bluuebunny/crossref_metadata_2025 huggingface dataset:
Streptococcus pneumoniae TIGR4 Phase-Locked Opacity Variants Differ in Virulence Phenotypes
Authors: Oliver Melissa B. , Basu Roy Ankita , Kumar Ranjit , Lefkowitz Elliot J. , Swords W. Edward
Published: November 2017

A growing number of bacterial species undergo epigenetic phase variation due to variable expression or specificity of DNA-modifying enzymes. For pneumococci, this phase variation has long been appreciated as being revealed by changes in colony opacity, which are reflected in changes in expression or accessibility of factors on the bacterial surface. Recent work showed that recombination-generated variation in alleles of the HsdS DNA methylase specificity subunit mediated pneumococcal phase variation. We generated phase-locked populations of
S. pneumoniae
TIGR4 expressing a single nonvariant
hsdS
allele and observed significant differences in gene expression and virulence. These results highlight the importance of focused pathogenesis studies within specific phase types. Moreover, the generation of single-allele
hsdS
constructs will greatly facilitate such studies.
Chromosomal Targeting by the Type III-A CRISPR-Cas System Can Reshape Genomes in Staphylococcus aureus
Authors: Guan Jing , Wang Wanying , Sun Baolin
Published: November 2017

Staphylococcus aureus
is a pathogen that can cause a wide range of infections in humans. Studies have suggested that CRISPR-Cas systems can drive the loss of integrated mobile genetic elements (MGEs) by chromosomal targeting. Here we demonstrate that CRISPR-mediated cleavage contributes to the partial deletion of integrated SCC
mec
in methicillin-resistant
S. aureus
(MRSA), which provides a strategy for the treatment of MRSA infections. The spacer within artificial CRISPR arrays should contain more than 25 nucleotides for immunity, and consecutive trinucleotide pairings between a selected target and the 5′ tag of crRNA can block targeting. These findings add to our understanding of the molecular mechanisms of the type III-A CRISPR-Cas system and provide a novel strategy for the exploitation of engineered CRISPR immunity against integrated MGEs in bacteria for clinical and industrial applications.
Prevalence and factors associated with age-related macular degeneration in a southwestern island population of Japan: the Kumejima Study
Authors: Obata Ryo , Yanagi Yasuo , Inoue Tatsuya , Yasuda Miho , Oshima Yuji , Sawaguchi Shoichi , Iwase Aiko , Araie Makoto
Published: November 2017

Aims

To evaluate the prevalence of and factors associated with age-related macular degeneration (AMD) in a rural population of southwestern Japan.

Methods

This population-based cross-sectional study of all residents aged 40 years or older was conducted on the island of Kumejima, Okinawa, Japan. Of 4632 eligible residents, 3762 completed a comprehensive questionnaire and underwent ocular examination (participant rate, 81.2%). A non-mydriatic fundus photograph was used to grade AMD lesions according to the Wisconsin protocol. Prevalence of AMD was calculated and factors associated with AMD were identified by logistic regression.

Results

Of 3068 subjects with gradable photographs, 469 had early AMD and 4 had late AMD. Age-adjusted prevalence was 13.4% for any AMD, 13.3% for early AMD and 0.09% for late AMD. In multivariate analysis, any AMD was positively associated with age (OR 1.04 per year, 95% CI 1.03 to 1.05), male sex (OR 1.42, 95% CI 1.14 to 1.75) and history of cataract surgery (OR 1.35, 95% CI 1.00 to 1.82) and was negatively associated with longer axial length (OR 0.85 per millimetre, 95% CI 0.74 to 0.96). Early AMD similarly showed significant associations with these same factors.

Conclusions

Prevalence of early or late AMD in a southwestern island population of Japan was 13.4% or 0.09%. Our data suggest relatively high prevalence for early AMD and low prevalence for late AMD in this sample of rural Japanese population. Significant factors associated with any or early AMD were mostly similar to that of previous studies.
Ocular findings in Loeys-Dietz syndrome
Authors: Busch Catharina , Voitl Robert , Goergen Barbara , Zemojtel Tomasz , Gehle Petra , Salchow Daniel J
Published: November 2017

Background

Loeys-Dietz syndrome (LDS), an autosomal-dominant connective tissue disorder, is characterised by systemic manifestations including arterial aneurysm and craniofacial dysmorphologies. Although ocular involvement in LDS has been reported, detailed information on those manifestations is lacking.

Methods

Retrospective chart review of patients with diagnosed LDS and comparison with age-matched control patients.

Results

Mean age was 37.8±14.6 years (patients with LDS) and 38.4±13.5 years (controls). Patients with LDS less frequently had iris transillumination, cataract and glaucoma compared with controls. Scleral and retinal vascular abnormalities were not found in any of the LDS eyes. Ectopia lentis was found in one patient with LDS. The eyes of patients with LDS tended to be more myopic (spherical equivalent, −2.47±2.70 dioptres (dpt) vs −1.30±2.96dpt (controls); P=0.08) and longer (24.6±1.7mm vs 24.1±1.5mm (controls); P=0.10). Central corneal thickness was significantly reduced in LDS eyes (521±48µm vs 542±37µm (controls); P=0.02). Corneal curvature (43.06±1.90dpt (LDS) versus 43.00±1.37dpt (controls); P=0.72) and interpupillary distance (65.0±6.0mm (LDS) vs 64.3±4.8mm (controls); P=0.66) did not differ significantly between both groups. Visual acuity was similar between both groups (0.03±0.09logarithm of the minimum angle of resolution (logMAR) for LDS eyes and 0.05±0.17logMAR for control eyes, P=0.47).

