bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic impact of regional lymphadenectomy in canine stage II cutaneous mast cell tumours
Authors: Marconato Laura , Polton Gerry , Stefanello Damiano , Morello Emanuela , Ferrari Roberta , Henriques Joaquim , Tortorella Giovanni , Benali Silvia L. , Bergottini Raffaella , Vasconi Maria E. , Annoni Maurizio , Sabattini Silvia
Published: July 2018

Lymph node (LN) metastasis in canine cutaneous mast cell tumours (cMCTs) is a well‐known negative prognostic factor. The role of lymphadenectomy in the treatment of stage II disease remains controversial because of its uncertain therapeutic benefit. Aim of this retrospective study was to investigate the impact of lymphadenectomy on tumour control and survival for dogs with stage II cMCTs. Dogs with firstly occurring, histologically confirmed cMCT with LN metastasis undergoing resection of the primary tumour and medical treatment thereafter were retrospectively enrolled. Dogs were classified into two groups: LN sampling (LNS; diagnosis of metastasis obtained by cytology) and regional LN dissection (LND; diagnosis obtained by histopathology). To determine the therapeutic value of lymphadenectomy, the characteristics of recurrence (local, nodal and distant) and survival were compared between groups. Evaluated outcome variables included signalment, anatomic location, diameter, ulceration, substage, surgical margins, Patnaik grading, Kiupel grading and medical treatment. Overall, 152 dogs were included: 81 underwent LND as part of primary surgery and 71 LNS. The median follow‐up time was 409 days for LND group and 620 days for LNS group. On univariable analysis, the risk of developing local, nodal or distant relapse was significantly higher in the LNS group compared with LND (P < 0.001). On multivariable analysis, the risk of tumour progression and tumour‐related death were 5.47 and 3.61 times higher in the LNS group, respectively (P < 0.001). Regional lymphadenectomy may have therapeutic value and improve prognosis in dogs with stage II cMCTs undergoing surgical removal of the primary tumour and medical treatment.
Ventral cervical versus bilateral lateral approach for extirpation of mandibular and medial retropharyngeal lymph nodes in dogs
Authors: Wainberg S. H. , Oblak M. L. , Giuffrida M. A.
Published: July 2018

Objective

To compare ventral cervical and bilateral lateral incisions for extirpation of mandibular and medial retropharyngeal lymph nodes in dogs.

Study design

Prospective randomized, crossover controlled cadaver trial.

Sample population

Eight veterinarians with advanced surgical training.

Methods

Study participants were randomized to perform both techniques on paired cadavers. Time to extirpation of the first and last lymph node, length of incisions, and complications were recorded for both techniques. Participants were asked to rate satisfaction with their ability to identify local anatomy and lymph nodes as well as overall preferred technique by using a 10‐point numerical rating scale.

Results

The total length of skin incised for the bilateral lateral approach exceeded that of the ventral cervical approach by 52.1 mm (mean, P < .001). The surgical time for removal of all 4 lymph nodes did not differ between the 2 approaches. The bilateral lateral approach was preferred by 62.5% (5/8) of participants for visualization of mandibular lymph nodes, and the ventral cervical approach was preferred by 87.5% (7/8) of participants for visualization of local anatomy. Overall, 62.5% (5/8) preferred the ventral cervical approach and 37.5% (3/8) preferred the bilateral lateral approach.

Conclusion

The ventral cervical approach was preferred by participants for its perceived superior visualization of local anatomy and access to lymph nodes for removal. This approach also resulted in an overall shorter incision length.

Clinical significance

A ventral cervical or bilateral lateral approach allows successful removal of the medial mandibular and retropharyngeal lymph nodes in dogs, and surgical approach may be selected according to individual preference.
Noise levels in veterinary operating rooms and factors that contribute to their variations
Authors: Dornbusch Josephine , Boston Sarah , Colee James
Published: July 2018

Objective

To quantify noise levels in veterinary operating rooms (OR) and evaluate factors affecting them.

Study design

Pilot study.

Sample population

Seventy‐seven small‐animal surgical procedures at the University of Florida College of Veterinary Medicine Small Animal Hospital.

Methods

A decibel‐measuring device was used to measure mean A‐weighted, median, and maximum decibel readings within the OR. The number of people present in the OR, the number of people scrubbed in, the surgery service, and whether or not music was playing were recorded.

Results

The mean, median, and maximum decibel levels for all surgeries were 71.7 A‐weighted decibels [dB(A)], 69.4 dB(A), and 90.3 dB(A), respectively. Neurologic surgeries were associated with higher noise levels. OR with music playing were louder than those without music (P < .001). None of the other factors evaluated were associated with noise levels.

Conclusion

Neurological surgeries and playing music in the OR were associated with higher noise levels. The average noise levels in our veterinary OR were high and exceeded World Health Organization (WHO) recommendations.

Clinical significance

This is the first published study to quantify noise levels in a veterinary OR. Noise levels that exceed WHO recommended levels warrant additional investigation for potential side effects on surgical patients and OR staff.
Biomechanical evaluation of 6 transarticular tibiotarsal immobilization methods in canine cadaveric limbs
Authors: Sugiyama Takanori , Woodward Andrew , Ryan Stewart D.
Published: July 2018

Objective

To determine the effects of 6 types of transarticular immobilization techniques on tibiotarsal joint angles during stimulated weight bearing.

