bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of class I and II HLA alleles and haplotypes with susceptibility to vitiligo: a study of patients with vitiligo from southeast Brazil
Authors: Ramire Leandro D. , Marcos Elaine V. C. , Godoy Deise A. S. , de Souza‐Santana Fabiana C.
Published: January 2016

Background

The association of vitiligo with the HLA complex has been previously described in various populations worldwide. However, until now, no similar study has been conducted in Brazil. The aim of this study was to determine the association of HLA alleles with vitiligo in the population of southeast Brazil.

Methods

DNA samples from 116 patients with vitiligo and 243 healthy controls were obtained using the salting‐out technique. HLA class I (A*, B*, C*) and class II (DRB1* and DQB1*) alleles were amplified by polymerase chain reaction with specific oligonucleotide sequences.

Results

The case–control study identified susceptibility associations with alleles HLA‐A*02 (P = 0.0001, Pc = 0.0020, odds ratio [OR] = 2.68, 95% confidence interval [CI] = 1.69–4.26) and HLA‐DRB1*07 (P = 0.0001, Pc = 0.0013, OR = 2.69, 95% CI = 1.66–4.34). The alleles HLA‐A*32 (P = 0.0156, Pc = 0.3120, OR = 22.43, 95% CI = 1.12–449.46) and HLA‐DQB1*06 (P = 0.0207, Pc = 0.1035, OR = 0.28, 95% CI = 0.10–0.81) were associated with both localized and generalized vitiligo. The haplotype analysis revealed that A*02‐B*51‐C*15‐DRB1*07‐DQB1*02 (P = 0.0113), A*02‐B*15‐C*07‐DRB1*13‐DQB1*06 (P = 0.0340), and A*29‐B*44‐C*16‐DRB1*07‐DQB1*02 (P = 0.0340) were associated with a predisposition to the disease.

Conclusions

Our results show that HLA alleles and haplotypes may contribute to the pathogenesis of vitiligo in the Brazilian population.
Pressure ulcers in trauma patients with suspected spine injury: a prospective cohort study with emphasis on device‐related pressure ulcers
Authors: Ham Wietske HW , Schoonhoven Lisette , Schuurmans Marieke J , Leenen Luke PH
Published: January 2016

Of all patients in a hospital environment, trauma patients may be particularly at risk for developing (device‐related) pressure ulcers (PUs), because of their traumatic injuries, immobility, and exposure to immobilizing and medical devices. Studies on device‐related PUs are scarce. With this study, the incidence and characteristics of PUs and the proportion of PUs that are related to devices in adult trauma patients with suspected spinal injury were described. From January–December 2013, 254 trauma patients were visited every 2 days for skin assessment. The overall incidence of PUs was 28·3% (n = 72/254 patients). The incidence of device‐related PUs was 20·1% (n = 51), and 13% (n = 33) developed solely device‐related PUs. We observed 145 PUs in total of which 60·7% were related to devices (88/145). Device‐related PUs were detected 16 different locations on the front and back of the body. These results show that the incidence of PUs and the proportion of device‐related PUs is very high in trauma patients.
Accounting for actions and omissions: a discourse analysis of student nurse accounts of responding to instances of poor care
Authors: Ion Robin , Smith Kate , Moir Jim , Nimmo Sheila
Published: January 2016

Aims

To explore how nursing students account for decisions to report or not report poor care witnessed on placement and to examine the implications of findings for educators.

Background

Concern has been raised about the extent to which cases of poor care go unreported. Failure to report cases may have serious consequences for patient safety.

Design

Semistructured interviews were conducted with 13 undergraduate students at a UK university during 2013. They were asked to consider their response to episodes of poor practice witnessed on placement.

Methods

Data were transcribed verbatim and categorized according to whether or not students reported concerns. Cases were analysed in accordance with Potter and Wetherall's version of discourse analysis to identify the discursive strategies used to account for decisions to report or not report poor practice.

Results

Participants took care to present themselves in a positive light regardless of whether or not they had reported an episode of concern. Those who had reported tended to attribute their actions to internal factors such as moral strength and a commitment to a professional code. Those who had not or would not report concerns provided accounts which referred to external influences that prevented them from doing so or made reporting pointless.

Conclusion

This study provides information about how students account for their actions and omissions in relation to the reporting of poor care. Findings suggest ways educators might increase reporting of concerns.
Trophic contamination by pyrolytic polycyclic aromatic hydrocarbons does not affect aerobic metabolic scope in zebrafish Danio rerio
Authors: Lucas J. , Bonnieux A. , Lyphout L. , Cousin X. , Miramand P. , Lefrançois C.
Published: January 2016

The effect of trophic exposure to pyrolitic polycyclic aromatic hydrocarbons (PAH) on aerobic metabolism of zebrafish Danio rerio was investigated. There were no significant differences in standard metabolic rate (SMR), active metabolic rate (AMR) or aerobic metabolic scope (AS) at any sublethal concentration of PAH in the diet of adult or juvenile fish. This suggests that under these experimental conditions, exposure to PAH in food did not influence aerobic metabolism of this species.
Experimental methods in aquatic respirometry: the importance of mixing devices and accounting for background respiration
Authors: Rodgers G. G. , Tenzing P. , Clark T. D.
Published: January 2016

