherine A.
Published: December 2015

Molecular surveillance is essential to monitor HIV diversity and track emerging strains. We have developed a universal library preparation method (HIV-SMART [i.e.,
s
witching
m
echanism
a
t 5′ end of
R
NA
t
ranscript]) for next-generation sequencing that harnesses the specificity of HIV-directed priming to enable full genome characterization of all HIV-1 groups (M, N, O, and P) and HIV-2. Broad application of the HIV-SMART approach was demonstrated using a panel of diverse cell-cultured virus isolates. HIV-1 non-subtype B-infected clinical specimens from Cameroon were then used to optimize the protocol to sequence directly from plasma. When multiplexing 8 or more libraries per MiSeq run, full genome coverage at a median ∼2,000× depth was routinely obtained for either sample type. The method reproducibly generated the same consensus sequence, consistently identified viral sequence heterogeneity present in specimens, and at viral loads of ≤4.5 log copies/ml yielded sufficient coverage to permit strain classification. HIV-SMART provides an unparalleled opportunity to identify diverse HIV strains in patient specimens and to determine phylogenetic classification based on the entire viral genome. Easily adapted to sequence any RNA virus, this technology illustrates the utility of next-generation sequencing (NGS) for viral characterization and surveillance.
Structure-Based Mutagenesis of Sulfolobus Turreted Icosahedral Virus B204 Reveals Essential Residues in the Virion-Associated DNA-Packaging ATPase
Authors: Dellas Nikki , Snyder Jamie C. , Dills Michael , Nicolay Sheena J. , Kerchner Keshia M. , Brumfield Susan K. , Lawrence C. Martin , Young Mark J.
Published: December 2015

Sulfolobus
turreted icosahedral virus (STIV), an archaeal virus that infects the hyperthermoacidophile
Sulfolobus solfataricus
, is one of the most well-studied viruses of the domain
Archaea
. STIV shares structural, morphological, and sequence similarities with viruses from other domains of life, all of which are thought to belong to the same viral lineage. Several of these common features include a conserved coat protein fold, an internal lipid membrane, and a DNA-packaging ATPase. B204 is the ATPase encoded by STIV and is thought to drive packaging of viral DNA during the replication process. Here, we report the crystal structure of B204 along with the biochemical analysis of B204 mutants chosen based on structural information and sequence conservation patterns observed among members of the same viral lineage and the larger FtsK/HerA superfamily to which B204 belongs. Both
in vitro
ATPase activity assays and transfection assays with mutant forms of B204 confirmed the essentiality of conserved and nonconserved positions. We also have identified two distinct particle morphologies during an STIV infection that differ in the presence or absence of the B204 protein. The biochemical and structural data presented here are not only informative for the STIV replication process but also can be useful in deciphering DNA-packaging mechanisms for other viruses belonging to this lineage.

IMPORTANCE
STIV is a virus that infects a host from the domain
Archaea
that replicates in high-temperature, acidic environments. While STIV has many unique features, there exist several striking similarities between this virus and others that replicate in different environments and infect a broad range of hosts from
Bacteria
and
Eukarya
. Aside from structural features shared by viruses from this lineage, there exists a significant level of sequence similarity between the ATPase genes carried by these different viruses; this gene encodes an enzyme thought to provide energy that drives DNA packaging into the virion during infection. The experiments described here highlight the elements of this enzyme that are essential for proper function and also provide supporting evidence that B204 is present in the mature STIV virion.
Homologous Recombination Repair Factors Rad51 and BRCA1 Are Necessary for Productive Replication of Human Papillomavirus 31
Authors: Chappell William H. , Gautam Dipendra , Ok Suzan T. , Johnson Bryan A. , Anacker Daniel C. , Moody Cary A.
Published: December 2015