Study design

Canine ex vivo biomechanical study.

Sample population

Canine cadaveric pelvic limbs (n = 15).

Methods

A validation study was conducted to determine tibiotarsal flexion before and after transection of the superficial digital flexor tendon in 5 canine cadaveric limbs without tibiotarsal joint immobilization. Six transarticular tibiotarsal immobilization techniques were tested sequentially in 10 canine cadaveric pelvic limbs. The tibiotarsal joint angles were measured from lateral projection radiographs before and during axial loading of 200 N. Mixed linear models were applied to determine the effects of the immobilization techniques on change in tibiotarsal joint angle under loading.

Results

There was no change of tibiotarsal joint angle between extended digits and flexed digits under both unloaded and loaded conditions. Change in tibiotarsal joint angles did not differ among any of the immobilization techniques tested here (mean change 1.36°, range 0‐5). The main contributor to variance in angle explained by the final model was associated with the random effect for limb.

Conclusion

Changes in tibiotarsal joint angles during single static loading in canine cadaveric limbs for the 6 immobilization techniques were minimal.

Clinical significance

The 6 techniques appear equally effective at limiting tibiotarsal joint flexion during single axial loading of 200 N. Cyclic mechanical testing of these techniques is recommended to support our findings and validate their clinical application.
Biogeography and early emergence of the genusDidelphis(Didelphimorphia, Mammalia)
Authors: Dias Cayo A. R. , Perini Fernando A.
Published: July 2018

The genusDidelphiscomprises six species of relatively large‐sized New World marsupials ranging from Argentina to Canada. Most of the diversity of the genus occurs in the Neotropical region, where two groups of species are currently recognized: theDidelphis marsupialisgroup, includingD. marsupialisandD. aurita,and theD. albiventrisgroup comprisingD. albiventris,D. imperfectaandD. pernigra. The genus also includesD. virginiana,the only livingDidelphisspecies reaching the Nearctic region.Didelphis'wide latitudinal distribution, wide range of environments in which it can be found as well as the disjunct, and spatially complementary distributions shown by its species raise some questions regarding the historical biogeography of the genus and how it relates to the geological and climatic events of the Plio‐Pleistocene. The present study is aimed at answering biogeographic and historical questions concerning the evolution ofDidelphis.We employed molecular methods to infer a multi‐locus time‐calibrated phylogeny including allDidelphisspecies which served as a framework for biogeographic analyses. Our results suggest that the basalmost divergence inDidelphisis an event older than previously thought, probably having taken place at some point betweenca.4.3 and 7.4 Mya following a vicariant event. Our results also suggest a northern South American origin for the genus, and that it possibly expanded its range to North America before the GABI. Climatic‐driven modifications in Neotropical environments during the late Pliocene and early Pleistocene favored the dispersion to new ecosystems triggering the emergence of new lineages.
Effects of Most to Least Prompting Procedure on Teaching Exercise for Adults with Intellectual Disabilities
Authors: Kurt Özgür , Çuhadar Selmin
Published: July 2018

In this research, the effectiveness of the most to least prompting instruction method in teaching dynamic stretching exercises to adults with intellectual disabilities has been evaluated. At the same time, the impact of this instruction on flexibility and balance which are among physical fitness components has also been determined. A single subject multiple baseline model across behaviors with probe conditions was used. Participants in the study were four women, 34-37 years old. The single opportunity method was used while collecting the data of the study, and all sessions were completed at the end of a period of 16-week. The results obtained from the study indicated that the most to least prompting method was influential in all the participants' learning about dynamic stretching exercises. At the same time, result of the evaluation of the pre-test and post-test measures revealed increases in flexibility and balance of the participants in various ratios. The results of the study indicate that the most to least prompting method was an influential method in teaching dynamic stretching exercises to adults with intellectual disabilities, making these exercises maintenance and generalization them. The results of the interviews conducted with teachers and parents in the study showed that the views of teachers and parents towards the most to least prompting method were positive.
Bioinspired, nanoscale approaches in contemporary bioanalytics (Review)
Authors: Michelle Grandin H. , Guillaume-Gentil Orane , Zambelli Tomaso , Mayer Michael , Houghtaling Jared , Palivan Cornelia G. , Textor Marcus , Höök Fredrik
Published: July 2018

