bluuebunny/crossref_metadata_2025 huggingface dataset:
Epstein-Barr Virus Fusion with Epithelial Cells Triggered by gB Is Restricted by a gL Glycosylation Site
Authors: Möhl Britta S. , Chen Jia , Park Seo Jin , Jardetzky Theodore S. , Longnecker Richard
Published: September 2017

Epstein-Barr virus (EBV) entry into epithelial cells is mediated by the conserved core fusion machinery, composed of the fusogen gB and the receptor-binding complex gH/gL. The heterodimeric gH/gL complex binds to the EBV epithelial cell receptor or gp42, which binds to the B-cell receptor, triggering gB-mediated fusion of the virion envelope with cellular membranes. Our previous study found that the gL glycosylation mutant N69L/S71V had an epithelial cell-specific hyperfusogenic phenotype. To study the influence of this gL mutant on the initiation and kinetics of gB-driven epithelial cell fusion, we established a virus-free split-green fluorescent protein cell-cell fusion assay that enables real-time measurements of membrane fusion using live cells. The gL_N69L/S71V mutant had a large increase in epithelial cell fusion activity of up to 300% greater than that of wild-type gL starting at early time points. The hyperfusogenicity of the gL mutant was not a result of alterations in complex formation with gH or alterations in cellular localization. Moreover, the hyperfusogenic phenotype of the gL mutant correlated with the formation of enlarged syncytia. In summary, our present findings highlight an important role of gL in the kinetics of gB-mediated epithelial cell fusion, adding to previous findings indicating a direct interaction between gL and gB in EBV membrane fusion.

IMPORTANCE
EBV predominantly infects epithelial cells and B lymphocytes, which are the cells of origin for the EBV-associated malignancies Hodgkin and Burkitt lymphoma as well as nasopharyngeal carcinoma. Contrary to the other key players of the core fusion machinery, gL has the most elusive role during EBV-induced membrane fusion. We found that the glycosylation site N69/S71 of gL is involved in restricting epithelial cell fusion activity, strongly correlating with syncytium size. Interestingly, our data showed that the gL glycosylation mutant increases the fusion activity of the hyperfusogenic gB mutants, indicating that this gL mutant and the gB mutants target different steps during fusion. Our studies on how gL and gB work together to modulate epithelial cell fusion kinetics are essential to understand the highly tuned tropism of EBV for epithelial cells and B lymphocytes and may result in novel strategies for therapies preventing viral entry into target host cells. Finally, making our results of particular interest is the absence of gL syncytial mutants in other herpesviruses.
APOBEC3A Is Upregulated by Human Cytomegalovirus (HCMV) in the Maternal-Fetal Interface, Acting as an Innate Anti-HCMV Effector
Authors: Weisblum Yiska , Oiknine-Djian Esther , Zakay-Rones Zichria , Vorontsov Olesya , Haimov-Kochman Ronit , Nevo Yuval , Stockheim David , Yagel Simcha , Panet Amos , Wolf Dana G.
Published: September 2017

Human cytomegalovirus (HCMV) is the leading cause of congenital infection and is associated with a wide range of neurodevelopmental disabilities and intrauterine growth restriction. Yet our current understanding of the mechanisms modulating transplacental HCMV transmission is poor. The placenta, given its critical function in protecting the fetus, has evolved effective yet largely uncharacterized innate immune barriers against invading pathogens. Here we show that the intrinsic cellular restriction factor
apo
lipoprotein B
e
diting
c
atalytic subunit-like 3A (APOBEC3A [A3A]) is profoundly upregulated following
ex vivo
HCMV infection in human decidual tissues—constituting the maternal aspect of the placenta. We directly demonstrated that A3A severely restricted HCMV replication upon controlled overexpression in epithelial cells, acting by a cytidine deamination mechanism to introduce hypermutations into the viral genome. Importantly, we further found that A3 editing of HCMV DNA occurs both
ex vivo
in HCMV-infected decidual organ cultures and
in vivo
in amniotic fluid samples obtained during natural congenital infection. Our results reveal a previously unexplored role for A3A as an innate anti-HCMV effector, activated by HCMV infection in the maternal-fetal interface. These findings pave the way to new insights into the potential impact of APOBEC proteins on HCMV pathogenesis.

IMPORTANCE
In view of the grave outcomes associated with congenital HCMV infection, there is an urgent need to better understand the innate mechanisms acting to limit transplacental viral transmission. Toward this goal, our findings reveal the role of the intrinsic cellular restriction factor A3A (which has never before been studied in the context of HCMV infection and vertical viral transmission) as a potent anti-HCMV innate barrier, activated by HCMV infection in the authentic tissues of the maternal-fetal interface. The detection of naturally occurring hypermutations in clinical amniotic fluid samples of congenitally infected fetuses further supports the idea of the occurrence of A3 editing of the viral genome in the setting of congenital HCMV infection. Given the widely differential tissue distribution characteristics and biological functions of the members of the A3 protein family, our findings should pave the way to future studies examining the potential impact of A3A as well as of other A3s on HCMV pathogenesis.
Ecophysiology of Freshwater Verrucomicrobia Inferred from Metagenome-Assembled Genomes
Authors: He Shaomei , Stevens Sarah L. R. , Chan Leong-Keat , Bertilsson Stefan , Glavina del Rio Tijana , Tringe Susannah G. , Malmstrom Rex R. , McMahon Katherine D.
Published: September 2017

