bluuebunny/crossref_metadata_2025 huggingface dataset:
High body mass index is a strong predictor of intraoperative acquired pressure injury in spinal surgery patients when prophylactic film dressings are applied: A retrospective analysis prior to the BOSS Trial
Authors: Yoshimura Mine , Ohura Norihiko , Santamaria Nick , Watanabe Yorikatsu , Akizuki Tanetaka , Gefen Amit
Published: February 2020

We reported the efficacy of soft silicone multilayered foam dressings in preventing intraoperatively acquired pressure injuries (IAPIs) in the prone position using a Relton‐Hall frame (BOSS trial). The aim of this study was to clarify the incidence and extract the risk factors for IAPIs in cases in which polyurethane film dressing was used against IAPIs before the BOSS trial period. This study conducted as a retrospective dual‐center cohort study between August 2014 and Jun 2015 using the medical records in the operating room. The incidence of IAPIs that developed within 24 hours after surgery was 7.1% (7/99). The multivariate logistic regression analysis revealed that body mass index (BMI) (P = .0016, odds ratio [OR]: 1.22, 95% confidence interval (CI) 1.08‐1.4) and length of surgery (P < .0001, OR 2.47, 95% CI 1.86‐3.51) were independently associated with the development of IAPIs. Since high BMI was not extracted in BOSS trial, we conclude that the application of soft silicone multilayer foam dressings is important for preventing the development of IAPIs in patients with high BMI values.
Surgical site infection following operative treatment of open fracture: Incidence and prognostic risk factors
Authors: Hu Qifeng , Zhao Yanhui , Sun Baishan , Qi Wei , Shi Pengju
Published: February 2020

Considering the high incidence of postoperative complications of open fracture, management of this injury is an intractable challenge for orthopaedist, and surgical site infection (SSI) is the devastate one. Screening for high‐risk patients and target them with appropriate interventions is important in clinical practice. The aim of this study was to identify modifiable factors that were associated with SSI following operative treatment of open fractures. This retrospective, multicentre study was conducted at three hospitals. A total of 2692 patients with complete data were recruited between June 2015 and July 2018. Demographic characteristics, operation relative variables, additional comorbidities, and biochemical indexes were extracted and analysed. Receiver operating characteristic analysis was performed to detect the optimum cut‐off value for some variables. Univariate and multivariate logistic analysis models were performed, respectively, to identify the independent risk factors of SSI. The overall incidence of SSI was 18.6%, with 17.0% and 1.6% for superficial and deep infection, respectively. Results of univariate and multivariate analyses showed the following: fracture type, surgical duration > 122 minutes, anaesthesia time > 130 minutes, intraoperative body temperature < 36.4°C, blood glucose (GLU) > 100 mg/dL, blood platelet (PLT) < 288 × 109, and white blood cells (WBC) > 9.4 × 109 were independent risk factors of postoperative wound infection following operative treatment of open fractures. Six modifiable factors such as surgical duration > 122 minutes, anaesthesia time > 130 minutes, intraoperative body temperature < 36.4°C, GLU > 100 mg/dL, PLT < 288 × 109, and WBC > 9.4 × 109 play an important role in the prevention of SSI, and these factors should be optimized perioperatively.
Mechanism on reduction and nitridation of micrometer‐sized titania with ammonia gas
Authors: Liu Yongjie , Wang Yue , Zhang Yu , You Zhixiong , Lv Xuewei
Published: February 2020

Ammonia gas can be simultaneously used as a reductant and nitrogen source to prepare TiN from titania. In this work, the mechanisms on reduction and nitridation of micrometer‐sized anatase with ammonia gas have been investigated, using both thermodynamic and experimental studies. The thermodynamic analysis indicated that reduction and nitridation of TiO2 by NH3 was feasible. Anatase will undergo different paths to form TiN, depending on the reaction temperature. Upon heating, NH3 was seen to partially decompose into N2 and H2, although the actual NH3 decomposition ratio was less than the theoretical value. The experimental results indicated that the obtained titanium nitride was non‐stoichiometric (TiNxO1−x, x ≤ 1), as it contained a certain amount of oxygen. Based on the phase transformation and X‐ray photoelectron spectroscopy analysis, the reduction and nitridation routes were deduced: TiO2 reacted with NH3 to form TiNxO1−x directly, at lower temperatures, and followed the path TiO2 → TinO2n−1 → TiNxO1−x, at higher temperatures. TinO2n−1 was determined to be Ti4O7 and Ti3O5 at 1100°C and 1200°C, respectively. Reaction temperature and time significantly affected the oxygen and nitrogen contents in TiNxO1−x, with the lattice parameter of roasted products gradually increasing—approaching those of pure TiN—with an increase in reaction temperature and holding time. At the same time, the content of oxygen in TiNxO1−x decreased, and its nitrogen content correspondingly increased.
Older Patient and Caregiver Perspectives on Medication Value and Deprescribing: A Qualitative Study
Authors: Pickering Aimee N. , Hamm Megan E. , Dawdani Alicia , Hanlon Joseph T. , Thorpe Carolyn T. , Gellad Walid F. , Radomski Thomas R.
Published: February 2020

OBJECTIVES

Shared decision making is essential to deprescribing unnecessary or harmful medications in older adults, yet patients' and caregivers' perspectives on medication value and how this affects their willingness to discontinue a medication are poorly understood. We sought to identify the most significant factors that impact the perceived value of a medication from the perspective of patients and caregivers.

