bluuebunny/crossref_metadata_2025 huggingface dataset:
Multimorbidity, eHealth and implications for equity: a cross-sectional survey of patient perspectives on eHealth
Authors: Mangin Dee , Parascandalo Jenna , Khudoyarova Olga , Agarwal Gina , Bismah Verdah , Orr Sherrie
Published: February 2019

Objective

There is increasing awareness of the burden of medical care experienced by those with multimorbidity. There is also increasing interest and activity in engaging patients with chronic disease in technology-based health-related activities (‘eHealth’) in family practice. Little is known about patients’ access to, and interest in eHealth, in particular those with a higher burden of care associated with multimorbidity. We examined access and attitudes towards eHealth among patients attending family medicine clinics with a focus on older adults and those with polypharmacy as a marker for multimorbidity.

Design

Cross-sectional survey of consecutive adult patients attending consultations with family physicians in the McMaster University Sentinel and Information Collaboration practice-based research network. We used univariate and multivariate analyses for quantitative data, and thematic analysis for free text responses.

Setting

Primary care clinics.

Participants

693 patients participated (response rate 70%). Inclusion criteria: Attending primary care clinic. Exclusions: Too ill to complete survey, cannot speak English.

Results

The majority of participants reported access to the internet at home, although this decreased with age. Participants 70 years and older were less comfortable using the internet compared with participants under 70. Univariate analyses showed age, multimorbidity, home internet access, comfort using the internet, privacy concerns and self-rated health all predicted significantly less interest in eHealth. In the multivariate analysis, home internet access and multimorbidity were significant predictors of disinterest in eHealth. Privacy and loss of relational connection were themes in the qualitative analysis.

Conclusion

There is a significant negative association between multimorbidity and interest in eHealth. This is independent of age, computer use and comfort with using the internet. These findings have important implications, particularly the potential to further increase health inequity.
Automatic brain lesion segmentation on standard MRIs of the human head: a scoping review protocol
Authors: Gryska Emilia Agnieszka , Schneiderman Justin , Heckemann Rolf A
Published: February 2019

Introduction

Automatic brain lesion segmentation from medical images has great potential to support clinical decision making. Although numerous methods have been proposed, significant challenges must be addressed before they will become established in clinical and research practice. We aim to elucidate the state of the art, to provide a synopsis of competing approaches and identify contrasts between them.

Methods and analysis

We present the background and study design of a scoping review for automatic brain lesion segmentation methods for conventional MRI according to the framework proposed by Arksey and O’Malley. We aim to identify common image processing steps as well as mathematical and computational theories implemented in these methods. We will aggregate the evidence on the efficacy and identify limitations of the approaches. Methods to be investigated work with standard MRI sequences from human patients examined for brain lesions, and are validated with quantitative measures against a trusted reference. PubMed, IEEE Xplore and Scopus will be searched using search phrases that will ensure an inclusive and unbiased overview. For matching records, titles and abstracts will be screened to ensure eligibility. Studies will be excluded if a full paper is not available or is not written in English, if non-standard MR sequences are used, if there is no quantitative validation, or if the method is not automatic. In the data charting phase, we will extract information about authors, publication details and study cohort. We expect to find information about preprocessing, segmentation and validation procedures. We will develop an analytical framework to collate, summarise and synthesise the data.

Ethics and dissemination

Ethical approval for this study is not required since the information will be extracted from published studies. We will submit the review report to a peer-reviewed scientific journal and explore other venues for presenting the work.
Socioeconomic inequalities in reach, compliance and effectiveness of lifestyle interventions among workers: protocol for an individual participant data meta-analysis and equity-specific reanalysis
Authors: Oude Hengel Karen M , Coenen Pieter , Robroek Suzan J W , Boot Cecile R L , van der Beek Allard J , Van Lenthe Frank J , Burdorf Alex
Published: February 2019

Introduction

Obesity and unhealthy behaviour are more prevalent among workers with a low compared with a high socioeconomic position (SEP), and thus contribute to socioeconomic health inequalities. The occupational setting is considered an important setting to address unhealthy behaviours due to the possibility to efficiently reach a large group of adults through worksite health promotion. This paper describes the rationale and design for an individual participant data (IPD) meta-analysis and a socioeconomic equity-specific reanalysis aiming to: (1) investigate socioeconomic differences in the effectiveness of interventions aimed at promoting healthy behaviour and preventing obesity, (2) examine socioeconomic differences in reach and compliance and (3) to investigate underlying factors affecting possible socioeconomic differences.

Methods and analysis

A systematic search was conducted in electronic databases including Embase, Medline Ovid, Web of Science, Cochrane Central and Google Scholar as well as in grey literature and trial registries. Two researchers have independently selected a total of 34 relevant studies (from 88 articles). Responsible researchers of these eligible studies were asked to provide their study data and an assessment of the methodological criteria was done. The data of the intervention studies will be pooled for the IPD meta-analysis, whereas the socioeconomic equity-specific reanalysis will focus on each study separately, stratified for SEP. Both methods will be conducted to investigate socioeconomic differences in effectiveness, reach and compliance (research aims 1 and 2). For research aim 3, different factors, such as population characteristics, organisational work environment and intervention characteristics, will be investigated as possible moderators in the associations between SEP and effectiveness, reach and compliance.