Freshwater
Verrucomicrobia
spp. are cosmopolitan in lakes and rivers, and yet their roles and ecophysiology are not well understood, as cultured freshwater
Verrucomicrobia
spp. are restricted to one subdivision of this phylum. Here, we greatly expanded the known genomic diversity of this freshwater lineage by recovering 19
Verrucomicrobia
draft genomes from 184 metagenomes collected from a eutrophic lake and a humic bog across multiple years. Most of these genomes represent the first freshwater representatives of several
Verrucomicrobia
subdivisions. Genomic analysis revealed
Verrucomicrobia
to be potential (poly)saccharide degraders and suggested their adaptation to carbon sources of different origins in the two contrasting ecosystems. We identified putative extracellular electron transfer genes and so-called “
Planctomycete
-specific” cytochrome
c
-encoding genes and identified their distinct distribution patterns between the lakes/layers. Overall, our analysis greatly advances the understanding of the function, ecophysiology, and distribution of freshwater
Verrucomicrobia
, while highlighting their potential role in freshwater carbon cycling.
The Biofilm Inhibitor Carolacton Enters Gram-Negative Cells: Studies Using a TolC-Deficient Strain of Escherichia coli
Authors: Donner Jannik , Reck Michael , Bunk Boyke , Jarek Michael , App Constantin Benjamin , Meier-Kolthoff Jan P. , Overmann Jörg , Müller Rolf , Kirschning Andreas , Wagner-Döbler Irene
Published: September 2017

The emergence of pathogens resistant against most or all of the antibiotics currently used in human therapy is a global threat, and therefore the search for antimicrobials with novel targets and modes of action is of utmost importance. The myxobacterial secondary metabolite carolacton had previously been shown to inhibit biofilm formation and growth of streptococci. Here, we investigated if carolacton could act against Gram-negative bacteria, which are difficult targets because of their double-layered cytoplasmic envelope. We found that the model organismEscherichia coliis susceptible to carolacton, similar to the Gram-positiveStreptococcus pneumoniae, if its multidrug efflux system AcrAB-TolC is either inactivated genetically, by disruption of thetolCgene, or physiologically by coadministering an efflux pump inhibitor. A carolacton epimer that has a different steric configuration at carbon atom 9 is completely inactive, suggesting that carolacton may interact with the same molecular target in both Gram-positive and Gram-negative bacteria.
Stent-assisted coiling of a ruptured vertebrobasilar junction aneurysm via direct vertebral artery puncture
Authors: Dobrocky Tomas , Beck Juergen , Gralla Jan , Mordasini Pasquale
Published: September 2017

A 78-year-old patient was admitted with subarachnoid hemorrhage caused by rupture of a broad-based vertebrobasilar junction aneurysm. Direct endovascular access to the vertebrobasilar circulation was not possible due to chronic occlusion of the proximal dominant left vertebral artery (VA), hypoplastic right VA and posterior communicating arteries. The distal cervical left VA was reconstituted by muscular branches of the ascending cervical artery. Therefore, endovascular access was gained by direct percutaneous VA puncture guided by a roadmap-controlled anterior approach at the level of C5 proximally to the main reconstituting collateral feeders. Successful endovascular treatment of the aneurysm was performed by stent-assisted coiling. Closure of the puncture site at the cervical VA level was achieved by occluding the proximal part of the VA with coils. The post-interventional clinical course was uneventful; early post-interventional CT showed no evidence of cervical hematoma.
Functional performance 6 months after ACL reconstruction can predict return to participation in the same preinjury activity level 12 and 24 months after surgery
Authors: Nawasreh Zakariya , Logerstedt David , Cummer Kathleen , Axe Michael , Risberg May Arna , Snyder-Mackler Lynn
Published: September 2017

Background

Assessing athletes’ readiness is a key component for successful outcomes after ACL reconstruction (ACLR).

Objectives

To investigate whether return-to-activity criteria, individually or in combination, at 6 months after ACLR can predict return to participation in the same preinjury activity level at 12 and 24 months after ACLR.

Methods

Ninety-five level I/II participants completed return-to-activity criteria testing (isometric quadriceps index, single-legged hop tests, Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) and Global Rating Score (GRS)) at 6 months after ACLR. The PASS group was defined as scoring>90% on all criteria and the FAIL group as scoring <90% on any criteria. At 12 and 24 months after ACLR, participants were asked if they had returned to participate in the same preinjury activity level or not. All return-to-activity criteria, except quadriceps index, were entered into the logistic regression model.

Results

81% and 84.4% of the PASS group returned to participation in the same preinjury activity level, while only 44.2% and 46.4% of the FAIL group returned at 12 and 24 months, respectively, after ACLR. The 6-meter timed hop, single hop and triple hop limb symmetry indexes; GRS; and KOS-ADLS individually predicted the outcome of interest at 12 months after ACLR (range: R2: 0.12–0.22, p<0.024). In combination, they explained 27% of the variance (p=0.035). All hop tests, individually, predicted the outcome of interest at 24 months after ACLR (range: R2: 0.26–0.37; p<0.007); in combination they explained 45% of the variance (p<0.001).

