bluuebunny/crossref_metadata_2025 huggingface dataset:
Ambulatory diagnostic ECG monitoring for syncope and collapse: An assessment of clinical practice in the United States
Authors: Benditt David G. , Adkisson Wayne O. , Sutton Richard , Mears Robin K. , Sakaguchi Scott
Published: January 2018

Introduction

Diagnostic ambulatory electrocardiogram (AECG) monitoring is widely used for evaluating syncope and collapse, and practice guidelines provide recommendations regarding optimal AECG device selection. However, whether physicians utilize AECGs in accordance with the pertinent guidelines is unclear. This study assessed utilization of AECG monitoring systems for syncope and collapse diagnosis by physicians in the United States.

Methods and results

A quantitative survey was undertaken of physicians comprising multiple specialties (emergency department, n = 35; primary care, n = 35; hospitalists, n = 30; neurologists, n = 30; nonimplanting, n = 34, and implanting‐cardiologists, n = 35). Depending on specialty, respondents reported that neural‐reflex and orthostatic causes accounted for 17–23%, cardiac causes for 12–20%, and “neurological causes” (specifically psychogenic pseudo‐syncope/pseudo‐seizures and acute cerebrovascular conditions) for 7–12% of their syncope/collapse cases. The choice of AECG technology varied by specialty. Thus, despite patients having daily symptoms, 25% of respondents chose an AECG technology other than a Holter‐type monitor. Conversely, when monitoring for infrequent events (e.g., less than monthly), 12–18% indicated that they would choose a 24‐ to 48‐hour Holter, 20–34% would choose either a conventional event recorder or a mobile cardiac telemetry system, and only 53–65% would select an insertable cardiac monitor.

Conclusions

In evaluation of syncope/collapse, most U.S. clinicians across specialties use AECGs appropriately, but in a substantial minority there remains discordance between choice of AECG technology and guideline‐based recommendations.
Predictors and outcomes of patients requiring repeat transvenous lead extraction of pacemaker and defibrillator leads
Authors: Claridge Simon , Johnson Jonathan , Sadnan Gazi , Behar Jonathan M. , Porter Bradley , Sieniewicz Benjamin , Jackson Tom , Webb Jessica , Gould Justin , Sohal Manav , Hamid Shoaib , Patel Nik , Gill Jaswinder , Rinaldi Christopher A.
Published: January 2018

Background

A proportion of patients who undergo an initial lead extraction procedure will require a second, repeat extraction. Data regarding this clinical entity are scarce and neither the predisposing risk factors for, nor outcomes from, these procedures have been described previously. We sought to determine the incidence, risk factors, and outcomes of repeat lead extraction.

Methods

A database of extraction procedures from 2001 to 2015 was analyzed. Repeat extraction procedures were identified and the indication for extraction was dichotomized into infection and lead‐related problems. Univariate and multivariate analyses were performed to identify predictors of repeat extraction.

Results

807 extraction procedures were identified in 755 patients of whom 6% required a repeat extraction. At multivariate analysis, only suffering a major complication at the initial extraction procedure (odds ratio [OR] 21.5, 95% confidence interval [CI] 2.69–171.92; P < 0.01), complexity of device (cardiac resynchronization devices/implantable cardioverter defibrillators) (OR 2.58, 95% CI 1.2–5.2; P = 0.01), and age (OR 1.02 per year, 95% CI 1.0–1.4; P  =  0.03) were significant predictors of repeat extraction. When repeat extraction was required for infection there was a significant increase in mortality compared with those who did not require a second procedure (36% vs 23%; P  =  0.02).

Conclusions

Repeat lead extraction is required in 6% of cases. Complexity of device, age at extraction, and a major complication at the first extraction were predictors of repeat extraction. Mortality is significantly increased where the repeat procedure is for infection. Clinicians should alert patients to the potential need for further extraction and the increased risks of repeat procedures when indicated for infection.
A rare presentation of congenital syphilis: Pemphigus syphiliticus in a newborn infant with extensive desquamation of the extremities
Authors: Wang Elizabeth A. , Chambers Cindy J. , Silverstein Marc
Published: January 2018

Congenital syphilis is an infection transmitted from mother to fetus and can present with early but variable cutaneous manifestations. In rare situations, a bullous eruption known as pemphigus syphiliticus may develop. We present an unusual case of broad desquamation of the extremities in a newborn infant who was found to have congenital syphilis. Pemphigus syphiliticus should be considered in the differential diagnosis of neonatal bullous eruptions and erosions.
Promoting customer engagement: A new trend in utility regulation
Authors: Hahn Robert , Metcalfe Robert , Rundhammer Florian
Published: January 2018

This paper traces a new development in regulation that encourages utilities to engage more directly with their customers. We make four contributions: First, we perform a comprehensive analysis of how regulators are using customer engagement, and offer a simple model for understanding different customer engagement initiatives. Second, we review assessments of customer engagement. We find that there arenoquantitative, empirically robust assessments of the effectiveness of customer engagement as a regulatory tool. Third, we develop two detailed case studies of an energy regulator and a water regulator that are in the forefront of customer engagement efforts. We find that there is no direct link between the engagement strategy used and the economic incentives received by a firm. Finally, we propose a framework for improving the customer engagement process. The new framework relies on microeconomics, modern tools of program evaluation, and supplying the regulated firm with direct incentives to engage with the customer.
Impact of Middle School Student Energy Monitoring Activities on Climate Change Beliefs and Intentions
Authors: Christensen Rhonda , Knezek Gerald
Published: January 2018