Conclusions

Ocular features of LDS include decreased central corneal thickness and mild myopia. Ectopia lentis may be slightly more common than in controls but appears less common than in Marfan syndrome. Hypertelorism, scleral and retinal vascular abnormalities were not features of LDS.
Comparison of Outcomes of antibiotic Drugs and Appendectomy (CODA) trial: a protocol for the pragmatic randomised study of appendicitis treatment
Authors: Davidson Giana H , Flum David R , Talan David A , Kessler Larry G , Lavallee Danielle C , Bizzell Bonnie J , Farjah Farhood , Stewart Skye D , Krishnadasan Anusha , Carney Erin E , Wolff Erika M , Comstock Bryan A , Monsell Sarah E , Heagerty Patrick J , Ehlers Annie P , DeUgarte Daniel A , Kaji Amy H , Evans Heather L , Yu Julianna T , Mandell Katherine A , Doten Ian C , Clive Kevin S , McGrane Karen M , Tudor Brandon C , Foster Careen S , Saltzman Darin J , Thirlby Richard C , Lange Erin O , Sabbatini Amber K , Moran Gregory J
Published: November 2017

Introduction

Several European studies suggest that some patients with appendicitis can be treated safely with antibiotics. A portion of patients eventually undergo appendectomy within a year, with 10%–15% failing to respond in the initial period and a similar additional proportion with suspected recurrent episodes requiring appendectomy. Nearly all patients with appendicitis in the USA are still treated with surgery. A rigorous comparative effectiveness trial in the USA that is sufficiently large and pragmatic to incorporate usual variations in care and measures the patient experience is needed to determine whether antibiotics are as good as appendectomy.

Objectives

The Comparing Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial for acute appendicitis aims to determine whether the antibiotic treatment strategy is non-inferior to appendectomy.

Methods/Analysis

CODA is a randomised, pragmatic non-inferiority trial that aims to recruit 1552 English-speaking and Spanish-speaking adults with imaging-confirmed appendicitis. Participants are randomised to appendectomy or 10 days of antibiotics (including an option for complete outpatient therapy). A total of 500 patients who decline randomisation but consent to follow-up will be included in a parallel observational cohort. The primary analytic outcome is quality of life (measured by the EuroQol five dimension index) at 4 weeks. Clinical adverse events, rate of eventual appendectomy, decisional regret, return to work/school, work productivity and healthcare utilisation will be compared. Planned exploratory analyses will identify subpopulations that may have a differential risk of eventual appendectomy in the antibiotic treatment arm.

Ethics and dissemination

This trial was approved by the University of Washington’s Human Subjects Division. Results from this trial will be presented in international conferences and published in peer-reviewed journals.

Trial registration number

NCT02800785.
Knowledge, attitudes and intention regarding mHealth in generation Y: evidence from a population based cross sectional study in Chakaria, Bangladesh
Authors: Rahman M Shafiqur , Hanifi Syed , Khatun Fatema , Iqbal Mohammad , Rasheed Sabrina , Ahmed Tanvir , Hoque Shahidul , Sharmin Tamanna , Khan Nazib-Uz Zaman , Mahmood Shehrin Shaila , Bhuiya Abbas
Published: November 2017

Background and objectives

mHealth offers a new opportunity to ensure access to qualified healthcare providers. Therefore, to better understand its potential in Bangladesh, it is important to understand how young people use mobile phones for healthcare. Here we examine the knowledge, attitudes and intentions to use mHealth services among young population.

Design

Population based cross sectional household survey.

Setting and participants

A total of 4909 respondents, aged 18 years and above, under the Chakaria Health and Demographic Surveillance System (HDSS) area, were interviewed during the period November 2012 to April 2013.

Methods

Participants younger than 30 years of age were defined as young (or generation Y). To examine the level of knowledge about and intention towards mHealth services in generation Y compared with their older counterparts, the percentage of the respective outcome measure from a 2×2 contingency table and adjusted odds ratio (aOR), which controls for potential confounders such as mobile ownership, sex, education, occupation and socioeconomic status, were estimated. The aOR was estimated using both the Cochran–Mantel–Haenszel approach and multivariable logistic regression models controlling for confounders.

Results

Generation Y had significantly greater access to mobile phones (50%vs40%) and better knowledge about its use for healthcare (37.8%vs27.5%;aOR 1.6 (95% CI1.3 to 2.0)). Furthermore, the level of knowledge about two existing mHealth services in generation Y was significantly higher compared with their older counterparts, with aOR values of 3.2 (95% CI 2.6 to 5.5) and 1.5 (95% CI 1.1 to 1.8), respectively. Similarly, generation Y showed significantly greater intention towards future use of mHealth services compared with their older counterparts (aOR 1.3 (95% CI 1.1 to 1.4)). The observed associations were not modified by sociodemographic factors.

Conclusion

There is a greater potential for mHealth services in the future among young people compared with older age groups. However, given the low overall use of mHealth, appropriate policy measures need to be formulated to enhance availability, access, utilisation and effectiveness of mHealth services.
Preventing type 2 diabetes: systematic review of studies of cost-effectiveness of lifestyle programmes and metformin, with and without screening, for pre-diabetes
Authors: Roberts Samantha , Barry Eleanor , Craig Dawn , Airoldi Mara , Bevan Gwyn , Greenhalgh Trisha
Published: November 2017

Objective

Explore the cost-effectiveness of lifestyle interventions and metformin in reducing subsequent incidence of type 2 diabetes, both alone and in combination with a screening programme to identify high-risk individuals.