DESIGN

Qualitative study using focus groups conducted in September and October 2018.

SETTING

Participants from the Pepper Geriatric Research Registry (patients) and the Pitt+Me Registry (caregivers) maintained by the University of Pittsburgh.

PARTICIPANTS

Six focus groups of community‐dwelling adults aged 65 years or older, or their caregivers, prescribed five or more medications in the preceding 12 months.

MEASUREMENTS

We sought to identify (1) general views on medication value and what makes medication worth taking; (2) how specific features such as cost or side effects impact perceived value; and (3) reactions to clinical scenarios related to deprescribing.

RESULTS

We identified four themes. Perceived effectiveness was the primary factor that caused participants to consider a medication to be of high value. Participants considered a medication to be of low value if it adversely affected quality of life. Participants also cited cost when determining value, especially if it resulted in material sacrifices. Participants valued medications prescribed by providers with whom they had good relationships rather than valuing level of training. When presented with clinical scenarios, participants ably weighed these factors when determining the value of a medication and indicated whether they would adhere to a deprescribing recommendation.

CONCLUSION

We identified that perceived effectiveness, adverse effects on quality of life, cost, and a strong relationship with the prescriber influenced patients' and caregivers' views on medication value. These findings will enable prescribers to engage older patients in shared decision making when deprescribing unnecessary medications and will allow health systems to incorporate patient‐centered assessment of value into systems‐based deprescribing interventions. J Am Geriatr Soc 68:746–753, 2020
Exploring scoring methods for research studies: Accuracy and variability of visual and automated sleep scoring
Authors: Berthomier Christian , Muto Vincenzo , Schmidt Christina , Vandewalle Gilles , Jaspar Mathieu , Devillers Jonathan , Gaggioni Giulia , Chellappa Sarah L. , Meyer Christelle , Phillips Christophe , Salmon Eric , Berthomier Pierre , Prado Jacques , Benoit Odile , Bouet Romain , Brandewinder Marie , Mattout Jérémie , Maquet Pierre
Published: February 2020

Sleep studies face new challenges in terms of data, objectives and metrics. This requires reappraising the adequacy of existing analysis methods, including scoring methods. Visual and automatic sleep scoring of healthy individuals were compared in terms of reliability (i.e., accuracy and stability) to find a scoring method capable of giving access to the actual data variability without adding exogenous variability. A first dataset (DS1, four recordings) scored by six experts plus an autoscoring algorithm was used to characterize inter‐scoring variability. A second dataset (DS2, 88 recordings) scored a few weeks later was used to explore intra‐expert variability. Percentage agreements and Conger's kappa were derived from epoch‐by‐epoch comparisons on pairwise and consensus scorings. On DS1 the number of epochs of agreement decreased when the number of experts increased, ranging from 86% (pairwise) to 69% (all experts). Adding autoscoring to visual scorings changed the kappa value from 0.81 to 0.79. Agreement between expert consensus and autoscoring was 93%. On DS2 the hypothesis of intra‐expert variability was supported by a systematic decrease in kappa scores between autoscoring used as reference and each single expert between datasets (.75–.70). Although visual scoring induces inter‐ and intra‐expert variability, autoscoring methods can cope with intra‐scorer variability, making them a sensible option to reduce exogenous variability and give access to the endogenous variability in the data.
Rapid block of pre‐mRNA splicing by chemical inhibition of analog‐sensitive CRK9 in Trypanosoma brucei
Authors: Gosavi Ujwala , Srivastava Ankita , Badjatia Nitika , Günzl Arthur
Published: February 2020

Trypanosoma brucei CRK9 is an essential cyclin‐dependent kinase for the parasite‐specific mode of pre‐mRNA processing. In trypanosomes, protein coding genes are arranged in directional arrays that are transcribed polycistronically, and individual mRNAs are generated by spliced leader trans‐splicing and polyadenylation, processes that are functionally linked. Since CRK9 silencing caused a decline of mRNAs, a concomitant increase of unspliced pre‐mRNAs and the disappearance of the trans‐splicing Y structure intermediate, CRK9 is essential for the first step of splicing. CRK9 depletion also caused a loss of phosphorylation in RPB1, the largest subunit of RNA polymerase (pol) II. Here, we established cell lines that exclusively express analog‐sensitive CRK9 (CRK9AS). Inhibition of CRK9AS in these cells by the ATP‐competitive inhibitor 1‐NM‐PP1 reproduced the splicing defects and proved that it is the CKR9 kinase activity that is required for pre‐mRNA processing. Since defective trans‐splicing was detected as early as 5 min after inhibitor addition, CRK9 presumably carries out reversible phosphorylation on the pre‐mRNA processing machinery. Loss of RPB1 phosphorylation, however, took 12–24 hr. Surprisingly, RNA pol II‐mediated RNA synthesis in 24 hr‐treated cells was upregulated, indicating that, in contrast to other eukaryotes, RPB1 phosphorylation is not a prerequisite for transcription in trypanosomes.
Irisin promotes cementoblast differentiation via p38 MAPK pathway
Authors: Zhu Jiaqi , Wang Yunlong , Cao Zhengguo , Du Mingyuan , Hao Yunru , Pan Jiawen , He Hong
Published: February 2020

Objective

Irisin is a newly identified exercise‐induced myokine which can affect glucose metabolism and cortical bone mass and strength. However, the influence of irisin on cementoblasts remains largely unknown.