In light of an increasing trend in fish biology towards using static respirometry techniques without the inclusion of a mixing mechanism and without accurately accounting for the influence of microbial (background) respiration, this paper quantifies the effect of these approaches on the oxygen consumption rates (ṀO2) measured from juvenile barramundi Lates calcarifer (mean ± s.e. mass = 20·31 ± 0·81 g) and adult spiny chromis damselfish Acanthochromis polyacanthus (22·03 ± 2·53 g). Background respiration changed consistently and in a sigmoidal manner over time in the treatment with a mixing device (inline recirculation pump), whereas attempts to measure background respiration in the non‐mixed treatment yielded highly variable estimates of ṀO2 that were probably artefacts due to the lack of water movement over the oxygen sensor during measurement periods. This had clear consequences when accounting for background respiration in the calculations of fish ṀO2. Exclusion of a mixing device caused a significantly lower estimate of ṀO2 in both species and reduced the capacity to detect differences between individuals as well as differences within an individual over time. There was evidence to suggest that the magnitude of these effects was dependent on the spontaneous activity levels of the fish, as the difference between mixed and non‐mixed treatments was more pronounced for L. calcarifer (sedentary) than for A. polyacanthus (more spontaneously active). It is clear that respirometry set‐ups for sedentary species must contain a mixing device to prevent oxygen stratification inside the respirometer. While more active species may provide a higher level of water mixing during respirometry measurements and theoretically reduce the need for a mixing device, the level of mixing cannot be quantified and may change with diurnal cycles in activity. To ensure consistency across studies without relying on fish activity levels, and to enable accurate assessments of background respiration, it is recommended that all respirometry systems should include an appropriate mixing device.
Careful Conversations and Careful Sex: HIV Posttesting Experiences Among African American Men in Rural Florida
Authors: Aholou Tiffiany M. , Sutton Madeline Y. , Brown Emma (E.J.)
Published: January 2016

Purpose

In the United States, black/African American (black) men bear the greatest burden of human immunodeficiency virus (HIV), accounting for 42% of new HIV infections in 2012 despite being 6% of the population. In Florida, heterosexual HIV transmission has increased among black men. Few studies have examined HIV testing experiences for black heterosexual men (BHM) in the rural South. This study describes the post‐HIV‐testing trial experiences of BHM in rural Florida.

Methods

We conducted 12 focus groups (4‐7 participants per group) in 3 rural Florida counties with BHM who participated in a larger randomized HIV testing trial. Interviews were professionally transcribed and data were analyzed using NVivo 10. The qualitative analysis was informed by the strengths perspective (ie, emphasis on abilities rather than risks) and used a thematic analytical approach.

Results

Sixty‐seven men participated (median age 41.5 years); 39 (58%) earned a monthly income of less than $500, 38 (57%) attained education through high school or higher, 37 (55%) were unmarried, and 40 (60%) reported practicing monogamy; all who tested for HIV were negative for HIV. We identified 3 main themes based on self‐reported actions: (1) risk reduction (eg, more consistent condom use, fewer sex partners), (2) sexual health communications with sex partners (eg, negotiating HIV testing with sex partners, getting to know partners better), and (3) health communications with peers and family (eg, disclosing test results, encouraging others to get tested).

Conclusions

Among BHM, being in this HIV testing study facilitated increased protective behaviors and communications for HIV prevention. Interventions for BHM in rural areas warrant incorporating these strategies to encourage routine HIV testing.
Avr4 promotes Cf‐4 receptor‐like protein association with the BAK1/SERK3 receptor‐like kinase to initiate receptor endocytosis and plant immunity
Authors: Postma Jelle , Liebrand Thomas W. H. , Bi Guozhi , Evrard Alexandre , Bye Ruby R. , Mbengue Malick , Kuhn Hannah , Joosten Matthieu H. A. J. , Robatzek Silke
Published: January 2016

The first layer of plant immunity is activated by cell surface receptor‐like kinases (RLKs) and proteins (RLPs) that detect infectious pathogens. Constitutive interaction with the SUPPRESSOR OF BIR1 (SOBIR1) RLK contributes to RLP stability and kinase activity. As RLK activation requires transphosphorylation with a second associated RLK, it remains elusive how RLPs initiate downstream signaling.

We employed live‐cell imaging, gene silencing and coimmunoprecipitation to investigate the requirement of associated kinases for functioning and ligand‐induced subcellular trafficking of Cf RLPs that mediate immunity of tomato against Cladosporium fulvum.

Our research shows that after elicitation with matching effector ligands Avr4 and Avr9, BRI1‐ASSOCIATED KINASE 1/SOMATIC EMBRYOGENESIS RECEPTOR KINASE 3 (BAK1/SERK3) associates with Cf‐4 and Cf‐9. BAK1/SERK3 is required for the effector‐triggered hypersensitive response and resistance of tomato against C. fulvum. Furthermore, Cf‐4 interacts with SOBIR1 at the plasma membrane and is recruited to late endosomes upon Avr4 trigger, also depending on BAK1/SERK3.