Design

Systematic review of economic evaluations.

Data sources and eligibility criteria

Database searches (Embase, Medline, PreMedline, NHS EED) and citation tracking identified economic evaluations of lifestyle interventions or metformin alone or in combination with screening programmes in people at high risk of developing diabetes. The International Society for Pharmaco-economics and Outcomes Research’s Questionnaire to Assess Relevance and Credibility of Modelling Studies for Informing Healthcare Decision Making was used to assess study quality.

Results

27 studies were included; all had evaluated lifestyle interventions and 12 also evaluated metformin. Primary studies exhibited considerable heterogeneity in definitions of pre-diabetes and intensity and duration of lifestyle programmes. Lifestyle programmes and metformin appeared to be cost effective in preventing diabetes in high-risk individuals (median incremental cost-effectiveness ratios of £7490/quality-adjusted life-year (QALY) and £8428/QALY, respectively) but economic estimates varied widely between studies. Intervention-only programmes were in general more cost effective than programmes that also included a screening component. The longer the period evaluated, the more cost-effective interventions appeared. In the few studies that evaluated other economic considerations, budget impact of prevention programmes was moderate (0.13%–0.2% of total healthcare budget), financial payoffs were delayed (by 9–14 years) and impact on incident cases of diabetes was limited (0.1%–1.6% reduction). There was insufficient evidence to answer the question of (1) whether lifestyle programmes are more cost effective than metformin or (2) whether low-intensity lifestyle interventions are more cost effective than the more intensive lifestyle programmes that were tested in trials.

Conclusions

The economics of preventing diabetes are complex. There is some evidence that diabetes prevention programmes are cost effective, but the evidence base to date provides few clear answers regarding design of prevention programmes because of differences in denominator populations, definitions, interventions and modelling assumptions.
Impact of informal caregiving on older adults’ physical and mental health in low-income and middle-income countries: a cross-sectional, secondary analysis based on the WHO’s Study on global AGEing and adult health (SAGE)
Authors: Lambert Sylvie D , Bowe Steven J , Livingston Patricia M , Heckel Leila , Cook Selina , Kowal Paul , Orellana Liliana
Published: November 2017

Objectives

A high proportion of care stemming from chronic disease or disability in low-income and middle-income countries is provided by informal caregivers. The goal of this study was to determine the level of burden experienced by these caregivers, explore associated factors and assess whether caregivers’ and non-caregivers’ health differed.

Design and setting

This cross-sectional study was a secondary analysis of data on caregivers’ burden, health and health risk factors in Ghana, India and the Russian Federation collected as part of the WHO’s Study on global AGEing and adult health (SAGE) Wave 1.

Participants

Caregivers in Ghana (n=143), India (n=490) and Russia (n=270) completed the measures.

Outcome measures

Factors associated (ie, demographics and caregiving profile variables) with burden were explored among caregivers. Then, quality of life (QOL), perceived stress, depression, self-rated health (SRH) and health risk factors were compared between caregivers and matched non-caregivers (1:2).

Results

The largest caregiving subgroups were spouses and adult children. Caregivers mostly cared for one person and provided financial, social/emotional and/or physical support, but received little support themselves. Burden level ranged from 17.37 to 20.03. Variables associated with burden were mostly country-specific; however, some commonality for wealth, type of care and caregiving duration was noted. Caregivers with a moderate or high level of burden reported lower QOL and higher perceived stress than those experiencing low burden. Caregivers reported lower QOL and SRH than non-caregivers.

Conclusion

Given the lack of support received and consequences of the burden endured by caregivers, policy and programme initiatives are needed to ensure that caregivers in low- and middle-income countries can fulfil their role without compromising their own health.
AreIL18RAPgene polymorphisms associated with body mass regulation? A cross-sectional study
Authors: Martínez-Barquero Vanesa , Marco Griselda de , Martínez-Hervas Sergio , Adam-Felici Victoria , Pérez-Soriano Cristina , Gonzalez-Albert Verónica , Rojo Gemma , Ascaso Juan Francisco , Real José Tomás , Garcia-Garcia Ana Barbara , Martín-Escudero Juan Carlos , Cortes Raquel , Chaves Felipe Javier
Published: November 2017

Objectives

To investigate the association betweenIL18RAPand body mass index (BMI) and obesity and to verify the effect of a polymorphism in the microRNA136 (MIR136)IL18RAPbinding region.

Design

We analysed samples from two Spanish cross-sectional studies, VALCAR (Spanish Mediterranean coast) and Hortega (Spanish centre). These studies aimed at analysing cardiovascular risk and development of cardiovascular disease in the general population. Both populations correspond to regions with different characteristics.

Setting

FiveIL18RAPsingle nucleotide polymorphisms were selected using the SYSNPs web tool and analysed by oligonucleotide ligation assay (SNPlex). For the MIR136 functional study, cells were transfected with plasmids containing different rs7559479 polymorphism alleles and analysed by luciferase reporter assays.

Participants

1970 individuals (Caucasian, both genders): VALCAR (468) and Hortega (1502).