Conclusion

Return to participation in the same preinjury activity level at 12 and 24 months after ACLR was higher in those who passed the criteria compared with those who failed. Individual and combined return-to-activity criteria predicted the outcomes of interest, with the hop tests as consistent predictors at 12 and 24 months after ACLR.
A systematic review of prospective epidemiological research into injury and illness in Olympic combat sport
Authors: Bromley Sally J , Drew Michael K , Talpey Scott , McIntosh Andrew S , Finch Caroline F
Published: September 2017

Background

Combat sports involve body contact through striking, kicking and/or throwing. They are anecdotally referred to as ‘dangerous’, yet long-term investigation into specific injury rates is yet to be explored.

Objective

To describe incidence and prevalence of injury and illness within Olympic combat sports and to investigate risk of bias of prospective injury and illness research within these sports.

Methods

We systematically searched literature published up until May 2016. We included prospective studies of injury/illness in elite combat athletes lasting more than 12 weeks. Risk of bias was assessed using a modified version of the Downs and Black checklist for methodological quality. Included studies were mapped to the Oxford Centre for Evidence-Based Medicine levels of evidence.

Results

Nine studies were included, and most (n=6) had moderate risk of bias. Studies provided level 1/2b evidence that the most frequently injured areas were the head/face (45.8%), wrist (12.0%) and lower back (7.8%) in boxing; the lower back (10.9%), shoulder (10.2%) and knee (9.7%) in judo; the fingers (22.8%) and thigh (9.1%) in taekwondo; and the knee (24.8%), shoulder (17.8%) and head/face (16.6%) in wrestling. Heterogeneity of injury severity classifications and inconsistencies inexposure measures prevented any direct comparisons of injury severity/incidence across combat sports.

Conclusions

There is currently a lack of consensus in the collection of injury/illness data, limiting the development of prevention programmes for combat sport as a whole. However, sport-specific data that identify body areas with high injury frequency can provide direction to clinicians, enabling them to focus their attention on developing pathologies in these areas. In doing so, clinicians can enhance the practical elements of their role within the integrated combat sport performance team and assist in the regular update of surveillance records.
Systematic review of innovation design contests for health: spurring innovation and mass engagement
Authors: Pan Stephen W , Stein Gabriella , Bayus Barry , Tang Weiming , Mathews Allison , Wang Cheng , Wei Chongyi , Tucker Joseph D
Published: September 2017

We undertook a systematic review evaluating the effectiveness and cost of health-focused innovation design contests. We followed Cochrane guidance and systematically searched eight databases. Articles were included if they reported an open contest focused on improving health, required participants submit finished design solutions and contained a prize structure. We searched 3579 citations, identifying 29 health-focused innovation design contests which collectively received 15494 contest submissions. Contests solicited submissions worldwide (7) and exclusively from North America (13), Asia (4), Africa (2), Australia (2) and Europe (1). Submissions per contest ranged from 3 to 11354 (median of 73). Contest entrants were tasked with helping develop health promotion messages (HPM) (25) and improve predictive clinical models, protocols and/or algorithms (4). Two types of contests emerged—those focused on high-quality, innovative outcomes and those focused on the process of mass community engagement. All outcome-oriented contests had innovation design contest solutions equivalent or superior to the comparator (100%; 7/7). Two of two studies found that innovation design contests saved money (100%; 2/2). Five of seven process-oriented contests concluded the contest improved at least one health indicator (71%; 5/7). Innovation design contests are an effective way to solicit innovative solutions to health problems and spur mass community engagement.
A frog in the throat?
Authors: Waseem Hunniya , Welch Matthew
Published: September 2017

Clinical introduction

A 44-year-old woman, with an unremarkable medical history, presented in the middle of the night with discomfort in her throat. She described being assaulted by an assailant who put his ‘fist in her mouth’, trying to suffocate her. On examination, she had normal observations and no signs of injury, other than scratch marks around her mouth; she reported no odynophagia and was able to swallow fluids readily. During examination, she complained that lying flat made her increasingly uncomfortable and was causing burgeoning dyspnoea. She had lateral soft tissue radiography of her neck as shown in figure 1.

Figure 1

Lateral neck soft tissue radiograph of the 44-year-old woman.

Question

What is the diagnosis?

Caustic stricture of the oesophagus

Pharyngeal perforation

Pharyngeal pouch

Boerhaave’s syndrome
PP18 Interim analysis of ambulance logistics and timings in patients recruited into the rapid intervention with glyceryl trinitrate in hypertensive stroke trial-2 (right-2)
Authors: Dixon Mark , Scutt Polly , Appleton Jason P , Spaight Robert , Johnson Roderick , Niroshan Siriwardena A , Bath Philip M
Published: September 2017

Background

Stroke is a severe condition with high morbidity and mortality. Despite treatment effects in acute stroke being predominantly time dependent (e.g. thrombolysis and thrombectomy), proven treatments are hospital based and require prior brain scanning to identify intracerebral haemorrhage. Commencing treatment in the ambulance could dramatically reduce time to treatment.

Methods

The rapid intervention with glyceryl trinitrate in hypertensive stroke trial-2 (RIGHT-2) is a multicentre prospective randomised single-blind blinded-endpoint parallel group trial assessing the safety and efficacy of ambulance-based, paramedic-delivered glyceryl trinitrate (GTN) when administered within 4 hours of stroke onset. Paramedics trained in RIGHT-2 procedures assess, take appropriate consent and enrol eligible FAST-positive patients and apply the first of four GTN or sham transdermal patches that are continued during hospital admission. Timings, vital signs and distances are recorded.

