bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Ceftriaxone, Cefepime, Doxycycline, Ciprofloxacin, and Combination Therapy for Vibrio vulnificus Foodborne Septicemia
Authors: Trinh Sonya A. , Gavin Hannah E. , Satchell Karla J. F.
Published: October 2017

FoodborneVibrio vulnificusinfections are associated with higher rates of sepsis and mortality than wound infections; however, antibiotic efficacy studies have not been performed in foodborne infection models. The efficacies of ceftriaxone, cefepime, doxycycline, ciprofloxacin, and combination therapy were assessed inV. vulnificusintestinal infection in mice in order to model foodborne infections. In accordance with prior studies of cefotaxime, cefepime was synergistic with doxycycline and ciprofloxacinin vitro; combination therapy significantly decreased bacterial growth, by ≥2 log10units, from that with antibiotic monotherapy (P< 0.01).In vivo, survival rates in the ceftriaxone (50%), doxycycline (79%), and ciprofloxacin (80%) groups were significantly higher than those in the control group (0%) (P< 0.0001). Survival was significantly higher with ceftriaxone-doxycycline (91%) or ceftriaxone-ciprofloxacin (100%) therapy than with ceftriaxone (50%) (P≤ 0.05). Survival with cefepime-doxycycline (96%) or cefepime-ciprofloxacin (90%) therapy was significantly higher than that with cefepime alone (20%) (P< 0.001). There was no difference in survival between the combination therapy groups. Thus, we conclude that combination therapy was the most effective treatment for foodborneV. vulnificussepticemia. In a septic patient with a recent ingestion of raw seafood, cefepime in combination with doxycycline or ciprofloxacin should be initiated for coverage of resistant Gram-negative organisms andV. vulnificuspending a microbiological diagnosis. Once a diagnosis of foodborneV. vulnificussepticemia is established, treatment can safely transition to ceftriaxone in combination with doxycycline or ciprofloxacin.
Tissue Distribution and Elimination of Isavuconazole following Single and Repeat Oral-Dose Administration of Isavuconazonium Sulfate to Rats
Authors: Schmitt-Hoffmann Anne-Hortense , Kato Kota , Townsend Robert , Potchoiba Michael J. , Hope William W. , Andes David , Spickermann Jochen , Schneidkraut Marlowe J.
Published: October 2017

Quantitative whole-body autoradiography was used to assess the distribution and tissue penetration of isavuconazole in rats following single and repeated oral-dose administration of radiolabeled isavuconazonium sulfate, the prodrug of isavuconazole. Following a single-dose administration of radiolabeled isavuconazonium sulfate (labeled on the active moiety), radioactivity was detectable within 1 h postdose in 56 of 65 tissue/fluid specimens. The highest maximum concentrations (
C
max
) were observed in bile and liver (66.6 and 24.7 μg eq/g, respectively). The lowest
C
max
values were in bone and eye lens (0.070 and 0.077 μg eq/g, respectively). By 144 h postdose, radioactivity was undetectable in all tissues/fluids except liver (undetectable at 336 h) and adrenal gland tissues (undetectable at 672 h). Following daily administration for up to 21 days, 1-h-postdose
C
max
values were the highest on or before day 14 in all except seven tissues/fluids, of which only rectum mucosa and small intestine mucosa had
C
max
values >25% higher than all other 1-h-postdose values. For 24-h-postdose
C
max
values, only large intestine, large intestine mucosa, and urine had the highest
C
max
values at day 21. The penetration of single oral doses of unlabeled isavuconazole (25 mg/kg of body weight isavuconazonium sulfate) and voriconazole (50 mg/kg) into rat brain (assessed using liquid chromatography-tandem mass spectrometry) was also compared. Brain concentration/plasma concentration ratios reached approximately 1.8:1 and 2:1, respectively. These data suggest that isavuconazole penetrates most tissues rapidly, reaches a steady state in most or all tissues/fluids within 14 days, does not accumulate in tissues/fluids over time, and achieves potentially efficacious concentrations in the brain.
Development and Qualification of an Opsonophagocytic Killing Assay To Assess Immunogenicity of a Bioconjugated Escherichia coli Vaccine
Authors: Abbanat Darren , Davies Todd A. , Amsler Karen , He Wenping , Fae Kellen , Janssen Sarah , Poolman Jan T. , van den Dobbelsteen Germie P. J. M.
Published: October 2017

The global burden of disease caused by extraintestinal pathogenic
Escherichia coli
(ExPEC) is increasing as the prevalence of multidrug-resistant strains rises. A multivalent ExPEC O-antigen bioconjugate vaccine could have a substantial impact in preventing bacteremia and urinary tract infections. Development of an ExPEC vaccine requires a readout to assess the functionality of antibodies. We developed an opsonophagocytic killing assay (OPA) for four ExPEC serotypes (serotypes O1A, O2, O6A, and O25B) based on methods established for pneumococcal conjugate vaccines. The performance of the assay was assessed with human serum by computing the precision, linearity, trueness, total error, working range, and specificity. Serotypes O1A and O6A met the acceptance criteria for precision (coefficient of variation for repeatability and intermediate precision, ≤50%), linearity (90% confidence interval of the slope of each strain, 0.80, 1.25), trueness (relative bias range, −30% to 30%), and total error (total error range, −65% to 183%) at five serum concentrations and serotypes O2 and O25B met the acceptance criteria at four concentrations (the lowest concentration for serotypes O2 and O25B did not meet the system suitability test of maximum killing of ≥85% of
E. coli
cells). All serotypes met the acceptance criteria for specificity (opsonization index value reductions of ≤20% for heterologous serum preadsorption and ≥70% for homologous serum preadsorption). The assay working range was defined on the basis of the lowest and highest concentrations at which the assay jointly fulfilled the target acceptance criteria for linearity, precision, and accuracy. An OPA suitable for multiple
E. coli
serotypes has been developed, qualified, and used to assess the immunogenicity of a 4-valent
E. coli
bioconjugate vaccine (ExPEC4V) administered to humans.
RNA Interference Screening Reveals Host CaMK4 as a Regulator of Cryptococcal Uptake and Pathogenesis
Authors: Srikanta Deepa , Hole Camaron R. , Williams Matthew , Khader Shabaana A. , Doering Tamara L.
Published: October 2017