The Going Green! Middle Schoolers Out to Save the World project aims to direct middle school students' enthusiasm for hands‐on activities toward interest in science and other STEM areas while guiding them to solve real‐world problems. Students in this project are taught by their teachers to use energy monitoring equipment to audit standby power consumed by electronic devices in their homes and communities. Major findings were: (a) Beliefs in climate change increased more for students in the treatment than comparison group, pre to post; and (b) For girls there was a larger positive impact on climate change beliefs than for boys. These and additional findings presented in this paper provide evidence that a hands‐on engaged‐learning curriculum can have a positive influence on climate change beliefs and intentions and strengthen the association between the two constructs.
Quality of omeprazole purchased via the Internet and personally imported into Japan: comparison with products sampled in other Asian countries
Authors: Rahman Mohammad Sofiqur , Yoshida Naoko , Sugiura Sakura , Tsuboi Hirohito , Keila Tep , Kiet Heng Bun , Zin Theingi , Tanimoto Tsuyoshi , Kimura Kazuko
Published: January 2018

Objective

To evaluate the quality of omeprazole personally imported into Japan via the Internet and to compare the quality of these samples with previously collected samples from two other Asian countries.

Methods

The samples were evaluated by observation, authenticity investigation and pharmacopoeial quality analysis. Quality comparison of some selected samples was carried out by dissolution profiling, Raman spectroscopy and principle component analysis (PCA).

Results

Observation of the Internet sites and samples revealed some discrepancies including the delivery of a wrong sample and the selling of omeprazole without a prescription, although it is a prescription medicine. Among the 28 samples analysed, all passed the identification test, 26 (93%) passed the quantity and content uniformity tests and all passed the dissolution test. Dissolution profiling confirmed that all the personally imported omeprazole samples remained intact in the acid medium. On the other hand, six samples from two of the same manufacturers, previously collected during surveys in Cambodia and Myanmar, frequently showed premature omeprazole release in acid. Raman spectroscopy and PCA showed significant variation between omeprazole formulations in personally imported samples and the samples from Cambodia and Myanmar.

Conclusions

Our results indicate that the pharmaceutical quality of omeprazole purchased through the Internet was sufficient, as determined by pharmacopeial tests. However, omeprazole formulations distributed in different market segments by the same manufacturers were of diverse quality. Measures are needed to ensure consistent quality of products and to prevent entry of substandard products into the legitimate supply chain.
β-Arrestin–biased β-adrenergic signaling promotes extinction learning of cocaine reward memory
Authors: Huang Bing , Li Youxing , Cheng Deqin , He Guanhong , Liu Xing , Ma Lan
Published: January 2018

Enhancing the activity of the β-arrestin arm of β-adrenergic signaling may help to prevent relapse in cocaine addicts.
Molecular Characterization of IMP-1-Producing Enterobacter cloacae Complex Isolates in Tokyo
Authors: Aoki Kotaro , Harada Sohei , Yahara Koji , Ishii Yoshikazu , Motooka Daisuke , Nakamura Shota , Akeda Yukihiro , Iida Tetsuya , Tomono Kazunori , Iwata Satoshi , Moriya Kyoji , Tateda Kazuhiro
Published: January 2018

Although KPC enzymes are most common among carbapenemases produced by
Enterobacter cloacae
complex globally, the epidemiology varies from one country to another. While previous studies have suggested that IMP enzymes are most common in Japan, detailed analysis has been scarce thus far. Here, we carried out a molecular epidemiological study and plasmid analysis of IMP-1-producing
E. cloacae
complex isolates collected from three hospitals in central Tokyo using whole-genome sequencing. Seventy-one isolates were classified into several sequence types (STs), and 49 isolates were identified as
Enterobacter hormaechei
ST78. Isolates of ST78 were divided into three clades by core-genome single nucleotide polymorphism (SNP)-based phylogenetic analysis. Whereas isolates of clade 3 were isolated from only one hospital, isolates of clade 1 and 2 were identified from multiple hospitals. Ten of 12 clade 1 isolates and 1 of 4 clade 2 isolates carried
bla
IMP-1
on IncHI2 plasmids, with high similarity of genetic structures. In addition, these plasmids shared backbone structures with IncHI2 plasmids carrying
bla
IMP
reported from other countries of the Asia-Pacific region. All isolates of clade 3 except one carried
bla
IMP-1
in In1426 on IncW plasmids. An isolate of clade 3, which lacked IncW plasmids, carried
bla
IMP-1
in In1426 on an IncFIB plasmid. These observations suggest that IMP-producing
E. cloacae
complex isolates with a diversity of host genomic backgrounds have spread in central Tokyo, and they indicate the possible contribution of IncHI2 plasmids toward this phenomenon.
Neutralizing Alpha-Toxin Accelerates Healing of Staphylococcus aureus-Infected Wounds in Nondiabetic and Diabetic Mice
Authors: Ortines Roger V. , Liu Haiyun , Cheng Lily I. , Cohen Taylor S. , Lawlor Heather , Gami Abhishek , Wang Yu , Dillen Carly A. , Archer Nathan K. , Miller Robert J. , Ashbaugh Alyssa G. , Pinsker Bret L. , Marchitto Mark C. , Tkaczyk Christine , Stover C. Kendall , Sellman Bret R. , Miller Lloyd S.
Published: January 2018