Results

317 participants enrolled across five UK NHS ambulance services were assessed in this interim analysis. Median [interquartile range] timings in minutes were: symptom onset to 999 call 14 [5, 52], call-dispatch 2 [1, 6], onset-randomisation 60 [40, 105], scene-randomisation 21 [14, 31] with no difference between participants scoring FAST 2 or 3, scene-departure 32 [25, 40]), departure-hospital 16 [10, 24]. All timings were comparable to a cohort of 49 stroke patients across East Midlands Ambulance Service who were not enrolled in to RIGHT-2, e.g. scene-departure 32 [23, 40].

Conclusions

Randomisation of participants to an ambulance-based stroke trial is possible with paramedics rapidly identifying eligible patients, gaining appropriate consent, randomising and commencing treatment en route to hospital without prolonging time spent on scene.
PP19 A study of the prevalence of impaired awareness of hypoglycaemia in people who have had a severe hypoglycaemic emergency and been attended by the ambulance service
Authors: Duncan Edward AS , Fitzpatrick David , Evans Josie
Published: September 2017

Background

Severe hypoglycaemia is a serious condition and accounts for 0.6%–1.0% of all UK emergency ambulance calls per annum. Our previous qualitative research suggested that many Diabetes related hypoglycaemia patients attended by the ambulance service experienced impaired awareness of hypoglycaemia (IAH), a treatable condition which reduces patients’ awareness of the signs and symptoms of an impending severe hypoglycaemic emergency. The prevalence of IAH among people with type 1 Diabetes is approximately 25%. In type 2 its prevalence is approximately 10%. However the prevalence of IAH in people who use the ambulance service due to a hypoglycaemic emergency was unknown. Our aim therefore was to investigate the prevalence of IAH in patients who require ambulance service attendance due to severe hypoglycaemia.

Methods

We undertook a national cross-sectional survey of the prevalence of IAH. An a priori target sample size of 415 was set to allow estimation of proportions of IAH within a 5% margin of error (99% CI). From January–June 2016, patients (>16 years) attended by the Scottish Ambulance Service due a Diabetes related emergency with a blood glucose <4 mmol/L were identified as potential participants. A questionnaire with two standardised IAH measures (Gold et al. and Clarke et al) was posted to potential participants within a month of their severe hypoglycaemic event. Consent to participate was assumed through questionnaire return. Ethical approval was received from the National Research Ethics Service (15/EE/0383).

Results

Five hundred and ninety-two questionnaires were returned. The prevalence of impaired awareness of hypoglycaemia in among participants as measured using the two standardised measures was 53% and 57% respectively.

Conclusion

IAH is considerably more prevalent among people who have a severe hypoglycaemic emergency and call the ambulance service than in the general Diabetic population. This knowledge will assist in the development of an intervention to reduce hypoglycaemic emergencies and may lead to improved outcomes and cost savings.
PP22 Alternative care pathways for patients with low risk tia attended by emergency ambulance: a national survey
Authors: Porter Alison , Bulger Jenna , Hampton Chelsey , Jones Charlene , Rees Nigel , Seagrove Anne , Snooks Helen
Published: September 2017

Background

Patients presenting to emergency ambulance services with TIA are usually conveyed to the nearest Emergency Department (ED) with subsequent referral to specialist assessment at a TIA clinic within one week if at low risk of stroke. There is the opportunity for paramedics to refer patients with TIA at low risk of recurrent stroke directly to specialist TIA clinic, if such protocols can be shown to be safe and cost effective.

We aimed to describe current service developments across the UK for the pre-hospital emergency care of patients with TIA, to inform the development of an intervention for testing.

Methods

We surveyed all UK Ambulance Trusts (n=13) by email, asking them to identify initiatives related to the management of TIA, and followed up services reporting an alternative TIA pathway by telephone to gather further details.

Results

Twelve ambulance services responded to our survey. Nine reported that they had no current TIA referral pathway; of these, one had a pathway which was discontinued due to service reconfiguration. Three reported currently using a TIA referral pathway. All (4/4) pathways which had been introduced used the FAST test and ABCD2 tool to screen patients, in line with national guidelines, and classified patients as low risk if the ABCD2 score was 3 or below. All pathways indicated that eligible low-risk TIA patients should be referred by paramedics to specialist care, 2/4 by telephone, and 2/4 by fax. Non-conveyance exclusion criteria varied.

Although protocol compliance was audited in an initial pilot in one service, no formal evaluation of effectiveness was reported.

Conclusion

Several UK ambulance services have introduced referral pathways for low risk TIA patients, avoiding the ED. None have evaluated the safety (subsequent stroke or serious misdiagnosis) or cost effectiveness. A clinical trial to evaluate the safety and effectiveness of alternative care pathways for patients with suspected TIA presenting to emergency ambulance services is indicated.
PP26 Missed opportunities in ambulance sepsis care?
Authors: Prothero Larissa S , de Carteret Emma , Nicholls Tracy
Published: September 2017

Background

Two-thirds of severe sepsis patients are initially seen in the emergency department, with the majority arriving via ambulance. Since early sepsis recognition, diagnosis and clinical management are considered key for optimal patient outcomes, ambulance clinicians are well placed to have a key role in sepsis care. This study aims to identify key patient, clinician and organisation-derived factors which lead to missed sepsis recognition and delayed access to definitive care in the ambulance setting.