These observations indicate that RLP‐mediated resistance and endocytosis require ligand‐induced recruitment of BAK1/SERK3, reminiscent of BAK1/SERK3 interaction and subcellular fate of the FLAGELLIN SENSING 2 (FLS2) RLK. This reveals that diverse classes of cell surface immune receptors share common requirements for initiation of resistance and endocytosis.
NADPH oxidases differentially regulate ROS metabolism and nutrient uptake under cadmium toxicity
Authors: Gupta D. K. , Pena L. B. , Romero‐Puertas M. C. , Hernández A. , Inouhe M. , Sandalio L. M.
Published: January 2016

The role of NADPH oxidases under cadmium (Cd) toxicity was studied using Arabidopsis thaliana mutants AtrbohC, AtrbohD and AtrbohF, which were grown under hydroponic conditions with 25 and 100 μM Cd for 1 and 5 days. Cadmium reduced the growth of leaves in WT, AtrbohC and D, but not in AtrbohF. A time‐dependent increase in H2O2 and lipid peroxidation was observed in all genotypes, with AtrbohC showing the smallest increase. An opposite behaviour was observed with NO accumulation. Cadmium increased catalase activity in WT plants and decreased it in Atrboh mutants, while glutathione reductase and glycolate oxidase activities increased in Atrboh mutants, and superoxide dismutases were down‐regulated in AtrbohC. The GSH/GSSG and ASA/DHA couples were also affected by the treatment, principally in AtrbohC and AtrbohF, respectively. Cadmium translocation to the leaves was severely reduced in Atrboh mutants after 1 day of treatment and even after 5 days in AtrbohF. Similar results were observed for S, P, Ca, Zn and Fe accumulation, while an opposite trend was observed for K accumulation, except in AtrbohF. Thus, under Cd stress, RBOHs differentially regulate ROS metabolism, redox homeostasis and nutrient balance and could be of potential interest in biotechnology for the phytoremediation of polluted soils.
From Social Instrument to Migration Management Tool: Assisted Voluntary Return Programmes – The Case of Belgium
Authors: Lietaert Ine , Broekaert Eric , Derluyn Ilse
Published: January 2016

The return of migrants to their country of origin and the development of efficient return measures have become more prominent on the political agenda of many Western European countries. Since policymakers prefer ‘voluntary’ return, governmental programmes to support the return of migrants – Assisted Voluntary Return (AVR) programmes – were developed as far back as the 1970s and have played an increasingly important role in migration policy over the last three decades. At the same time, general migration policy and welfare systems have undergone profound change, including in the meanings and connotations attached to social welfare, return support and return policy. This raises questions about the implications of these broader societal and policy changes for the widely implemented AVR programmes. In this article, we discuss the interpretation and evolution of AVR programmes by analyzing how one particular European country, Belgium, has developed its AVR programme over time. We explore the evolution of the programme's content, target group and institutional positioning, which shed light on its changing goals and are closely linked to a broader shift towards a ‘managerial’ approach to migration policy and the welfare state. We argue that return support may become decontextualized when it adopts ‘conditional entitlement’ as a central principle. This leads to strong differentiation, based on personal responsibility, between ‘deserving’ and ‘undeserving’ migrants, the levelling down of the support given to returnees, and a more coercive voluntary return policy in which social support is linked to deportation.
Buffy coat smear or Knott's test: which to choose for canine microfilaria screening in field studies?
Authors: Marcos Ricardo , Pereira Cristina , Santos Marta , Luzzago Camilla , Lauzi Stefania , Maia João P. , Faustino Augusto , Puente‐Payo Pablo
Published: January 2016

Background

In recent years, an increasing number of cases of canine dirofilariasis have been reported worldwide. However, the rate of infection in dogs is largely unknown in many remote areas, and the importance of field studies for determination of the prevalence of canine dirofilariasis in such areas is well recognized. The detection of microfilariae by the modified Knott's test (MKT) is a recommended screening method for canine dirofilariasis.

Objectives

The purposes of this study were to compare the diagnostic sensitivity of the MKT with the buffy coat smear method (BCS), and to evaluate the utility of these 2 methods under field study conditions.

Methods

One hundred and fifty dogs of the Maio Island of Republic of Cabo Verde, were screened for microfilariae using MKT and BCS. The results of the 2 methods were generated in a blinded manner and statistically compared.

Results

The detection rate was 4.67% with the MKT and 5.33% with BCS, which is statistically not different. The latter allowed a morphologic identification of Dirofilaria repens (later confirmed by molecular biology methods) and an estimation of parasite load, which varied from 15 to 185 microfilariae/mL.

Conclusions

The methods MKT and BCS were comparable in terms of diagnostic sensitivity. However, the BCS was technically less demanding and produced permanent preparations, in which co‐infection with other hematologic pathogens can easily be assessed. Overall, this method is well suited to assess microfilariae in a large number of animals, and it could replace the MKT in studies devoted to dirofilariasis.
Modeling complete removal of risk assessment questions in the USA predicts the risk of HIV exposure in blood recipients could increase despite the use of nucleic acid testing
Authors: Yang H. , Anderson S. A. , Forshee R. , Williams A. , Epstein J. S. , Marks P. W.
Published: January 2016

Background and Objectives

The safety of the blood supply in a number of countries is achieved by interventions that include behaviour‐based time‐limited or indefinite deferrals and screening of donated units for transfusion‐transmitted infections. The relatively high sensitivity of nucleic acid testing (NAT) used in blood donor screening has raised the question of whether such time‐based deferrals can be eliminated in favour of individual risk assessment.