Ethics and dissemination

The Medical Ethical Committee of Erasmus MC declared that the Medical Research Involving Human Subjects Act does not apply to the meta-analyses. The findings will be disseminated through peer-reviewed publications and (inter)national conference presentations.

Trial registration number

CRD42018099878.
Contribution of adverse events to death of hospitalised patients
Authors: Haukland Ellinor Christin , Mevik Kjersti , von Plessen Christian , Nieder Carsten , Vonen Barthold
Published: February 2019

Background

There is no standardised method to investigate death as a patient safety indicator and we need valid and reliable measurements to use adverse events contributing to death as a quality measure.

Objective

To investigate the contribution of severe adverse events to death in hospitalised patients and clarify methodological differences using the Global Trigger Tool method on all inpatient deaths compared with a sample of general hospitalised patients.

Method

Retrospective records reviewing using the Global Trigger Tool method.

Results

In 0.3% of hospital admissions, adverse events contribute to inpatient death. Patients who die in hospital have twice the rate of adverse events per 1000 patient days compared with general patients, 76.7 vs 36.5 (p<0.001, RR 2.10, 95% CI 1.79 to 2.47). Patients dying in hospital experience seven times the rate of severe adverse events, 38.4% vs 5.2% (p<0.001, RR 2.10, 95% CI 1.79 to 2.47). For 86 out of 377 inpatient deaths, the adverse event is so severe that it contributes to death. 27.9% of severe adverse events contributing to death originate in primary care. Lower respiratory infections (p<0.001, RR 2.81, 95% CI 1.76 to 4.51), medication harm (p<0.001, RR 5.21, 95% CI 3.04 to 8.94) and pressure ulcers (p=0.04, RR 2.23, 95% CI 1.03 to 4.85) are significantly more frequent for inpatient deaths than in the general sample of hospital patients.

Conclusions

Patients dying in hospitals experience seven times the rate of severe adverse events. Reviewing all inpatient death by the Global Trigger Tool method discloses new valid and reliable data of severe adverse events contributing to death which otherwise would be undetected.
Reducing hospital-acquired pressure injuries
Authors: Al-Otaibi Yasser K , Al-Nowaiser Noura , Rahman Arshur
Published: February 2019

Hospital-acquired pressure injury is a common preventable condition. Our hospital is a 144-bed governmental hospital in the Kingdom of Saudi Arabia that was found to have a 7.5% prevalence of hospital-acquired pressure injury in 2016. The aim of the improvement project was to reduce the prevalence of pressure injuries in our hospital from 7.5% to below 4% by the end of 2017. Our strategy for improvement was based on the Institute for Healthcare Improvement Model for Improvement. The change strategy was based on implementing an evidence-based risk assessment tool and a bundled evidence-based pressure injury prevention (PIP) intervention termed PIP bundle. After implementing the change package, we observed a reduction in the prevalence of pressure injuries by 84% (RR 0.16;95% CI 0.07 to 0.3; p value <0.0001) over a period of 12 weeks, in addition to an improvement in the compliance of pressure injury risk assessment and PIP interventions. The use of an evidenced-based bundled approach to prevent hospital-acquired pressure injuries has resulted in a significant reduction in the rate of pressure injuries. Improvement results were sustainable. In addition, our outcome measure exhibited minimal variability.
Use of WHO standards to improve quality of maternal and newborn hospital care: a study collecting both mothers’ and staff perspective in a tertiary care hospital in Italy
Authors: Lazzerini Marzia , Valente Emanuelle Pessa , Covi Benedetta , Semenzato Chiara , Ciuch Margherita
Published: February 2019

Background

WHO developed a list of standards for improving maternal and newborn hospital care. However, there is little experience on their use, and no precise guidance on their implementation. This study aimed at documenting the use of the WHO standards for improving the quality of maternal and neonatal care (QMNC) in a tertiary hospital, Northeast Italy.

Methods

The study was conducted between May 2016 and May 2018, in three phases: phase I—sensitisation and training of health professionals; phase II—data collection on the WHO standards through a survey among service users and providers; phase III—based on the findings of phase II, development of recommendations for improving the QMNC.

Results

Overall, 101 health professionals were successfully trained. 1050 mothers and 105 hospital staff participated in the survey. Key indicators of QMNC (and related prevalence) from the mothers survey included: caesarean section (23.1%); episiotomy (18.3%); restrictions to free movements during labour (46.5%), lithotomy position for staff choice (69.3%); skin to skin (80.8%); early breast feeding (67.2%); information on newborn danger signs (47.2%); high satisfaction with QMNC (68.8%). Only 1.2% and 0.7% of women respectively reported discrimination or abuse. Key indicators (and prevalence) reported from staff included: availability of clinical protocols (37%); regular training (14%); health information system used for quality improvement (16.3%); training on effective communication (9.7%) and on emotional support (19.6%); protocols to prevent mistreatment and abuse (6.9%). On several indicators, the opinions of mothers on QMNC was better than those of staff. Overall, 55 quality improvement recommendations were agreed.