The genesis for this topical review stems from the interdisciplinary Biointerfaces International conference 2016 (BI 2016) in Zurich, Switzerland, wherein the need for advances in analytical tools was both expressed and addressed. Pushing the limits of detection for characterizing individual components, such as single proteins, single drug-delivery vehicles, or probing single living cells in a more natural environment, will contribute to the understanding of the complex biomolecular systems central to a number of applications including medical diagnostics, tissue engineering, and drug screening and delivery. Accordingly, the authors begin with an overview of single nanoparticle analytics highlighting two emerging techniques and how they compare with existing techniques. The first is based on single particle tracking of nanoparticles tethered to a mobile supported lipid bilayer, enabling the simultaneous characterization of both size and composition of individual nanoparticles. The second technique is based on probing variations in the ionic conduction across nanoscale apertures for detection of not only nanoparticles but also membrane-tethered proteins, thereby allowing a multiparameter characterization of individual nanoscopic objects, addressing their size, shape, charge, and dipole moment. Subsequently, the authors lead into an example of an area of application that stands to benefit from such advances in bioanalytics, namely, the development of biomimetic lipid- and polymer-based assemblies as stimuli-responsive artificial organelles and nanocarriers designed to optimize delivery of next generation high-molecular-weight biological drugs. This in turn motivates the need for additional advanced techniques for investigating the cellular response to drug delivery, and so the review returns again to bioanalytics, in this case single-cell analysis, while highlighting a technique capable of probing and manipulating the content of individual living cells via fluidic force microscopy. In presenting a concerted movement in the field of bioinspired bioanalytics, positioned in the context of drug delivery, while also noting the critical role of surface modifications, it is the authors’ aim to evaluate progress in the field of single component bioanalytics and to emphasize the impact of initiating and maintaining a fruitful dialogue among scientists, together with clinicians and industry, to guide future directions in this area and to steer innovation to successful translation.
Rheological behaviors of H-shaped polymers incorporated with short branches under shear and elongational flows via FENE-Rouse model
Authors: Jeong Seung Heum , Kim Jun Mo , Baig Chunggi
Published: July 2018

We present a detailed study of the effects of short branches on the rheological behaviors of H-shaped long-chain branched polymers under shear and uniaxial elongational flows using (single “phantom” chain) bead-spring Brownian dynamics simulations. To clarify the fundamental role of short branches in both flow types, the short branches are distributed either along the chain backbone or along the four dangling long arms of the H-polymer. We observe that the fast random motions of the highly mobile short branches (in association with their very short characteristic relaxation time scales) constantly disturb chain conformation, generally leading to a more compact and less deformed chain structure against the applied flow. Accordingly, the structural and dynamical properties of the short-chain branched (SCB) H-polymers in response to the flow are strongly dependent on the location of the short branches along the chain. For instance, in comparison to the original H-polymer, the H-(SCB_backbone) polymer, where the short branches are allocated along the backbone, exhibits considerably less shear-thinning behavior resulting from the lesser degree of chain alignment and structural deformation of the SCB backbone. In contrast, the H-(SCB_arm) polymer, where the short branches are allocated along the four long arms, displays a higher degree of shear-thinning behavior arising from an effective tensile force (created by the tightly coiled “superbead” character of the arms via fast short-branch dynamics) that stretches out the backbone. Importantly, the fundamental role of the short branches in determining rheological characteristics of the SCB H-polymers remains unchanged, regardless of the flow type and flow strength.
Data Analyses When Sample Sizes Are Small: Modern Advances for Dealing With Outliers, Skewed Distributions, and Heteroscedasticity
Authors: Wilcox Rand , Peterson Travis J. , McNitt-Gray Jill L.
Published: July 2018

The paper reviews advances and insights relevant to comparing groups when the sample sizes are small. There are conditions under which conventional, routinely used techniques are satisfactory. But major insights regarding outliers, skewed distributions, and unequal variances (heteroscedasticity) make it clear that under general conditions they provide poor control over the type I error probability and can have relatively poor power. In practical terms, important differences among groups can be missed and poorly characterized. Many new and improved methods have been derived that are aimed at dealing with the shortcomings of classic methods. To provide a conceptual basis for understanding the practical importance of modern methods, the paper reviews some modern insights related to why methods based on means can perform poorly. Then some strategies for dealing with nonnormal distributions and unequal variances are described. For brevity, the focus is on comparing 2 independent groups or 2 dependent groups based on the usual difference scores. The paper concludes with comments on issues to consider when choosing from among the methods reviewed in the paper.
Chipmakers look past Moore's law, and silicon
Authors: Service Robert F.
Published: July 2018

Novel computer chip materials explored in $1.5 billion U.S. military research program.
Diatom ooze—A large marine mercury sink
Authors: Zaferani Sara , Pérez-Rodríguez Marta , Biester Harald
Published: July 2018

Mercury sinking

Mercury is a highly toxic, globally ubiquitous pollutant that can seriously damage human health. Most mercury pollution enters the atmosphere from burning coal and other fossil fuels and from industrial activity, but where does it all go? Zaferani
et al.
analyzed biogenic siliceous sediments (diatom ooze) from off the coast of Antarctica and found that they contained surprisingly large amounts of mercury. The results suggest that as much as 25% of mercury emissions over the past 150 years could be trapped in sediments like these, revealing the important role that the marine biological pump may play in the global mercury cycle.

Science
, this issue p.
797
Selective functionalization of methane, ethane, and higher alkanes by cerium photocatalysis
Authors: Hu Anhua , Guo Jing-Jing , Pan Hui , Zuo Zhiwei
Published: July 2018

Radically transforming light hydrocarbons

The methane, ethane, and propane in natural gas are mostly inert under ambient conditions. Mainly they are burned to produce heat. Hu
et al.
show that a simple cerium salt paired with an alcohol can catalytically transform these and other simple hydrocarbons into reactive radicals at room temperature (see the Perspective by Kanai). The reactions rely on light to photolytically cleave cerium alkoxide bonds, producing alkoxy radicals that strip H atoms from the hydrocarbons and regenerate the alcohol. The resultant alkyl radicals readily add to azo compounds, olefins, and aromatics.