Materials and Methods

Data on the annual number of incident human immunodeficiency virus (HIV) infections associated with various behaviours and on the performance characteristics of NAT applied to donor screening were used to model the number of potentially infected units that might escape detection in the worst‐case scenario in which individual risk assessment was implemented, but was not effective as a screening tool, and donors did not otherwise self‐select for lower risk.

Results

In the absence of effective individual risk‐based screening or donor self‐selection, the model predicts that in the United States, an additional 39 (95% CI 35–43) HIV‐infected units would escape detection by nucleic acid testing, potentially capable of exposing approximately 68 (95% CI 61–75) individuals to the risk of HIV infection through the administration of prepared blood components.

Conclusion

Despite some inherent uncertainty, the worst‐case scenario of completely ineffective individual risk assessment, absence of donor self‐selection and increased reliance on NAT for blood screening is estimated to be associated with an approximately fourfold increase in the risk of HIV exposure through transfusion in the United States.
Effect of Arthroscopic Lavage on Systemic and Synovial Fluid Serum Amyloid A in Healthy Horses
Authors: Sanchez‐Teran Andres F. , Bracamonte José L. , Hendrick Steven , Burguess Hilary J. , Duke‐Novakovski Tanya , Schott Monica , Hoff Brent , Rubio‐Martínez Luis M.
Published: January 2016

Objective

To evaluate the effect of arthroscopic lavage on systemic serum amyloid A (SAA) and SAA, total protein, nucleated cell count, and percentage of neutrophils in synovial fluid in healthy horses.

Study Design

Prospective experimental study.

Animals

Healthy adult horses (n = 6).

Methods

Middle carpal joints were randomly assigned to 1 of 2 treatments: arthrocentesis (controls) or arthroscopic lavage, with 30 day washout period between treatments. Synovial fluid and blood samples were collected at 0, 24, 48, 72, 96, and 120 hours. Measurements included systemic and synovial fluid SAA, as well as total protein, nucleated cell count, and percentages of neutrophils in synovial fluid. Data were analyzed by median quantile regression and Wilcoxon signed‐rank test and significance level set atP < .05.

Results

Systemic and synovial fluid SAA did not increase from baseline (except systemic SAA at 24 hours for both treatments) and were not significantly different between treatments. Total protein values were significantly increased after arthroscopic lavage (except at 96 hours) but not in controls at all time points. With both treatments, nucleated cell counts significantly increased from baseline values at all time points. Percentages of neutrophils were significantly increased after arthroscopic lavage at all time points, but only at 24 hours in controls.

Conclusion

Total protein, nucleated cell count, and percentage of neutrophils in synovial fluid were significantly increased after arthroscopic lavage; however, synovial fluid SAA was not affected by this procedure. Further research is warranted to validate synovial fluid SAA as a monitoring tool during treatment of septic arthritis.
Arthroscopic, Computed Tomography, and Radiographic Findings in 25 Dogs With Lameness After Arthroscopic Treatment of Medial Coronoid Disease
Authors: Coppieters Eva , Seghers Hanna , Verhoeven Geert , Gielen Ingrid , Samoy Yves , de Bakker Evelien , Van Ryssen Bernadette
Published: January 2016

Objective

To describe the radiographic, computed tomography (CT), and arthroscopic findings in the elbow of dogs admitted for elbow lameness after previous arthroscopic treatment of medial coronoid disease (MCD).

Study Design

Retrospective case series.

Animals

Client‐owned dogs (n = 25) admitted for elbow lameness after arthroscopic treatment.

Methods

Clinical records (2005–2009), including radiographs, CT images, and arthroscopic findings, from the first and second presentation of dogs diagnosed with medial coronoid disease were searched and reviewed.

Results

Twenty‐nine joints were included in this study. The mean age at first treatment was 2.2 years. Second presentation was at a mean of 2.7 years later and progressive osteoarthritis and cartilage damage was noticed in all joints. Arthroscopic findings included a calcified body in 11/29 joints (38%), multiple small calcified bodies in 1/29 joint (3%), loose scar tissue in 12/29 joints (42%), and immobile scar tissue in 2/29 joints (7%). Three of 29 joints (10%) did not have any calcified body or loose scar tissue found but had erosion of the medial compartment as the only pathology diagnosed in the coronoid region. Characteristics of flexor enthesopathy were identified in 9/29 joints (31%).