Staphylococcus aureus
wound infections delay healing and result in invasive complications such as osteomyelitis, especially in the setting of diabetic foot ulcers. In preclinical animal models of
S. aureus
skin infection, antibody neutralization of alpha-toxin (AT), an
S. aureus
-secreted pore-forming cytolytic toxin, reduces disease severity by inhibiting skin necrosis and restoring effective host immune responses. However, whether therapeutic neutralization of alpha-toxin is effective against
S. aureus
-infected wounds is unclear. Herein, the efficacy of prophylactic treatment with a human neutralizing anti-AT monoclonal antibody (MAb) was evaluated in an
S. aureus
skin wound infection model in nondiabetic and diabetic mice. In both nondiabetic and diabetic mice, anti-AT MAb treatment decreased wound size and bacterial burden and enhanced reepithelialization and wound resolution compared to control MAb treatment. Anti-AT MAb had distinctive effects on the host immune response, including decreased neutrophil and increased monocyte and macrophage infiltrates in nondiabetic mice and decreased neutrophil extracellular traps (NETs) in diabetic mice. Similar therapeutic efficacy was achieved with an active vaccine targeting AT. Taken together, neutralization of AT had a therapeutic effect against
S. aureus
-infected wounds in both nondiabetic and diabetic mice that was associated with differential effects on the host immune response.
Differential
In Vitro
Cytokine Induction by the Species of Cryptococcus gattii Complex
Authors: Herkert Patricia F. , dos Santos Jessica C. , Hagen Ferry , Ribeiro-Dias Fatima , Queiroz-Telles Flávio , Netea Mihai G. , Meis Jacques F. , Joosten Leo A. B.
Published: January 2018

Cryptococcal species vary in capsule and cell size, thermotolerance, geographic distribution, and affected populations.
Cryptococcus gattii sensu stricto
and
C. deuterogattii
affect mainly immunocompetent hosts; however,
C. bacillisporus
,
C. decagattii
, and
C. tetragattii
cause infections mainly in immunocompromised hosts. This study aimed to compare the capacities of different species of the
C. gattii
species complex to induce cytokines and antimicrobial molecules in human peripheral blood mononuclear cells (PBMCs).
Cryptococcus bacillisporus
and
C. deuterogattii
induced the lowest levels of tumor necrosis factor alpha (TNF-α), interleukin-1β (IL-1β), and IL-6 among the five species of the
C. gattii
complex.
Cryptococcus deuterogattii
induced higher levels of IL-22 than those induced by
C. tetragattii
and the environmental species
C. flavescens
. In addition,
C. bacillisporus
and
C. gattii sensu stricto
proliferated inside human monocyte-derived macrophages after 24 h of infection. All
Cryptococcus
species were able to generate reactive oxygen species (ROS) in human PBMCs, with
C. bacillisporus
and
C. deuterogattii
being more efficient than the other species. In conclusion,
C. bacillisporus
and
C. deuterogattii
induce lower levels of the proinflammatory cytokines TNF-α, IL-1β, and IL-6 and higher ROS levels than those induced by the other species. Species of the
Cryptococcus gattii
complex have different abilities to induce cytokine and ROS production by human PBMCs.
Cyclic di-GMP Regulates TfoY in Vibrio cholerae To Control Motility by both Transcriptional and Posttranscriptional Mechanisms
Authors: Pursley Benjamin R. , Maiden Michael M. , Hsieh Meng-Lun , Fernandez Nicolas L. , Severin Geoffrey B. , Waters Christopher M.
Published: January 2018

3′,5′-Cyclic diguanylic acid (c-di-GMP) is a bacterial second messenger molecule that is a key global regulator inVibrio cholerae, but the molecular mechanisms by which this molecule regulates downstream phenotypes have not been fully characterized. One such regulatory factor that may respond to c-di-GMP is the Vc2 c-di-GMP-binding riboswitch that is hypothesized to control the expression of the downstream putative transcription factor TfoY. Although much is known about the physical and structural properties of the Vc2 riboswitch aptamer, the nature of its expression and function inV. choleraehas not been investigated. Here, we show that Vc2 functions as an off switch to inhibit TfoY production at intermediate and high concentrations of c-di-GMP. At low c-di-GMP concentrations, TfoY production is induced to stimulate dispersive motility. We also observed increased transcription oftfoYat high intracellular concentrations of c-di-GMP, but this induction is independent of the Vc2 riboswitch and occurs via transcriptional control of promoters upstream oftfoYby the previously identified c-di-GMP dependent transcription factor VpsR. Our results show that TfoY is induced by c-di-GMP at both low and high intracellular concentrations of c-di-GMP via posttranscriptional and transcriptional mechanisms, respectively. This regulation contributes to the formation of three distinct c-di-GMP signaling states inV. cholerae.