Methods

The East of England Ambulance Service NHS Trust declares any missed cases of sepsis as a Serious Incident (SI; NHS England Serious Incident Framework 2015) to support clinician and service learning and prevent reoccurrence. A qualitative thematic review, based on the Yorkshire Contributory Factors Framework, has being conducted using seventeen sepsis-related SI reports generated between March 2014 and March 2016.

Results

SIs were usually associated with emergency/999 calls resulting in non-conveyance. Breathing/respiratory problems were the most prevalent chief complaint. Perceived contributory factors to these incidences were:

‘Patient-derived’: unwell patients with capacity choosing to remain at home, despite advice to attend hospital; presence of co-morbidities and other medical conditions.

‘Clinician-derived’: inadequate patient assessment and triage; failure to recognise sepsis markers and use screening tools; low index of suspicion for sepsis and rapid patient deterioration; insufficient safety-netting and documentation; communication errors.

‘Organisation-derived’: increasing service demands; mismatch between clinician and vehicle response allocation; lower acuity calls receiving delayed responses at peak demand; variable provision of staff training; lack of clinical practice monitoring; lack of safety culture; promotion of alternative care pathways.

Conclusions

Errors in pre-hospital sepsis care occur at all service levels. SI reports provide invaluable systems-based analyses of healthcare episodes and offer concise guidance to prevent error reoccurrence and improve future care. The study findings will inform the development of a prospective sepsis risk assessment tool using prospective hazards analysis methodologies.
OP07 Might ambulance service organisational culture affect ambulance non conveyance rates?
Authors: Knowles Emma , Ahmed Nisar , Bishop-Edwards Lindsey , O’Cathain Alicia
Published: September 2017

Background

Ambulance services are experiencing increasing demand for response to emergency calls. In response, they have increased the proportion of patients not conveyed to an emergency department (ED). Alternatives to transporting patients to an ED include the provision of telephone advice only (‘hear and treat’), treatment at the scene (‘see and treat’) and transport to another facility (‘see and convey elsewhere’). There is considerable variation in the rates of different types of non-conveyance, and in non-conveyance overall, between ambulance services in England. Understanding of the reasons for this variation has been limited and relatively unexplored. We will explore if there is variability in perceptions of the organisational culture within each individual ambulance service and show this in the context of non conveyance rates.

Methods

We undertook 50 qualitative telephone interviews with ambulance service providers and commissioners in the 10 larger ambulance services in England, to identify factors that may explain variation in rates of ambulance non-conveyance. Data was analysed using a Framework model.

Results

Amongst interviewees there was variation in the perceptions they held regarding the organisational culture of the ambulance service which they were employed by. Recent management restructuring within the ambulance service, perception of management support across the organisation, motivation of the organisation to undertake non conveyance, and perceptions of support for staff undertaking non conveyance varied across the 10 ambulance services. We will present this qualitative data alongside routine data identifying non conveyance rates in each service, and explore whether organisational culture appears to be related to ambulance non conveyance rates.

Implications

Organisational culture is a complex issue but one which is potentially modifiable. Building a greater understanding of ambulance service organisational culture and how this relates to ambulance non conveyance may help identify ways of improving service delivery across all ambulance services.
PP08 Does current pre-hospital analgesia effectively reduce paediatric pain within a uk ambulance service: a service evaluation
Authors: Whitley Gregory , Bath-Hextall Fiona
Published: September 2017

Introduction

Pain is one of the most common symptoms presented by patients of all ages to ambulance services, however very few children receive analgesia. Analgesic treatment of pre-hospital injured children is viewed as ‘suboptimal’. The aim of this study was to explore current analgesia given to traumatically injured children in the pre-hospital setting and examine whether a clinically meaningful reduction in pain was achieved.

Methods

We evaluated electronic patient report forms over a two-year period (2013–2014) within a UK ambulance service NHS trust. All traumatically injured children within the age range 1–17 with a clinical impression of a fracture, dislocation, wound or burn were included. Patients with a Glasgow Coma Scale of <15 were excluded. The outcome measure was a reduction in numeric pain rating scale or Wong and Baker faces of ≥2 out of 10.

Results

Of the evaluable patients (n=11,317), 90.8% had a documented pain score, or a reason why a pain score could not be documented. For patients reporting pain (n=7483), 51.6% (n=3861) received analgesia, 9.6% (n=717) received no analgesia but did receive alternative treatment and 38.8% (n=2905) received no analgesia and no alternative treatment. Morphine sulphate IV, oral morphine, Entonox, paracetamol suspension and poly-analgesia all achieved a clinically meaningful median reduction in pain score; –3.0 (IQR, –5.0 to –2.0),–2.0 (–5.0 to –2.0),–2.0 (–4.0 to –1.0),–2.0 (–4.0 to 0.0) and –3.0 (–4.0 to –1.0), respectively.