Results

rs2293225, rs2272127 and rs7559479 showed the following associations: rs7559479 G allele correlated with a higher obesity risk (P=0.01; OR=1.82; 95% CI 1.15 to 2.87 for the VALCAR group; P=0.033; OR=1.35; 95% CI 1.03 to 1.79 for the Hortega population) and higher body mass index (BMI) values (P=0.0045; P=0.1 for VALCAR and Hortega, respectively); a significant association with obesity (P=0.0024, OR=1.44, 95% CI 1.14 to 1.82) and increased BMI values (P=0.008) was found when considering both populations together. rs2293225 T allele was associated with lower obesity risk (P=0.036; OR=0.60; 95% CI 0.35 to 0.96) and lower BMI values (P=0.0038; OR=1.41) while the rs2272127 G allele was associated with lower obesity risk (P=0.028; OR=0.66; 95% CI 0.44 to 0.97) only in the VALCAR population. A reporter assay showed that the presence of the A allele in rs7559479 was associated with increased MIR136 binding toIL18RAP.

Conclusions

Our results suggest that polymorphisms inIL18RAPinfluence susceptibility to obesity. We demonstrated that the A allele in rs7559479 increases MIR136 binding, which regulates IL-18 system activity.
Benefits and risks of Iron interventions in children (BRISC): protocol for a three-arm parallel-group randomised controlled field trial in Bangladesh
Authors: Hasan Mohammed Imrul , Hossain Sheikh Jamal , Braat Sabine , Dibley Michael John , Fisher Jane , Grantham-McGregor Sally , Tofail Fahmida , Simpson Julie A , Arifeen Shams EI , Hamadani Jena , Biggs Beverley-Ann , Pasricha Sant-Rayn
Published: November 2017

Introduction

Anaemia is a major global health problem affecting about 43% of preschool children globally and 60% of 6–24-month-old children in rural Bangladesh, half of which is attributed to iron deficiency (ID). Although WHO recommends universal supplementation with iron or home fortification with iron-containing multiple micronutrient powders (MMPs) to children under 2 years, evidence for benefits of these interventions on childhood development (a key rationale for these interventions) and harms (especially infection) remains limited. This study aims to evaluate the impact of iron or MMPs supplementation compared with placebo on (a) children’s development, (b) growth, (c) morbidity from infections and (d) haematological and iron indices.

Methods and analysis

This study is a three-arm, blinded, double-dummy, parallel-group, placebo-controlled superiority trial using stratified individual block randomisation. The trial will randomise 3300 children aged 8–9 months equally to arm 1: iron syrup (12.5 mg elemental iron), placebo MMPs; arm 2: MMPs (including 12.5 mg elemental iron), placebo syrup; and arm 3: placebo syrup, placebo MNPs. Children will receive interventions for 3 months based on WHO recommendations and then be followed up for 9 months post intervention. The primary outcome is cognitive composite score measured by Bayley III. Secondary outcomes include motor and language composite score by Bayley III, behaviour rating using selected items from Wolke’s rating scales and BSID-II behaviour ratings, temperament, growth, haemoglobin, anaemia and iron status, and infectious morbidity. Outcomes will be measured at baseline, at the end of 3-month intervention and after 9 months postintervention follow-up.

Ethics and dissemination

The trial has been approved by the Ethical Review Committee of icddr,b (Dhaka, Bangladesh) and the Melbourne Health Human Research Ethics Committee (Melbourne, Australia). Results of the study will be disseminated through scientific publications, presentations at international meetings and policy briefs to key stakeholders.

Trial registration number

ACTRN12617000660381;Pre-results.

WHO Universal Trial Number

U1111-1196-1125.
Dynamic treatment selection and modification for personalised blood pressure therapy using a Markov decision process model: a cost-effectiveness analysis
Authors: Choi Sung Eun , Brandeau Margaret L , Basu Sanjay
Published: November 2017

Objective

Personalised medicine seeks to select and modify treatments based on individual patient characteristics and preferences. We sought to develop an automated strategy to select and modify blood pressure treatments, incorporating the likelihood that patients with different characteristics would benefit from different types of medications and dosages and the potential severity and impact of different side effects among patients with different characteristics.

Design, setting and participants

We developed a Markov decision process (MDP) model to incorporate meta-analytic data and estimate the optimal treatment for maximising discounted lifetime quality-adjusted life-years (QALYs) based on individual patient characteristics, incorporating medication adjustment choices when a patient incurs side effects. We compared the MDP to current US blood pressure treatment guidelines (the Eighth Joint National Committee, JNC8) and a variant of current guidelines that incorporates results of a major recent trial of intensive treatment (Intensive JNC8). We used a microsimulation model of patient demographics, cardiovascular disease risk factors and side effect probabilities, sampling from the National Health and Nutrition Examination Survey (2003–2014), to compare the expected population outcomes from adopting the MDP versus guideline-based strategies.

Main outcome measures

Costs and QALYs for the MDP-based treatment (MDPT), JNC8 and Intensive JNC8 strategies.

Results

Compared with the JNC8 guideline, the MDPT strategy would be cost-saving from a societal perspective with discounted savings of US$1187 per capita (95% CI 1178 to 1209) and an estimated discounted gain of 0.06 QALYs per capita (95% CI 0.04 to 0.08) among the US adult population. QALY gains would largely accrue from reductions in severe side effects associated with higher treatment doses later in life. The Intensive JNC8 strategy was dominated by the MDPT strategy.

Conclusions

An MDP-based approach can aid decision-making by incorporating meta-analytic evidence to personalise blood pressure treatment and improve overall population health compared with current blood pressure treatment guidelines.
Diagnostic and laboratory test ordering in Northern Portuguese Primary Health Care: a cross-sectional study
Authors: Sá Luísa , Teixeira Andreia Sofia Costa , Tavares Fernando , Costa-Santos Cristina , Couto Luciana , Costa-Pereira Altamiro , Hespanhol Alberto Pinto , Santos Paulo , Martins Carlos
Published: November 2017

Objectives

To characterise the test ordering pattern in Northern Portugal and to investigate the influence of context-related factors, analysing the test ordered at the level of geographical groups of family physicians and at the level of different healthcare organisations.