IMPORTANCEThe bacterial pathogenVibrio choleraemust transition between life in aquatic environmental reservoirs and life in the gastrointestinal tract. Biofilm formation and bacterial motility, and their control by the second messenger molecule c-di-GMP, play integral roles in this adaptation. Here, we define the third major mechanism by which c-di-GMP controls bacterial motility. This pathway utilizes a noncoding RNA element known as a riboswitch that, when bound to c-di-GMP, inhibits the expression of the transcription factor TfoY. TfoY production switchesV. choleraemotility from a dense to a dispersive state. Our results suggest that the c-di-GMP signaling network ofV. choleraecan exist in at least three distinct states to regulate biofilm formation and motility.
Corynebacterium diphtheriae Iron-Regulated Surface Protein HbpA Is Involved in the Utilization of the Hemoglobin-Haptoglobin Complex as an Iron Source
Authors: Lyman Lindsey R. , Peng Eric D. , Schmitt Michael P.
Published: January 2018

Corynebacterium diphtheriae
utilizes various heme-containing proteins, including hemoglobin (Hb) and the hemoglobin-haptoglobin complex (Hb-Hp), as iron sources during growth in iron-depleted environments. The ability to utilize Hb-Hp as an iron source requires the surface-anchored proteins HtaA and either ChtA or ChtC. The ability to bind hemin, Hb, and Hb-Hp by each of these
C. diphtheriae
proteins requires the previously characterized conserved region (CR) domain. In this study, we identified an Hb-Hp binding protein, HbpA (38.5 kDa), which is involved in the acquisition of hemin iron from Hb-Hp. HbpA was initially identified from total cell lysates as an iron-regulated protein that binds to both Hb and Hb-Hp
in situ
. HbpA does not contain a CR domain and has sequence similarity only to homologous proteins present in a limited number of
C. diphtheriae
strains. Transcription of
hbpA
is regulated in an iron-dependent manner that is mediated by DtxR, a global iron-dependent regulator. Deletion of
hbpA
from
C. diphtheriae
results in a reduced ability to utilize Hb-Hp as an iron source but has little or no effect on the ability to use Hb or hemin as an iron source. Cell fractionation studies showed that HbpA is both secreted into the culture supernatant and associated with the membrane, where its exposure on the bacterial surface allows HbpA to bind Hb and Hb-Hp. The identification and analysis of HbpA enhance our understanding of iron uptake in
C. diphtheriae
and indicate that the acquisition of hemin iron from Hb-Hp may involve a complex mechanism that requires multiple surface proteins.

IMPORTANCE
The ability to utilize host iron sources, such as heme and heme-containing proteins, is essential for many bacterial pathogens to cause disease. In this study, we have identified a novel factor (HbpA) that is crucial for the use of hemin iron from the hemoglobin-haptoglobin complex (Hb-Hp). Hb-Hp is considered one of the primary sources of iron for certain bacterial pathogens. HbpA has no similarity to the previously identified Hb-Hp binding proteins, HtaA and ChtA/C, and is found only in a limited group of
C. diphtheriae
strains. Understanding the function of HbpA may significantly increase our knowledge of how this important human pathogen can acquire host iron that allows it to survive and cause disease in the human respiratory tract.
Two Residues in NSP9 Contribute to the Enhanced Replication and Pathogenicity of Highly Pathogenic Porcine Reproductive and Respiratory Syndrome Virus
Authors: Zhao Kuan , Gao Jia-Cong , Xiong Jun-Yao , Guo Jin-Chao , Yang Yong-Bo , Jiang Cheng-Gang , Tang Yan-Dong , Tian Zhi-Jun , Cai Xue-Hui , Tong Guang-Zhi , An Tong-Qing
Published: January 2018

Highly pathogenic porcine reproductive and respiratory syndrome virus (HP-PRRSV) possesses greater replicative capacity and pathogenicity than classical PRRSV. However, the factors that lead to enhanced replication and pathogenicity remain unclear. In our study, an alignment of all available full-length sequences of North American-type PRRSVs (
n
= 204) revealed two consistent amino acid mutations that differed between HP-PRRSV and classical PRRSV and were located at positions 519 and 544 in nonstructural protein 9. Next, a series of mutant viruses with either single or double amino acid replacements were generated from HP-PRRSV HuN4 and classical PRRSV CH-1a infectious cDNA clones. Deletion of either of the amino acids led to a complete loss of virus viability. In both Marc-145 and porcine alveolar macrophages, the replicative efficiencies of mutant viruses based on HuN4 were reduced compared to the parent, whereas the replication level of CH-1a-derived mutant viruses was increased. Plaque growth assays showed clear differences between mutant and parental viruses. In infected piglets, the pathogenicity of HuN4-derived mutant viruses, assessed through clinical symptoms, viral load in sera, histopathology examination, and thymus atrophy, was reduced. Our results indicate that the amino acids at positions 519 and 544 in NSP9 are involved in the replication efficiency of HP-PRRSV and contribute to enhanced pathogenicity. This study is the first to identify specific amino acids involved in PRRSV replication or pathogenicity. These findings will contribute to understanding the molecular mechanisms of PRRSV replication and pathogenicity, leading to better therapeutic and prognostic options to combat the virus.