High-risk human papillomavirus 31 (HPV31)-positive cells exhibit constitutive activation of the ATM-dependent DNA damage response (DDR), which is necessary for productive viral replication. In response to DNA double-strand breaks (DSBs), ATM activation leads to DNA repair through homologous recombination (HR), which requires the principal recombinase protein Rad51, as well as BRCA1. Previous studies from our lab demonstrated that Rad51 and BRCA1 are expressed at high levels in HPV31-positive cells and localize to sites of viral replication. These results suggest that HPV may utilize ATM activity to increase HR activity as a means to facilitate viral replication. In this study, we demonstrate that high-risk HPV E7 expression alone is sufficient for the increase in Rad51 and BRCA1 protein levels. We have found that this increase occurs, at least in part, at the level of transcription. Studies analyzing protein stability indicate that HPV may also protect Rad51 and BRCA1 from turnover, contributing to the overall increase in cellular levels. We also demonstrate that Rad51 is bound to HPV31 genomes, with binding increasing per viral genome upon productive replication. We have found that depletion of Rad51 and BRCA1, as well as inhibition of Rad51's recombinase activity, abrogates productive viral replication upon differentiation. Overall, these results indicate that Rad51 and BRCA1 are required for the process of HPV31 genome amplification and suggest that productive replication occurs in a manner dependent upon recombination.

IMPORTANCE
Productive replication of HPV31 requires activation of an ATM-dependent DNA damage response, though how ATM activity contributes to replication is unclear. Rad51 and BRCA1 play essential roles in repair of double-strand breaks, as well as the restart of stalled replication forks through homologous recombination (HR). Given that ATM activity is required to initiate HR repair, coupled with the requirement of Rad51 and BRCA1 for productive viral replication, our findings suggest that HPV may utilize ATM activity to ensure localization of recombination factors to productively replicating viral genomes. The finding that E7 increases the levels of Rad51 and BRCA1 suggests that E7 contributes to productive replication by providing DNA repair factors required for viral DNA synthesis. Our studies not only imply a role for recombination in the regulation of productive HPV replication but provide further insight into how HPV manipulates the DDR to facilitate the productive phase of the viral life cycle.
Microbial Surface Colonization and Biofilm Development in Marine Environments
Authors: Dang Hongyue , Lovell Charles R.
Published: December 2015

Biotic and abiotic surfaces in marine waters are rapidly colonized by microorganisms. Surface colonization and subsequent biofilm formation and development provide numerous advantages to these organisms and support critical ecological and biogeochemical functions in the changing marine environment. Microbial surface association also contributes to deleterious effects such as biofouling, biocorrosion, and the persistence and transmission of harmful or pathogenic microorganisms and their genetic determinants. The processes and mechanisms of colonization as well as key players among the surface-associated microbiota have been studied for several decades. Accumulating evidence indicates that specific cell-surface, cell-cell, and interpopulation interactions shape the composition, structure, spatiotemporal dynamics, and functions of surface-associated microbial communities. Several key microbial processes and mechanisms, including (i) surface, population, and community sensing and signaling, (ii) intraspecies and interspecies communication and interaction, and (iii) the regulatory balance between cooperation and competition, have been identified as critical for the microbial surface association lifestyle. In this review, recent progress in the study of marine microbial surface colonization and biofilm development is synthesized and discussed. Major gaps in our knowledge remain. We pose questions for targeted investigation of surface-specific community-level microbial features, answers to which would advance our understanding of surface-associated microbial community ecology and the biogeochemical functions of these communities at levels from molecular mechanistic details through systems biological integration.
Social (pragmatic) communication disorders and autism spectrum disorder
Authors: Baird Gillian , Norbury Courtenay Frazier
Published: December 2015

Changes have been made to the diagnostic criteria for autism spectrum disorder (ASD) in the recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), and similar changes are likely in the WHO International Classification of Diseases (ICD-11) due in 2017. In light of these changes, a new clinical disorder, social (pragmatic) communication disorder (SPCD), was added to the neurodevelopmental disorders section of DSM-5. This article describes the key features of ASD, SPCD and the draft ICD-11 approach to pragmatic language impairment, highlighting points of overlap between the disorders and criteria for differential diagnosis.
Paediatric abdominal tuberculosis in developed countries: case series and literature review
Authors: Delisle Megan , Seguin Jade , Zeilinski David , Moore Dorothy L
Published: December 2015

Objective

To provide an insight into the presentation, diagnosis and management of paediatric abdominal tuberculosis (TB) in developed countries.