Conclusions

Information on the WHO standards can be collected from both services users and providers and can be proactively used for planning improvements on QMNC.
Primary palliative care research: opportunities and challenges
Authors: Barclay Stephen , Moran Emily , Boase Sue , Johnson Margaret , Lovick Roberta , Graffy Jonathan , White Patrick L , Deboys Brenda , Harrison Katy , Swash Brooke
Published: February 2019

Introduction

Primary care has a central role in palliative and end of life care: 45.6% of deaths in England and Wales occur under the care of primary care teams at home or in care homes. The Community Care Pathways at the End of Life (CAPE) study investigated primary care provided for patients in the final 6 months of life. This paper highlights the opportunities and challenges associated with primary palliative care research in the UK, describing the methodological, ethical, logistical and gatekeeping challenges encountered in the CAPE study and how these were addressed.

The study methods

Using a mixed-methods approach, quantitative data were extracted from the general practitioner (GP) and district nurse (DN) records of 400 recently deceased patients in 20 GP practices in the East of England. Focus groups were conducted with some GPs and DNs, and individual interviews held with bereaved carers and other GPs and DNs.

The challenges addressed

Considerable difficulties were encountered with ethical permissions, with GP, DN and bereaved carer recruitment and both quantitative and qualitative data collection. These were overcome with flexibility of approach, perseverance of the research team and strong user group support. This enabled completion of the study which generated a unique primary palliative care data set.
Relevance of early intervention in Fahr’s disease: understanding through a case study
Authors: Ahmad Jamshed , Gupta Bandna , Kar Sujita Kumar
Published: February 2019

Intracranial calcification may result from disturbances in calcium metabolism. It often remains asymptomatic, but may present with symptoms like seizure and neurological deficits. Correction of the underlying metabolic disturbance before damage of neuronal tissues due to intracranial calcification may be useful in preventing irreversible neurological deficits. This window period may be the crucial period that needs a thorough clinical evaluation and urgent intervention. We highlight the case of an adult woman with Fahr’s disease presented with generalised tonic-clonic seizure. The management priorities were also discussed along with review of literature.
Digital immunohistochemistry implementation, training and validation: experience and technical notes from a large clinical laboratory
Authors: Williams Bethany Jill , Jayewardene Dharshana , Treanor Darren
Published: February 2019

Aims

To consider the value proposition of digitisation of clinical immunohistochemistry services, and to develop an approach to digital immunohistochemistry implementation and validation in a large clinical laboratory.

Methods

A methodology for slide scanning in the laboratory was developed, in addition to a novel validation exercise, to allow pathologists to identify the strengths and weaknesses of digital immunohistochemistry reporting, and train in digital immunohistochemistry slide assessment.

Results

A total of 1480 digital immunohistochemistry slides were assessed by 24 consultant pathologists, with complete clinical concordance between the digital and the glass slide assessment observed. Certain stains were identified as being difficult/time consuming to assess using ×20 digital slides. These stains were rescanned at ×40, which improved the confidence of the pathologists to make a digital assessment. Full digitisation of immunohistochemistry slides was achieved, introducing six new steps into the pre-existing laboratory workflow.

Conclusions

While initially encountering challenges in terms of workflow, our experience showed that a well-designed, adequately resourced and well-managed scanning process can minimise the delay in slides being made available for review. Our approach to validation highlighted the need for careful assessment of a digital pathology system and scanning protocols before pathologists are expected to transfer from the light microscope to the digital microscope for routine immunohistochemistry assessment.
Bullying and bystander behaviour and health outcomes among adolescents in Ireland
Authors: Callaghan Mary , Kelly Colette , Molcho Michal
Published: February 2019

Background

Little is known about the impact of being a bystander to bullying. This study compared health outcomes among bullies, victims and bystanders, and investigated actions taken by bystanders when they saw bullying.

Method

Participants included 7522 students aged 12–18 years that completed self-report questionnaires in the 2013/2014 Health Behaviour in School-aged Children survey. Binary logistic regression models (controlled for bully, victim, bystander status and demographic variables) were used to investigate the associations between participation in bullying as a bully, victim and bystander and health outcomes.

Results

Overall, 13.3% of adolescents reported being a bully, 25.1% reported being a victim and 30.5% reported that they saw bullying, in the last couple of months. Bystanders were significantly more likely to experience psychological symptoms (OR 1.355), somatic symptoms (OR 1.392) and low life satisfaction (OR 1.268) than those who were not bystanders. Helping the victim was significantly associated with experiencing psychological symptoms (OR 1.240), somatic symptoms (OR 1.251) and low life satisfaction (OR 1.198). Being a bully was significantly associated with experiencing psychological symptoms (OR 1.382) and not having excellent health (OR 1.252). Victims were significantly more likely to experience psychological symptoms (OR 2.437), somatic symptoms (OR 2.364), low life satisfaction (OR 2.564) and not having excellent health (OR 1.559).