Cryptococcus neoformans
, the causative agent of cryptococcosis, is an opportunistic fungal pathogen that kills over 200,000 individuals annually. This yeast may grow freely in body fluids, but it also flourishes within host cells. Despite extensive research on cryptococcal pathogenesis, host genes involved in the initial engulfment of fungi and subsequent stages of infection are woefully understudied. To address this issue, we combined short interfering RNA silencing and a high-throughput imaging assay to identify host regulators that specifically influence cryptococcal uptake. Of 868 phosphatase and kinase genes assayed, we discovered 79 whose silencing significantly affected cryptococcal engulfment. For 25 of these, the effects were fungus specific, as opposed to general alterations in phagocytosis. Four members of this group significantly and specifically altered cryptococcal uptake; one of them encoded CaMK4, a calcium/calmodulin-dependent protein kinase. Pharmacological inhibition of CaMK4 recapitulated the observed defects in phagocytosis. Furthermore, mice deficient in CaMK4 showed increased survival compared to wild-type mice upon infection with
C. neoformans
. This increase in survival correlated with decreased expression of pattern recognition receptors on host phagocytes known to recognize
C. neoformans
. Altogether, we have identified a kinase that is involved in
C. neoformans
internalization by host cells and in host resistance to this deadly infection.
Model of Chronic Equine Endometritis Involving a Pseudomonas aeruginosa Biofilm
Authors: Ferris Ryan A. , McCue Patrick M. , Borlee Grace I. , Glapa Kristina E. , Martin Kevin H. , Mangalea Mihnea R. , Hennet Margo L. , Wolfe Lisa M. , Broeckling Corey D. , Borlee Bradley R.
Published: October 2017

Bacteria in a biofilm community have increased tolerance to antimicrobial therapy. To characterize the role of biofilms in equine endometritis, six mares were inoculated withlux-engineeredPseudomonas aeruginosastrains isolated from equine uterine infections. Following establishment of infection, the horses were euthanized and the endometrial surfaces were imaged for luminescence to localize adherentlux-labeled bacteria. Samples from the endometrium were collected for cytology, histopathology, carbohydrate analysis, and expression of inflammatory cytokine genes. Tissue-adherent bacteria were present in focal areas between endometrial folds (6/6 mares). The Pel exopolysaccharide (biofilm matrix component) and cyclic di-GMP (biofilm-regulatory molecule) were detected in 6/6 mares and 5/6 mares, respectively, from endometrial samples with tissue-adherent bacteria (P< 0.05). A greater incidence (P< 0.05) of Pel exopolysaccharide was present in samples fixed with Bouin's solution (18/18) than in buffered formalin (0/18), indicating that Bouin's solution is more appropriate for detecting bacteria adherent to the endometrium. There were no differences (P> 0.05) in the number of inflammatory cells in the endometrium between areas with and without tissue-adherent bacteria. Neutrophils were decreased (P< 0.05) in areas surrounding tissue-adherent bacteria compared to those in areas free of adherent bacteria. Gene expression of interleukin-10, an immune-modulatory cytokine, was significantly (P< 0.05) increased in areas of tissue-adherent bacteria compared to that in endometrium absent of biofilm. These findings indicate thatP. aeruginosaproduces a biofilm in the uterus and that the host immune response is modulated focally around areas with biofilm, but inflammation within the tissue is similar in areas with and without biofilm matrix. Future studies will focus on therapeutic options for elimination of bacterial biofilm in the equine uterus.
Effect of a smaller target range on the compliance in targeting and distribution of oxygen saturation in preterm infants
Authors: van Zanten Henriëtte Anje , Pauws Steffen C , Stenson Ben J , Walther Frans J , Lopriore Enrico , te Pas Arjan B
Published: October 2017

Background

Following recent recommendations, the oxygen saturation (SpO2) target range for preterm infants in our nursery was narrowed towards the higher end from 85%–95% to 90%–95%. We determined the effect of narrowing the SpO2 target range on the compliance in target range and distribution of SpO2 in preterm infants.

Methods

Before and after changing the target range from 85%–95% to 90%–95%, infants <30 weeks of gestation receiving oxygen were compared during their admission on the neonatal intensive care unit. For each infant, distribution of SpO2 was noted by collecting SpO2 samples each minute, and the percentage of time spent with SpO2 within 90%–95% was calculated. Oxygen was manually adjusted. Hypoxaemic events (SpO2 <80%) where oxygen was titrated were analysed.