IMPORTANCE
Porcine reproductive and respiratory syndrome (PRRS), caused by porcine reproductive and respiratory syndrome virus (PRRSV), is a significant threat to the global pig industry. Highly pathogenic PRRSV (HP-PRRSV) first emerged in China in 2006 and has subsequently spread across Asia, causing considerable damage to local economies. HP-PRRSV strains possess a greater replication capacity and higher pathogenicity than classical PRRSV strains, although the mechanisms that underlie these characteristics are unclear. In the present study, we identified two mutations in HP-PRRSV strains that distinguish them from classical PRRSV strains. Further experiments that swapped the two mutations in an HP-PRRSV strain and a classical PRRSV strain demonstrated that they are involved in the replication efficiency of the virus and its virulence. Our findings have important implications for understanding the molecular mechanisms of PRRSV replication and pathogenicity and also provide new avenues of research for the study of other viruses.
Trends and correlates of the public’s perception of healthcare systems in the European Union: a multilevel analysis of Eurobarometer survey data from 2009 to 2013
Authors: AlSaud AlJohara M , Taddese Henock B , Filippidis Filippos T
Published: January 2018

Objective

The aim of the study is to assess trends in public perceptions of health systems in 27 European Union (EU) member states following the financial crisis (2009–2013), in order to discuss observed changes in the context of the financial crisis.

Design

Repeated cross-sectional studies.

Setting

27 EU countries.

Participants

EU citizens aged 15 years and older.

Methods

The study mainly uses the Eurobarometer Social Climate Survey, conducted annually between 2009 and 2013, thereby analysing 116 706 observations. A multilevel logistic regression was carried out to analyse trends over time and the factors associated with citizens’ perceptions of their healthcare systems.

Results

Europeans generally exhibit positive perceptions of their national healthcare systems, 64.0% (95% CI 63.6% to 64.4%). However, we observed a significant drop in positive perceptions in the years following the crisis, especially within countries most affected by the crisis. Concerning fiscal characteristics, wealthier countries and those dedicating higher proportion of their national income to health were more likely to maintain positive perceptions. At the individual level, perceptions of healthcare systems were significantly associated with respondents’ self-perceptions of their social status, financial capacity and overall satisfaction in life.

Conclusions

Our finding confirms previous observations that citizens’ perceptions of their healthcare systems may reflect their overall prospects within the broader socioeconomic systems they live in; which have in turn been affected by the financial crisis and the policy measures instituted in response.
The association between macronutrient intake and cognition in individuals aged under 65 in China: a cross-sectional study
Authors: Ding Bingjie , Xiao Rong , Ma Weiwei , Zhao Lei , Bi Yanxia , Zhang Yong
Published: January 2018

Objective

The aim of this retrospective study was to explore the correlation between daily energy intake from macronutrients and cognitive functions in a Chinese population aged less than 65 years.

Design

This is a cross-sectional study to explore the relationships between macronutrients' intake and cognitive function. The analysis of variance (ANOVA) and χ2test were used to compare the demographic and physical characteristics, lifestyle and laboratory parameters with the intake of macronutrients among different quartiles of % fat/energy. Multivariate logistic regression analysis was applied to identify the potential risk factors of mild cognitive impairment (MCI).

Participants

Young and middle-aged participants (age <65 years) were recruited from Beijing, China. The Montreal cognitive assessment (MoCA) and mini-mental state examination (MMSE) were used to evaluate the cognitive functions, and the dietary intake of the participants was estimated with a semi-quantitative food frequency questionnaire (FFQ).

Results

Among the 661 participants, 80 (12.1%) had MCI, while 581 (87.9%) had normal cognitive functions. On evaluating the data based on the age group, educational background, and conditions of hyperlipidaemia and total energy intake, the results revealed that high % fat (upper quartile: adjusted OR (aOR) 3.90, 95% CI1.53 to 9.89, P=0.004), and high % protein intake (upper quartile: aOR 2.77, 95% CI 1.24 to 6.15) were greatly associated with increased frequency of MCI, while high % carbohydrate intake (upper quartile: aOR0.30, 95% CI 0.12 to 0.72) was correlated with decreased prevalence of MCI.

Conclusion

The dietary pattern with high percentage of energy intake from fat and protein, and low-energy intake from carbohydrate might have been associated with cognitive decline in a Chinese population under 65 years of age.
Perceptions of the uses of routine general practice data beyond individual care in England: a qualitative study
Authors: Wyatt David , Cook Jenny , McKevitt Christopher
Published: January 2018

Objective

To investigate how different lay and professional groups perceive and understand the use of routinely collected general practice patient data for research, public health, service evaluation and commissioning.

Design, method, participants and setting

We conducted a multimethod, qualitative study. This entailed participant observation of the design and delivery of a series of deliberative engagement events about a local patient database made of routine primary care data. We also completed semistructured interviews with key professionals involved in the database. Qualitative data were thematically analysed. The research took place in an inner city borough in England.

Results

Of the community groups who participated in the six engagement events (111 individual citizens), five were health focused. It was difficult to recruit other types of organisations. Participants supported the uses of the database, but it was unclear how well they understood its scope and purpose. They had concerns about transparency, security and the potential misuse of data. Overall, they were more focused on the need for immediate investment in primary care capacity than data infrastructures to improve future health. The 10 interviewed professionals identified the purpose of the database in different ways, according to their interests. They emphasised the promise of the database as a resource in health research in its own right and in linking it to other datasets.

Conclusions

Findings demonstrate positivity to the uses of this local database, but a disconnect between the long-term purposes of the database and participants’ short-term priorities for healthcare quality. Varying understandings of the database and the potential for it to be used in multiple different ways in the future cement a need for systematic and routine public engagement to develop and maintain public awareness. Problems recruiting community groups signal a need to consider how we engage wider audiences more effectively.
Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: a prospective, direct observation study
Authors: Westbrook Johanna I , Raban Magdalena Z , Walter Scott R , Douglas Heather
Published: January 2018

Background

Interruptions and multitasking have been demonstrated in experimental studies to reduce individuals’ task performance. These behaviours are frequently used by clinicians in high-workload, dynamic clinical environments, yet their effects have rarely been studied.