Material and methods

An immortalized mouse cementoblast cell line OCCM‐30 was used in this study. Cementoblast differentiation markers and PGC‐1α in cells cultured with mineral induction medium were evaluated by qRT‐PCR. Cementoblast mineralization was evaluated by alizarin red staining. Differentiation markers and the activity of p38 MAPK pathway under irisin stimulation were assessed by qRT‐PCR or Western blot analysis. p38 MAPK pathway inhibitor SB203580 or p38 siRNA was used to further identify the regulatory mechanism. Cell proliferation treated with irisin was examined by CCK‐8 method.

Results

The expression of Runx2, osterix, ALP, and PGC‐1α was up‐regulated consistently under mineral induction. The formation of mineralized nodules was increased by irisin. Runx2, osterix, ALP, and osteocalcin were obviously up‐regulated under irisin stimulation as well as the activity of p38 MAPK pathway. When pretreated with SB203580 or p38 siRNA before irisin stimulation, the irisin‐induced differentiation was distinctly suppressed. OCCM‐30 cell proliferation was enhanced when treated with high‐dose irisin for long time.

Conclusion

Irisin can promote the differentiation of cementoblasts via p38 MAPK pathway.
True bipolar or extended bipolar left ventricular pacing is associated with better survival in cardiac resynchronization therapy patients
Authors: Kutyifa Valentina , Jame Sina , Wang Paul J. , Musat Dan , Jones Paul , Wehrenberg Scott , Stein Kenneth
Published: February 2020

Background

Limited studies are available on the clinical significance of left ventricular (LV) lead polarity in patients undergoing cardiac resynchronization therapy (CRT), with a recent study suggesting better outcomes with LV true bipolar pacing.

Objective

We aimed to determine whether true bipolar LV pacing is associated with reduced mortality in a large, real‐life CRT cohort, followed by remote monitoring.

Methods

We analyzed de‐identified device data from CRT patients followed by the Boston Scientific LATITUDE remote monitoring database system. Patients with LV bipolar leads paced between the LV ring and LV tip were identified as true bipolar and those with LV bipolar leads paced between LV tip or LV ring and right ventricular (RV) coil were identified as extended bipolar. Patients with unipolar leads were identified as unipolar.

Results

Of the 59 046 patients included in the study, 2927 had unipolar pacing, 34 390 had extended bipolar pacing, and 21 729 had true bipolar pacing. LV true bipolar pacing was associated with a significant 30% lower risk of all‐cause mortality as compared to unipolar pacing (hazards ratio [HR] = 0.70, 95% CI: 0.62‐0.79, P < .001), after adjustment for age, gender, LV lead impedance, LV pacing threshold, and BIV pacing percentage <95%. Extended bipolar LV pacing was also associated with 24% lower risk of all‐cause mortality when compared to unipolar LV pacing (HR = 0.76, 95% CI: 0.68‐0.85; P < .001). However, there were no differences in outcomes between true bipolar and extended bipolar LV pacing (HR = 0.97, 95% CI: 0.93‐1.01; P = .198).

Conclusion

True bipolar or extended bipolar LV pacing is associated with a lower risk of mortality in CRT patients as compared to unipolar LV pacing.
Correlation of gene expression profiling score, cardiac hemodynamics and echocardiographic parameters in asymptomatic, rejection‐free pediatric heart transplant recipients
Authors: Das Bibhuti B. , Chan Kak‐Chen , Winchester Robert W. , Zakrzewski Megan , Niu Jianli
Published: February 2020

Objectives

To correlate gene expression profiling scores obtained by AlloMap® with cardiac hemodynamics, cardiac allograft vasculopathy (CAV), and echocardiographic parameters in asymptomatic, rejection‐free pediatric heart transplant (HT) recipients.

Methods

Single‐institution retrospective study of 210 AlloMap scores obtained concomitantly with cardiac catheterization and echocardiogram from 55 children during follow‐up after cardiac transplantation.

Results

The median age at HT was 5.1 years (range, 0.9‐14.1), with 29 males and 26 females. AlloMap scores were high in <2 years vs ≥2 years of age at the time of HT (P = .001), and trending higher with time after HT (R2 = .04, P = .004). There was no significant difference in scores between ACR grades 0 and 1R or CAV. There was mild to modest correlation of AlloMap scores with the mean right atrial pressure (P = .002), and pulmonary capillary wedge pressure (P = .02), but no correlation was found with LV SF% (P = .3), LV EF% (P = .5), or RV FAC % (P = .8).