Results

Data were analysed for 104 infants (57 before and 47 after the range was narrowed). The narrower range was associated with an increase in the median (IQR) SpO2 (93% (91%–96%) vs 94% (92%–97%), p=0.01), but no increase in median time SpO2 within 90%–95% (49.2% (39.6%–59.7%) vs (46.9% (27.1%–57.9%), p=0.72). The distribution of SpO2 shifted to the right with a significant decrease in SpO2 <90%, but not <80%. The count of minute values for Sp02 <80% decreased, while the frequency and duration of hypoxaemic events and oxygen titration were not different.

Conclusion

Narrowing the target range from 85%–95% to 90%–95% in preterm infants was associated with an increase in median SpO2 and a rightward shift in the distribution, but no change in time spent between 90% and 95%.
Retinal hemangioblastoma: prevalence, incidence and frequency of underlying von Hippel-Lindau disease
Authors: Binderup Marie Louise Mølgaard , Stendell Anne-Sophie , Galanakis Michael , Møller Hans Ulrik , Kiilgaard Jens F , Bisgaard Marie Luise
Published: October 2017

Background and aims

We aimed to determine the frequency of von Hippel-Lindau disease (vHL) as the underlying cause of retinal hemangioblastoma and to estimate retinal hemangioblastoma incidence and prevalence in a national cohort study.

Methods

Through the national patient register and vHL research database, we identified 81 patients diagnosed with a retinal hemangioblastoma in Denmark between 1977 and 2014. Consent was obtained for 54 living and 10 deceased patients with retinal hemangioblastoma. For each participant, we collected medical records and family information. Almost all (63 of 64) participants were or had previously been tested for mutations in the VHL gene.

Results

Overall, 84% of the participants (54 of the 64) had vHL. Compared with the non-vHL patients, the vHL patients had their first retinal hemangioblastoma at a younger age (22.5 vs 40 years), and were more likely to have an asymptomatic first hemangioblastoma (80% vs 20%). Overall, 76% (41 of 54) of the vHL patients had a family history of vHL, while none of the patients without vHL did. Despite the rarity of the disease, on average more than eight new tumours are diagnosed each year due to multiple tumour development in vHL patients. The estimated prevalence of patients with retinal hemangioblastoma was up to 1 in 73 080 individuals.

Conclusion

In the first national study in which almost all participants were genetically tested, vHL was the underlying cause of retinal hemangioblastoma in 84% of cases; more often than previously reported. We recommend that genetic and clinical vHL screening should be performed in all patients with retinal hemangioblastoma.
Interlower and postlower eyelid retractor fat pads: a cadaveric microscopic study
Authors: Mupas-Uy Jacqueline T , Takahashi Yasuhiro , Nakano Takashi , Naito Munekazu , Ikeda Hiroshi , Miyazaki Hidetaka , Kakizaki Hirohiko , Malhotra Raman
Published: October 2017

Background

To report the histological microscopic anatomy of the interlower and postlower eyelid retractor (LER) fat pads.

Methods

In this experimental microscopic study, 31 exenterated orbits from 31 Japanese cadavers (19 right and 12 left; 15 male and 16 female; mean age of death, 81.0±8.8 years; range, 52–97 years) fixed in 10% buffered formalin were used. Masson trichrome was used to stain sagittal full sections of exenterated tissues. Microscopic examination of the lower eyelids was carried out.

Results

The exenterated orbits demonstrated the presence of the histological existence of inter-LER fat pad (80.6%) and post-LER fat pad (22.6%) in the lower eyelids. The inter-LER fat pad was thick and located between the anterior and posterior layers of the LER, where the blood vessels passed through in 18 specimens (72.0%). The post-LER pad was thin, subtle and located between the posterior layer of the LER and conjunctiva.

Conclusion

This study reports a novel finding of the inter-LER and post-LER fat pads. Awareness of these fat layers provides surgeons with additional anatomical detail of lower eyelid anatomy.
MicroRNA-20a-5p suppresses IL-17 production by targeting OSM and CCL1 in patients with Vogt-Koyanagi-Harada disease
Authors: Chang Rui , Yi Shenglan , Tan Xiao , Huang Yang , Wang Qingfeng , Su Guannan , Zhou Chunjiang , Cao Qingfeng , Yuan Gangxiang , Kijlstra Aize , Yang Peizeng
Published: October 2017

Aim

To elucidate the role of microRNA-20a-5p (miR-20a-5p) in the pathogenesis of Vogt-Koyanagi-Harada (VKH) disease.

Methods

Quantitative real-time PCR was used to quantify miR-20a-5p expression in CD4+ T cells from patients with active VKH and normal controls. The promoter methylation status of miR-20a-5p was detected by bisulfite sequencing PCR. Targets were evaluated by a luciferase reporter assay. The functional effects of miR-20a-5p on CD4+ T cells from patients with active VKH were assessed by upregulation or downregulation of its expression using liposomes.

Results

The miR-20a-5p level was significantly decreased in CD4+ T cells from patients with active VKH as compared with normal controls. The two genes, oncostatin M (OSM) and C-C motif chemokine ligand 1 (CCL1), were identified as targets of miR-20a-5p. The upregulation of miR-20a-5p significantly suppressed interleukin 17 (IL-17) production in CD4+ T cells from patients with active VKH, whereas downregulation of miR-20a-5p exhibited an inverse effect. In addition, overexpression of OSM and CCL1 could rescue the effect of the upregulation of miR-20a-5p. Moreover, the level of miR-20a-5p was reduced in response to hypermethylation of the promoter. Further study showed that miR-20a-5p suppressed the activity of the phosphoinositide 3-kinase-AKT pathway.