Conclusion

Arthroscopic treatment of MCD, even with limited cartilage lesions, may not resolve lameness in some dogs. Calcified bodies or loose scar tissue near the medial coronoid process are a frequent followup finding in these joints.
Conformability of a Thin Elastic Membrane Laminated on a Soft Substrate With Slightly Wavy Surface
Authors: Wang Liu , Lu Nanshu
Published: January 2016

When laminating a thin elastic membrane on a substrate with surface roughness, three scenarios can happen: fully conformed (FC), i.e., the membrane completely follows the surface morphology of the substrate without any interfacial gap, nonconformed (NC), i.e., the membrane remains flat if gravity is not concerned, and partially conformed (PC). Good conformability can enhance effective membrane-to-substrate adhesion strength and can facilitate signal/heat/mass transfer across the interface, which are of great importance to soft electronics laminated on rough bio-tissues. To reveal governing parameters in this problem and to predict conformability, energy minimization is implemented after successfully finding the substrate elastic energy under partially conformable contact. Four dimensionless governing parameters involving the substrate roughness, membrane thickness, membrane and substrate elastic moduli, and membrane-to-substrate intrinsic work of adhesion have been identified to analytically predict the conformability status and the area of contact. The analytical prediction has found excellent agreement with experimental observations. In summary, an experimentally validated quantitative guideline for the conformability of elastic membrane on soft corrugated substrate has been established in the four-parameter design space.
Biomechanics of Step Initiation After Balance Recovery With Implications for Humanoid Robot Locomotion
Authors: Miller Buffinton Christine , Buffinton Elise M. , Bieryla Kathleen A. , Pratt Jerry E.
Published: January 2016

Balance-recovery stepping is often necessary for both a human and humanoid robot to avoid a fall by taking a single step or multiple steps after an external perturbation. The determination of where to step to come to a complete stop has been studied, but little is known about the strategy for initiation of forward motion from the static position following such a step. The goal of this study was to examine the human strategy for stepping by moving the back foot forward from a static, double-support position, comparing parameters from normal step length (SL) to those from increasing SLs to the point of step failure, to provide inspiration for a humanoid control strategy. Healthy young adults instrumented with joint reflective markers executed a prescribed-length step from rest while marker positions and ground reaction forces (GRFs) were measured. The participants were scaled to the Gait2354 model in opensim software to calculate body kinematic and joint kinetic parameters, with further post-processing in matlab. With increasing SL, participants reduced both static and push-off back-foot GRF. Body center of mass (CoM) lowered and moved forward, with additional lowering at the longer steps, and followed a path centered within the initial base of support (BoS). Step execution was successful if participants gained enough forward momentum at toe-off to move the instantaneous capture point (ICP) to within the BoS defined by the final position of both feet on the front force plate. All lower extremity joint torques increased with SL except ankle joint. Front knee work increased dramatically with SL, accompanied by decrease in back-ankle work. As SL increased, the human strategy changed, with participants shifting their CoM forward and downward before toe-off, thus gaining forward momentum, while using less propulsive work from the back ankle and engaging the front knee to straighten the body. The results have significance for human motion, suggesting the upper limit of the SL that can be completed with back-ankle push-off before additional knee flexion and torque is needed. For biped control, the results support stability based on capture-point dynamics and suggest strategy for center-of-mass trajectory and distribution of ground force reactions that can be compared with robot controllers for initiation of gait after recovery steps.
Evolutionary Optimization of Model Parameters for Electro-Injectors in Common Rail Diesel Engines
Authors: Lino Paolo , Maione Guido , Saponaro Fabrizio , Li Kang
Published: January 2016

One of the main issues in the design, modeling, and control of innovative automotive engines is to reduce energy consumption and emission of pollutants and, at the same time, to guarantee a high level of performance indices. In particular, enhanced model-based control of the injection process has been a hot research topic in recent years to increase the combustion efficiency in common rail (CR) diesel engines and to meet strict legislations. This paper focuses on the development of a more accurate model for the electro-injector in CR diesel engines. The model takes into account the mechanical deformation of relevant parts of the electro-injector and the nonlinear fuel flow. Model parameters are then optimized by an evolutionary strategy. Simulation results confirm that the optimized model can be helpful for predicting the real trend of the injected fuel flow rate, evidenced by experimental data, thus can be helpful for injection control of CR diesel engines.
Experimental Investigation of Steam Ejector System With an Extra Low Generating Temperature
Authors: Dong Jingming , Kang C. L. , Wang H. M. , Ma H. B.
Published: January 2016

A steam ejector system is environmentally friendly but limited to utilizing thermal energy with a temperature typically ranging from 100 °C to 200 °C. As the steam generating temperature decreases, the utilization of the thermal energy from such a low-temperature heat source becomes very challenging. In this investigation, an experimental steam ejector system was designed and constructed to investigate the performance of the ejector system with water as the working fluid at steam generating temperatures ranging from 40 °C to 60 °C. A convergent nozzle and a de Laval nozzle were used in the steam ejector as the primary nozzles, respectively. The experimental results show that the steam ejector at a generating temperature ranging from 40 °C to 60 °C can function. The performance of the convergent nozzle is a little better than that of the de Laval nozzle in most cases at the given working condition. For power plant or desalination system applications, the system coefficient of performance (COP) of the ejector with convergent nozzle could reach 3.06 when the steam generating temperature is 40 °C and the evaporator temperature is 25 °C. For refrigeration application, the ejector with a de Laval nozzle can achieve a system COP of 0.21 and 0.4 at a generating temperature of 60 °C. The results of this investigation enabled a better understanding of system performance characteristics in a steam ejector system at a generating temperature below 100 °C.
Absolute measurement of LDR brachytherapy source emitted power: Instrument design and initial measurements
Authors: Malin Martha J. , Palmer Benjamin R. , DeWerd Larry A.
Published: January 2016

Purpose:

Energy‐based source strength metrics may find use with model‐based dose calculation algorithms, but no instruments exist that can measure the energy emitted from low‐dose rate (LDR) sources. This work developed a calorimetric technique for measuring the power emitted from encapsulated low‐dose rate, photon‐emitting brachytherapy sources. This quantity is called emitted power (EP). The measurement methodology, instrument design and performance, and EP measurements made with the calorimeter are presented in this work.