Science
, this issue p.
668
; see also p.
647
A quantum future awaits
Authors: Taylor Jacob M.
Published: July 2018

A century ago, the quantum revolution quietly began to change our lives. A deeper understanding of the behavior of matter and light at atomic and subatomic scales sparked a new field of science that would vastly change the world's technology landscape. Today, we rely upon the science of quantum mechanics for applications ranging from the Global Positioning System to magnetic resonance imaging to the transistor. The advent of quantum computers presages yet another new chapter in this story that will enable us to not only predict and improve chemical reactions and new materials and their properties, for example, but also to provide insights into the emergence of spacetime and our universe. Remarkably, these advances may begin to be realized in a few years.
Development and Validation of a Phenotypic High-Content Imaging Assay for Assessing the Antiviral Activity of Small-Molecule Inhibitors Targeting Zika Virus
Authors: Bernatchez Jean A. , Yang Zunhua , Coste Michael , Li Jerry , Beck Sungjun , Liu Yan , Clark Alex E. , Zhu Zhe , Luna Lucas A. , Sohl Christal D. , Purse Byron W. , Li Rongshi , Siqueira-Neto Jair L.
Published: July 2018

Zika virus (ZIKV) has been linked to the development of microcephaly in newborns, as well as Guillain-Barré syndrome. There are currently no drugs available to treat ZIKV infection, and accordingly, there is an unmet medical need for the discovery of new therapies.
RNA Polymerase Mutations Selected during Experimental Evolution Enhance Replication of a Hybrid Vaccinia Virus with an Intermediate Transcription Factor Subunit Replaced by the Myxoma Virus Ortholog
Authors: Stuart Carey A. , Zhivkoplias Erik K. , Senkevich Tatiana G. , Wyatt Linda S. , Moss Bernard
Published: July 2018

Previous studies demonstrated the experimental evolution of vaccinia virus (VACV) following deletion of a host range gene important for evasion of host immune defenses. We have extended experimental evolution to essential genes that cannot be deleted but could be replaced by a divergent orthologous gene from another poxvirus. Replacement of a VACV transcription factor gene with one from a distantly related poxvirus led to decreased fitness as evidenced by diminished replication. Serially passaging the hybrid virus at a low multiplicity of infection provided conditions for selection of adaptive mutations that improved replication. Notably, these included five independent mutations of the largest and second largest RNA polymerase subunits. This approach should be generally applicable for investigating adaptation to swapping of orthologous genes encoding additional essential proteins of poxviruses as well as other viruses.
Air-Liquid Interface System To Understand Epstein-Barr Virus-Associated Nasopharyngeal Carcinoma
Authors: Hopcraft Sharon E. , Moody Cary A. , Damania Blossom
Published: July 2018

Epstein-Barr virus (EBV) infects epithelial cells and is associated with epithelial malignancies. Although EBV reactivation is induced by epithelial differentiation, the available methods for differentiation are not widely used.
Postnatal cardiovascular adaptation
Authors: Gill Andrew William
Published: July 2018

The heart undergoes rapid transformations in function during the transition to extrauterine life. Our understanding of the adaptive physiology underlying this process is able to inform the clinical management of infants who are struggling to complete this complex transition. Much of our knowledge of the cardiac transition is derived from the preterm infant in whom the preparative adaptations are incomplete and clinical sequelae all too common. This review will re-examine the cardiac transition highlighting the physiology that drives it and suggest appropriate clinical intervention to support the process.
Supporting breathing of preterm infants at birth: a narrative review
Authors: Martherus Tessa , Oberthuer André , Dekker Janneke , Hooper Stuart B , McGillick Erin V , Kribs Angela , te Pas Arjan B
Published: July 2018

Most very preterm infants have difficulty aerating their lungs and require respiratory support at birth. Currently in clinical practice, non-invasive ventilation in the form of continuous positive airway pressure (CPAP) and positive pressure ventilation (PPV) is applied via facemask. As most very preterm infants breathe weakly and unnoticed at birth, PPV is often administered. PPV is, however, frequently ineffective due to pressure settings, mask leak and airway obstruction. Meanwhile, high positive inspiratory pressures and spontaneous breathing coinciding with inflations can generate high tidal volumes. Evidence from preclinical studies demonstrates that high tidal volumes can be injurious to the lungs and brains of premature newborns. To reduce the need for PPV in the delivery room, it should be considered to optimise spontaneous breathing with CPAP. CPAP is recommended in guidelines and commonly used in the delivery room after a period of PPV, but little data is available on the ideal CPAP strategy and CPAP delivering devices and interfaces used in the delivery room. This narrative review summarises the currently available evidence for why PPV can be inadequate at birth and what is known about different CPAP strategies, devices and interfaces used the delivery room.
Nebulised surfactant to reduce severity of respiratory distress: a blinded, parallel, randomised controlled trial
Authors: Minocchieri Stefan , Berry Clare A , Pillow J Jane
Published: July 2018

Objective

To evaluate if nebulised surfactant reduces intubation requirement in preterm infants with respiratory distress treated with nasal continuous positive airway pressure (nCPAP).

Design

Double blind, parallel, stratified, randomised control trial.