Conclusions

Our findings indicate that downregulation of miR-20a-5p is caused by promoter hypermethylation. MiR-20a-5p could also suppress the production of IL-17 by targeting OSM and CCL1 production in CD4+ T cells in patients with active VKH.
Prevalence and incidence of non-arteritic anterior ischaemic optic neuropathy in South Korea: a nationwide population-based study
Authors: Lee Ju-Yeun , Park Kyung-Ah , Oh Sei Yeul
Published: October 2017

Aims

To determine the age and sex-specific prevalence and incidence of non-arteritic anterior ischaemic optic neuropathy (NAION) in South Korea.

Methods

This is a nationwide population-based study using data from the Korean national health claims database to identify patients with NAION using the registration programme database, which comprises ophthalmologist-confirmed NAION from 2011 through 2015. We evaluated prevalence and incidence rates using these data.

Results

Among 25 816 797 of entire population 40 years of age or older, 26 167 patients had NAION (47.8% men) during the 5-year study period. The prevalence in the general population 40 years of age or older was 102.87 (95% CI 95.22 to 110.53) per 100 000 people. In men, it was 111.10 (95% CI 101.19 to 121.02), and in women, it was 94.64 (95% CI 89.25 to 100.03) per 100 000 people. The prevalence increased with advancing age and peaked at 70–74 years in men and 65–69 years in women. The incidence in the general population 40 years of age or older was 11.35 (95% CI 10.37 to 12.33) per 100 000 person-years. In men, it was 14.89 (95% CI 12.26 to 16.91), and in women, it was 9.92 (95% CI 8.85 to 10.99) per 100 000 person-years. The incidence increased with advancing age and peaked at 80–84 years in men and 70–74 years in women.

Conclusions

The prevalence and incidence estimates of NAION are comparable with those of Caucasians. These detailed estimates could promote understanding of the disease’s pathophysiology and allow for appropriate planning within the healthcare system.
The Norwegian patient experiences with GP questionnaire (PEQ-GP): reliability and construct validity following a national survey
Authors: Holmboe Olaf , Iversen Hilde Hestad , Danielsen Kirsten , Bjertnaes Oyvind
Published: October 2017

Objectives

The aim of this study was to test the reliability and validity of a new questionnaire for measuring patient experiences with general practitioners (PEQ-GP) following a national survey.

Setting

Postal survey among patients on any of 500 GPs patient lists in Norway. GPs were stratified by practice size and geographical criteria.

Participants

4964 patients who had at least one consultation with their regular GP in the foregoing 12 months were included in the study. The patients were randomly selected after the selection of GPs. 2377 patients (49%) responded to the survey.

Primary and secondary outcome measures

The items were assessed for missing data and ceiling effects. Factor structure was assessed using exploratory factor analyses. Reliability was tested with item–total correlation, Cronbach’s alpha and test–retest correlations. Item discriminant validity was tested by correlating items with all scales. Construct validity was assessed through associations of scale scores with health status, the patients’ general satisfaction with the services, whether the patient had been incorrectly treated by the GP and whether the patient would recommend the GP to others.

Results

Item missing varied from 1.0% to 3.1%, while ceiling effects varied from 16.1% to 45.9%. The factor analyses identified three factors. Reliability statistics for scales based on these three factors, and two theoretically derived scales, showed item–total correlations ranging from 0.63 to 0.85 and Cronbach’s alpha values from 0.77 to 0.93. Test–retest correlation for the five scales varied from 0.72 to 0.88. All scales had the expected association with other variables.

Conclusions

The PEQ-GP has good evidence for data quality, internal consistency and construct validity. The PEQ-GP is recommended for use in local, regional and national surveys in Norway, but further studies are needed to assess the instrument’s ability to detect differences over time and between different GPs.
People’s experiences of hospital care on the weekend: secondary analysis of data from two national patient surveys
Authors: Graham Chris
Published: October 2017

Objective

To determine whether patients treated in hospital on the weekend report different experiences of care compared with those treated on weekdays.

Design

This is a secondary analysis of the 2014 National Health Service (NHS) adult inpatient survey and accident and emergency (A&E) department surveys. Differences were tested using independent samples t-tests and multiple regression, adjusting for patient age group, sex, ethnicity, proxy response, NHS trust, route of admission (for the inpatient survey) and destination on discharge (for the A&E survey).

Setting

The inpatient survey included 154 NHS hospital trusts providing overnight care; the A&E survey 142 trusts with major emergency departments.

Participants

Three cohorts were analysed: patients attending A&E, admitted to hospital and discharged from hospital. From the inpatient survey’s 59 083 responses, 10 382 were admitted and 11 542 discharged on weekends or public holidays. The A&E survey received 39 320 responses, including 11 542 (29.4%) who attended on the weekend or on public holidays. Weekday and weekend attendees’ response rates were similar once demographic characteristics were accounted for.

Main outcome measures

For the A&E survey, six composite dimensions covered waiting times, doctors and nurse, care and treatment, cleanliness, information on discharge, and overall experiences. For the inpatient survey, three questions covered admissions and two dimensions covered information about discharge and about medicines.

Results

People attending A&E on weekends were significantly more favourable about ‘doctors and nurses’ and ‘care and treatment’. Inpatients admitted via A&E on a weekend were more positive about the information given to them in A&E than others. Other dimensions showed no differences between people treated on weekdays or on weekends.