Methods

The records of all children at the Montreal Children's Hospital (MCH) admitted with abdominal TB between 1990 and 2014 were reviewed. An automated and manual literature search from 1946 to 2014 was performed.

Results

(1) Case series: six cases were identified at the MCH. All were male between 5 and 17 years of age. All were from populations known to have high rates of TB (aboriginal, immigrant). Three underwent major surgical interventions and three underwent ultrasound (US) or CT aspiration or biopsy for diagnosis. (2) Literature review: 29 male (64%) and 16 female subjects (36%) aged between 14 months and 18 years were identified, including the MCH patients. All patients except one were from populations with a high incidence of TB. Most presented with a positive tuberculin skin test (90%), abdominal pain (76%), fever (71%) and weight loss (68%). On imaging, 22 (49%) were classified with gastrointestinal TB with colonic wall irregularity (41%) and 19 (42%) with peritoneal TB with ascites (68%). A positive culture was obtained in 33 (73%) patients. Three cases used CT- or US-guided aspiration or biopsy to obtain tissue samples. A surgical intervention was performed in 34 (76%) children; 13 (38%) of these were for diagnosis.

Conclusions

Diagnosis based on clinical features (abdominal pain, fever and weight loss) and CT- or US-guided aspiration or biopsy may encourage physicians to adopt a more conservative approach to abdominal TB.
Families’ priorities in life-limiting illness: improving quality with online empowerment
Authors: Harris Nicola , Beringer Antonia , Fletcher Margaret
Published: December 2015

Objective

Improving quality of life (QOL) is the central focus of palliative care support for children with life-limiting illness (LLI), but achieving this can be challenging.

Intervention

MyQuality is an online tool that enables families to choose and monitor parameters they identify as having an impact on their QOL, which aims to improve patient–professional communications and also to enhance patient empowerment within healthcare dialogues.

Design

A longitudinal, multisite mixed-method evaluation of MyQuality. Families were invited to use MyQuality and completed semi-structured interviews and a Family Empowerment Scale (FES) at T=0 and T+3 months.

Patients and setting

Thirty-two families of children with LLIs, attending three children's hospices in one UK region.

Outcome measures

Website access, usage patterns and parameter choice, FES scores and qualitative evaluation of interviews.

Results

23/32 families chose to use the website. Mean duration of use was 106 days (range 2–301), with families choosing two or three parameters (range 1–15), most commonly seizures (24/32), constipation (9/32), pain (6/32) and sleep problems (6/32). Mean FES scores increased over time (3.45–3.85). Interview feedback confirmed the acceptability and ease of use of the website, and the value of a graphic record of change over time to support ongoing management and collaborative review of medical, nursing or social interventions.

Conclusions

The identification and monitoring of patient-generated priorities via the MyQuality website empowers families and supports collaboration between parents and professionals to ensure that palliative care is truly patient and family centred.
Quality of life Evaluation in patients receiving Steroids (the QuESt tool): initial development in children and young people with acute lymphoblastic leukaemia
Authors: Adams M , Robling M , Grainger J , Tomlins J , Johnson A , Morris S , Velangi M , Jenney M
Published: December 2015

Background

The powerful cytotoxic and immunomodulatory effects of corticosteroids are an important element of the success that has been achieved in the treatment of acute lymphoblastic leukaemia (ALL). In addition to physical side effects, corticosteroids can adversely influence behaviour, cognitive function and mood leading to significantly impaired quality of life (QoL). A number of tools exist for assessing QoL, but none of these specifically examines changes attributable to steroids.

Methods

Children and young adults aged 8–24 years and parents of children receiving maintenance therapy for ALL from four UK centres were invited to participate. The study comprised three stages carried out over 2 years: (1) focus groups and interviews where participants were asked to describe their experiences of dexamethasone; (2) analysis of questionnaires sent to healthcare professionals and patients to evaluate the importance and relevance of the questions; and (3) cognitive interviewing.

Results

Interpretative phenomenological analysis of focus group and interview transcripts identified that dexamethasone adversely influenced behaviour, appetite, body image, mood and family relationships. 157 electronic survey responses were analysed leading to further item development. Cognitive interviewing confirmed face validity and internal consistency. QuESt comprises 28 questions within four domains and has three age-specific versions.