Conclusions

Our study provides preliminary data that the AlloMap score must be studied carefully before it can be used in children, particularly in those under 2 years of age. Monitoring of serial scores for each patient could potentially reflect changes in allograft performance that may determine indications for catheterization and biopsy which needs to be validated in future studies.
Understanding Risk Information Seeking and Processing during an Infectious Disease Outbreak: The Case of Zika Virus
Authors: Hubner Austin Y. , Hovick Shelly R.
Published: February 2020

This study draws on the Planned Risk Information Seeking Model (PRISM) to assess Zika virus information seeking and systematic processing, paying particular attention to the relationship between perceived knowledge and knowledge insufficiency. Novel risks, such as Zika, provide an interesting context for examining whether information‐seeking models, such as PRISM, are able to predict information seeking when available information is limited or scarce. A cross‐sectional, online study of men and women of childbearing age (N = 494) residing in the state of Florida was conducted. Our results provide some support for the PRISM for predicting Zika information seeking intention, as well as systematic processing of information. We also found that individuals with high levels of perceived knowledge were more likely to report high level of knowledge insufficiency, illustrating that contextual factors may impact the fit of risk information seeking models.
Brief Cognitive‐based Psychosocial Intervention and Case Management for Suicide Attempters Discharged from the Emergency Department in Taipei, Taiwan: A Randomized Controlled Study
Authors: Lin Yi‐Chun , Liu Shen‐Ing , Chen Shu‐Chin , Sun Fang‐Ju , Huang Hui‐Chun , Huang Chiu‐Ron , Chiu Yu‐Chuan
Published: February 2020

Objective

We examined the effectiveness of brief cognitive‐based psychotherapy plus standard case management in the prevention of further suicide attempts, clinical severity, and treatment adherence in a randomized clinical trial compared with standard case management.

Method

Among five hundred and ninety‐seven patients presenting with suicide attempts, 147 participants were included. They were randomized into two groups. After a 6‐session intervention over four months, all participants were re‐evaluated at the 6th and 12th months.

Results

At a 6‐month assessment, the intervention had approximately halved the odds of following suicide attempts and doubled the odds of outpatient visits in comparison with standard case management, although the differences did not attain statistical significance. At a 12‐month assessment, the two groups did not differ significantly in any of the outcome variables. Generalized linear mixed models indicated that intervention did not significantly decrease the subsequent suicide risk and severity of clinical symptoms, but it did increase psychiatric outpatient treatment adherence. The subgroup analysis revealed that the intervention increased the outpatient clinic visits only for repetitive attempters, not for first‐time attempters.

Conclusions

Further studies are needed to test whether more intensive psychotherapy sessions might be more effective in decreasing the probability of further attempt and the severity of symptoms.
Everything is everything: Embodiment, affect, and the Black Atlantic archive
Authors: Joseph Etienne , Bell Connie
Published: February 2020

This short piece explores the concept of the Black Atlantic archive in terms of an acceptance that “everything is everything,” a concept that Africans and their descendants in the “new world” have accounted for in the development of their various cosmological frameworks.
Causes of Child Marriage and Its Effects on the Child in Jigawa State, North West Nigeria: Implications for Counselling
Authors: Onoyase Anna
Published: February 2020

This research sought to find out the causes of child marriage and its effects on the child in Jigawa State, North-West Nigeria. In order to carry out this investigation, the researcher formulated two research questions and one hypothesis to guide the investigation. An instrument tagged “Causes of Child Marriage And Its Effects On The Child” (COCMAIETCQ) was constructed by the investigator to collect information from the respondents. The instrument has 21 items, 10 on the causes of child marriage and 11 on effects of child marriage. The researcher conducted a reliability test on the instrument using split – half method to get a reliability coefficient of 0.79. The researcher used the purposive sampling technique to select 270 married men and women that took part in the research. The investigator used 3 research assistants to administer 270 copies of the questionnaire on the respondents in the urban, semi – urban and rural areas of Jigawa State. The research assistants retrieved 72, 88 and 71 copies of the questionnaire from the respondents in urban, semi – urban and rural areas respectively. The researcher collated the data from the field work, used the mean and standard deviation to answer the research questions while one – way Analysis of Variance (ANOVA) was used to test the hypothesis at 0.05 level of significance. The investigator used 2.50 as benchmark to know if respondents agreed or disagreed with each of the 21 items of the instrument. The investigation revealed that there is child marriage due to poverty of parents with mean score of 3.18, Islamic religion allows child marriage with mean score of 2.90, and high bride price encourages child marriage with mean score of 2.65.  The research equally revealed that young married girls may develop obstetric fistula due to prolonged delivery with mean score of 3.22, early marriage of girls could lead to their drop – out from school with mean score of 3.19 and child marriage violates women’s right to consensual marriage with mean score of 2.99. One of the recommendations was that the Jigawa State government should enact a law that prohibits child marriage so that women’s rights to freedom of education are not violated.
Influence of level difference due to vocal folds angular asymmetry on auto-oscillating replicas
Authors: Bouvet Anne , Tokuda Isao , Pelorson Xavier , Van Hirtum Annemie
Published: February 2020