Conclusions

Patients attending emergency departments or admitted to or discharged from an inpatient episode on weekends and public holidays report similar or more positive experiences of care to other patients after adjusting for patient characteristics.
Effects of efforts to optimise morbidity and mortality rounds to serve contemporary quality improvement and educational goals: a systematic review
Authors: Smaggus Andrew , Mrkobrada Marko , Marson Alanna , Appleton Andrew
Published: October 2017

Background

The quality and safety movement has reinvigorated interest in optimising morbidity and mortality (M&M) rounds. We performed a systematic review to identify effective means of updating M&M rounds to (1) identify and address quality and safety issues, and (2) address contemporary educational goals.

Methods

Relevant databases (Medline, Embase, PubMed, Education Resource Information Centre, Cumulative Index to Nursing and Allied Health Literature, Healthstar, and Global Health) were searched to identify primary sources. Studies were included if they (1) investigated an intervention applied to M&M rounds, (2) reported outcomes relevant to the identification of quality and safety issues, or educational outcomes relevant to quality improvement (QI), patient safety or general medical education and (3) included a control group. Study quality was assessed using the Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education instruments. Given the heterogeneity of interventions and outcome measures, results were analysed thematically.

Results

The final analysis included 19 studies. We identified multiple effective strategies (updating objectives, standardising elements of rounds and attaching rounds to a formal quality committee) to optimise M&M rounds for a QI/safety purpose. These efforts were associated with successful integration of quality and safety content into rounds, and increased implementation of QI interventions. Consistent effects on educational outcomes were difficult to identify, likely due to the use of methodologies ill-fitted for educational research.

Conclusions

These results are encouraging for those seeking to optimise the quality and safety mission of M&M rounds. However, the inability to identify consistent educational effects suggests the investigation of M&M rounds could benefit from additional methodologies (qualitative, mixed methods) in order to understand the complex mechanisms driving learning at M&M rounds.
Wisdom of patients: predicting the quality of care using aggregated patient feedback
Authors: Griffiths Alex , Leaver Meghan P
Published: October 2017

Background

The Care Quality Commission (CQC) is responsible for ensuring the quality of healthcare in England. To that end, CQC has developed statistical surveillance tools that periodically aggregate large numbers of quantitative performance measures to identify risks to the quality of care and prioritise its limited inspection resource. These tools have, however, failed to successfully identify poor-quality providers. Facing continued budget cuts, CQC is now further reliant on an ‘intelligence-driven’, risk-based approach to prioritising inspections and a new effective tool is required.

Objective

To determine whether the near real-time, automated collection and aggregation of multiple sources of patient feedback can provide a collective judgement that effectively identifies risks to the quality of care, and hence can be used to help prioritise inspections.

Methods

Our Patient Voice Tracking System combines patient feedback from NHS Choices, Patient Opinion, Facebook and Twitter to form a near real-time collective judgement score for acute hospitals and trusts on any given date. The predictive ability of the collective judgement score is evaluated through a logistic regression analysis of the relationship between the collective judgement score on the start date of 456 hospital and trust-level inspections, and the subsequent inspection outcomes.

Results

Aggregating patient feedback increases the volume and diversity of patient-centred insights into the quality of care. There is a positive association between the resulting collective judgement score and subsequent inspection outcomes (OR for being rated ‘Inadequate’ compared with ‘Requires improvement’ 0.35 (95% CI 0.16 to 0.76), Requires improvement/Good OR 0.23 (95% CI 0.12 to 0.44), and Good/Outstanding OR 0.13 (95% CI 0.02 to 0.84), with p<0.05 for all).

Conclusions

The collective judgement score can successfully identify a high-risk group of organisations for inspection, is available in near real time and is available at a more granular level than the majority of existing data sets. The collective judgement score could therefore be used to help prioritise inspections.
The civilian validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to primary major incident triage
Authors: Vassallo James , Smith Jason , Bouamra Omar , Lecky Fiona , Wallis Lee A
Published: October 2017

Introduction

Triage is a key principle in the effective management of a major incident. Existing triage tools have demonstrated limited performance at predicting need for life-saving intervention (LSI). Derived on a military cohort, the Modified Physiological Triage Tool (MPTT) has demonstrated improved performance. Using a civilian trauma registry, this study aimed to validate the MPTT in a civilian environment.

Methods

Retrospective database review of the Trauma Audit and Research Network (TARN) database for all adult patients (>18 years) between 2006 and 2014. Patients were defined as Priority One if they received one or more LSIs from a previously defined list. Only patients with complete physiological data were included. Patients were categorised by the MPTT and existing triage tools using first recorded hospital physiology. Performance characteristics were evaluated using sensitivity, specificity and area under receiver operating characteristic (AUROC).

Results

During the study period, 218 985 adult patients were included in the TARN database. 127 233 (58.1%) had complete data: 55.6% male, aged 61.4 (IQR 43.1–80.0) years, Injury Severity Score 9 (IQR 9–16), 96.5% suffered blunt trauma and 24 791 (19.5%) were Priority One. The MPTT (sensitivity 57.6%, specificity 71.5%) outperformed all existing triage methods with a 44.7% absolute reduction in undertriage compared with existing UK civilian methods. AUROC comparison supported the use of the MPTT over other tools (P<0.001.)