Setting

Sole tertiary neonatal unit in West Australia.

Patients

Preterm infants (290–336 weeks’ gestational age, GA) less than 4 hours of age requiring 22%–30% supplemental oxygen, with informed parental written consent.

Interventions

Infants were randomised within strata (290–316 and 320–336 weeks’ GA) to bubble nCPAP or bubble nCPAP and nebulised surfactant (200 mg/kg: poractant alfa) using a customised vibrating membrane nebuliser (eFlow neonatal). Surfactant nebulisation (100 mg/kg) was repeated after 12 hours for persistent supplemental oxygen requirement.

Main outcome measures

The primary outcomes were requirement for intubation and duration of mechanical ventilation at 72 hours. Data analysis followed the intention-to-treat principle.

Results

360 of 606 assessed infants were eligible; 64 of 360 infants were enrolled and randomised (n=32/group). Surfactant nebulisation reduced the requirement for intubation within 72 hours: 11 of 32 infants were intubated after continuous positive airway pressure (CPAP) and nebulised surfactant compared with 22 of 32 infants receiving CPAP alone (relative risk (95% CI)=0.526 (0.292 to 0.950)). The reduced requirement for intubation was limited to the 320–336 weeks’ GA stratum. The median (range) duration of ventilation in the first 72 hours was not different between the intervention (0 (0–62) hours) and control (9 (0–64) hours; p=0.220) groups. There were no major adverse events.

Conclusions

Early postnatal nebulised surfactant may reduce the need for intubation in the first 3 days of life compared with nCPAP alone in infants born at 290–336 weeks’ GA with mild respiratory distress syndrome. Confirmation requires further adequately powered studies.

Trial registration number

ACTRN12610000857000.
Sexual orientation-related disparities in employment, health insurance, healthcare access and health-related quality of life: a cohort study of US male and female adolescents and young adults
Authors: Charlton Brittany M , Gordon Allegra R , Reisner Sari L , Sarda Vishnudas , Samnaliev Mihail , Austin S Bryn
Published: July 2018

Objective

To investigate sexual orientation-related disparities in employment and healthcare, including potential contributions to health-related quality of life (HRQL).

Setting

Growing Up Today Study, a USA-based longitudinal cohort that began in 1996; predominantly composed of participants who are white and of middle-to-high socioeconomic positions.

Participants

9914 participants 18–32 years old at the most recent follow-up questionnaire.

Primary outcome measure

In 2013, participants reported if, in the last year, they had been unemployed, uninsured or lacked healthcare access (routine physical exam). Participants completed the EQ-5D-5L, a validated, preference-weighted measurement of HRQL. After adjusting for potential confounders, we used sex-stratified, log-binomial models to calculate the association of sexual orientation with employment, health insurance and healthcare access, while examining if these variables attenuated the sexual orientation-related HRQL disparities.

Results

Sexual minority women and men were about twice as likely as their respective heterosexual counterparts to have been unemployed and uninsured. For example, the risk ratio (95% CI) of uninsured bisexual women was 3.76 (2.42 to 5.85) and of unemployed mostly heterosexual men was 1.82 (1.30 to 2.54). Routine physical examination was not different across sexual orientation groups (p>0.05). All sexual minority subgroups had worse HRQL than heterosexuals (p<0.05) across the five EQ-5D-5L dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). Controlling for employment and health insurance did not substantially attenuate the existing sexual orientation-related HRQL disparities.

Conclusions

Research on sexual orientation-related disparities in employment and healthcare has often been limited to comparisons between cohabitating different-sex and same-sex adult couples, overlooking sexual minority subgroups (eg, bisexuals vs lesbians), non-cohabitating populations and young people. Less is known about sexual orientation-related disparities in HRQL including potential contributions from employment and healthcare. The current study documents that disparities in employment, health insurance and various HRQL dimensions are pervasive across sexual minority subgroups, non-cohabitating couples and youth in families of middle-to-high socioeconomic positions.
Prevalence and associated factors of post-traumatic stress disorder among emergency responders of Addis Ababa Fire and Emergency Control and Prevention Service Authority, Ethiopia: institution-based, cross-sectional study
Authors: Bezabh Yodit Habtamu , Abebe Solomon Mekonnen , Fanta Tolesa , Tadese Agitu , Tulu Mikiyas
Published: July 2018

Objective

To assess the prevalence and associated factors of post-traumatic stress disorder (PTSD) among emergency responders at Addis Ababa Fire and Emergency Control and Prevention Service Authority, Ethiopia.

Design

Institution-based, cross-sectional design.

Setting

The study was conducted at the Fire and Emergency Control and Prevention Service Authority, Addis Ababa, Ethiopia.

Participants

603 emergency responders who worked in the Fire and Emergency Control and Prevention Authority during the study period.

Measurement

Data were collected using a self-administered questionnaire: an adaptation of the standardised PTSD Checklist–Civilian Version. The questionnaire was administered to subjects on duty. Social support was measured using the Oslo 3-Item Social Support Scale, while other stressful life events were measured using the List of Threatening Experiences, that is, experiencing one or more stressful life events in the last 6 months. Reliability and construct validity were verified. To be diagnosed with PTSD, a subject must display at least three different types of symptoms at once. Coded variables were entered into Epi Info V.3.5.1 and then exported to SPSS V.20 for analysis. Descriptive and bivariate and multivariate logistic regressions and 95% CI were employed to establish and test statistically significant associations.