Design

Cross-sectional study.

Setting

Northern Primary Health Care, Portugal.

Participants

Records about diagnostic and laboratory tests ordered from 2035 family physicians working at the Northern Regional Health Administration, who served approximately 3.5 million Portuguese patients, in 2014.

Outcomes

To determine the 20 most ordered diagnostic and laboratory tests in the Northern Regional Health Administration; to identify the presence and extent of variations in the 20 most ordered diagnostic and laboratory tests between the Groups of Primary Care Centres and between health units; and to study factors that may explain these variations.

Results

The 20 most ordered diagnostic and laboratory tests almost entirely comprise laboratory tests and account for 70.9% of the total tests requested. We can trace a major pattern of test ordering for haemogram, glucose, lipid profile, creatinine and urinalysis. There was a significant difference (P<0.001) in test orders for all tests between Groups of Primary Care Centres and for all tests, except glycated haemoglobin (P=0.06), between health units. Generally, the Personalised Healthcare Units ordered more than Family Health Units.

Conclusions

The results from this study show that the most commonly ordered tests in Portugal are laboratory tests, that there is a tendency for overtesting and that there is a large variability in diagnostic and laboratory test ordering in different geographical and organisational Portuguese primary care practices, suggesting that there may be considerable potential for the rationalisation of test ordering. The existence of Family Health Units seems to be a strong determinant in decreasing test ordering by Portuguese family physicians. Approaches to ensuring more rational testing are needed.
Views of commissioners, managers and healthcare professionals on the NHS Health Check programme: a systematic review
Authors: Mills Katie , Harte Emma , Martin Adam , MacLure Calum , Griffin Simon J , Mant Jonathan , Meads Catherine , Saunders Catherine L , Walter Fiona M , Usher-Smith Juliet A
Published: November 2017

Objective

To synthesise data concerning the views of commissioners, managers and healthcare professionals towards the National Health Service (NHS) Health Check programme in general and the challenges faced when implementing it in practice.

Design

A systematic review of surveys and interview studies with a descriptive analysis of quantitative data and thematic synthesis of qualitative data.

Data sources

An electronic literature search of MEDLINE, Embase, Health Management Information Consortium, Cumulative Index of Nursing and Allied Health Literature, Global Health, PsycInfo, Web of Science, OpenGrey, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials.gov and the International Standard Randomised Controlled Trial Number registry from 1 January 1996 to 9 November 2016 with no language restriction and manual screening of reference lists of all included papers.

Inclusion criteria

Primary research reporting views of commissioners, managers or healthcare professionals on the NHS Health Check programme and its implementation in practice.

Results

Of 18 524 citations, 15 articles met the inclusion criteria. There was evidence from both quantitative and qualitative studies that some commissioners and general practice (GP) healthcare professionals were enthusiastic about the programme, whereas others raised concerns around inequality of uptake, the evidence base and cost-effectiveness. In contrast, those working in pharmacies were all positive about programme benefits, citing opportunities for their business and staff. The main challenges to implementation were: difficulties with information technology and computer software, resistance to the programme from some GPs, the impact on workload and staffing, funding and training needs. Inadequate privacy was also a challenge in pharmacy and community settings, along with difficulty recruiting people eligible for Health Checks and poor public access to some venues.

Conclusions

The success of the NHS Health Check Programme relies on engagement by those responsible for its commissioning, management and delivery. Recognising and addressing the challenges identified in this review, in particular the concerns of GPs, are important for the future of the programme.
Smoking and quit attempts during pregnancy and postpartum: a longitudinal UK cohort
Authors: Cooper Sue , Orton Sophie , Leonardi-Bee Jo , Brotherton Emma , Vanderbloemen Laura , Bowker Katharine , Naughton Felix , Ussher Michael , Pickett Kate E , Sutton Stephen , Coleman Tim
Published: November 2017

Objectives

Pregnancy motivates women to try stopping smoking, but little is known about timing of their quit attempts and how quitting intentions change during pregnancy and postpartum. Using longitudinal data, this study aimed to document women’s smoking and quitting behaviour throughout pregnancy and after delivery.

Design

Longitudinal cohort survey with questionnaires at baseline (8–26 weeks’ gestation), late pregnancy (34–36 weeks) and 3 months after delivery.

Setting

Two maternity hospitals in one National Health Service hospital trust, Nottingham, England.

Participants

850 pregnant women, aged 16 years or over, who were current smokers or had smoked in the 3 months before pregnancy, were recruited between August 2011 and August 2012.

Outcome measures

Self-reported smoking behaviour, quit attempts and quitting intentions.

Results

Smoking rates, adjusting for non-response at follow-up, were 57.4% (95% CI 54.1 to 60.7) at baseline, 59.1% (95% CI 54.9 to 63.4) in late pregnancy and 67.1% (95% CI 62.7 to 71.5) 3 months postpartum. At baseline, 272 of 488 current smokers had tried to quit since becoming pregnant (55.7%, 95% CI 51.3 to 60.1); 51.3% (95% CI 44.7 to 58.0) tried quitting between baseline and late pregnancy and 27.4% (95% CI 21.7 to 33.2) after childbirth. The percentage who intended to quit within the next month fell as pregnancy progressed, from 40.4% (95% CI 36.1 to 44.8) at baseline to 29.7% (95% CI 23.8 to 35.6) in late pregnancy and 14.2% (95% CI 10.0 to 18.3) postpartum. Postpartum relapse was lower among women who quit in the 3 months before pregnancy (17.8%, 95% CI 6.1 to 29.4) than those who stopped between baseline and late pregnancy (42.9%, 95% CI 24.6 to 61.3).