Conclusion

Within a civilian trauma registry population, the MPTT demonstrates improved performance at predicting need for LSI, with the lowest rates of undertriage and an appropriate level of overtriage. We suggest the MPTT be considered as an alternative to existing triage tools.
Covered TIPS versus endoscopic band ligation plus propranolol for the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis: a randomised controlled trial
Authors: Lv Yong , Qi Xingshun , He Chuangye , Wang Zhengyu , Yin Zhanxin , Niu Jing , Guo Wengang , Bai Wei , Zhang Hongbo , Xie Huahong , Yao Liping , Wang Jianhong , Li Tao , Wang Qiuhe , Chen Hui , Liu Haibo , Wang Enxing , Xia Dongdong , Luo Bohan , Li Xiaomei , Yuan Jie , Han Na , Zhu Ying , Xia Jielai , Cai Hongwei , Yang Zhiping , Wu Kaichun , Fan Daiming , Han Guohong
Published: October 2017

Objective

Limited data are available on the prevention of variceal rebleeding in cirrhotic patients with portal vein thrombosis (PVT). This study aimed to compare transjugular intrahepatic portosystemic shunt (TIPS) with covered stents versus endoscopic band ligation (EBL) plus propranolol for the prevention of variceal rebleeding among patients with cirrhosis and PVT.

Design

Consecutive cirrhotic patients (94% Child-Pugh class A or B) with PVT who had variceal bleeding in the past 6 weeks were randomly assigned to TIPS group (n=24) or EBL plus propranolol group (EBL+drug, n=25), respectively. Primary endpoint was variceal rebleeding. Secondary endpoints included survival, overt hepatic encephalopathy (OHE), portal vein recanalisation and rethrombosis, other complications of portal hypertension and adverse events.

Results

During a median follow-up of 30 months in both groups, variceal rebleeding was significantly less frequent in the TIPS group (15% vs 45% at 1 year and 25% vs 50% at 2 years, respectively; HR=0.28, 95% CI 0.10 to 0.76, p=0.008), with a significantly higher portal vein recanalisation rate (95% vs 70%; p=0.03) and a relatively lower rethrombosis rate (5% vs 33%; p=0.06) compared with the EBL+drug group. There were no statistically significant differences in survival (67% vs 84%; p=0.152), OHE (25% vs 16%; p=0.440), other complications of portal hypertension and adverse events between groups.

Conclusion

Covered TIPS placement in patients with PVT and moderately decompensated cirrhosis was more effective than EBL combined with propranolol for the prevention of rebleeding, with a higher probability of PVT resolution without increasing the risk of OHE and adverse effects, but this benefit did not translate into improved survival.

Trial registration number

ClinicalTrials.gov: NCT01326949.
Outcomes of persistent pulmonary hypertension following transcatheter aortic valve replacement
Authors: Masri Ahmad , Abdelkarim Islam , Sharbaugh Michael S , Althouse Andrew D , Xu Jeffrey , Han Wei , Chan Stephen Y , Katz William E , Crock Frederick W , Harinstein Matthew E , Kliner Dustin E , Navid Forozan , Lee Joon S , Gleason Thomas G , Schindler John T , Cavalcante João L
Published: October 2017

Objectives

To determine the prevalence and factors associated with persistent pulmonary hypertension (PH) following transcatheter aortic valve replacement (TAVR) and its relationship with long-term mortality.

Methods

Consecutive patients who underwent TAVR from July 2011 through January 2016 were studied. The prevalence of baseline PH (mean pulmonary artery pressure ≥25 mm Hg on right heart catheterisation) and the prevalence and the predictors of persistent≥moderate PH (pulmonary artery systolic pressure (PASP)>45 mm Hg on 1 month post-TAVR transthoracic Doppler echocardiography) were collected. Cox models quantified the effect of persistent PH on subsequent mortality while adjusting for confounders.

Results

Of the 407 TAVR patients, 273 (67%) had PH at baseline. Of these, 102 (25%) had persistent≥moderate PH. Mortality at 2 years in patients with no baseline PH versus those with PH improvement (follow-up PASP≤45 mm Hg) versus those with persistent≥moderate PH was 15.4%, 16.6% and 31.3%, respectively (p=0.049). After adjusting for Society of Thoracic Surgeons Predicted Risk of Mortality and baseline right ventricular function (using tricuspid annular plane systolic excursion), persistent≥moderate PH remained associated with all-cause mortality (HR=1.82, 95% CI 1.06 to 3.12, p=0.03). Baseline characteristics associated with increased likelihood of persistent≥moderate PH were ≥moderate tricuspid regurgitation, ≥moderate mitral regurgitation, atrial fibrillation/flutter, early (E) to late (A) ventricular filling velocities (E/A ratio) and left atrial volume index.

Conclusions

Persistency of even moderate or greater PH at 1 month post-TAVR is common and associated with higher all-cause mortality.
Risk Engagement and Protection Survey (REPS): developing and validating a survey tool on fathers’ attitudes towards child injury protection and risk engagement
Authors: Olsen Lise L , Ishikawa Takuro , Mâsse Louise C , Chan Grace , Brussoni Mariana
Published: October 2017

Introduction

Fathers play a unique role in keeping children safe from injury yet understanding of their views and attitudes towards protecting children from injury and allowing them to engage in risks is limited. The purpose of this study was to develop and validate an instrument to measure fathers’ attitudes towards these two constructs.

Methods and findings

An instrument was developed that used prior qualitative research to inform item generation. The questions were assessed for content validity with experts, then pilot-tested with fathers. The survey was completed by 302 fathers attending hospital with their child for an injury or non-injury reason. Results of confirmatory factor analysis identified eight items relating to the protection from injury factor and six items relating to the risk engagement factor. Correlation between the two factors was low, suggesting these are two independent constructs.