Methods:

A calorimeter operating with a liquid helium thermal sink was developed to measure EP from LDR brachytherapy sources. The calorimeter employed an electrical substitution technique to determine the power emitted from the source. The calorimeter's performance and thermal system were characterized. EP measurements were made using four 125I sources with air‐kerma strengths ranging from 2.3 to 5.6 U and corresponding EPs of 0.39–0.79 μW, respectively. Three Best Medical 2301 sources and one Oncura 6711 source were measured. EP was also computed by converting measured air‐kerma strengths to EPs through Monte Carlo‐derived conversion factors. The measured EP and derived EPs were compared to determine the accuracy of the calorimeter measurement technique.

Results:

The calorimeter had a noise floor of 1–3 nW and a repeatability of 30–60 nW. The calorimeter was stable to within 5 nW over a 12 h measurement window. All measured values agreed with derived EPs to within 10%, with three of the four sources agreeing to within 4%. Calorimeter measurements had uncertainties ranging from 2.6% to 4.5% at the k = 1 level. The values of the derived EPs had uncertainties ranging from 2.9% to 3.6% at the k = 1 level.

Conclusions:

A calorimeter capable of measuring the EP from LDR sources has been developed and validated for 125I sources with EPs between 0.43 and 0.79 μW.
Part 5: Targeting Cancer Pathways: Understanding Immune Checkpoints
Authors: Allison James P. , Freeman Gordon J. , Gotwals Philip J.
Published: January 2016

This webinar is the fifth in a series focusing on the cancer pathways that support tumor development, the emerging research in identifying and targeting these pathways, and innovations in the development of increasingly effective cancer therapy options. Recent advances in our understanding of cancer have revealed that the disease cannot be understood through simple analysis of genetic mutations within cancerous cells. Instead, tumors should be considered as complex tissues in which the cancer cells communicate directly and indirectly with the surrounding cellular microenvironment and evolve traits that promote their own survival. In this webinar, we will explore how tumors exploit immune modulatory mechanisms to generate and thrive in their own immunosuppressive microenvironment. Further, we will examine how these mechanisms can be targeted to develop better therapeutic options.

View the Webinar
Complete Genome and Plasmid Sequences of Three Canadian Isolates of Salmonella enterica subsp.
enterica
Serovar Heidelberg from Human and Food Sources
Authors: Labbé Geneviève , Edirmanasinghe Romaine , Ziebell Kim , Nash John H. E. , Bekal Sadjia , Parmley E. Jane , Mulvey Michael R. , Johnson Roger P.
Published: January 2016

Isolates of
Salmonella enterica
subsp.
enterica
serovar Heidelberg are often associated with poultry products and may cause severe human illness. Here, we report the fully assembled genome and plasmid sequences of three
S
. Heidelberg strains with phage types 9, 29, and 41.
Cross-sectional associations between high-deprivation home and neighbourhood environments, and health-related variables among Liverpool children
Authors: Noonan Robert J , Boddy Lynne M , Knowles Zoe R , Fairclough Stuart J
Published: January 2016

Objectives

(1) To investigate differences in health-related, home and neighbourhood environmental variables between Liverpool children living in areas of high deprivation (HD) and medium-to-high deprivation (MD) and (2) to assess associations between these perceived home and neighbourhood environments and health-related variables stratified by deprivation group.

Design

Cross-sectional study.

Setting

10 Liverpool primary schools in 2014.

Participants

194 children aged 9–10 years.

Main outcome measures

Health-related variables (self-reported physical activity (PA) (Physical Activity Questionnaire for Older Children, PAQ-C), cardiorespiratory fitness, body mass index (BMI) z-scores, waist circumference), home environment variables: (garden/backyard access, independent mobility, screen-based media restrictions, bedroom media) and neighbourhood walkability (Neighbourhood Environment Walkability Scale for Youth, NEWS-Y).

Explanatory measures

Area deprivation.

Results

There were significant differences between HD and MD children's BMI z-scores (p<0.01), waist circumference (p<0.001) and cardiorespiratory fitness (p<0.01). HD children had significantly higher bedroom media availability (p<0.05) and independent mobility scores than MD children (p<0.05). MD children had significantly higher residential density and neighbourhood aesthetics scores, and lower crime safety, pedestrian and road traffic safety scores than HD children, all of which indicated higher walkability (p<0.01). HD children's BMI z-scores (β=−0.29, p<0.01) and waist circumferences (β=−0.27, p<0.01) were inversely associated with neighbourhood aesthetics. HD children's PA was negatively associated with bedroom media (β=−0.24, p<0.01), and MD children's PA was positively associated with independent mobility (β=0.25, p<0.01). MD children's independent mobility was inversely associated with crime safety (β=−0.28, p<0.01) and neighbourhood aesthetics (β=−0.24, p<0.05).