Dysphonia is often caused by level difference between left and right vocal folds, which are positioned on different angles with respect to the transverse plane, resulting in angular asymmetry. Unilateral vocal fold paralysis may cause such angular asymmetry. In this case, the normal vocal fold is located on the transverse plane, whereas the paralyzed vocal fold is rotated in the sagittal plane as its posterior edge is moved up to the superior direction. The effect of such angular asymmetry (up to 25°) between the left and right vocal fold on the auto-oscillation is experimentally studied using mechanical replicas. For all replicas, it is observed that, as full contact between vocal folds is lost, increase of angular asymmetry results in a decrease of the signal-to-noise ratio, an increase of the total harmonic distortion rate, and an increase of the oscillation threshold pressure. These general tendencies are in agreement with clinical findings reported for vertical level difference during phonation. In analogy to the preceding experimental study in which vocal folds are spaced in parallel with a vertical trade-off, a formula is proposed to describe the oscillation threshold as a function of angular asymmetry.
Coimmunoprecipitation with MYR1 Identifies Three Additional Proteins within the Toxoplasma gondii Parasitophorous Vacuole Required for Translocation of Dense Granule Effectors into Host Cells
Authors: Cygan Alicja M. , Theisen Terence C. , Mendoza Alma G. , Marino Nicole D. , Panas Michael W. , Boothroyd John C.
Published: February 2020

Toxoplasmais an extremely successful intracellular parasite and important human pathogen. Upon infection of a new cell,Toxoplasmaestablishes a replicative vacuole and translocates parasite effectors across this vacuole to function from the host cytosol and nucleus. These effectors play a key role in parasite virulence. The work reported here newly identifies three parasite proteins that are necessary for protein translocation into the host cell. These results significantly increase our knowledge of the molecular players involved in protein translocation inToxoplasma-infected cells and provide additional potential drug targets.
Fifteen-minute consultation: Management of the infant born to a mother with toxoplasmosis in pregnancy
Authors: Saso Anja , Bamford Alasdair , Grewal Karen , Noori Muna , Hatcher James , D'Arco Felice , Guy Edward , Lyall Hermione
Published: February 2020

Congenital toxoplasmosis occurs following transplacental transfer ofToxoplasma gondii. Irrespective of symptom status at birth, infants with congenital infection may develop serious long-term sequelae, including learning disability, seizures, hydrocephalus, motor and hearing deficits, chorioretinitis and retinal scarring with impaired vision. Timely diagnosis facilitates early initiation of therapy, aimed at prevention or amelioration of adverse clinical consequences. Diagnosis can be difficult, however, since acutely infected mothers are often asymptomatic and laboratory testing can be complex. Moreover, any decision to start treatment in the newborn must include careful consideration of the benefits and risks. This paper outlines a structured approach for managing an infant born to a woman with possible or confirmedT. gondiiinfection during pregnancy, including key aspects of the antenatal history, interpretation and timing of investigations, treatment and appropriate follow-up. Our recommendations are based on current evidence in the literature, consensus from two UK paediatric infectious disease centres and the UK specialist Toxoplasma Reference Unit.
Age as a risk factor for steroid-induced ocular hypertension in the non-paediatric population
Authors: Choi Wungrak , Bae Hyoung Won , Choi Eun Young , Kim Minha , Kim Eun Woo , Kim Chan Yun , Kim Min , Seong Gong Je
Published: February 2020

Background/aims

To evaluate the age-related risk of steroid-induced ocular hypertension by analysing intraocular pressure (IOP) changes after intravitreal dexamethasone (DEX, Ozurdex) implant injection.

Methods

A retrospective observational study was conducted among patients (n=455; 570 eyes) who had received DEX injection. IOP was measured prior to injection and after 1 week and 1, 2, 3, 6 and 12 months. Results were divided into seven categories based on patient age: 16–30, 31–40, 41–50, 51–60, 61–70, 71–80 and 81–90 years. The IOP elevation rate was compared among the groups.

Results

The IOP elevation rate was 42.9% in patients aged ≤30 years (35.3%, 28.3%, 14.9%, 12.2%, 8.4% and 9.1% in the 31–40, 41–50, 51–60, 61–70, 71–80 and 81–90 groups, respectively). Regardless of how IOP was measured, there was an increasing trend in the incidence of IOP elevation with decreasing age. Furthermore, there was a significant stepwise increase in the OR with decreasing age groups. After the 51–60 group was set as the reference point, the ORs (95% CIs) were 5.048 (1.436 to 17.747), 3.671 (1.101 to 12.238), 2.538 (1.043 to 6.178), 0.947 (0.431 to 2.078), 0.713 (0.312 to 1.626) and 0.646 (0.137 to 3.048) in the ≤30, 31–40, 41–50, 61–70, 71–80 and 81–90 groups, respectively.

Conclusion

The rate of adverse elevations in IOP after steroid use was significantly lower in older patients than in younger patients. Therefore, caution is required when prescribing steroids to younger patients (<51 years).
Protocol for the SAFEST review: the Shock-Absorbing Flooring Effectiveness SysTematic review including older adults and staff in hospitals and care homes
Authors: Drahota Amy , Felix Lambert M , Keenan Bethany E , Lachance Chantelle C , Laing Andrew , Mackey Dawn C , Raftery James
Published: February 2020

Introduction

Falls in hospitals and care homes are a major issue of international concern. Inpatient falls are the most commonly reported safety incident in the UK’s National Health Service (NHS), costing the NHS £630 million a year. Injurious falls are particularly life-limiting and costly. There is a growing body of evidence on shock-absorbing flooring for fall-related injury prevention; however, no systematic review exists to inform practice.