Conclusions

The Risk Engagement and Protection Survey offers a tool for measuring attitudes and assisting with intervention strategy development in ways that reflect fathers’ views and promotes a balanced view of children’s needs for safety with their needs for engaging in active, healthy risk-taking.
Messy entanglements: research assemblages in heart transplantation discourses and practices
Authors: Shildrick Margrit , Carnie Andrew , Wright Alexa , McKeever Patricia , Jan Emily Huan-Ching , De Luca Enza , Bachmann Ingrid , Abbey Susan , Dal Bo Dana , Poole Jennifer , El-Sheikh Tammer , Ross Heather
Published: October 2017

The paper engages with a variety of data around a supposedly single biomedical event, that of heart transplantation. In conventional discourse, organ transplantation constitutes an unproblematised form of spare part surgery in which failing biological components are replaced by more efficient and enduring ones, but once that simple picture is complicated by employing a radically interdisciplinary approach, any biomedical certainty is profoundly disrupted. Our aim, as a cross-sectorial partnership, has been to explore the complexities of heart transplantation by explicitly entangling research from the arts, biosciences and humanities without privileging any one discourse. It has been no easy enterprise yet it has been highly productive of new insights. We draw on our own ongoing funded research with both heart donor families and recipients to explore our different perceptions of what constitutes data and to demonstrate how the dynamic entangling of multiple data produces a constitutive assemblage of elements in which no one can claim priority. Our claim is that the use of such research assemblages and the collaborations that we bring to our project breaks through disciplinary silos to enable a fuller comprehension of the significance and experience of heart transplantation in both theory and practice.
Does size matter concerning impact of position on oxygenation status in spontaneously breathing patients with unilateral effusion?
Authors: Michaelides Stylianos A , Michailidis Avgerinos-Romanos , Bablekos George D , Analitis Antonis , Michalatou Maria , Koulouris Nikolaos
Published: October 2017

Background

Inconsistent and contradictory findings have appeared in the literature concerning the impact of body position on oxygenation in pleural effusion.

Methods

We attempted to elucidate whether the size of the pleural effusion in patients with no parenchymal disease is the main determinant of posture-induced alterations in oxygenation parameters. We studied 62 spontaneously breathing patients aged 65.3±7.8 years (mean±SD), of whom 36 had large and massive-sized effusions (Group A) and 26 had small and moderate-sized effusions (Group B). Arterial blood gases were determined in four different body positions: sitting (SIT), supine (SUP), ipsilateral (IPS) and contralateral (CON) to the effusion side, after remaining relaxed for at least 20 min in each position. Separation into groups A and B was deliberately set from the position of the fluid meniscus line on a posteroanterior chest film just above the upper costal margin of the sixth anterior rib. A two-way ANOVA model with outcome variables PaO2, PaCO2 and [A–a] DO2 was used.

Results

In both groups the best oxygenation was found in SIT. The worst oxygenation (highest [A–a] DO2 value) occurred in group A in CON compared with IPS (59.4±7.6 vs 49.0±7.5 mm Hg, p<0.001) and in group B in IPS compared with CON (51.0±8.7 vs 39.5±9.2 mm Hg, p<0.001). Also, PaCO2 showed significant differences in both groups in IPS compared with CON (p=0.002).

Conclusions

Patients with large-sized effusions exhibit the worst oxygenation when lying on the side contralateral to the effusion, while those with small-sized effusions exhibit the worst oxygenation when lying on the side ipsilateral to the effusion.
Genetic divergence among and within Arctic char (Salvelinus alpinus) populations inhabiting landlocked and sea-accessible sites in Labrador, Canada
Authors: Salisbury Sarah J. , Booker Connor , McCracken Gregory R. , Knight Tom , Keefe Donald , Perry Robert , Ruzzante Daniel E.
Published: October 2017

Anadromous, resident, and landlocked Arctic char (Salvelinus alpinus) differentially experience drift and gene flow, making them ideal for studying incipient divergence. We investigated genetic divergence within and among char occupying landlocked and sea-accessible sites in Labrador, Canada, using 11 microsatellites. Unlike anadromous char, landlocked char were highly genetically differentiated. Genetic subgroups were detected within landlocked and sea-accessible sites. Within Ramah Lake (a sea-accessible site containing two subgroups), one subgroup matured at a small size, and both subgroups had equal proportions of males to females. These findings refute residency as a sneaker male tactic and instead suggest the presence of reproductively isolated resident and anadromous char. Subgroups demonstrated equal frequencies of Atlantic and Arctic lineage mtDNA haplotypes, suggesting their genetic differences were not due to allopatry during the last glacial maximum. Our results are therefore consistent with the sympatric genetic divergence of resident and anadromous Arctic char morphs.
“I kind of feel like sometimes I am shoving it under the carpet”: Documenting women’s experiences with post-abortion support in Ontario
Authors: LaRoche Kathryn J. , Foster Angel M.
Published: October 2017

Background: Abortion has been available without criminal restriction in Canada since 1988, and approximately 33 000 terminations take place in Ontario each year.

Objectives: This study aimed to explore women’s expressed desire for post-abortion support services, document the priorities expressed by women in seeking post-abortion support, and identify actionable strategies to improve post-abortion support services in Ontario.

Methods: Between 2012 and 2014 we conducted in-depth, open-ended interviews with 60 Anglophone women from across Ontario who had recently had an abortion. We aimed to rigorously explore the compounding issues of age and geography on women’s abortion experiences. We analyzed our data for content and themes and reported on the findings related to post-abortion support.