Conclusions

QuESt is the first treatment-specific QoL measure for children and young adults receiving corticosteroids. It can be completed in 10–15 min by children aged ≥8 years. Further validity and reliability testing will be undertaken. Although the initial application is for ALL, QuESt may also be a valuable tool for understanding the impact of corticosteroids in other paediatric conditions.
Touch-screen technology usage in toddlers
Authors: Ahearne Caroline , Dilworth Sinead , Rollings Rachel , Livingstone Vicki , Murray Deirdre
Published: December 2015

Objective

To establish the prevalence and patterns of use of touch-screen technologies in the toddler population.

Design

Parental questionnaires were completed for children aged 12 months to 3 years examining access to touch-screen devices and ability to perform common forms of interaction with touch-screen technologies.

Results

The 82 questionnaires completed on typically developing children revealed 71% of toddlers had access to touch-screen devices for a median of 15 min (IQR: 9.375–26.25) per day. By parental report, 24 months was the median age of ability to swipe (IQR: 19.5–30.5), unlock (IQR: 20.5–31.5) and active looking for touch-screen features (IQR: 22–30.5), while 25 months (IQR: 21–31.25) was the median age of ability to identify and use specific touch-screen features. Overall, 32.8% of toddlers could perform all four skills.

Conclusions

From 2 years of age toddlers have the ability to interact purposefully with touch-screen devices and demonstrate a variety of common skills required to utilise touch-screen technology.
Does pulse oximeter use impact health outcomes? A systematic review
Authors: Enoch Abigail J , English Mike , Shepperd Sasha
Published: December 2015

Objective

Do newborns, children and adolescents up to 19 years have lower mortality rates, lower morbidity and shorter length of stay in health facilities where pulse oximeters are used to inform diagnosis and treatment (excluding surgical care) compared with health facilities where pulse oximeters are not used?

Design

Studies were obtained for this systematic literature review by systematically searching the Database of Abstracts of Reviews of Effects, Cochrane, Medion, PubMed, Web of Science, Embase, Global Health, CINAHL, WHO Global Health Library, international health organisation and NGO websites, and study references.

Patients

Children 0–19 years presenting for the first time to hospitals, emergency departments or primary care facilities.

Interventions

Included studies compared outcomes where pulse oximeters were used for diagnosis and/or management, with outcomes where pulse oximeters were not used. Main outcome measures: mortality, morbidity, length of stay, and treatment and management changes.

Results

The evidence is low quality and hypoxaemia definitions varied across studies, but the evidence suggests pulse oximeter use with children can reduce mortality rates (when combined with improved oxygen administration) and length of emergency department stay, increase admission of children with previously unrecognised hypoxaemia, and change physicians’ decisions on illness severity, diagnosis and treatment. Pulse oximeter use generally increased resource utilisation.

Conclusions

As international organisations are investing in programmes to increase pulse oximeter use in low-income settings, more research is needed on the optimal use of pulse oximeters (eg, appropriate oxygen saturation thresholds), and how pulse oximeter use affects referral and admission rates, length of stay, resource utilisation and health outcomes.
Has the athlete trained enough to return to play safely? The acute:chronic workload ratio permits clinicians to quantify a player's risk of subsequent injury
Authors: Blanch Peter , Gabbett Tim J
Published: December 2015

The return to sport from injury is a difficult multifactorial decision, and risk of reinjury is an important component. Most protocols for ascertaining the return to play status involve assessment of the healing status of the original injury and functional tests which have little proven predictive ability. Little attention has been paid to ascertaining whether an athlete has completed sufficient training to be prepared for competition. Recently, we have completed a series of studies in cricket, rugby league and Australian rules football that have shown that when an athlete's training and playing load for a given week (acute load) spikes above what they have been doing on average over the past 4 weeks (chronic load), they are more likely to be injured. This spike in the acute:chronic workload ratio may be from an unusual week or an ebbing of the athlete's training load over a period of time as in recuperation from injury. Our findings demonstrate a strong predictive (R2=0.53) polynomial relationship between acute:chronic workload ratio and injury likelihood. In the elite team setting, it is possible to quantify the loads we are expecting athletes to endure when returning to sport, so assessment of the acute:chronic workload ratio should be included in the return to play decision-making process.
Australasian College of Sports Physicians—position statement: the place of mesenchymal stem/stromal cell therapies in sport and exercise medicine
Authors: Osborne Hamish , Anderson Lynley , Burt Peter , Young Mark , Gerrard David
Published: December 2015