Objective

To assess the relative contributions of interruptions and multitasking by emergency physicians to prescribing errors.

Methods

36 emergency physicians were shadowed over 120 hours. All tasks, interruptions and instances of multitasking were recorded. Physicians’ working memory capacity (WMC) and preference for multitasking were assessed using the Operation Span Task (OSPAN) and Inventory of Polychronic Values. Following observation, physicians were asked about their sleep in the previous 24 hours. Prescribing errors were used as a measure of task performance. We performed multivariate analysis of prescribing error rates to determine associations with interruptions and multitasking, also considering physician seniority, age, psychometric measures, workload and sleep.

Results

Physicians experienced 7.9 interruptions/hour. 28 clinicians were observed prescribing 239 medication orders which contained 208 prescribing errors. While prescribing, clinicians were interrupted 9.4 times/hour. Error rates increased significantly if physicians were interrupted (rate ratio (RR) 2.82; 95% CI 1.23 to 6.49) or multitasked (RR 1.86; 95% CI 1.35 to 2.56) while prescribing. Having below-average sleep showed a >15-fold increase in clinical error rate (RR 16.44; 95% CI 4.84 to 55.81). WMC was protective against errors; for every 10-point increase on the 75-point OSPAN, a 19% decrease in prescribing errors was observed. There was no effect of polychronicity, workload, physician gender or above-average sleep on error rates.

Conclusion

Interruptions, multitasking and poor sleep were associated with significantly increased rates of prescribing errors among emergency physicians. WMC mitigated the negative influence of these factors to an extent. These results confirm experimental findings in other fields and raise questions about the acceptability of the high rates of multitasking and interruption in clinical environments.
Digital pathology access and usage in the UK: results from a national survey on behalf of the National Cancer Research Institute’s CM-Path initiative
Authors: Williams Bethany Jill , Lee Jessica , Oien Karin A , Treanor Darren
Published: January 2018

Aim

To canvass the UK pathology community to ascertain current levels of digital pathology usage in clinical and academic histopathology departments, and prevalent attitudes to digital pathology.

Methods

A 15-item survey was circulated to National Health Service and academic pathology departments across the UK using the SurveyMonkey online survey tool. Responses were sought at a departmental or institutional level. Where possible, departmental heads were approached and asked to complete the survey, or forward it to the most relevant individual in their department. Data were collected over a 6-month period from February to July 2017.

Results

41 institutes from across the UK responded to the survey. 60% (23/39) of institutions had access to a digital pathology scanner, and 60% (24/40) had access to a digital pathology workstation. The most popular applications of digital pathology in current use were undergraduate and postgraduate teaching, research and quality assurance. Investigating the deployment of digital pathology in their department was identified as a high or highest priority by 58.5% of institutions, with improvements in efficiency, turnaround times, reporting times and collaboration in their institution anticipated by the respondents. Access to funding for initial hardware, software and staff outlay, pathologist training and guidance from the Royal College of Pathologists were identified as factors that could enable respondent institutions to increase their digital pathology usage.

Conclusion

Interest in digital pathology adoption in the UK is high, with usage likely to increase in the coming years. In light of this, pathologists are seeking more guidance on safe usage.
U-shaped association between fertility and mortality in a community-based sample of Japanese women
Authors: Konishi Shoko , Ng Chris Fook Sheng , Watanabe Chiho
Published: January 2018

Background

Prospective cohort studies of contemporary populations in both Western and Asian settings have reported a U-shaped association between fertility and mortality. We examined whether an association exists between fertility and all-cause and cause-specific mortality in a sample of Japanese women.

Methods

A prospective cohort study was conducted in one rural and one urban community in Gunma Prefecture, Japan, in 1993. A follow-up survey was conducted in the year 2000 in 4858 women aged 47–77 years, and information on demographic and lifestyle characteristics was collected. Mortality and migration data through December 2008 were obtained. A Cox proportional hazard model was used to examine the relationship between parity and mortality.

Results

Compared with women with 2–4 children (reference group), higher total mortality was observed among women with 0–1 or 5+ children. Low (HR 1.7, 95% CI 1.2 to 2.3) and high (HR 2.1, 95% CI 1.0 to 4.7) parities were both associated with higher all-cause mortality even after adjusting for potential confounders. Mortality due to ischaemic heart disease exhibited a significant association with parity; the HRs were 3.2 (95% CI 1.1 to 9.2) for women with 0–1 child and 8.7 (95% CI 1.7 to 45.5) for women with 5 or more children. No significant association was observed for mortality from malignancies, cancer of the digestive system, cardiovascular disease or cerebrovascular disease.

Conclusions

There exists a U-shaped association between parity and all-cause mortality and cause-specific mortality due to ischaemic heart disease among Japanese women.
Moderate use of alcohol is associated with lower levels of C reactive protein but not with less severe joint inflammation: a cross-sectional study in early RA and healthy volunteers
Authors: Mangnus Lukas , van Steenbergen Hanna W , Nieuwenhuis Wouter P , Reijnierse Monique , van der Helm-van Mil Annette H M
Published: January 2018

Objectives

Moderate alcohol consumption is protective against rheumatoid arthritis (RA) development and associated with lower levels of systemic inflammation in RA and in the general population. We therefore hypothesised that moderate alcohol consumption is associated with less severe local inflammation in joints in RA, detected by MRI. Since asymptomatic persons can have low-grade MRI-detected inflammation, we also hypothesised that alcohol consumption is associated with the extent of MRI inflammation in asymptomatic volunteers.