Methods and analysis

We will systematically identify, appraise and summarise studies investigating the clinical and cost-effectiveness, and experiences of shock-absorbing flooring in hospitals and care homes. Our search will build on an extensive search conducted by a scoping review (inception to May 2016). We will search electronic databases (AgeLine, CINAHL, MEDLINE, NHS Economic Evaluation Database, Scopus and Web of Science; May 2016–present), trial registries and grey literature. We will conduct backward and forward citation searches of included studies, and liaise with study researchers. We will evaluate the influence of floors on fall-related injuries, falls and staff work-related injuries through randomised and non-randomised studies, consider economic and qualitative evidence, and implementation factors. We will consider risk of bias, assess heterogeneity and explore potential effect modifiers via subgroup analyses and sensitivity analyses. Where appropriate we will combine studies through meta-analysis. We will use the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach to evaluate the quality of evidence and present the results using summary of findings tables, and adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines.

Ethics and dissemination

We will follow the ethical principles of systematic review conduct, by attending to publication ethics, transparency and rigour. Our dissemination plan includes peer-reviewed publication, presentations, press release, stakeholder symposium, patient video and targeted knowledge-to-action reports. This review will inform decision-making around falls management in care settings and identify important directions for future research.

PROSPERO registration number

CRD42019118834.
Open-label placebo treatment of women with premenstrual syndrome: study protocol of a randomised controlled trial
Authors: Frey Nascimento Antje , Gaab Jens , Kirsch Irving , Kossowsky Joe , Meyer Andrea , Locher Cosima
Published: February 2020

Introduction

Recent evidence suggests that for certain clinical conditions, placebos can improve clinical outcomes even without deception. These so-called open-label placebos (OLPs) bear the advantage of a significant lower risk of adverse events and comply with ethical principles. Although premenstrual syndrome (PMS) seems to be considerably susceptible to placebo effects, no study has examined open-OLP responses on PMS.

Methods and analysis

To test the efficacy of OLPs in women suffering from PMS, a clinical randomised controlled trial including two OLP study groups (with and without treatment rationale) was designed to investigate on the effect on PMS. PMS symptoms are monitored on a daily basis via a symptom diary, adverse events are monitored intermittently. The study started in spring 2018 and patients will be included until a maximum of 150 participants are randomised. Besides the primary outcome PMS symptom intensity and interference, an array of further variables is assessed. Multilevel modelling will be used for data analyses.

Ethics and dissemination

Ethics approval was obtained from the Ethics Committee Northwest and Central Switzerland. Results of the main analysis and of secondary analyses will be submitted for publication in peer-reviewed journals.

Trial registration numbers

(1) ClinicalTrials.gov (NCT03547661); (2) Swiss national registration (SNCTP000002809).
Patient burden and clinical advances associated with postapproval monotherapy cancer drug trials: a retrospective cohort study
Authors: Carlisle Benjamin Gregory , Doussau Adélaïde , Kimmelman Jonathan
Published: February 2020

Objectives

After regulatory approval, drug companies, public funding agencies and academic researchers often pursue trials aimed at extending the uses of a new drug by testing it in new non-approved indications. Patient burden and clinical impact of such research are not well understood.

Design and setting

We conducted a retrospective cohort study of postapproval clinical trials launched within 5 years after the drug’s first approval, testing anticancer drugs in monotherapy in indications that were first pursued after a drug’s first Food and Drug Administration (FDA) license, for all 12 anticancer drugs approved between 2005 and 2007. FDA, Medline and Embase search date 2019 February 12.

Primary and secondary outcome measures

Our primary objective was to measure burden and clinical impact for patients enrolling in these trials. Each trial was sorted into a ‘trajectory’ defined by the drug and cancer indication. The risk was operationalised by proportions of grade 3–4 severe adverse events and deaths. The clinical impact was measured by estimating the proportion of patients participating in trajectories that resulted in FDA approval, uptake into National Comprehensive Cancer Network (NCCN) clinical practice guidelines or advancement to randomised controlled trials within 8 years.

Results

Our search captured 104 published trials exploring monotherapy, including 69 unique trajectories. In total, trials in our sample enrolled 4699 patients. Grade 3–4 adverse events were experienced by 19.6% of patients; grade 5 events were experienced by 2.8% of patients. None of the trajectories launched after initial drug approval received FDA approval. Five trajectories were recommended by the NCCN within 8 years of the first trial within that trajectory. Eleven trajectories were advanced to randomised controlled testing.

Conclusions

The challenges associated with unlocking new applications for drugs that first received approval from 2005 to 2007 were similar to those for developing new drugs altogether. Our findings can help inform priority setting in research and provide a basis for calibrating expectations when considering enrolment in label-extending trials.
Retrospective cohort study of the relationship between systolic blood pressure variability and multiple sclerosis disability
Authors: Goldman Myla D , Min Seulgi , Lobo Jennifer M , Sohn Min-Woong
Published: February 2020

Objective

To examine the relationship between visit-to-visit systolic blood pressure (SBP) variability and patient-reported outcome measure of disability in multiple sclerosis (MS) patients.