Purpose and scope

This Position Statement has been written expressly for members of the Australasian College of Sports Physicians (ACSP); however, it may also be of interest to the wider medical community, sporting organisations, athletes and the general community. It has been informed by a comprehensive review of the scientific literature and the opinions of kindred organisations. This statement outlines the use of mesenchymal stem cell (MSC) therapies in the broad context of Sport and Exercise Medicine, recognising that every medical practitioner should respect: (1) the evidence for the therapeutic use of MSCs and (2) the priority for patient health and welfare.
Time to wake up: individualising the approach to sleep promotion interventions
Authors: Fullagar Hugh H K , Bartlett Jonathan D
Published: December 2015

Sleep is fundamental to normal physiological and cognitive function. Sleep promotion strategies have been used extensively in clinical settings, as a treatment for various ailments (ie, insomnia). However, sleep problems are prevalent outside these realms, with 56% of American, 31% of Western European and 29% of Japanese people suffering from sleep problems the previous year. The global public health concern over sleep has increased the demand for sleep promotion interventions, but the efficacy of these strategies is unclear in otherwise healthy and athletic populations. One possibility is due to the presentation and analysis of grouped data, despite sleep naturally being a highly variable and inherent trait. We argue the case for (1) presenting sleep data at the individual level and (2) individualising sleep promotion interventions.
Adverse reactions following routine anticholinergic eye drops in a paediatric population: an observational cohort study
Authors: van Minderhout Helena M , Joosse Maurits V , Grootendorst Diana C , Schalij-Delfos Nicoline E
Published: December 2015

Objectives

To investigate the presence, nature and relationship to age, sex, ethnicity and body mass index (BMI) of adverse reactions following routine cycloplegic eye drops in children.

Design

Prospective observational cohort study.

Setting

Ophthalmology outpatient clinic Dutch metropolitan hospital; February, March and April 2009.

Participants

Children aged 3–14-year-old children receiving two drops of cyclopentolate 1% (C+C) or one drop of cyclopentolate 1% and one drop of tropicamide 1% (C+T). Patients were categorised by age (3–6, 7–10 and 11–14 years), sex, ethnicity and body mass index (BMI) (low, normal or high).

Outcome measures

Rate and nature of adverse reactions reported at 45 min following treatment. Crude and adjusted ORs for reporting an adverse reaction using stepwise regression analysis with BMI, age, ethnicity and sex.

Results

912 of 915 eligible patients participated (99.7%). Adverse reactions were reported for C+C in 10.3% and in C+T in 4.8% (42/408 and 24/504, p=0.002), respectively. Central effects were present in 95% in C+C and in 92% in C+T. Compared to C+T, an increased risk was present in C+C (crude OR 2.3 (1.4 to 3.9), p=0.002). Forward adjustment showed BMI to be an influencing factor in treatment (OR 3.1 (1.7 to 5.6), p<0.001). In a multivariate model, a dose of cyclopentolate remained associated with adverse reactions. Analysis per BMI and regime and age category and regime, indicated associations with low BMI (OR C+C 21.4 (6.7 to 67.96), p<0.001, respectively, C+T 5.2 (2.1 to 12.8), p<0.001) and young age (OR C+C 8.1 (2.7 to 24.8), p<0.001).

Conclusions

Adverse reactions were common and almost exclusively involved the central nervous system. Both presence and severity were associated with repeated instillation of cyclopentolate 1%, low BMI and young age. In specific paediatric populations, a single dose of cyclopentolate must be considered. Vital function monitoring facilities are advisable. Adjustment of guidelines is recommended.
First results about recovery of walking function in patients with intensive care unit-acquired muscle weakness from the General Weakness Syndrome Therapy (GymNAST) cohort study
Authors: Mehrholz Jan , Mückel Simone , Oehmichen Frank , Pohl Marcus
Published: December 2015

Objectives

To describe the time course of recovery of walking function and other activities of daily living in patients with intensive care unit (ICU)-acquired muscle weakness.