Conclusion

In Ireland, being a bystander to bullying is more prevalent in schools than bullying perpetration or victimisation. The impact of being a bystander to bullying needs to be highlighted and included in intervention development.
Therapeutic Targets for the Anemia of Predialysis Chronic Kidney Disease: A Meta-Analysis of Randomized, Controlled Trials
Authors: Liu Hongyong , Ye Yuqiu , Chen Yanbing , Zhang Yunqiang , Li Shaomin , Hu Wentao , Yang Rongqian , Zhang Zhesi , Peng Hongquan , Lv Linsheng , Liu Xun
Published: February 2019

Anemia is one of the major complications in predialysis patients with chronic kidney disease (CKD). A clearer cognition of the prognostic impact of hemoglobin (Hb) or hematocrit (Hct) target on the outcomes of predialysis patients with CKD is significant. This article aims to establish the suitable hemoglobin target to provide clinical guidance. MEDLINE, EmBase, the Cochrane Library and other databases were searched with both MeSH terms and keywords to gather researches that assessed all-cause mortality, stroke, treatment of renal replacement, and transfusion. The meta-analysis was accomplished via Revman 5.3 version. Totally, 13 eligible studies involving 7606 patients were included. There was a significantly lower risk of transfusion (risk ratio (RR) 0.59, 95% CI 0.52 to 0.67; p<0.00001) in the higher hemoglobin group than in the lower one. However, no significant difference was found in all-cause mortality (RR 1.10, 95% CI 0.98 to 1.23; p=0.11), stroke (RR 1.32, 95% CI 0.82 to 2.10; p=0.25) and treatment of renal replacement including hemodialysis, peritoneal dialysis and renal transplant (RR 1.08, 95% CI 0.95 to 1.22; p= 0.23) between the higher hemoglobin group and the lower one. The results favor the higher hemoglobin target. To target the higher hemoglobin when treating predialysis patients with CKD may decrease the risk of transfusion without increasing the risk of death, stoke, and treatment of renal replacement.
Atrial dysplasia in the atria of humans without cardiovascular disease
Authors: Li Guo-Liang , Fontaine Guy , Wu Jine , Fan Shuanliang , Sun Chaofeng , Saguner Ardan M
Published: February 2019

Research on atrial histology of humans without cardiovascular disease is scarce. Therefore, our aim was to study human atrial histology in subjects without cardiovascular disease. Histology of the right atrium, left atrium or atrial septum was studied in eight patients (one newborn infant and seven adults) who died of a non-cardiac cause and who were not known to suffer from any cardiovascular pathology. Staining with hematoxylin phloxine saffron or Masson's trichrome was performed to have a better identification of fibrosis and H&E for better identification of lymphocytes. Atrial histology was compared with the histology of the left ventricle and was taken from a collection of standard glass slides. Common light microscopic examination and numeric image processing was performed in all samples. Left atrial histology showed a substantial amount of adipocytes and interstitial fibrosis, associated with replacement fibrosis in some of these cases including one case of lymphocytic infiltrates, similar to the histologic changes of the right ventricle (RV) known in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVD). Furthermore, we identified a perpendicular orientation of atrial myocardial fibres, which is also a feature of the thin RV free wall. A similar histologic substrate to the RV myocardium known in ARVD is found in the atria of humans without an overt cardiovascular pathology. This may explain the high prevalence of atrial fibrillation in the general population.
Targeting Cholesterol Metabolism in Glioblastoma: A New Therapeutic Approach in Cancer Therapy
Authors: Pirmoradi Leila , Seyfizadeh Nayer , Ghavami Saeid , Zeki Amir A , Shojaei Shahla
Published: February 2019

Glioblastoma multiforme (GBM) is the most aggressive malignant brain tumor known with a poor survival rate despite current advances in the field of cancer. Additional research into the pathophysiology of GBM is urgently needed given the devastating nature of this disease. Recent studies have revealed the unique cellular physiology of GBM cells as compared with healthy astrocytes. Intriguingly, GBM cells are incapable of de novo cholesterol synthesis via the mevalonate pathway. Thus, the survival of GBM cells depends on cholesterol uptake via low-density lipoprotein receptors (LDLRs) in the form of apolipoprotein-E-containing lipoproteins and ATP-binding cassette transporter A1 (ABCA1) that efflux surplus cholesterol out of cells. Liver X receptors regulate intracellular cholesterol levels in neurons and healthy astrocytes through changes in the expression of LDLR and ABCA1 in response to cholesterol and its derivatives. In GBM cells, due to the dysregulation of this surveillance pathway, there is an accumulation of intracellular cholesterol. Furthermore, intracellular cholesterol regulates temozolomide-induced cell death in glioblastoma cells via accumulation and activation of death receptor 5 in plasma membrane lipid rafts. The mevalonate pathway and autophagy flux are also fundamentally related with implications for cell health and death. Thus, via cholesterol metabolism, the mevalonate pathway may be a crucial player in the pathogenesis and treatment of GBM where our current understanding is still lacking. Targeting cholesterol metabolism in GBM may hold promise as a novel adjunctive clinical therapy for this devastating cancer.
Measuring network disruption in neurodegenerative diseases: New approaches using signal analysis
Authors: McMackin Roisin , Muthuraman Muthuraman , Groppa Sergiu , Babiloni Claudio , Taylor John-Paul , Kiernan Matthew C , Nasseroleslami Bahman , Hardiman Orla
Published: February 2019

Advanced neuroimaging has increased understanding of the pathogenesis and spread of disease, and offered new therapeutic targets. MRI and positron emission tomography have shown that neurodegenerative diseases including Alzheimer’s disease (AD), Lewy body dementia (LBD), Parkinson’s disease (PD), frontotemporal dementia (FTD), amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) are associated with changes in brain networks. However, the underlying neurophysiological pathways driving pathological processes are poorly defined. The gap between what imaging can discern and underlying pathophysiology can now be addressed by advanced techniques that explore the cortical neural synchronisation, excitability and functional connectivity that underpin cognitive, motor, sensory and other functions. Transcranial magnetic stimulation can show changes in focal excitability in cortical and transcortical motor circuits, while electroencephalography and magnetoencephalography can now record cortical neural synchronisation and connectivity with good temporal and spatial resolution.