Conclusions

Analgesia administered to traumatically injured children in the pre-hospital setting within this UK ambulance service NHS trust produces clinically meaningful reductions in pain for these patients. The concern is that a large number of patients received neither analgesia nor alternative treatment. There is a real need to identify barriers to analgesia administration in this patient group.
PP09 Pre-hospital diagnostic accuracy for hyperventilation syndrome
Authors: Wilson Caitlin , Harley Clare , Steels Stephanie
Published: September 2017

Background

Hyperventilation syndrome (HVS) encompasses a wide variety of symptoms and is diagnosed by excluding organic causes for patients’ symptoms. Literature suggests that HVS should be diagnosed and treated pre-hospitally to avoid costly attendances at Accident and Emergency departments. The study aim was to determine diagnostic accuracy for HVS of paramedics and emergency medical technicians (index test) in comparison to hospital doctors (reference standard).

Methods

A retrospective cross-sectional audit of routine data utilising linked pre-hospital and in-hospital patient records of adult patients (age ≥18 years) transported via emergency ambulance to two Accident and Emergency departments in the United Kingdom from January 2012 – December 2013. Agreement between pre-hospital and in-hospital HVS diagnoses was calculated using percent agreement, Cohen’s kappa and prevalence-adjusted bias-adjusted kappa. Accuracy was measured using sensitivity, specificity, predictive values and likelihood ratios with 95% confidence intervals.

Results

A total of 19 386 records were included in the analysis. Percent agreement between pre-hospital clinicians and hospital doctors was 98.73%, producing kappa of κ=0.57 and adjusted kappa of PABAK=0.97. Pre-hospital clinicians had a sensitivity 0.88 (0.82, 0.92) and specificity 0.99 (0.99, 0.99) for diagnosing HVS, with PPV 0.42 (0.37, 0.47), NPV 1.00 (1.00, 1.00), LR +75.2 (65.3, 86.5) and LR- 0.12 (0.08, 0.18). Subgroup analyses for sensitivity were statistically non-significant but for positive predictive values were statistically significant (p<0.001) for the number of pre-hospital diagnoses and patient age.

Conclusions

Paramedics and emergency medical technicians were able to diagnose HVS pre-hospitally with almost perfect specificity and good sensitivity. Pre-hospital diagnostic accuracy was highest for patients less than 30 years of age and if HVS was the sole diagnosis documented. Following this study, a review of the local ambulance service policy excluding adult HVS patients from referrals to Primary Care Services is anticipated.
Cost-effectiveness of neighbourhood slow zones in New York City
Authors: Jiao Boshen , Kim Sooyoung , Hagen Jonas , Muennig Peter Alexander
Published: September 2017

Background

Neighbourhood slow zones (NSZs) are areas that attempt to slow traffic via speed limits coupled with other measures (eg, speed humps). They appear to reduce traffic crashes and encourage active transportation. We evaluate the cost-effectiveness of NSZs in New York City (NYC), which implemented them in 2011.

Methods

We examined the effectiveness of NSZs in NYC using data from the city’s Department of Transportation in an interrupted time series analysis. We then conducted a cost-effectiveness analysis using a Markov model. One-way sensitivity analyses and Monte Carlo analyses were conducted to test error in the model.

Results

After 2011, road casualties in NYC fell by 8.74% (95% CI 1.02% to 16.47%) in the NSZs but increased by 0.31% (95% CI −3.64% to 4.27%) in the control neighbourhoods. Because injury costs outweigh intervention costs, NSZs resulted in a net savings of US$15 (95% credible interval: US$2 to US$43) and a gain of 0.002 of a quality-adjusted life year (QALY, 95% credible interval: 0.001 to 0.006) over the lifetime of the average NSZ resident relative to no intervention. Based on the results of Monte Carlo analyses, there was a 97.7% chance that the NSZs fall under US$50 000 per QALY gained.

Conclusion

While additional causal models are needed, NSZs appeared to be an effective and cost-effective means of reducing road casualties. Our models also suggest that NSZs may save more money than they cost.
Do we need bone mineral density to estimate osteoporotic fracture risk? A 10-year prospective multicentre validation study
Authors: Marques Andréa , Lucas Raquel , Simões Eugénia , Verstappen Suzanne M M , Jacobs Johannes W G , da Silva Jose A P
Published: September 2017

Objective

Evaluate the performance of FRAX®, with and without bone mineral densitometry (BMD), in predicting the occurrence of fragility fractures over 10 years.

Methods

Participants aged ≥40 years at baseline, with a complete set of data and a minimum of 8.5 years of follow-up were identified from three cohorts (n=2626). Ten-year fracture risk at baseline were estimated with FRAX® and assessed by comparison with observed fractures and receiver operating characteristic analysis.

Results

During a mean (SD) follow-up of 9.12 (1.5) years, 178 participants suffered a major osteoporotic (MOP) fracture and 28 sustained a hip fracture. The predictive performance of FRAX® was superior to that of BMD alone for both MOP and hip fractures. The area under the curve (AUC) of FRAX® without BMD was 0.76 (95% CI 0.72 to 0.79) for MOP fractures and 0.78 (95% CI 0.69 to 0.86) for hip fractures. No significant improvements were found when BMD was added to clinical variables to predict either MOP (0.78, 95% CI 0.74 to 0.82, p=0.25) or hip fractures (0.79, 95% CI 0.69 to 0.89, p=0.72).

AUCs for FRAX® (with and without BMD) were greater for men than for women. FRAX®, with and without BMD, tended to underestimate the number of MOP fractures and to overestimate the number of hip fractures in females. In men, the number of observed fractures were within the 95% CI of the number predicted, both with and without BMD.