Results

A total of 603 subjects participated in the study, with 19.9% prevalence rate of PTSD (95% CI 16.9 to 23.1). The study found family history of mental illness (adjusted OR (AOR)=2.82; 95% CI 1.65 to 4.84), longer years of service (AOR=2.67; 95% CI 1.54 to 4.63), as well as prolonged exposure to emergency situations (AOR=0.44; 95% CI 0.24 to 0.84) and road traffic accidents (AOR=2.71; 95% CI 1.67 to 4.42) as significant predictors of PTSD among emergency responders.

Conclusion

The prevalence of PTSD was high among the study population. Family history of mental illness, length of service, duration of exposure and type of exposure were found to be associated with PTSD. Mental health education and linking emergency responders with available mental health services/facilities should be prioritised to mitigate the problem.
Can a bothersome course of pelvic pain from mid-pregnancy to birth be predicted? A Norwegian prospective longitudinal SMS-Track study
Authors: Malmqvist Stefan , Kjaermann Inger , Andersen Knut , Gausel Anne Marie , Økland Inger , Larsen Jan Petter , Bronnick Kolbjorn S
Published: July 2018

Objective

To explore if pregnant women with pelvic girdle pain (PGP), subgrouped following the results from two clinical tests with high validity and reliability, differ in demographic characteristics and weekly amount of days with bothersome symptoms through the second half of pregnancy.

Design

A prospective longitudinal cohort study.

Participants

Pregnant women with pelvic and lumbopelvic pain due for their second-trimester routine ultrasound examination.

Setting

Obstetric outpatient clinic at Stavanger University Hospital, Norway.

Methods

Women reporting pelvic and lumbopelvic pain completed a questionnaire on demographic and clinical features. They were clinically examined following a test procedure recommended in the European guidelines for the diagnosis and treatment of PGP. Women without pain symptoms completed a questionnaire on demographic data. All women were followed weekly through an SMS-Track survey until delivery.

Primary and secondary outcome measures

The outcome measures were the results from clinical diagnostic tests for PGP and the number of days per week with bothersome pelvic pain.

Results

503 women participated. 42% (212/503) reported pain in the lumbopelvic region and 39% (196/503) fulfilled the criteria for a probable PGP diagnosis. 27% (137/503) reported both the posterior pelvic pain provocation (P4) and the active straight leg raise (ASLR) tests positive at baseline in week 18, revealing 7.55 (95% CI 5.54 to 10.29) times higher mean number of days with bothersome pelvic pain compared with women with both tests negative. They presented the highest scores for workload, depressed mood, pain level, body mass index, Oswestry Disability Index and the number of previous pregnancies. Exercising regularly before and during pregnancy was more common in women with negative tests.

Conclusion

If both P4 and ASLR tests were positive mid-pregnancy, a persistent bothersome pelvic pain of more than 5 days per week throughout the remainder of pregnancy could be predicted. Increased individual control over work situation and an active lifestyle, including regular exercise before and during pregnancy, may serve as a PGP prophylactic.
Cohort profile: the Martinique Cancer Registry and the quality of life prostate cancer cohort (QoL Prostate-MQ): challenges and prospects for reducing disparities in the Caribbean
Authors: Joachim Clarisse , Veronique-Baudin Jacqueline , Almont Thierry , Ulric-Gervaise Stephen , Macni Jonathan , Pierre-Louis Olivier , Godaert Lidvine , Drame Moustapha , Novella Jean-Luc , Farid Karim , Vinh-Hung Vincent , Escarmant Patrick
Published: July 2018

Purpose

Recording cancer data in cancer registries is essential for producing reliable population-based data for service planning, monitoring and evaluation. Prostate cancer (PCa) remains the most frequent type of cancer in terms of incidence and mortality in men in the Caribbean. The quality of life PCa cohort will assess quality of life and patient outcomes in Martinique using a digital platform for patient-reported outcome measures.

Participants

The Martinique Cancer Registry database is the largest clinical database among the French population-based cancer registries in the Caribbean, including more than 38 000 cancer cases, with 1650 new cancer cases per year, including 550 new PCa cases per year (2010–2014 latest period). In 2018, follow-up will include vital status, assessment of quality of life with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ) Core 30 and the Prostate cancer module QLQ-PR25. Urinary incontinence and erectile dysfunction recorded prior to treatment will be analysed 1 and 5 years after treatment.

Findings to date

The registry includes data on circumstances of diagnosis, clinical stage at diagnosis. For PCa, the registry includes blood prostate-specific antigen level at the time of diagnosis, Gleason score and primary treatment.

Future plans

Further studies will provide detailed data regarding the quality of diagnosis and management of patients with PCa in Martinique; analysing quality of care will be the next challenge.

Quality of life and patient outcomes will be evaluated using a digital platform for patient-reported outcome measurement and electronic records.
Effects of retinopathy and chronic kidney disease on long-term mortality in type 2 diabetic inpatients with normal urinary albumin or protein: a retrospective cohort study
Authors: Li Yu-Hsuan , Sheu Wayne H-H , Lee I-Te
Published: July 2018

Objective

Normoalbuminuric chronic kidney disease (NA-CKD) is recognised as a distinct phenotype of diabetic kidney disease, but the role of diabetic retinopathy (DR) in predicting long-term mortality among these patients remains unclear. Here, we aimed to investigate the effects of DR and CKD on mortality in type 2 diabetic patients with normoalbuminuria.