Here we reflect on the most promising new approaches to measuring network disruption in AD, LBD, PD, FTD, MS, and ALS. We consider the most groundbreaking and clinically promising studies in this field. We outline the limitations of these techniques and how they can be tackled and discuss how these novel approaches can assist in clinical trials by predicting and monitoring progression of neurophysiological changes underpinning clinical symptomatology.
TM1-1 Seizure prophylaxis in gliomas (SPRING): a phase III randomised controlled trial comparing prophylactic levetiracetam versus no prophylactic anti-epileptic drug in glioma surgery
Authors: Jenkinson MD , Watts C , Marson AG , Hill R , Murray K , Vale L , Bulbeck H , Grant R
Published: February 2019

Objectives

There is no consensus regarding the need for prophylactic anti-epileptic drug (AED) in seizure-naive newly-diagnosed glioma patients. Data regarding prophylactic AED use are scant and inconclusive from older, small studies that enrolled patients with brain metastases, benign tumours and gliomas. A definitive randomised controlled trial (RCT) is needed to determine whether the policy of prophylactic AED therapy reduces the risk of first seizures in this population.

Design

Multi-centre RCT.

Subjects

Inclusion criteria: i. seizure-naive, ii. supratentorial glioma suitable for surgery (biopsy/resection), iii. age ≥16 years; iv. Karnofsky performance status >60.

Methods

Patients are randomised 1:1. Levetiracetam 500 mg bd for 2 weeks, increased to 750 mg bd thereafter for 1 year. Non-blinded. No placebo. Primary Outcome: one year risk of first seizure. Secondary outcomes: time to first seizure, time to first tonic-clonic seizure, mood, fatigue, quality of life, progression free survival, overall survival and incremental cost per QALY. Estimate of 1 year seizure rate in glioma after surgery is 20%. Based on a reduction in seizure rate to 10% a total of 806 patients will be recruited.

Results

Grant awarded by NIHR. Feasibility questionnaire demonstrated prophylactic AED rarely used. Neurosurgeons willing to randomise. 15 UK centres have expressed interest in participating.

Conclusions

SPRING will establish class I evidence for the use of seizure prophylaxis in glioma surgery. The trial will open to recruitment in January 2019.
TP1-3 Final phase of recruitment and statistics analysis plan for Dex-CSDH trial
Authors: Edlmann E , Kolias A , Thelin E , Gatt D , Al-Tamimi Y , Owusu-Agyemang K , Suttner N , Holton P , Bulters D , Allison A , Bond S , Tarantino S , Davis-Wilkie C , Pantaleo B , Turner C , Hutchinson PJ ,   Dex-CSDH collaborative group,   BNTRC
Published: February 2019

Objectives

Review recruitment progression and statistical analysis plan for Dex-CSDH trial.

Design

A UK multi-centre, randomised, double-blind, placebo-controlled trial of dexamethasone versus placebo for CSDH.

Subjects

Symptomatic, adult CSDH patients admitted to a participating neurosurgical unit.

Methods

Trial participants receive a 2 week course of dexamethasone in addition to standard care, including surgery. The primary outcome measure is the modified Rankin Scale (mRS) at 6 months. An mRS of 0–3 requires the patient to be independently mobile and we have considered this a favourable outcome, with scores 4–6 (non-mobile) as unfavourable. The primary analysis will be performed on an intention-to-treat basis, estimating the absolute difference between the two treatment arms in the proportions achieving a favourable outcome. Secondary analysis will be done with an ordinal analysis of mRS scores and proportional odds logistic regression of the original mRS score adjusting for baseline covariates (age, GCS).

Results

629/750 patients (84%) have been recruited to the Dex-CSDH trial which is on-going as of 20-06-2018. Recruitment progress and follow-up at time of presentation will be reviewed alongside full statistical analysis plan.

Conclusions

The Dex-CSDH trial is drawing close to target following excellent recruitment across 22 UK centres. Transparent communication of the statistical analysis plan is essential prior to unblinding of the data. Up-to-date recruitment and primary endpoint completion rates will also be reviewed.
TM3-4 The effect of acetazolamide on intracranial pressure: primary study with prolonged continuous intracranial pressure monitoring
Authors: Thompson S , Chan H , Thorne L , Watkins L , Toma A
Published: February 2019

Objectives

Acetazolamide has frequently been used as a first-line treatment for idiopathic Intracranial Hypertension (IIH) and other disorders which lead to a non-acute rise in intracranial pressure (ICP). The effect of acetazolamide has been observed through lumbar puncture, however the effect of acetazolamide on ICP has not been studied in continuous ICP measurement.

Design

A retrospective study of a prospectively built ICP database

Subjects

All patients with continuous ICP monitoring demonstrating 24 hours on and 24 hours off acetazolamide were included in the study.

Methods

Patients median ICP and median pulse amplitude over 24 hour monitoring period on and off Diamox was assessed.