Conclusion

FRAX® without BMD provided good fracture prediction. Adding BMD to FRAX® did not improve the performance of the tool in the general population.
Role of Schmallenberg virus infection in congenital malformations in ruminants in Scotland in spring 2017
Authors: Brülisauer F. , Scholes S. , Caldow G. L. , Rocchi M. , Dagleish M. P. , Chianini F.
Published: September 2017

Scotland's Rural College (SRUC), together with the Moredun Research Institute, carries out surveillance for Schmallenberg virus (SBV) infection in cattle and sheep. This article reports findings relating to diagnoses of fetopathy associated with SBV infection and other congenital malformations in these species made between January 1 and May 5, 2017.
Interannual variation in bryophyte dispersal: linking bryophyte phenophases and weather conditions
Authors: Barbé Marion , Fenton Nicole J. , Caners Richard , Bergeron Yves
Published: September 2017

In the context of global changes that modify the distribution range of species, there is an urgent need to identify climate variables affecting species dispersal. We investigated patterns of aerial propagule release (sexual and asexual) of boreal bryophytes in response to weather. We present the first community-level study that examines the impact of weather on the phenology of bryophytes, and we divided it into phases. Bryophyte propagule rain was trapped in 2013 (summer and fall) and 2014 (spring and fall), and climatic variables were collated from the years 2012 to 2014. The phases of the phenology and the weather variables one season to two years preceding propagule release, which may influence the dispersal of propagules, were identified. Propagule release varies with weather conditions at the time of dispersal (direct effects), but is also associated with weather during the winter and summer one year preceding dispersal (indirect effects), which presumably influences survival, growth, and fertilization of the mother plant as well as propagule and sporophyte development. We suggest that propagule release is related to weather conditions occurring from one to several previous seasons, particularly humidity, temperature, and length (duration) of winter. Dividing the phenology into phases, we present an innovative method that should provide new insights into bryophyte dispersal dynamics in response to climate.
Quantitative approaches to sensory information encoding by bat noseleaves and pinnae
Authors: Müller Rolf
Published: September 2017

The biosonar systems of horseshoe bats (Rhinolophidae) and Old World round leaf-nosed bats (Hipposideridae) incorporate a pervasive dynamic at the interfaces for ultrasound emission (noseleaves) and reception (pinnae). Changes in the shapes of these structures alter the acoustic characteristics of the biosonar system and could hence influence the encoding of sensory information. The focus of the present work is on approaches that can be used to investigate the hypothesis that the interface dynamic effects sensory information encoding. Mutual information can be used as a metric to quantify the extent to which the different ultrasonic emission and reception characteristics (beampatterns) provide independent views of the environment. Two different quantitative approaches have been taken to evaluate the relationship between dynamically encoded additional sensory information and sensing performance in finding the direction of a biosonar target. The first approach is to determine an upper bound on the number of different directions that can be distinguished by virtue of distinct spectral signatures. The second approach is based on a lower bound (Cramér–Rao) on the variance of direction estimates. All these different metrics demonstrate that the peripheral dynamics seen in bats result in the encoding of additional sensory information that is suitable for enhancing biosonar performance.
Structural transition of carbon nanoparticles caused by energetic collisions
Authors: Cai Ri , Ye Jun , Wang Qingbin , Chen Guohui , Liu Junting , Shi Liangyuan , Lin Mingwei , Xie Zhuoming , Liang Jianfu , Huang Hui , Liu Jinming , Li Mingjun , Liu Cheng , Song Hanbiao
Published: September 2017

A broad general interest in the process of affecting the energetic deposition of flying nanoparticles has prompted a new opportunity to consider the medium-energy region in which the nanoparticles maintain their integrity and must respond to the energetic shock caused by collisions. We herein report our experimental results on the structural transition of the carbon nanoparticles induced by such energetic collisions. The beam energy was varied from 0 keV to 30 keV for a nanoparticle with over 5000 carbon atoms. Electron energy loss spectroscopy, X-ray photoemission spectroscopy, and Raman spectroscopy were carried out on the samples using a series of beam energies. These tests revealed that some graphitic sheets were formed at the higher beam energy while the sp3 ratio was unexpectedly higher for a medium beam energy.
Strain gradient visco-plasticity with dislocation densities contributing to the energy
Authors: Röger Matthias , Schweizer Ben
Published: September 2017

We consider the energetic description of a visco-plastic evolution and derive an existence result. The energies are convex, but not necessarily quadratic. Our model is a strain gradient model in which the curl of the plastic strain contributes to the energy. Our existence results are based on a time-discretization, the limit procedure relies on Helmholtz decompositions and compensated compactness.
EFFECT OF INTERRUPTED BORIDING ON MICROSTRUCTURE AND MECHANICAL PROPERTIES OF 16MnCr5 STEELS
Authors: CALIK A. , UCAR N. , KOCASLAN A. , KARAKAS S.
Published: September 2017