Design

A retrospective cohort study of individuals with MS who completed a patient-determined disease steps (PDDS) scale between 2011 and 2015 at an MS specialty clinic.

Participants

Individuals with MS for whom both a completed PDDS scale and ≥3 SBP measures within the prior 12 months of the survey were available.

Main outcome measure

Participants were grouped into three classes of disability (no or mild (PDDS 0–1), moderate (2–3), severe (4–7)). SBP variability was calculated as within-subject SD using all SBP measures taken during the past 12 months. SBP variability was analysed by Tertile groups.

Results

Ninety-two subjects were included in this analysis. Mean PDDS score was 2.22±1.89. Compared with subjects in Tertile 1 (lowest variability), the odds of being in a higher disability group was 3.5 times higher (OR=3.48; 95% CI: 1.08 to 11.25; p=0.037) in Tertile 2 and 5.2 times higher (OR=5.19; 95% CI: 1.53 to 17.61; p=0.008) in Tertile 3 (highest variability), independent of mean SBP, age, sex, race/ethnicity, body mass index and comorbidities (p for trend=0.008). Mean PDDS scores were 1.52±1.18 in Tertile 1, 2.73±1.02 in Tertile 2 and 2.42±0.89 in Tertile 3 after adjusting for the same covariates.

Conclusions

Our results show a significant gradient relationship between SBP variability and MS-related disability. More research is needed to determine the underlying pathophysiological relationship between SBP variability and MS disability progression.
Acute rule-out of non–ST-segment elevation acute coronary syndrome in the (pre)hospital setting by HEART score assessment and a single point-of-care troponin: rationale and design of the ARTICA randomised trial
Authors: Aarts Goaris W A , Camaro Cyril , van Geuns Robert-Jan , Cramer Etienne , van Kimmenade Roland R J , Damman P , van Grunsven Pierre M , Adang Eddy , Giesen Paul , Rutten Martijn , Ouwendijk Olaf , Gomes Marc E R , van Royen Niels
Published: February 2020

Introduction

Because of the lack of prehospital protocols to rule out a non-ST-segment elevation acute coronary syndrome (NSTE-ACS), patients with chest pain are often transferred to the emergency department (ED) for thorough evaluation. However, in low-risk patients, an ACS is rarely found, resulting in unnecessary healthcare consumption. Using the HEART (History, ECG, Age, Risk factors and Troponin) score, low-risk patients are easily identified. When a point-of-care (POC) troponin measurement is included in the HEART score, an ACS can adequately be ruled out in low-risk patients in the prehospital setting. However, it remains unclear whether a prehospital rule-out strategy using the HEART score and a POC troponin measurement in patients with suspected NSTE-ACS is cost-effective.

Methods and analysis

The ARTICA trial is a randomised trial in which the primary objective is to investigate the cost-effectiveness after 30 days of an early rule-out strategy for low-risk patients suspected of a NSTE-ACS, using a modified HEART score including a POC troponin T measurement. Patients are included by ambulance paramedics and 1:1 randomised for (1) presentation at the ED (control group) or (2) POC troponin T measurement (intervention group) and transfer of the care to the general practitioner in case of a low troponin T value. In total, 866 patients will be included. Follow-up will be performed after 30 days, 6 months and 12 months.

Ethics and dissemination

This trial has been accepted by the Medical Research Ethics Committee region Arnhem-Nijmegen. The results of this trial will be disseminated in one main paper and in additional papers with subgroup analyses.

Trial registration number

Netherlands Trial Register (NL7148).
Endocannabinoids in aqueous humour of patients with or without diabetes
Authors: Richardson Patrick , Ortori Catherine , Barrett Dave , O'Sullivan Saoirse , Idris Iskandar
Published: February 2020

Objective

The primary aim was to determine endocannabinoid (EC) concentrations of 2-arachidonoylglycerol (2-AG), oleoylethanolamine (OEA), palmitoylethanolamine (PEA) and anandamide (AEA) in the aqueous humour of patients, and to investigate any differences in gender and diabetic or ocular disease status.

Methods and Analysis

Adult participants (age >18 years) listed for a routine cataract surgery were recruited. For patients with diabetes, results from their most recent retinopathy grading were recorded. A sample of aqueous humour was removed from the anterior chamber of the patients and snap-frozen in liquid nitrogen. Levels of 2-AG, PEA, OEA and AEA were measured by liquid chromatography-tandem mass spectrometry.

Results

Aqueous humour samples were taken from 93 patients (female:male=58:35), with a mean age±SD of 72.7±9.5 years. Following gender-specific analysis, the mean aqueous concentration of AEA in female patients without diabetes was significantly higher than in female patients with diabetes (0.20±0.03 nM vs 0.07±0.02 nM, p=0.001). Among female patients with diabetes, the aqueous concentration of 2-AG was higher in those with diabetic retinopathy compared with those with no retinopathy (0.30+0.16 nM vs 0.04±0.01 nM, p=0.0025). The aqueous level of the sum of EC was higher in those with ocular comorbidity (2.49±0.73 vs 1.44±0.17, p=0.0002).