Methods

188 newly presenting patients with RA and 192 asymptomatic volunteers underwent a unilateral contrast-enhanced 1.5T MRI of metacarpophalangeal, wrist and metatarsophalangeal joints. The MRIs were scored on synovitis, bone marrow oedema and tenosynovitis; the sum of these yielded the MRI inflammation score. MRI data were evaluated in relation to current alcohol consumption, categorised as non-drinkers, consuming 1–7 drinks/week, 8–14 drinks/week and >14 drinks/week. Association between C reactive protein (CRP) level and alcohol was studied in 1070 newly presenting patients with RA.

Results

Alcohol consumption was not associated with the severity of MRI-detected inflammation in hand and foot joints of patients with RA (P=0.55) and asymptomatic volunteers (P=0.33). A J-shaped curve was observed in the association between alcohol consumption and CRP level, with the lowest levels in patients consuming 1–7 drinks/week (P=0.037).

Conclusion

Despite the fact that moderate alcohol consumption has been shown protective against RA, and our data confirm a J-shaped association of alcohol consumption with CRP levels in RA, alcohol was not associated with the severity of joint inflammation. The present data suggest that the pathophysiological mechanism underlying the effect of alcohol consists of a systemic effect that might not involve the joints.
Long-term persistence of TNF-inhibitor treatment in patients with psoriatic arthritis. Data from the British Society for Rheumatology Biologics Register
Authors: Fagerli Karen Minde , Kearsley-Fleet Lianne , Watson Kath D , Packham Jon , Contributors Group BSRBR-RA , Symmons Deborah P M , Hyrich Kimme L
Published: January 2018

Background

Long-term effectiveness of tumour necrosis factor alpha inhibitors (TNFi) has mainly been explored in patients with rheumatoid arthritis (RA) and the data available on patients with psoriatic arthritis (PsA) includes limited follow-up.

Objective

Investigate long-term effectiveness of first TNFi in a PsA population by describing treatment persistence, identify factors associated with 5-year persistence and further investigate comparative long-term effectiveness of subsequent TNFi treatments through persistence to treatment.

Methods

Patients with a rheumatologist diagnosis of PsA receiving their first TNFi registered in the British Society for Rheumatology Biologics Register (BSRBR) (2002–2006) were included. Treatment at different time points was described and factors associated with 5-year treatment persistence were identified by logistic regression. Kaplan-Meier analysis was used to assess factors associated with persistence to first TNFi and subsequent TNFi treatments.

Results

At 5 years, 46.7% of patients were still on their initial TNFi treatment. Better 5 -year persistence was associated with male gender, use of etanercept or adalimumab rather than infliximab and absence of baseline comorbidity. Five-year persistence estimates (95% CI) of first, second and third TNFi were 53% (49% to 57%), 60% (43% to 57%) and 48% (36% to 59%), respectively.

Conclusion

We found good long-term persistence of TNFi in this PsA population both for the first and subsequent TNFi treatments. The relationship between persistence and relevant clinical factors was not strong and demonstrates the difficulties in predicting outcome of TNFi treatment in PsA.
Epidemiological characteristics and financial costs of the 1997 foot‐and‐mouth disease epidemic in Taiwan
Authors: Yang P. C. , Chu R. M. , Chung W. B. , Sung H. T.
Published: January 2018

Between March and July 1997, a devastating outbreak of foot‐and‐mouth disease (FMD), serotype O, occurred in pigs in Taiwan. A total of 6147 pig farms with more than 4 million pigs were infected, and 37.7 per cent of the pigs in Taiwan either died (0.18 million pigs) or were killed (3.85 million pigs). The epidemic reached its peak during the fifth week after it was first recognised. During the eighth and ninth weeks, a two‐dose blanket vaccination programme was instituted which led to a large reduction in new outbreaks. Except for two cities, the whole of Taiwan was declared an FMD‐infected zone. During the four months in which new farm outbreaks occurred, 21.7 per cent of the pigs on infected farms showed clinical signs, and there was an overall mortality of 3.95 per cent. During the early stages ofthe epidemic, the incubation period was as short as 24 hours and the case fatality rates for suckling piglets reached 100 per cent. The financial cost ofthe epidemic was estimated at US$ 378.6 million, including indemnities, vaccines, carcase disposal plus environmental protection, miscellaneous expenses, and loss of market value. Owing to the ban on exports of pork to Japan, it is estimated that the total economic cost to Taiwan's pig industry will be about US$ 1.6 billion.
A test of the predator satiation hypothesis, acorn predator size, and acorn preference
Authors: Greenberg C.H. , Zarnoch S.J.
Published: January 2018