Design

We conducted this study as a retrospective cohort study.

Setting

We collected clinical information from the medical records of a public medical centre in central Taiwan.

Participants

Patients with type 2 diabetes (n=665) who were hospitalised due to poor glucose control were consecutively enrolled and followed for a median of 6.7 years (IQR 4.1‒9.6 years). Patients with either urinary protein excretion >150 mg/day or urine albumin excretion >30 mg/day were excluded.

Primary outcome measure

All-cause mortality served as the primary follow-up outcome, and the mortality data were obtained from the national registry in Taiwan.

Results

The patients with CKD and DR showed the highest mortality rate (log-rank p<0.001). The risks of all-cause mortality (HR 2.263; 95% CI 1.551 to 3.302) and cardiovascular mortality (HR 2.471; 95% CI 1.421 to 4.297) were significantly greater in patients with CKD and DR than in those without CKD or DR, after adjusting for the associated risk factors.

Conclusions

DR is an independent predictor for all-cause and cardiovascular mortality in type 2 diabetic inpatients with normoalbuminuria. Moreover, DR with CKD shows the highest risks of all-cause and cardiovascular mortality among these patients. Funduscopy screening can provide additive information on mortality in patients with type 2 diabetes, even among those with NA-CKD.
Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes
Authors: Guest Julian F , Fuller Graham W , Vowden Peter , Vowden Kathryn Ruth
Published: July 2018

Objectives

The aim of this study was to estimate the patterns of care and annual levels of healthcare resource use attributable to managing pressure ulcers (PUs) in clinical practice in the community by the UK’s National Health Service (NHS), and the associated costs of patient management.

Methods

This was a retrospective cohort analysis of the records of 209 patients identified within a randomly selected population of 6000 patients with any type of wound obtained from The Health Improvement Network (THIN) Database, who developed a PU in the community and excluded hospital-acquired PUs. Patients’ characteristics, wound-related health outcomes and healthcare resource use were quantified over 12 months from initial presentation, and the corresponding total NHS cost of patient management was estimated at 2015/2016 prices.

Results

50% of all the PUs healed within 12 months from initial presentation, but this varied between 100% for category 1 ulcers and 21% for category 4 ulcers. The mean time to healing ranged from 1.0 month for a category 1 ulcer to 8 months for a category 3/4 ulcer and 10 months for an unstageable ulcer. Patients were predominantly managed in the community by nurses with minimal clinical involvement of specialist clinicians. Up to 53% of all the ulcers may have been clinically infected at the time of presentation, and 35% of patients subsequently developed a putative wound infection a mean 4.7 months after initial presentation. The mean NHS cost of wound care over 12 months ranged from £1400 for a category 1 ulcer to >£8500 for the other categories of ulcer. Additionally, the cost of managing an unhealed ulcer was 2.4 times more than that of managing a healed ulcer (mean of £5140 vs £12 300 per ulcer).

Conclusion

This study provides important insights into a number of aspects of PU management in clinical practice in the community that have been difficult to ascertain from other studies, and provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions.
Prehospital trauma death review in the State of Victoria, Australia: a study protocol
Authors: Mercier Eric , Cameron Peter A , Smith Karen , Beck Ben
Published: July 2018

Introduction

Regionalised trauma systems have been shown to improve outcomes for trauma patients. However, the evaluation of these trauma systems has been oriented towards in-hospital care. Therefore, the epidemiology and care delivered to the injured patients who died in the prehospital setting remain poorly studied. This study aims to provide an overview of a methodological approach to reviewing trauma deaths in order to assess the preventability, identify areas for improvements in the system of care provided to these patients and evaluate the potential for novel interventions to improve outcomes for seriously injured trauma patients.

Methods and analysis

The planned study is a retrospective review of prehospital and early in-hospital (<24 hours) deaths following traumatic out-of-hospital cardiac arrest that were attended by Ambulance Victoria between 2008 and 2014. Eligible patients will be identified from the Victorian Ambulance Cardiac Arrest Registry and linked with the National Coronial Information System. For patients who were transported to hospital, data will be linked the Victoria State Trauma Registry. The project will be undertaken in four phases: (1) survivability assessment; (2) preventability assessment; (3) identification of potential areas for improvement; and (4) identification of potentially useful novel technologies. Survivability assessment will be based on predetermined anatomical injuries considered unsurvivable. For patients with potentially survivable injuries, multidisciplinary expert panel reviews will be conducted to assess the preventability as well as the identification of potential areas for improvement and the utility of novel technologies.