Conclusions

Children living in HD areas had the least favourable health-related variables and were exposed to home and neighbourhood environments that are unconducive to health-promoting behaviours. Less access to bedroom media equipment and greater independent mobility were strongly associated with higher PA in HD and MD children, respectively. Facilitating independent mobility and encouraging outdoor play may act as effective strategies to enhance PA levels and reduce sedentary time in primary school-aged children.
Non-psychotropic medication and risk of suicide or attempted suicide: a systematic review
Authors: Gorton Hayley C , Webb Roger T , Kapur Navneet , Ashcroft Darren M
Published: January 2016

Objectives

To establish which non-psychotropic medications have been assessed in relation to risk of suicide or attempted suicide in observational studies, document reported associations and consider study strengths and limitations.

Design

Systematic review.

Methods

Four databases (Embase, Medline, PsycINFO and International Pharmaceutical Abstracts) were searched from 1990 to June 2014, and reference lists of included articles were hand-searched. Case–control, cohort and case only studies which reported suicide or attempted suicide in association with any non-psychotropic medication were included.

Outcome measures

The outcomes eligible for inclusion were suicide and attempted suicide, as defined by the authors of the included study.

Results

Of 11 792 retrieved articles, 19 were eligible for inclusion. Five studies considered cardiovascular medication and antiepileptics; two considered leukotriene receptor antagonists, isotretinoin and corticosteroids; one assessed antibiotics and another assessed varenicline. An additional study compared multiple medications prescribed to suicide cases versus controls. There was marked heterogeneity in study design, outcome and exposure classification, and control for confounding factors; particularly comorbid mental and physical illness. No increased risk was associated with cardiovascular medications, but associations with other medications remained inconclusive and meta-analysis was inappropriate due to study heterogeneity.

Conclusions

Whether non-psychotropic medications are associated with increased risk of suicide or attempted suicide remains largely unknown. Robust identification of suicide outcomes and control of comorbidities could improve quantification of risk associated with non-psychotropic medication, beyond that conferred by underlying physical and mental illnesses.
Prevalence of dry eye disease in visual display terminal workers: a systematic review and meta-analysis
Authors: Courtin Romain , Pereira Bruno , Naughton Geraldine , Chamoux Alain , Chiambaretta Frédéric , Lanhers Charlotte , Dutheil Frédéric
Published: January 2016

Objective

To evaluate the prevalence and risk factors of dry eye disease (DED) in workers using visual display terminals (VDT).

Design

Systematic review and meta-analysis.

Data sources

We searched PubMed, Cochrane Library, Embase and Science Direct databases for studies reporting DED prevalence in VDT workers.

Results

16 of the 9049 identified studies were included, with a total of 11 365 VDT workers. Despite a global DED prevalence of 49.5% (95% CI 47.5 to 50.6), ranging from 9.5% to 87.5%, important heterogeneity (I2=98.8%, p<0.0001) was observed. Variable diagnosis criteria used within studies were: questionnaires on symptoms, tear film anomalies and corneoconjunctival epithelial damage. Some studies combined criteria to define DED. Heterogeneous prevalence was associated with stratifications on symptoms (I2=98.7%, p<0.0001), tears (I2=98.5%, p<0.0001) and epithelial damage (I2=96.0%, p<0.0001). Stratification of studies with two criteria adjusted the prevalence to 54.0% (95% CI 52.1 to 55.9), whereas studies using three criteria resulted in a prevalence of 11.6% (95% CI 10.5 to 12.9). According to the literature, prevalence of DED was more frequent in females than in males and increased with age.

Conclusions

Owing to the disparity of the diagnosis criteria studied to define DED, the global prevalence of 49.5% lacked reliability because of the important heterogeneity. We highlight the necessity of implementing common DED diagnostic criteria to allow a more reliable estimation in order to develop the appropriate preventive occupational actions.
Improving the inspection and manual cleaning of dental instruments in a dental hospital
Authors: Campbell Louise , Barton Aisling , Boyle Rachael , Tully Vicki
Published: January 2016

Within the dental hospital setting, it is a frequent occurrence to find residual cement contaminating instruments in a newly opened kit having undergone the decontamination cycle. Any instrument found to be contaminated then cannot be used, as the area underneath the cement is not sterile. This in itself has several repercussions. These include: cross-contamination, since there is a chance that the cement will be removed and the contaminated instrument used; cost, as each new kit that will be opened due to contaminated instruments will incur decontamination costs; and finally time, which most importantly has an impact on patient experience. Our baseline data recording focussed on finding out the severity of the problem, which instruments were most affected, and how this affected patient treatment, using a questionnaire. Within the paediatric department, 27% of examination kits contained a contaminated instrument, almost one third of all kits used. This quality improvement project utilized a poster and team huddle discussions to raise awareness of the problem and successfully reduced the number of contaminated instrument kits to 7% over a period of four weeks.
Reduction of referral to assessment time for an older adults community mental health team
Authors: Sin Fai Lam Chun Chiang
Published: January 2016

Anecdotal evidence suggested that waiting times within the older adults community mental health team (OA CMHT) had been increasing over time. An assessment and evaluation was indicated to ensure best quality care was provided for patients.