Conclusions

Many pregnant smokers make quit attempts throughout pregnancy and postpartum, but intention to quit decreases over time; there is no evidence that smoking rates fall during gestation.
Method for sterility testing of corneal storage and transport media after removal of interfering antimicrobials: prospective validation study in compliance with the European Pharmacopoeia
Authors: Mistò Raffaela , Giurgola Laura , Pateri Francesca , Frigerio Elisabetta , Limongelli Anna , D’Amato Tóthová Jana
Published: November 2017

Objective

This study aimed at validating the method for sterility testing of the corneal culture medium, TISSUE-C, and the transport/deswelling medium, CARRY-C, according to the method suitability test, as defined by the European Pharmacopoeia (EP), using RESEP, which is a new medical device for removal of antimicrobial agents and an automated culture system.

Methods and analysis

The six EP reference strains were inoculated in TISSUE-C and CARRY-C. Half of the samples were treated with RESEP (RESEP+ group) prior to the sterility testing, whereas the remaining samples were untreated (RESEP− group). Growth controls were obtained by direct inoculation of the micro-organisms in the culture broths. Microbial growth was read by an automated light scattering culture system within 48 hours.

Results

The use of RESEP allowed detection of microbial growth in 100% of the tested samples, with a mean time to detection (TTD) comparable with that of the growth control group. Significantly lower sensitivity (38.83%±20.03% for both media, P<0.05) and TTD variability, depending on the tested micro-organism, were observed in the RESEP− group. The method specificity was 100% for both groups.

Conclusion

The use of RESEP increased the sensitivity of the sterility testing method to 100% and, for the first time, allowed validation of the method for sterility testing of corneal storage media according to the EP method suitability test. This further increases the safety of the corneas intended for transplantation.
Single-session versus staged procedures for elective multivessel percutaneous coronary intervention
Authors: Toyota Toshiaki , Morimoto Takeshi , Shiomi Hiroki , Yamaji Kyohei , Ando Kenji , Ono Koh , Shizuta Satoshi , Saito Naritatsu , Kato Takao , Kaji Shuichiro , Furukawa Yutaka , Nakagawa Yoshihisa , Kadota Kazushige , Horie Minoru , Kimura Takeshi
Published: November 2017

Objectives

To clarify the effect of single-session multivessel percutaneous coronary intervention (PCI) strategy relative to the staged multivessel strategy on clinical outcomes in patients with stable coronary artery disease (CAD) or non-ST-elevation acute coronary syndrome.

Methods

In the Coronary REvascularisation Demonstrating Outcome Study in Kyoto PCI/coronary artery bypass grafting registry cohort-2, there were 2018 patients who underwent elective multivessel PCI. Primary outcome measure was composite of all-cause death, myocardial infarction and stroke at 5-year follow-up.

Results

Single-session multivessel PCI and staged multivessel PCI were performed in 707 patients (35.0%) and 1311 patients (65.0%), respectively. The cumulative 5-year incidence of and adjusted risk for the primary outcome measure were not significantly different between the single-session and staged groups (26.7% vs 23.0%, p=0.45; HR 0.91, 95% CI 0.72 to 1.16, p=0.47). The 30-day incidence of all-cause death was significantly higher in the single-session group than in the staged group (1.1% vs 0.2%, p=0.009). However, the causes of death in 11 patients who died within 30 days were generally not related to the procedural complications, but related to the serious clinical status before PCI. For the subgroup analyses including age, gender, extent of CAD, severe chronic kidney disease and heart failure, there was no significant interaction between the subgroup factors and the effect of the single-session strategy relative to the staged strategy for the primary outcome measure.

Conclusions

The single-session multivessel PCI strategy was associated with at least comparable 5-year clinical outcomes compared with the staged multivessel PCI, although the prevalence of the single-session strategy was low in the present study.
Mammary phyllodes tumour: a 15-year multicentre clinical review
Authors: Co Michael , Chen Clement , Tsang Julia Y , Tse Gary , Kwong Ava
Published: November 2017

Aims

Phyllodes tumour (PT) is an uncommon fibroepithelial tumour of the breast. It has a spectrum of aggressiveness in biological behaviour with chance of local recurrence and, occasionally, metastasis.

Methods

A 15-year retrospective review from a multicentre database in Hong Kong was performed.

Results

Clinical and pathological records of 465 patients with 469 PTs between 1998 and 2014 were reviewed. Median age of occurrence was 44 years (range 12–86 years). 281 (59.9%) PTs were benign, 124 (26.4%) were borderline and 64 (13.6%) were malignant. About half of all PTs (239, 51.5%) were between 2 and 5 cm while another 186 (40.1%) were >5 cm in size. Most PT (84.6%) were radiologically benign. Breast-conserving surgery (BCS) was feasible in 384 (82%) patients, whereas 84 (18%) patients had mastectomy. Multivariate analysis found that positive surgical margin (P<0.001) and BCS (P<0.001) were the only significant risk factors for local recurrence, while large tumour size (P=0.008) and malignant PT histotype (P<0.001) were the only significant risk factors for metastasis. Long-term prognosis of benign and borderline PT was excellent. After median follow-up interval of 85 months (range 12–180 months), the disease-specific survival of benign, borderline and malignant PT were 99.6%, 100% and 90.6%, respectively.