Mast seeding is hypothesized to satiate seed predators with heavy production and reduce populations with crop failure, thereby increasing seed survival. Preference for red or white oak acorns could influence recruitment among oak species. We tested the predator satiation hypothesis, acorn preference, and predator size by concurrently measuring acorn production, mouse abundance, and white versus red oak acorn removal rates in exclosures allowing access by mice (HW), squirrels and smaller-sized vertebrates (WW), or all-sized vertebrates (C) for 12 years. Annual removal rate varied, but virtually all acorns were eventually removed from all exclosure types all years except one. Acorns were removed more slowly from HW than from WW or C exclosures, indicating that large vertebrates were not major acorn consumers, locally. Red and white oak acorn removal rates were similar except in two years, when red oak acorns were removed more rapidly. Removal slowed with increasing acorn crops, suggesting that heavy crops can “swamp” predators. Removal rate was negatively correlated with crop size the previous fall. A positive trend between mouse abundance and crop size the previous fall was evident; abundance decreased sharply the year following crop failures but not after moderate or heavy crops, suggesting that poor crops can dampen acorn predation the following year.
A field theoretic approach to the energy–momentum–tensor for theories coupled with gravity
Authors: Mukherjee Pradip , Saha Anirban , Roy Amit Singha
Published: January 2018

We provide a field-theoretic algorithm of obtaining energy–momentum–tensor (EMT) for gravitationally coupled scalar field theories. The method is equally applicable to both minimal and non-minimal coupling. The algorithm illuminates the connection between the EMT, obtained by functional variation of the metric, and local balance of energy and momentum.
Stability issues of nonlocal gravity during primordial inflation
Authors: Belgacem Enis , Cusin Giulia , Foffa Stefano , Maggiore Michele , Mancarella Michele
Published: January 2018

We study the cosmological evolution of some nonlocal gravity models, when the initial conditions are set during a phase of primordial inflation. We examine in particular three models, the so-called RT, RR and [Formula: see text] models, previously introduced by our group. We find that, during inflation, the RT model has a viable background evolution, but at the level of cosmological perturbations develops instabilities that make it nonviable. In contrast, the RR and [Formula: see text] models have a viable evolution even when their initial conditions are set during a phase of primordial inflation.
Properties of size-dependent models having quasiperiodic boundary conditions
Authors: Cavalcanti E. , Linhares C. A. , Malbouisson A. P. C.
Published: January 2018

Boundary condition effects are explored for size-dependent models in thermal equilibrium. Scalar and fermionic models are used for [Formula: see text] (films), [Formula: see text] (hollow cylinder) and [Formula: see text] (ring). For all models, a minimal length is found, below which no thermally-induced phase transition occurs. Using quasiperiodic boundary condition controlled by a contour parameter [Formula: see text] ([Formula: see text] is a periodic boundary condition and [Formula: see text] is an antiperiodic condition), it results that the minimal length depends directly on the value of [Formula: see text]. It is also argued that this parameter can be associated to an Aharonov–Bohm phase.
A New Low Voltage Analog Circuit Model for Hodgkin–Huxley Neuron Employing FGMOS Transistors
Authors: Salmanpour Ava , Farshidi Ebrahim , Asl Karim Ansari
Published: January 2018

A low voltage analog VLSI circuit model for Hodgkin–Huxley (HH) neuron cell equations (HH neuron model) is presented. Floating gate MOSFET (FGMOS) transistors in weak inversion region have been used to model HH equations such as gating variables, [Formula: see text] and [Formula: see text] functions and combined action of [Formula: see text], [Formula: see text] and [Formula: see text]. The combination of [Formula: see text], [Formula: see text] and [Formula: see text] controls the Na[Formula: see text] and K[Formula: see text] channel currents. The superiorities of the proposed circuits are low supply voltage, low power consumption, less circuit complexity and as a result, low costs are compared to the previous works. The proposed circuit which uses 24 transistors is simulated in Hspice software using 0.18[Formula: see text] technology and consumes 119[Formula: see text][Formula: see text]W.
Width of fission-fragment mass yield at simple statistical approach
Authors: Denisov V. Yu. , Belyanovska O. A. , Khomenkov V. P. , Sedykh I. Yu. , Sukhyy K. M.
Published: January 2018

Simple expression for the temperature dependence of the width of fission-fragment mass yields is obtained for high excitation energies. The width depends on the number of nucleons in nuclei, the volume and surface terms of the energy level density parameter, the temperature and the stiffness parameter of the potential related to mass-asymmetric degree of freedom. The contribution of the surface term of the energy level density parameter into the width is important at temperatures [Formula: see text][Formula: see text]MeV.
KAPow
Authors: Davis James J. , Hung Eddie , Levine Joshua M. , Stott Edward A. , Cheung Peter Y. K. , Constantinides George A.
Published: January 2018

In an FPGA system-on-chip design, it is often insufficient to merely assess the power consumption of the entire circuit by compile-time estimation or runtime power measurement. Instead, to make better decisions, one must understand the power consumed by each module in the system. In this work, we combine measurements of register-level switching activity and system-level power to build an adaptive online model that produces live breakdowns of power consumption within the design. Online model refinement avoids time-consuming characterization while also allowing the model to track long-term operating condition changes. Central to our method is an automated flow that selects signals predicted to be indicative of high power consumption, instrumenting them for monitoring. We named this technique KAPow, for ‘K’ounting Activity for Power estimation, which we show to be accurate and to have low overheads across a range of representative benchmarks. We also propose a strategy allowing for the identification and subsequent elimination of counters found to be of low significance at runtime, reducing algorithmic complexity without sacrificing significant accuracy. Finally, we demonstrate an application example in which a module-level power breakdown can be used to determine an efficient mapping of tasks to modules and reduce system-wide power consumption by up to 7%.