A comparison was made between waiting times in January to December 2011 compared with August 2013 to July 2014. In 2011 the mean number of days until initial assessment from the point of referral was 12 days for routine cases, and 3.6 days for urgent cases. The re-audit showed the number of days increased to 15.89 days for routine cases, and 9.81 days for urgent cases.

Contributory factors were reviewed, and it was felt that to address this problem, a duty worker role was necessary. The role of the duty worker was divided into triaging and allocating work. The triaging process was to ensure all urgent cases were highlighted early and acted upon.

The duty worker’s role was also to gather sufficient information from the referrer, to reduce the risks of inadequate knowledge delaying assessment. In addition, the allocating process required the duty worker to designate a clinician in charge of the case upon receipt of referral. This ensured that clinicians were able to offer the earliest possible appointment slot for the initial assessment, and thus reduce waiting times.

Following implementation, findings from September 2014 to February 2015 showed an improvement in average waiting times, as well as an improvement in the percentage of assessments reviewed within previously set standards. For routine reviews, the mean time until assessment was 10.68 days. For urgent reviews, the mean time until initial assessment was 6.8 days. However, it was noted that majority of urgent reviews were still not being reviewed in time.

The outcomes of this study demonstrated an improvement of both waiting times, and percentage of patients being seen within set standards following a single intervention. In the current climate of cost efficiency savings, it is important for services to continue to find ways to streamline and improve upon current practices, to ensure the best outcome for patients.
Importance of patient-centred signage and navigation guide in an orthopaedic and plastics clinic
Authors: Maqbool Talha , Raju Sneha , In Eunji
Published: January 2016

Gulshan & Nanji Orthopaedic and Plastics Center at the North York General Hospital is the second busiest site after the emergency department serving more than 26,000 patients annually. Increase in patient flow, overworked staff, and recent renovations to the hospital have resulted in patients experiencing long wait times, and thusly patient dissatisfaction and stress. Several factors contribute to patient dissatisfaction and stress: i) poor and unfriendly signage; ii) inconsistent utilization of the numbering system; and iii) difficulty navigating to and from the imaging center.

A multidisciplinary QI team was assembled to improve the patient experience. We developed a questionnaire to assess patient stress levels at the baseline. Overall, more than half of the patients (54.8%) strongly agreed or agreed to having a stressful waiting experience. Subsequently, based on patient feedback and staff perspectives, we implemented two PDSA cycles. For PDSA 1, we placed a floor graphic (i.e. black tape) to assist patients in navigating from the clinic to the imaging centre and back. For PDSA 2, we involved creating a single 21”×32” patient-friendly sign at the entrance to welcome patients, with clear instructions outlining registration procedures. Surveys were re-administered to assess patient stress levels. A combination of both interventions caused a statistically significant reduction in patient stress levels based on the Kruskal-Wallis and Mann-Whitney U Tests.

The present project highlighted the importance of involving stakeholders as well as frontline staff when undertaking quality improvement projects as a way to identify bottlenecks as well as establish sustainable solutions. Additionally, the team recognized the importance of incorporating empirical based solutions and involving experts in the field to optimize results. The present project successfully implemented strategies to improve patient satisfaction and reduce stress in a high flow community clinic. These endpoints were achieved by incorporating patient friendly signage, as well as improving patient flow directors.
Analgesia in hip fractures. Do fascia-iliac blocks make any difference?
Authors: Callear Jacqueline , Shah Ku
Published: January 2016

Despite recent national advances in the care for the hip fracture patient, significant morbidity and mortality persists. Some of this morbidity is attributable to the analgesia provided in the hospital setting. The National Institute of Health and Care Excellence and the Association of Anaesthetists of Great Britain and Ireland recommend the use of simple oral analgesia including opioids, with fascia-iliac blocks (FIB) used as an adjunct. Literature review reveals a paucity of evidence on this.

The aim of this project was to evaluate the proportion of patients receiving a fascia-iliac block prior to operative intervention. A secondary aim was to evaluate the efficacy of these blocks through analysis of pre and post-operative opioid usage, post-operative delirium, time to bowel opening, and naloxone use.

Patients who received a fascia-iliac block received significantly less post-operative and total analgesia (p=0.04, p=0.03), had lower rates of delirium (p=0.03) and those patients which were discharged directly home had a shorter inpatient stay (p=0.03). No patients who received a fascia-iliac block (FIB) needed naloxone to reverse opioid toxicity, whilst two without fascia-iliac block did. The results of the project eventually led to the introduction of a hip fracture care pathway which incorporates a single shot fascia-iliac block for all patients who are eligible. Within a two year study period, compliance with fascia-iliac blocks improved from 54% to 90%.

Our experience shows a great improvement in compliance with fascia-iliac blocks in the pre-operative period. This work has also underpinned the introduction of a new hip fracture care pathway ultimately to better patient care and outcomes.