Design

This is a cohort study.

Participants

We included critically ill patients with ICU-acquired muscle weakness.

Setting

Post-acute ICU and rehabilitation units in Germany.

Measures

We measured walking function, muscle strength, activities in daily living, motor and cognitive function.

Results

We recruited 150 patients (30% female) who fulfilled our inclusion and exclusion criteria. The primary outcome recovery of walking function was achieved after a median of 28.5 days (IQR=45) after rehabilitation onset and after a median of 81.5 days (IQR=64) after onset of illness. Our final multivariate model for recovery of walking function included two clinical variables from baseline: the Functional Status Score ICU (adjusted HR=1.07 (95% CI 1.03 to 1.12) and the ability to reach forward in cm (adjusted HR=1.02 (95% CI 1.00 to 1.04). All secondary outcomes but not pain improved significantly in the first 8 weeks after study onset.

Conclusions

We found good recovery of walking function for most patients and described the recovery of walking function of people with ICU-acquired muscle weakness.

Trials registrations number

Sächsische Landesärztekammer EK-BR-32/13-1; DRKS00007181, German Register of Clinical Trials.
Design, methodology and baseline characteristics of Tai Chi and its protective effect against ischaemic stroke risk in an elderly community population with risk factors for ischaemic stroke: a randomised controlled trial
Authors: Zheng Guohua , Zheng Xin , Li Junzhe , Duan Tingjin , Qi Dalu , Ling Kun , He Jian , Chen Lidian
Published: December 2015

Introduction

Controlling risk factors with regular exercise is effective and cost-effective for the primary prevention of ischaemic stroke. As a traditional Chinese form of exercise, Tai Chi might be beneficial in decreasing ischaemic stroke, but the evidence remains insufficient. We hypothesise that elderly community adults with risk factors for ischaemic stroke will decrease their ischaemic stroke risk by improving cerebral haemodynamic parameters, cardiopulmonary function, motor function, plasma risk indices, physical parameters or psychological outcomes after receiving 12 weeks of regular Tai Chi training compared with those who maintained their original physical activities. Therefore, we designed a randomised controlled trial that will systematically evaluate the protective effects of Tai Chi exercise on ischaemic stroke risk in an elderly community population with risk factors for ischaemic stroke.

Methods and analysis

A total of 170 eligible participants were randomly allocated into either the Tai Chi training group or the usual physical activity group. This paper reports on the design, intervention development and baseline characteristics of the participants. There were no significant differences between comparison groups in demographic characteristics or the baseline data of primary or secondary outcomes. Participants in the Tai Chi training group will receive 12 weeks of Tai Chi training with a frequency of 5 days/week and 60 min/day, while those in the usual physical activities group will maintain their original activities. Primary and secondary outcomes will be measured at the 12-week and 24-week follow-ups.

Ethics and dissemination

Ethical approval has been obtained from the Medical Ethics Committee of The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine (number 2013-020-02). The findings of this study will be communicated to healthcare professionals, participants and the public through peer-reviewed publications or scientific conferences.

Trial registration number

ChiCTR-TRC-13003601; Pre-results.
Feasibility of health systems strengthening in South Sudan: a qualitative study of international practitioner perspectives
Authors: Jones Abigail , Howard Natasha , Legido-Quigley Helena
Published: December 2015

Objective

To explore the feasibility of health systems strengthening from the perspective of international healthcare implementers and donors in South Sudan.

Design

A qualitative interview study, with thematic analysis using the WHO health system building blocks framework.

Setting

South Sudan.

Participants

17 health system practitioners, working for international agencies in South Sudan, were purposively sampled for their knowledge and experiences of health systems strengthening, services delivery, health policy and politics in South Sudan.