Results

12 patients (9F, 3M) underwent ICP monitoring with data collected during the same admission. 8 patients had IIH, 1 Chiari Malformation, 3 new diagnostic ICP procedures. 10 patients saw a reduction in ICP while on acetazolamide. Overall, patients experienced a Median reduction of 1.14 mmHg (Mean 1.16 mmHg, Range 4.24 to −4.445 mmHg). Patients (n9) who were on ≥1 g of acetazolamide per day experienced a median reduction in ICP of 1.595 mmHg (Mean 1.91 mmHg, Range 4.24–0.5 mmHg).

Conclusions

Our data suggests acetazolamide can reduce ICP quickly following commencement, however this reduction was relatively small. The effect seems greater with a higher dose. Larger numbers of patients are required to gain a greater understanding into the significance of acetazolamide on ICP, particularly the affect at larger doses.
Dietary patterns in relation to inflammation in shift workers
Authors: Khorasaniha Reihane , Siassi F , Khajehnasiri F , Qorbani M , Sotoudeh G
Published: February 2019

Introduction

Rotational shift work has a considerable effect on immune function and cause inflammation. In addition, it may lead to unhealthy dietary intake. No earlier study has examined the association between dietary patterns and inflammation in rotational shift workers. Therefore, this study was conducted to investigate the association between dietary patterns and circulating proinflammatory cytokines among shift workers.

Methods

This cross-sectional study was conducted among 257 male shift workers. Dietary intake of participants was examined using the semiquantitative Food Frequency Questionnaire. Serum concentrations of interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α) and high sensitivity C-reactive protein (hs-CRP) were measured using suitable commercial kits.

Results

Three main dietary patterns included green vegetables, yellow vegetables and cruciferous vegetables (VEG), liquid oils and mayonnaise, fast food and eggs (LFE), as well as tea and coffee, refined grains and spice (TRS). Subjects with the highest adherence to VEG dietary pattern had a significantly lower concentration of IL-6 (p<0.01) and TNF-α (p<0.001) as compared with those with the lowest adherence. On the other hand, a significant negative association was found between LFE dietary pattern and serum concentrations of IL-6 (p=0.01) and TNF-α (p=0.02). However, no significant association was found between adherence to VEG (p=0.34) or LFE (p=0.99) dietary patterns and levels of hs-CRP and between adherence to TRS dietary pattern and any of the inflammatory cytokines.

Conclusion

Adherence to VEG and LFE dietary patterns was inversely and directly associated to serum IL-6 and TNF-α concentrations in shift workers, respectively. However, no significant association was found between adherence to these two dietary patterns and serum hs-CRP concentrations and between TRS dietary pattern and any of the inflammatory cytokines.
It is never lawful or ethical to withdraw life-sustaining treatment from patients with prolonged disorders of consciousness
Authors: Foster Charles
Published: February 2019

In English law there is a strong (though rebuttable) presumption that life should be maintained. This article contends that this presumption means that it is always unlawful to withdraw life-sustaining treatment from patients in permanent vegetative state (PVS) and minimally conscious state (MCS), and that the reasons for this being the correct legal analysis mean also that such withdrawal will always be ethically unacceptable. There are two reasons for this conclusion. First, the medical uncertainties inherent in the definition and diagnosis of PVS/MCS are such that, as a matter of medical fact, it can never be established, with the degree of certainty necessary to rebut the presumption, that it is not in the patient’s best interest to remain alive. And second (and more controversially and repercussively), that even if permanent unconsciousness can be unequivocally demonstrated, the presumption is not rebutted. This is because there is plainly more to human existence than consciousness (or consciousness the markers of which can ever be demonstrated by medical investigations). It can never be said that the identity of the patient whose best interests are at stake evaporates (so eliminating the legal or ethical subject) when that person ceases to be conscious. Nor can it be said that the best interests of an unconscious person do not mandate continued biological existence. We simply cannot know. That uncertainty is legally conclusive, and (subject to resource allocation questions and views about the relevance of family wishes and the previously expressed wishes of the patient) should be ethically conclusive.
Evaluation of the Psychiatric Decisions Unit (PDU): effect on emergency department presentations and psychiatric inpatient admissions
Authors: Trethewey Samuel P , Deepak Shantal , Saad Samuel , Hughes Ellen , Tadros George
Published: February 2019

Background

Busy emergency departments (EDs) are not the optimum environment for assessment of patients in mental health crisis. The Psychiatric Decisions Unit (PDU) was developed by the Birmingham and Solihull Mental Health Foundation Trust as an enhanced assessment service to ensure patients in mental health crisis receive optimal care.

Aims

To evaluate the activities of the PDU and its impact on the frequency of ED presentations and inpatient admissions, and to explore patient satisfaction.

Methods

Data were collected over a 6-month period during 2015 regarding patient demographics, referral sources, length of stay, and frequency of mental health-related ED presentations and inpatient psychiatric admissions. Comparison group data were used to evaluate the impact of the PDU. Patient satisfaction was measured using the ‘Friends and Family Test’ and structured feedback forms.

Results

In total, 385 patients were referred to the PDU during the study period. Implementation of the PDU was associated with a 39% decrease in the number of patients taken to the ED by Street Triage and a 26% fall in inpatient psychiatric admissions via the Trusts’ in-hospital liaison psychiatry team. Ninety-eight per cent of patients surveyed felt that they were treated with respect and understanding, and 94% reported that they were likely or extremely likely to recommend the service to friends and family.