Conclusions

Local recurrence of PTs occurs irrespective of the tumour grade. Surgical margin is the only amendable factor to reduce the chance of recurrence.
Impact of increasing tobacco taxes on working-age adults: short-term health gain, health equity and cost savings
Authors: Cleghorn Christine L , Blakely Tony , Kvizhinadze Giorgi , van der Deen Frederieke S , Nghiem Nhung , Cobiac Linda J , Wilson Nick
Published: November 2017

Objective

The health gains and cost savings from tobacco tax increase peak many decades into the future. Policy-makers may take a shorter-term perspective and be particularly interested in the health of working-age adults (given their role in economic productivity). Therefore, we estimated the impact of tobacco taxes in this population within a 10-year horizon.

Methods

As per previous modelling work, we used a multistate life table model with 16 tobacco-related diseases in parallel, parameterised with rich national data by sex, age and ethnicity. The intervention modelled was 10% annual increases in tobacco tax from 2011 to 2020 in the New Zealand population (n=4.4 million in 2011). The perspective was that of the health system, and the discount rate used was 3%.

Results

For this 10-year time horizon, the total health gain from the tobacco tax in discounted quality-adjusted life years (QALYs) in the 20–65 year age group (age at QALY accrual) was 180 QALYs or 1.6% of the lifetime QALYs gained in this age group (11 300 QALYs). Nevertheless, for this short time horizon: (1) cost savings in this group amounted to NZ$10.6 million (equivalent to US$7.1 million; 95% uncertainty interval: NZ$6.0 million to NZ$17.7 million); and (2) around two-thirds of the QALY gains for all ages occurred in the 20–65 year age group. Focusing on just the preretirement and postretirement ages, the QALY gains in each of the 60–64 and 65–69 year olds were 11.5% and 10.6%, respectively, of the 268 total QALYs gained for all age groups in 2011–2020.

Conclusions

The majority of the health benefit over a 10-year horizon from increasing tobacco taxes is accrued in the working-age population (20–65 years). There remains a need for more work on the associated productivity benefits of such health gains.
Energy expenditure and intake during Special Operations Forces field training in a jungle and glacial environment
Authors: Johnson Caleb D. , Simonson Andrew J. , Darnell Matthew E. , DeLany James P. , Wohleber Meleesa F. , Connaboy Christopher
Published: November 2017

The purpose of this study was to identify and compare energy requirements specific to Special Operations Forces in field training, in both cool and hot environments. Three separate training sessions were evaluated, 2 in a hot environment (n = 21) and 1 in a cool environment (n = 8). Total energy expenditure was calculated using doubly labeled water. Dietary intake was assessed via self-report at the end of each training mission day, and macronutrient intakes were calculated. Across the 3 missions, mean energy expenditure (4618 ± 1350 kcal/day) exceeded mean energy intake (2429 ± 838 kcal/day) by an average of 2200 kcal/day. Macronutrient intakes (carbohydrates (g/(kg·day body weight (bw))−1) = 3.2 ± 1.2; protein (g/(kg·day bw)−1) = 1.3 ± 0.7; fat (g/(kg·day bw)−1) = 1.2 ± 0.7) showed inadequate carbohydrate and possibly protein intake across the study period, compared with common recommendations. Total energy expenditures were found to be similar between hot (4664 ± 1399 kcal/day) and cool (4549 ± 1221 kcal/day) environments. However, energy intake was found to be higher in the cool (3001 ± 900 kcal/day) compared with hot (2200 ± 711 kcal/day) environments. Based on the identified energy deficit, high variation in energy expenditures, and poor macronutrient intake, a greater attention to feeding practices during similar training scenarios for Special Operations Forces is needed to help maintain performance and health. The differences in environmental heat stress between the 2 climates/environments had no observed effect on energy expenditures, but may have influenced intakes.
Effects of dietary lysine level on the content and fatty acid composition of intramuscular fat in late-stage finishing pigs
Authors: Wang Taiji , Crenshaw Mark A. , Regmi Naresh , Rude Brian J. , Shamimul Hasan M. , Sukumaran Anuraj T. , Dinh Thu , Liao Shengfa F.
Published: November 2017

This study was conducted to investigate how dietary lysine level affects the intramuscular fat (IMF) content and fatty acid (FA) composition in late-stage finishing pigs. Nine crossbred barrows [94.4 ± 6.7 kg body weight (BW)] were randomly allotted to three treatment groups (n = 3). Three corn- and soybean-meal-based diets were formulated to meet the National Research Council (2012) requirements for various nutrients except for lysine, whose concentrations were 0.43%, 0.71%, and 0.98% (as-fed basis) for Diets 1 (lysine-deficient), 2 (lysine-adequate), and 3 (lysine-excess), respectively. After 5 wk of ad libitum access to diets, pigs were harvested and longissimus dorsi samples were collected. The IMF content and FA composition of the samples were analyzed by gas chromatography. Results showed that the IMF content of the muscle was increased linearly (P < 0.05) with decreasing dietary lysine level from 0.98% to 0.43%. Dietary lysine level altered the composition of FA, especially the unsaturated FA, in the muscle. Particularly, the percentages of C18:1 n-9 and total monounsaturated FA were higher, whereas the percentages of C18:2 n-6 and total polyunsaturated FA were lower, in the muscle of the pigs fed Diet 1. Collectively, dietary lysine deficiency increased the proportion of monounsaturated FA and decreased the proportion of polyunsaturated FA, which may benefit pork palatability.
Notification-Oriented Paradigm to Implement Digital Hardware
Authors: Kerschbaumer Ricardo , Linhares Robson R. , Simão Jean M. , Stadzisz Paulo C. , Erig Lima Carlos R.
Published: November 2017