Results

Participants universally reported the health workforce as insufficient and of low capacity and service delivery as poor, while access to medicines was restricted by governmental lack of commitment in undertaking procurement and supply. However, progress was clear in improved county health department governance, health management information system functionality, increased health worker salary harmonisation and strengthened financial management.

Conclusions

Resurgent conflict and political tensions have negatively impacted all health system components and maintaining or continuing health system strengthening has become extremely challenging. A coordinated approach to balancing humanitarian need particularly in conflict-affected areas, with longer term development is required so as not to lose improvements gained.
Incidence and survival of non-small cell lung cancer in Shanghai: a population-based cohort study
Authors: Fan Heng , Shao Zhen-Yi , Xiao Yuan-Yuan , Xie Zhi-Hui , Chen Wen , Xie Hua , Qin Guo-You , Zhao Nai-Qing
Published: December 2015

Objectives

Large population-based studies on the incidence and outcome of non-small cell lung cancer (NSCLC) are lacking in mainland China. This study aimed to investigate the NSCLC incidence, demographic features and survival as well as factors affecting survival of patients with NSCLC in Shanghai.

Design

Prospective observational cohort study.

Setting

Baseline information was collected from Shanghai Health Information Network, which is based on the Health Information Systems from all the comprehensive hospitals and specialist hospitals qualified for cancer diagnosis in the Shanghai metropolitan area.

Participants

All NSCLC cases identified from the database between 2011 and 2013 were recruited (15 020 patients).

Main results

The crude and age-adjusted incidences of NSCLC were 54.20 per 100 000 people (55.90 per 100 000 for men, 52.39 per 100 000 for women) and 39.05 per 100 000 people (41.43 per 100 000 for men and 37.13 per 100 000 for women), respectively. The median survival time was 22.7 months (95% CI 21.8 to 24.2 months) with an overall 1-year survival rate of 71.8% (95% CI 69.8% to 73.8%). The 1-year survival rate was 96.5% (95% CI 94.0% to 98.6%) in patients with stage I NSCLC, 89.1% (95% CI 83.3% to 94.9%) in patients with stage II NSCLC, 78.8% (95% CI 74.1% to 83.5%) in patients with stage IIIa NSCLC and 58.9% (95% CI 56.1% to 61.7%) in patients with stage IIIb/IV NSCLC. Multivariate analysis showed surgical resection (HR=0.607, 95% CI 0.511 to 0.722) and chemotherapy (HR=0.838, 95% CI 0.709 to 0.991) significantly improved survival. Factors associated with poor survival included older age, male sex, larger tumour size, lymph node metastasis, distant metastasis and squamous cell carcinoma.

Conclusions

A higher incidence and better survival rates for patients with NSCLC were identified when compared with previously published studies, which may provide evidence on the incidence and survival of NSCLC in China.
Changes in South Korean urbanicity and suicide rates, 1992 to 2012
Authors: Chan Chee Hon , Caine Eric D , You Sungeun , Yip Paul Siu Fai
Published: December 2015

Objectives

Studies have highlighted the association between the degree of urbanicity and spatial disparities in suicide, but few have evaluated its changes across time. We explored the geospatial trends of suicide in South Korea from 1992 to 2012, and their relationship to the nation's evolving urbanicity.

Setting

South Korea.

Primary outcome measures

Age-sex-specific suicide rate.

Results

Suicide rates increased in all regions of South Korea during the study period. Controlling the effects of age and sex, there was an overall inverse relationship between the degree of urbanicity and regional suicide rates. These associations were, however, attenuated across the periods, as there were smaller increases in suicide rates in mid-sized urban regions as compared to larger cities and to rural areas. Increases over time in the suicide rates among youth and working-age adults were greater in large urban centres and in rural regions. For elders, the increase was far greater in rural regions.

Conclusions

The association of urbanicity and the geospatial pattern of suicide in South Korea was a dynamic process and varied by age groups across the course of two decades. Internal migration and related social processes most likely contributed to these changes.
Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data
Authors: Jolley Rachel J , Quan Hude , Jetté Nathalie , Sawka Keri Jo , Diep Lucy , Goliath Jade , Roberts Derek J , Yipp Bryan G , Doig Christopher J
Published: December 2015

Objective

Administrative health data are important for health services and outcomes research. We optimised and validated in intensive care unit (ICU) patients an International Classification of Disease (ICD)-coded case definition for sepsis, and compared this with an existing definition. We also assessed the definition's performance in non-ICU (ward) patients.