Conclusions

Implementation of the PDU was associated with a reduction in the frequency of ED presentations and inpatient psychiatric admissions. This study suggests that patients are satisfied with the care provided at the PDU.
Outcome of multimodal MRI-guided intravenous thrombolysis in patients with stroke with unknown time of onset
Authors: Zhao Jie , Zhao Hongmei , Li Runtao , Li Jiangtao , Liu Chang , Lv Juan , Li Yanan , Liu Wei , Ma Dongpu , Hao Huaihai , Xiao Xinguang , Liu Junzhong , Yin Yongfeng , Liu Rongli , Yu Qiaoyan , Wei Yingjie , Li Pengyan , Wang Yue , Wang Runqing
Published: February 2019

Objective

Intravenous tissue plasminogen activator (tPA) is the standard therapy for patients with acute ischaemic stroke (AIS) within 4.5 hours of onset. Recent trials have expanded the endovascular treatment window to 24 hours. We investigated the efficacy and safety of using multimodal MRI to guide intravenous tPA treatment for patients with AIS of unknown time of onset (UTO).

Methods

Data on patients with AIS with UTO and within 4.5 hours of onset were reviewed. Data elements collected and analysed included: demographics, National Institutes of Health Stroke Scale (NIHSS) score at baseline and 2 hours, 24 hours, 7 days after thrombolysis and before discharge, the modified Rankin Scale (mRS) score at 3 months after discharge, imaging findings and any adverse event.

Results

Forty-two patients with UTO and 62 in control group treated within 4.5 hours of onset were treated with intravenous tPA. The NIHSS scores after thrombolysis and/or before discharge in UTO group were significantly improved compared with the baseline (p<0.05). Between the two groups, no significant differences in NIHSS score were observed (p>0.05). Utilising the non-inferiority test, to compare mRS scores (0–2) at 3 months between the two groups, the difference was 5.2% (92% CI, OR 0.196). Patients in the UTO group had mRS scores of 0-2, which were non-inferior to the control group. Their incidence of adverse events was similar.

Conclusions

Utilising multimodal MRI to guide intravenous only thrombolysis for patients with AIS with UTO was safe and effective. In those patients with AIS between 6 and 24 hours of time of onset but without large arterial occlusion, intravenous thrombolysis could be considered an option.
Baffin Bay/Nares Strait surface (seafloor) sediment mineralogy: further investigations and methods to elucidate spatial variations in provenance
Authors: Andrews John T.
Published: February 2019

The goal of the paper is to ascertain whether there are significant regional variations in sediment mineral composition that might be used to elucidate ice sheet histories. The weight percentages of nonclay and clay minerals were determined by quantitative X-ray diffraction. Cluster analysis, an unsupervised learning approach, is used to group sediment mineralogy of 263 seafloor/core top samples between ∼80°N and 62°N. The optimum number of clusters, based on 30 indexes, was three for the weight percentage data but varied with data transformations. Maps of the distribution of the three mineral clusters or facies indicate a significant difference in weight percentages between samples from the West Greenland and Baffin Island shelves. However, several indexes support a larger number of clusters and similar analyses of the spatial distribution and defining minerals of nine mineral facies indicated a strong association with the original three clusters and with broad geographic designations (i.e., West Greenland shelf, Baffin Island fiords, etc). Classification Decision Tree analysis indicates that this difference is primarily controlled by the percentages of plagioclase feldspars versus alkali feldspars.
VOLATILITY INFERENCE AND RETURN DEPENDENCIES IN STOCHASTIC VOLATILITY MODELS
Authors: PFANTE OLIVER , BERTSCHINGER NILS
Published: February 2019

Stochastic volatility models describe stock returns [Formula: see text] as driven by an unobserved process capturing the random dynamics of volatility [Formula: see text]. The present paper quantifies how much information about volatility [Formula: see text] and future stock returns can be inferred from past returns in stochastic volatility models in terms of Shannon’s mutual information. In particular, we show that across a wide class of stochastic volatility models, including a two-factor model, returns observed on the scale of seconds would be needed to obtain reliable volatility estimates. In addition, we prove that volatility forecasts beyond several weeks are essentially impossible for fundamental information theoretic reasons.
Experimental FTIR and theoretical investigation of the molecular structure and vibrational spectra of acetanilide using DFT and dispersion correction to DFT
Authors: Umar Yunusa , Abu-Thabit Nedal , Jerabek Paul , Ramasami Ponnadurai
Published: February 2019