The microstructure, microhardness and tensile properties of continuously borided and interrupted borided 16MnCr5 steel were compared. In the continuous process, boriding was carried out continuously at 1273[Formula: see text]K for 16[Formula: see text]h. In the interrupted process, after 5[Formula: see text]h of boriding at 1273[Formula: see text]K, the crucible containing the specimens and the boriding powders was removed from the furnace and cooled to 873[Formula: see text]K in still air for 30[Formula: see text]min and this procedure was repeated three times. Both boriding treatments were achieved in a solid medium using the powder pack method with commercial Ekabor-I powders as the boron source. X-ray diffraction studies indicated the presence of FeB and Fe2B phases in the boride layers for both boriding treatments. The transition zone was more pronounced in the continuously borided steel. The average hardness values of the boride layers were 1759 and 1648[Formula: see text]HV0.1for the continuously borided and interrupted borided steels, respectively. The hardness of the boride layers were considerably higher than the 200[Formula: see text]HV0.1hardness of the untreated steel. No significant difference in tensile properties could be observed between the two different boriding procedures.
The cocycle structure of the Alexander f-quandles on finite fields
Authors: Churchill Indu Rasika , Elhamdadi Mohamed , Fernando Neranga
Published: September 2017

We determine the second, third, and fourth cocycle groups of Alexander [Formula: see text]-quandles of the form [Formula: see text], where [Formula: see text] denotes the finite field of order [Formula: see text], [Formula: see text], and [Formula: see text]. We also state three conjectures about second, third, and fourth cohomology groups of these Alexander [Formula: see text]-quandles.
Symbolic computation in hyperbolic programming
Authors: Naldi Simone , Plaumann Daniel
Published: September 2017

Hyperbolic programming is the problem of computing the infimum of a linear function when restricted to the hyperbolicity cone of a hyperbolic polynomial, a generalization of semidefinite programming (SDP). We propose an approach based on symbolic computation, relying on the multiplicity structure of the algebraic boundary of the cone, without the assumption of determinantal representability. This allows us to design exact algorithms able to certify the multiplicity of the solution and the optimal value of the linear function.
Effect on frontier molecular orbitals of substituents in 5-position of uracil base pairs in vacuum and water
Authors: Üngördü Ayhan , Tezer Nurten
Published: September 2017

The most stable structure of 5-substituted uracil base pairs and metal-mediated-5-substituted uracil complexes are determined. Density functional theory (DFT) method is used in the calculations which are carried out both in vacuum and water. LANL2DZ and 6–311[Formula: see text]G(d,p) basis sets are used for metals and the rest atoms, respectively. Effects on frontier molecular orbitals and energy gaps of substituents in 5-position of uracil base pairs in vacuum and water are found. Conductivity of base pairs or complexes are investigated for single nanowires studied by band theory. It is expected that this study will be an example for future studies that require new nanotechnological applications.
Non-Deterministic Flow in Fuzzy Networks and Its Application in Identification of Human Trafficking Chains
Authors: Mordeson John N. , Mathew Sunil
Published: September 2017

Fuzzy networks serve as a reliable model in the study of several natural flows like flow of people between different countries, flow of data between different routers in internet etc. The node capacity restriction on fuzzy networks allows us to deal with the internal transits or capacities in an effective way. Connectivity concepts and domination in directed fuzzy networks are discussed in this paper. An application of directed fuzzy networks in human trafficking is also presented.
Fuzzy Incidence Blocks and their Applications in Illegal Migration Problems
Authors: Mathew Sunil , Mordeson John N.
Published: September 2017

Incidence blocks in fuzzy incidence graphs (FIGs) are studied in this paper. Incidence relations play very important roles in several natural and human made networks like road, pipe, power and data flow networks. Incidence blocks are characterized using strongest strong incidence paths. A more concrete structure called cyclically strong FIG (CSFIG) is also introduced and an application of fuzzy incidence blocks in illegal international migration is proposed.
Fuzzy Influence Graphs
Authors: Mathew Sunil , Mordeson John N.
Published: September 2017

Trafficking in persons is the most heinous and condemnable organized crime of our time. The eradication of this crime must involve the full cooperation of all. In this paper, we provide a mathematical method to model such cooperation. We use a new concept in fuzzy graph theory, namely, that of incidence. We introduce fuzzy influence graph and characterize influence cutpairs in fuzzy influence graphs since their removal increases the number of connected components of a fuzzy network and thus weakens the potential flow in the network. Some of the properties of influence pairs and influence cutnodes are also studied.
Human Trafficking: Policy Intervention
Authors: Mordeson John N. , Mallenby Michel , Mathew Sunil , Acharjee Santanu
Published: September 2017

In E. Lutz and R. Lotspich, sex markets and human trafficking: Cause–effect and policy interventions, The Protection Project Journal of Human Rights and Civil Society 2 (2009) 199–124, causal linkages between commercial sex and human trafficking were examined. A three-link chain of necessary conditions exists. All three are required for trafficking into commercial sex. Consequently, trafficking can be addressed by policy intervention at any link. Prospects for policy success at the three points of intervention were compared. It was shown that a strategy of suppressing sex markets is least likely to be successful in reducing the associated human trafficking. In this paper, we create a mathematical model of the work developed above. We use five methods to derive five different linear equations to measure the success of policy intervention. The methods are the analytical hierarchy process, the Guiasu method, the Dempster rule of combination method, the Yen method, and the set-valued statistical method. The equations are based on an expert’s opinion of the relative importance of the factors involved in sex trafficking. These equations are used to determine a measure of how well a particular state in the USA is doing in policy intervention.