Ethics and dissemination

The present study was approved by the Victorian Department of Justice and Regulation HREC (CF/16/272) and the Monash University HREC (CF16/532 – 2016000259). Results of the study will be published in peer-reviewed journals and reports provided to Ambulance Victoria, the Victorian State Trauma Committee and the Victorian State Government Department of Health and Human Services.
Patent foramen ovale closure, antiplatelet therapy or anticoagulation in patients with patent foramen ovale and cryptogenic stroke: a systematic review and network meta-analysis incorporating complementary external evidence
Authors: Mir Hassan , Siemieniuk Reed Alexander C , Ge Long Cruz , Foroutan Farid , Fralick Michael , Syed Talha , Lopes Luciane Cruz , Kuijpers Ton , Mas Jean-Louis , Vandvik Per O , Agoritsas Thomas , Guyatt Gordon H
Published: July 2018

Objective

To examine the relative impact of three management options in patients aged <60 years with cryptogenic stroke and a patent foramen ovale (PFO): PFO closure plus antiplatelet therapy, antiplatelet therapy alone and anticoagulation alone.

Design

Systematic review and network meta-analysis (NMA) supported by complementary external evidence.

Data sources

Medline, EMBASE and Cochrane CENTRAL.

Study selection

Randomised controlled trials (RCTs) addressing PFO closure and/or medical therapies in patients with PFO and cryptogenic stroke.

Review methods

We conducted an NMA complemented with external evidence and rated certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

Results

Ten RCTs in eight studies proved eligible (n=4416). Seven RCTs (n=3913) addressed PFO closure versus medical therapy. Of these, three (n=1257) addressed PFO closure versus antiplatelet therapy, three (n=2303) addressed PFO closure versus mixed antiplatelet and anticoagulation therapies and one (n=353) addressed PFO closure versus anticoagulation. The remaining three RCTs (n=503) addressed anticoagulant versus antiplatelet therapy. PFO closure versus antiplatelet therapy probably results in substantial reduction in ischaemic stroke recurrence (risk difference per 1000 patients over 5 years (RD): −87, 95% credible interval (CrI) −100 to −33; moderate certainty). Compared with anticoagulation, PFO closure may confer little or no difference in ischaemic stroke recurrence (low certainty) but probably has a lower risk of major bleeding (RD −20, 95% CrI −27 to −2, moderate certainty). Relative to either medical therapy, PFO closure probably increases the risk of persistent atrial fibrillation (RD 18, 95% CI +5 to +56, moderate certainty) and device-related adverse events (RD +36, 95% CI +23 to +50, high certainty). Anticoagulation, compared with antiplatelet therapy, may reduce the risk of ischaemic stroke recurrence (RD −71, 95% CrI −100 to +17, low certainty), but probably increases the risk of major bleeding (RD +12, 95% CrI −5 to +65, moderate certainty).

Conclusions

In patients aged <60 years, PFO closure probably confers an important reduction in ischaemic stroke recurrence compared with antiplatelet therapy alone but may make no difference compared with anticoagulation. PFO closure incurs a risk of persistent atrial fibrillation and device-related adverse events. Compared with alternatives, anticoagulation probably increases major bleeding.

PROSPERO registration number

CRD42017081567.
Measuring lupus arthritis activity using contrasted high-field MRI. Associations with clinical measures of disease activity and novel patterns of disease
Authors: Zollars Eric S , Hyer Madison , Wolf Bethany , Chapin Russell
Published: July 2018

Objective

Arthritis in SLE is poorly described, and there is no objective measure for quantification of arthritis. In this pilot study, we aim to assess the utility of the Rheumatoid Arthritis MRI Scoring System (RAMRIS) for the quantification of lupus arthritis.

Methods

Patients were eligible for entry into the study if they were evaluated at the Medical University of South Carolina Lupus Center and determined by their treating rheumatologist to have active hand arthritis due to SLE. Standard of care lupus activity measures were collected, along with a detailed physical exam. MRIs were obtained using standard musculoskeletal sequences with gadolinium contrast. Semiquantitative scoring of the images used the Outcome Measures in Rheumatology Clinical Trials RAMRIS system.

Results

RAMRIS demonstrates large amounts of synovitis, tenosynovitis, bone marrow oedema and erosive disease in only a minority of patients. Some patients were not scored as having any synovitis or tenosynovitis. We describe potential features of lupus arthritis that are not captured in the RAMRIS scores and may be contributing to symptoms.

Conclusion

Lupus arthritis is an entity separate from rheumatoid arthritis and requires the development of new quantitative methods to describe and quantitate it. MRI findings suggest the inadequacy of a typical lupus musculoskeletal measure including swollen/tender joint counts to assess the level of disease activity.
Effect of altering the ratio of exogenous gonadotropins on reproductive performance of primiparous sows during the seasonal infertility period
Authors: Am-in Nutthee , Techakumphu Mongkol , Kirkwood R.N.
Published: July 2018

At weaning, 150 primiparous sows were assigned sequentially to receive 400 IU equine chorionic gonadotropin (eCG) with 200 IU human chorionic gonadotropin (hCG) (Gn600), or 400 IU eCG with 400 IU hCG (Gn800), or served as untreated controls. Compared with control and Gn600, the Gn800 had increased estrus response by day 7 and reduced wean-to-estrus intervals (P < 0.05). Compared with controls, both Gn600 and Gn800 increased numbers of large follicles (≥6 mm) at estrus detection (P < 0.05) and the subsequent farrowing rates (P < 0.05). Litter size was unaffected. These data demonstrate the efficacy of supplemental hCG for alleviating effects of seasonal infertility in primiparous sows.