The FTIR spectrum of acetanilide (ACN) is recorded and analyzed. The optimized molecular structures, harmonic vibrational wavenumbers and corresponding vibrational assignments of the ACN are computationally examined by using the B3LYP density functional theory method together with the standard 6-311[Formula: see text]G([Formula: see text],[Formula: see text]) basis set. From the calculations, the ACN is predicted to exist predominantly in trans configuration with the relative energy, rotational barrier, and population of 2.8[Formula: see text]kcal/mol, 14.8[Formula: see text]kcal/mol, and 99.5%, respectively. The optimized structure shows that the amide group (CO–NH) of trans-ACN adopts a planar peptide-like conformation. The effect of the incorporation of dispersion correction to the B3LYP on the calculated equilibrium structure and vibrational spectra of ACN is investigated. The highest occupied and the lowest unoccupied molecular orbitals, IR intensities and molecular electrostatic potential results are reported. In addition, reliable vibrational assignments have been made on the basis of Potential Energy Distribution (PED) using VEDA4 program. Simulated IR spectrum are compared with the experimental FTIR and FT-Raman spectra. Energy decomposition analysis (EDA) revealed that Pauli repulsion is responsible for the increased stability of the trans over the cis isomer.
Super Finsler connection of superparticle on two-dimensional curved spacetime
Authors: Ootsuka Takayoshi , Ishida Muneyuki , Tanaka Erico , Yahagi Ryoko
Published: February 2019

We analyze the Casalbuoni–Brink–Schwarz superparticle model on a 2-dimensional curved spacetime as a super Finsler metric defined on a (2,2)-dimensional supermanifold. We propose a nonlinear Finsler connection which preserves this Finsler metric and calculates it explicitly. The equations of motion of the superparticle are reconstructed in the form of auto-parallel equations expressed by the super nonlinear connection.
Influence of excess lithium and sintering on the conductivity of Li1.3Al0.3Ti1.7(PO4)3
Authors: Li Ziying , Zhao Xiujian
Published: February 2019

NASICON-type samples with different amount of excess lithium content in starting materials, Li[Formula: see text]Al[Formula: see text]Ti[Formula: see text](PO4)3 ([Formula: see text]), were prepared by conventional solid-state reaction. Effect of excess lithium and sintering conditions on composition and electrical properties of LATP were investigated. X-ray diffraction and Scanning electron microscopy were used to characterize the composition, crystal structure and morphology, respectively. The total ionic conductivities of samples were measured by AC-impedance spectra. The optimal addition amount of excess Li was found to be 40[Formula: see text]mol.% with the highest conductivity of [Formula: see text][Formula: see text]S/cm at [Formula: see text]C. The improvement of the conductivity of LATP can be attributed to the increasing of Li[Formula: see text] carriers and the formation of glassy phase in samples which acted as binders and provided excess Li ion vacancies for lithium transport.
Optimal SUAS Path Planning in Three-Dimensional Constrained Environments
Authors: Zollars Michael D. , Cobb Richard G. , Grymin David J.
Published: February 2019

Small Unmanned Aircraft Systems have grown in autonomy and capability and continue to complement Department of Defense mission objectives. Teaming unmanned aircraft with manned vehicles can expand mission profiles and reduce risk to human life. To fully leverage unmanned systems, vehicles must be efficient and autonomous in path planning development. The work herein explores direct orthogonal collocation optimal control techniques combined with fast geometric path planning algorithms to reduce computation time and increase solution accuracy for small unmanned aircraft systems path planning missions. Previous work in the two-dimensional plane demonstrated a methodology to provide optimal flight paths through defined simplex corridors and simplified the optimal control parameter bounds by formulating the problem in the barycentric coordinate system. These methodologies are extended in this paper for three-dimensional flight and are solved with two different formulations for flight in an urban environment. The first formulation solves the constrained optimal control problem using a single phase while modeling the building constraints with superquadric functions. The second formulation implements the simplex methodology, eliminating polygonal constraints from the search domain, and solving the optimal path in a multiple phase approach. Results illustrate the benefits gained in computation time and accuracy when implementing simplex methods into the optimal control design and provide a foundation for closing the gap to real-time, onboard operations for unmanned vehicle path planning.
Is Antithrombotic Therapy Necessary Following Replantation of an Amputated Digit?
Authors: Matsusue Takeo
Published: February 2019

Background: Antithrombotic therapy following replantation remains controversial, and the survival of replanted digits is affected by various other factors, such as the state of vascular damage and the surgeon’s level of skill. The present study’s aim is to obtain clinical evidence for postoperative antithrombotic therapy in replantation, with antithrombotic therapy being the only variable.

Methods: This was a single-center retrospective study of patients who underwent replantation of a completely amputated digit by the same surgeon. The subject sample included 17 patients/19 digits (group A) in whom heparin and prostaglandin E1 (PGE1) were used postoperatively during a 1-year period, 19 patients/22 digits (group B) in whom heparin was not used postoperatively but PGE1 was used for a 1-year period, and 16 patients/19 digits (group C) in whom neither heparin not PGE1 were used postoperatively for a 1-year period.

Results: Patient background and surgical procedure were not significantly different among groups, and only the postoperative use of heparin and/or PGE1 showed differences. Incidence of arterial occlusion, venous occlusion, or vascular spasm were not significantly different among groups (arterial occlusion: 1 digit in group A, 2 in group B, and two in group C, p = 1; venous occlusion: 1 digit in group A, 2 in group B, and three in group C, p = 0.67; vascular spasm: 1 digit in group A, 2 in group B, and one in group C, p = 1). Postoperative bleeding was significantly more common in the group using heparin (7 patients in group A, 0 in group B, and zero in group C, p < 0.001).

Conclusions: These results suggest that heparin and PGE1 administration do not improve impaired blood flow following replantation. Considering the potential complications, heparin and PGE1 following replantation do not seem necessary.