Setting and participants

All adults (aged ≥18 years) admitted to a multisystem ICU with general medicosurgical ICU care from one of three tertiary care centres in the Calgary region in Alberta, Canada, between 1 January 2009 and 31 December 2012 were included.

Research design

Patient medical records were randomly selected and linked to the discharge abstract database. In ICU patients, we validated the Canadian Institute for Health Information (CIHI) ICD-10-CA (Canadian Revision)-coded definition for sepsis and severe sepsis against a reference standard medical chart review, and optimised this algorithm through examination of other conditions apparent in sepsis.

Measures

Sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) were calculated.

Results

Sepsis was present in 604 of 1001 ICU patients (60.4%). The CIHI ICD-10-CA-coded definition for sepsis had Sn (46.4%), Sp (98.7%), PPV (98.2%) and NPV (54.7%); and for severe sepsis had Sn (47.2%), Sp (97.5%), PPV (95.3%) and NPV (63.2%). The optimised ICD-coded algorithm for sepsis increased Sn by 25.5% and NPV by 11.9% with slightly lowered Sp (85.4%) and PPV (88.2%). For severe sepsis both Sn (65.1%) and NPV (70.1%) increased, while Sp (88.2%) and PPV (85.6%) decreased slightly.

Conclusions

This study demonstrates that sepsis is highly undercoded in administrative data, thus under-ascertaining the true incidence of sepsis. The optimised ICD-coded definition has a higher validity with higher Sn and should be preferentially considered if used for surveillance purposes.
McGRATH MAC videolaryngoscope versus Macintosh laryngoscope for orotracheal intubation in intensive care patients: the randomised multicentre MACMAN trial study protocol
Authors: Bailly Arthur , Lascarrou Jean Baptiste , Le Thuaut Aurelie , Boisrame-Helms Julie , Kamel Toufik , Mercier Emmanuelle , Ricard Jean Damien , Lemiale Virginie , Champigneulle Benoit , Reignier Jean
Published: December 2015

Introduction

Critically ill patients with acute respiratory, neurological or cardiovascular failure requiring invasive mechanical ventilation are at high risk of difficult intubation and have organ dysfunctions associated with complications of intubation and anaesthesia such as hypotension and hypoxaemia. The complication rate increases with the number of intubation attempts. Videolaryngoscopy improves elective endotracheal intubation. McGRATH MAC is the lightest videolaryngoscope and the most similar to the Macintosh laryngoscope. The primary goal of this trial was to determine whether videolaryngoscopy increased the frequency of successful first-pass intubation in critically ill patients, compared to direct view Macintosh laryngoscopy.

Methods and analysis

MACMAN is a multicentre, open-label, randomised controlled superiority trial. Consecutive patients requiring intubation are randomly allocated to either the McGRATH MAC videolaryngoscope or the Macintosh laryngoscope, with stratification by centre and operator experience. The expected frequency of successful first-pass intubation is 65% in the Macintosh group and 80% in the videolaryngoscope group. With α set at 5%, to achieve 90% power for detecting this difference, 185 patients are needed in each group (370 in all). The primary outcome is the proportion of patients with successful first-pass orotracheal intubation, compared between the two groups using a generalised mixed model to take the stratification factors into account.

Ethics and dissemination

The study project has been approved by the appropriate ethics committee (CPP Ouest 2, # 2014-A00674-43). Informed consent is not required, as both laryngoscopy methods are considered standard care in France; information is provided before study inclusion. If videolaryngoscopy proves superior to Macintosh laryngoscopy, its use will become standard practice, thereby decreasing first-pass intubation failure rates and, potentially, the frequency of intubation-related complications. Thus, patient safety should benefit. Further studies would be warranted to determine whether videolaryngoscopy is also beneficial in the emergency room and for prehospital emergency care.

Trial registration number

NCT02413723; Pre-results.