The growing demand for high-performance digital circuits, mainly involving FPGAs, increases the demand for high-level synthesis (HLS) tools. Traditional Hardware Description Languages (HDLs) are complex and depend on low-level abstractions, thereby requiring hardware detailed knowledge from developers. In turn, the current HLS tools are based on proprietary or C/C[Formula: see text] derived languages, which allow easier circuit description but decrease performance. This work presents an alternative solution for designing digital circuits, which arises from the Notification-Oriented Paradigm (NOP). The NOP is an alternative computing solution based upon a set of predefined interconnected entities whose collaborations are performed through precise notifications. The NOP, when targeted to digital hardware (DH), allows the developer to describe the circuit behavior just by connecting and parameterizing elements. The result is a VHDL file that can be compiled for any platform from any manufacturer. In order to check the functionality of this approach, sorting circuits were built both with usual VHDL and with the NOP VHDL aiming to compare the resulting circuits in terms of operating frequency and resource use. The results show that the NOP VHDL approach facilitates the build of digital circuits when compared to the VHDL usual approach without limiting the operating frequency or increasing the use of resources.
Stabilizing Sequence Search for Time-Controlled Switched Nonlinear Systems with All Unstable Modes
Authors: Wang Jiqiang
Published: November 2017

One of the important problems in time-controlled switched dynamical systems is to find a stabilizing time sequence if there is any. The problem is challenging for switched systems with all unstable modes. Two fundamental approaches are introduced, which are classified as the fast switching method and the method of converting state-controlled signals. Five schemes are delineated and validated in the numerical study based on the two approaches. The effects of switching frequency and duty ratio on the dynamical system performance are analyzed, from which important implications have been drawn for use in practical system design. The proposed methods shall also provide intuition into understanding the mechanism of how to maintain a dynamical system’s stability when all of its modes are unstable.
Numerical Investigation of Different Tip Clearances Effect on the Hydrodynamic Performance of Pumpjet Propulsor
Authors: Qin Denghui , Pan Guang , Huang Qiaogao , Zhang Zhengdong , Ke Jiujiu
Published: November 2017

Previous studies show that the tip clearance loss limits the improvement of turbomachinery performance, and it is roughly in close relation with the gap size. In this study, a pumpjet propulsor (PJP) with different sizes of tip clearances ([Formula: see text], 0.5, 1, 2, 3[Formula: see text]mm) has been presented to investigate the influence of tip clearances on PJP. This analysis is based on computational fluid dynamic (CFD) method, and the SST k-[Formula: see text] turbulence model is applied. Calculations are carried out with a worldwide employed ducted propeller (the Ka4-70 propeller in 19A duct) to verify the numerical simulation. And the grid independence validation is discussed. The numerical simulation of PJP flow with different tip clearances is carried out. Results show that the open water efficiency decreases gradually with the increase of tip clearance. The efficiency decreasing is caused by the tip flow loss. The shape of tip vortex of PJP which consisted of tip-separation vortex and tip-leakage vortex is presented. Furthermore, the formation and spread process of tip vortex at different tip clearances are discussed. Then, the effect of different tip clearances on the pressure field of rotor blade is investigated. The main pressure area affected by different tip clearances is mainly concentrated in the area above 0.9 spanwise of the suction side of rotor blade. Beyond that, the effects of different tip clearances on the velocity field of PJP has been studied.
Equine Intestinal Mucosal Pathobiology
Authors: Blikslager Anthony , Gonzalez Liara
Published: November 2017

The equine intestinal mucosa is intimately involved in maintaining homeostasis both on a systemic level by controlling extracellular fluid movement and at the local level to maintain barrier function. Horses are particularly susceptible to the clinical syndrome of colic, with the most severe cases involving strangulating obstruction that induces ischemia. Because of the mucosal vascular architecture, the mucosal epithelium is particularly susceptible to ischemic injury. The potential for reperfusion injury has been investigated and found to play a minimal role. However, inflammation does affect mucosal repair. Mechanisms of repair, including villus contraction, epithelial restitution, and tight junction closure, are critical to reforming the mucosal barrier. Nonsteroidal anti-inflammatory drugs have an impact on this repair, particularly at the level of the tight junctions. Completion of mucosal regeneration requires proliferation, which is now being actively studied in equine enteroids. All of these aspects of equine mucosal pathobiology are reviewed in depth.
The Dark Triad and Workplace Behavior
Authors: LeBreton James M. , Shiverdecker Levi K. , Grimaldi Elizabeth M.
Published: November 2017

Over the last 15 years, there has been growing fascination among scholars in studying “dark behaviors” and “dark traits,” especially as they are expressed in organizational contexts. One taxonomy of dark traits that has garnered special interest is the dark triad (DT), which is comprised of three toxic and malevolent traits: psychopathy, narcissism, and Machiavellianism. This chapter offers a review of DT research, with a particular focus on research relevant to the organizational sciences. We begin with a definition of personality in general and the traits of the DT in particular, including a discussion of the clinical and subclinical variants of these traits. We then review literature linking the DT traits to an array of organizational outcomes, discuss how the DT traits may be assessed, and conclude with recommendations for future work.