Results: One third of our participants expressed a desire for post-abortion support, yet few were able to access a timely, affordable, non-directive service. Women were uncertain about how to find services; most contacted a provider recommended by the clinic or searched online. Women were enthusiastic about a talkline format citing anonymity and convenience as the main advantages.

Conclusion: Our results suggest that exploring ways to expand post-abortion support services in Ontario is warranted. A talkline format could provide an anonymous, convenient, non-judgmental, and non-directive way to address this unmet need.
Testing dark matter with the anomalous magnetic moment in a dark matter quantum electrodynamics model
Authors: Das Ashok K. , Gamboa Jorge , Méndez Fernando , Tapia Natalia
Published: October 2017

We consider a model of dark quantum electrodynamics (QEDs) which is coupled to a visible photon through a kinetic mixing term. We compute the [Formula: see text] for the dark fermion, where [Formula: see text] is its gyromagnetic factor. We show that the [Formula: see text] of the dark fermion is related to the [Formula: see text] of (visible) QEDs through a constant which depends on the kinetic mixing factor. We determine [Formula: see text] as a function of the mass ratio [Formula: see text], where [Formula: see text] and [Formula: see text] denote the masses of the dark photon and the dark fermion, respectively, and we show how [Formula: see text] becomes very different for light and heavy fermions around [Formula: see text] eV.
Particle temperature and the chiral vortical effect in the early universe
Authors: Mukherjee Tamal K. , Sanyal Soma
Published: October 2017

We study the effect of hotter or colder particles on the evolution of the chiral magnetic field in the early universe. We are interested in the temperature-dependent term in the chiral vortical effect (CVE). There are no changes in the magnetic energy spectrum at large length scales but in the Kolmogorov regime we do find a difference. Our numerical results show that the Gaussian peak in the magnetic spectrum becomes negatively skewed. The negatively skewed peak can be fitted with a beta distribution. Analytically, one can relate the non-Gaussianity of the distribution to the temperature-dependent vorticity term. The vorticity term is therefore responsible for the beta distribution in the magnetic spectrum. Since the beta distribution has already been used to model turbulent dispersion in fluids, hence it seems that the presence of hotter or colder particles may lead to turbulence in the magnetized plasma.
A hollow inclusion self-similarity phononic crystal with an ultra-low-frequency bandgap
Authors: Gao Nansha , Hou Hong , Cheng Baozhu , Zhang Ruihao
Published: October 2017

FEA method is applied in order to investigate the bandgaps of two-dimensional (2D) phononic crystals which are composed with self-similarity hollow inclusions. Transmission spectra together with dispersion relations and displacement fields have been studied with FEA in detail. The simultaneous mechanisms of Bragg scattering enable multiterm bandgaps to be unfolded by the structure that can be effectively shifted by changing the lattice constant, matrix density and degree of self similarity. The smallest bandgap is located in the infrasonic wave range. Our results verify these phononic crystals with self-similar hollow inclusion structure which can change the number, location and width of bandgaps.
Laboratory studies of Miocene limestone in Sri Lanka
Authors: Jayawardena U. de S.
Published: October 2017

Geologically 10% of Sri Lanka is made up of Miocene limestone, which covers the northern and northwestern coastal belt of the island. It is used as a raw material for various industries, but at present only cement and lime are used for the construction industry. Therefore the author carried out a series of laboratory tests to determine the mechanical properties of limestone in Sri Lanka, with the aim of determining the suitability of Miocene limestone as aggregate for the construction industry. Borehole samples (NX size) of limestone were obtained from various drilling sites, and tests for physical and mechanical properties and ultrasonic wave velocities were carried out according to ASTM Standards at geotechnical and materials testing laboratories. According to the Los Angeles abrasion value (LAAV) and aggregate impact value (AIV) this limestone may be suitable as the base course material for road construction but may not be suitable for use as the surface material of highways or as railroad ballast. Ultrasonic wave velocities indicate that the limestone is highly compacted and solid. According to the compressive strength of solid limestone, buildings a few storeys high can be constructed on it after a detailed site investigation.
Texture and mineralogy influence on durability: the Macigno sandstone
Authors: Scrivano Simona , Gaggero Laura , Aguilar Josep Gisbert , de Kock Tim , Derluyn Hannelore , Cnudde Veerle
Published: October 2017

The behaviour of ornamental stones in response to environmental changes or interactions is crucial when dealing with the conservation of cultural heritage. Weathering factors affect each rock differently, depending on structure, mineralogy, and extraction and implementation techniques. This work focuses on the Macigno sandstone, a dimension stone often employed in Tuscany over the centuries. A thorough mineralogical (optical microscopy, scanning electron microscopy and X-ray powder diffraction) and petrophysical characterization (i.e. mercury intrusion porosimetry, X-ray computed tomography, hygroscopic adsorption behaviour, ultrasounds, image analysis and capillary uptake) was made of the sandstone type extracted in the area of Greve in Chianti. The lithotype shows mineralogical (i.e. presence of mixed-layer phyllosilicates) and micro-porosimetric features, leading to a high susceptibility to relative humidity variation. Moreover, the influence of swelling minerals is related to weathering due to saline solution. The joint application of petrographic and petrophysical techniques allows an understanding of the characteristic weathering pattern of exfoliation (i.e. detachment of multiple thin stone layers, centimetre scale, that are sub-parallel to the stone surface).