Conclusion

There were gender, diabetes status and comorbidity differences in aqueous humour EC levels. Since EC receptors are present in ocular tissues, including the retina (neurons, glia and endothelial cells), differential levels of ECs in the aqueous humour of patients with and without diabetes may provide a novel therapeutic target for diabetic retinopathy.
Evaluating the risks associated with Shiga-toxin-producing Escherichia coli (STEC) in private well waters in Canada
Authors: Reynolds Colin , Checkley Sylvia , Chui Linda , Otto Simon , Neumann Norman F.
Published: February 2020

Shiga-toxin-producing Escherichia coli (STEC) represent a major concern for waterborne disease outbreaks associated with consumption of contaminated groundwater. Over 4 million people rely on private groundwater systems as their primary drinking water source in Canada; many of these systems do not meet current standards for water quality. This manuscript provides a scoping overview of studies examining STEC prevalence and occurrence in groundwater, and it includes a synopsis of the environmental variables affecting survival, transport, persistence, and overall occurrence of these important pathogenic microbes in private groundwater wells used for drinking purposes.
Demographics of injuries indicate sexual coercion in a population of Painted Turtles (Chrysemyspicta)
Authors: Moldowan P.D. , Brooks R.J. , Litzgus J.D.
Published: February 2020

Sexually coercive reproductive tactics are widespread among animals. Males may employ specialized structures to harass, intimidate, or physically harm females to force copulation, and injuries to the head and neck are reported in taxa with sexually coercive mating systems. The mating tactics of Painted Turtles (Chrysemys picta (Schneider, 1783)) are typically described as involving male courtship and female choice. In contrast, female Painted Turtles in our study population display injuries on the head and neck indicative of bite wounds inflicted by sexually dimorphic tomiodonts and weaponized shell morphology of males during reproductive interactions. Using a 24-year data set, we demonstrate population-level trends in soft tissue wounds inflicted by conspecifics. Adult females experienced more wounding than adult males or juveniles, and larger females had a greater probability of wounding than smaller females. Wounding was concentrated on the dorsal head and neck of females, consistent with expectation of sexual coercion. Furthermore, elevated rates of fresh wounding occurred during late summer, concurrent with the breeding period. By assessing wound demographics, we provide indirect evidence that the tomiodonts and shell of male Painted Turtles inflict injury and function as sexual weapons. These findings shed new light on our understanding of mating system complexity in an often-overlooked and difficult-to-observe taxonomic group.
Tensor Bogolyubov representations of the renormalized square of white noise (RSWN) algebra
Authors: Rebei Habib , Accardi Luigi , Taouil Hajer
Published: February 2020

We introduce the quadratic analog of the tensor Bogolyubov representation of the CCR. Our main result is the determination of the structure of these maps: each of them is uniquely determined by two arbitrary complex-valued Borel functions of modulus [Formula: see text] and two maps of [Formula: see text] into itself whose inverses induce transformations that map the Lebesgue measure [Formula: see text] into measures [Formula: see text] absolutely continuous with respect to it. Furthermore, the Radon–Nikodyn derivatives [Formula: see text], of these measures with respect to [Formula: see text], must satisfy the relation [Formula: see text] for [Formula: see text]-almost every [Formula: see text]. This makes a surprising bridge with the hyperbolic sine and cosine defining the structure of usual (i.e. first-order) Bogolyubov transformations. The reason of the surprise is that the linear and quadratic commutation relations are completely different.
Ray tracing deformable scenes using dynamic bounding volume hierarchies
Authors: Wald Ingo , Boulos Solomon , Shirley Peter
Published: February 2020

The most significant deficiency of most of today's interactive ray tracers is that they are restricted to static walkthroughs. This restriction is due to the static nature of the acceleration structures used. While the best reported frame rates for static geometric models have been achieved using carefully constructed kd-trees, this article shows that bounding volume hierarchies (BVHs) can be used to efficiently ray trace large static models.More importantly, the BVH can be used to ray trace deformable models (sets of triangles whose positions change over time) with little loss of performance. A variety of efficiency techniques are used to achieve this performance, but three algorithmic changes to the typical BVH algorithm are mainly responsible. First, the BVH is built using a variant of the surface area heuristic conventionally used to build kd-trees. Second, the topology of the BVH is not changed over time so that only the bounding volumes need to be refit from frame-to-frame. Third, and most importantly, packets of rays are traced together through the BVH using a novel integrated packet-frustum traversal scheme. This traversal scheme elegantly combines the advantages of both packet traversal and frustum traversal and allows for rapid hierarchy descent for packets that hit bounding volumes as well as rapid exits for packets that miss. A BVH-based ray tracing system using these techniques is shown to achieve performance for deformable models comparable to that previously available only for static models.
Complexity in the interface age
Authors: Ubiquity staff
Published: February 2020

Do you control technology or does it control you? Jeremy J. Shapiro talks about the power struggle in machine/human relationships and what it means today to be information-technology literate. Shapiro is a faculty member in the Human and Organization Development Program at the Fielding Graduate Institute.
The development of a case study methodology in the information technology (IT) field
Authors: Lubbe Sam
Published: February 2020

An important step any researcher should take is establishing a framework in which to conduct the research.