bluuebunny/crossref_metadata_2025 huggingface dataset:
A Shape Memory Alloy-Based Compression Therapy Prototype Tested With Individuals in Seated Position
Authors: Moein Hadi , Wu Alex , Menon Carlo
Published: July 2017

Orthostatic intolerance in patients can occur secondary to concomitant venous pooling and enhanced capillary filtration when standing upright, and is one of the principle causes of syncope or fainting. Compression therapy is commonly recommended for the management of syncope based on the assumption that it increases venous return. Technologies currently used include compression stockings, whose efficacy has, however, been challenged, and intermittent pneumatic pressure devices, which highly restrict the patients' mobility. This paper therefore investigates a novel active compression brace (ACB), which could potentially provide intermittent pressure while not restricting movements. The ACB, actuated by shape memory alloy (SMA) wires, in this work was tested with twelve healthy individuals in a seated position. The experimental observation showed that the ACB can apply a constant initial pressure to the leg similar to commercial compression stockings and also produce intermittent pressure exceeding 30 mmHg. A comparison between analytical and experimental results showed a maximum of 2.08 mmHg absolute averaged difference among all the participants. A correlation analysis showed that the normalized root-mean-square deviation (NRMSD) between the experimental and analytical results had a significant negative correlation with the estimated total calf circumference minus the calf fat cross-sectional area (CSA). A calibration formula, accounting for fat and circumference of the leg, was introduced to account for these two parameters. The comfort of the ACB was also compared to two other available compression devices using questionnaires. No participants reported discomfort in terms of pressure, skin irritation, or heat generated by the ACB.
Design, Development, and Validation of an Intra-Osseous Needle Placement Guide
Authors: Slocum Alexander H. , Reinitz Steven D. , Jariwala Shailly H. , Van Citters Douglas W.
Published: July 2017

Intra-osseous (IO) needles are an easy and reliable alternative to intravenous (IV) access in the prehospital and emergency settings for treating patients in shock. The advantage of utilizing an IO is that secure, noncollapsible peripheral venous access can be obtained rapidly in critically ill patients. Placement of IO needles in the proximal tibia, humerus, or sternum, however, requires knowledge of human anatomy and the requisite skill to position, align, and place the device. In the developing world, this is not always available, and in the chaos of an in-hospital code, prehospital trauma, or a mass-casualty incident, even trained providers can have trouble correctly placing IV or IO needles. The Tib-Finder is an intuitive drill guide that significantly improves efficiency with which IO can be placed in the proximal tibia. Here, we present the conceptualization, design, and creation of an alpha-prototype Tib-Finder drill guide in less than 90 days; initial validation was achieved through analysis of anthropometric measurements of human skeletons, and usability studies were performed using untrained volunteers and mannequins. The Tib-Finder is intended to provide first responders and medical personnel, in the first world and the developing world, a way to accurately and repeatably locate the proximal tibia and achieve safe, rapid intravascular access in critically ill patients. Further, it eliminates the need for direct contact between patients and caregivers and improves the ease-of-use of IO devices by first responders and healthcare providers.
Experimental Research on the Cavitation Suppression in the Water Hydraulic Throttle Valve
Authors: Weijie Shi , Shuping Cao , Xiaohui Luo , Zuti Zhang , Yuquan Zhu
Published: July 2017

A water hydraulic throttle valve is often used to control the water flow in piping systems. When the water flows through the valve port, cavitation occurs frequently because of the high pressure drop across the valve. The cavitation can lead to wear, vibration and noise. To solve the problem, a modified throttle valve with a drainage device is proposed to suppress the cavitation. A contrasting test was conducted to analyze the effect of drainage device on the cavitation suppression. For evaluating the influence of inlet pressure and outlet pressure on the ability of the drainage device to suppress cavitation, the power spectrum density (PSD), normalized intensity, and cavitation suppression coefficient (CSC) of dynamic pressure are introduced. The results indicate that adopting the drainage device is a feasible method to suppress cavitation. In addition, the inlet pressure and outlet pressure have a great influence on the capacity for cavitation suppression of the drainage device (CCSDD) by changing the intensity of cavitation. When the inlet pressure is at 4.0 MPa, the cavitation is generated and the CCSDD is weak. With increasing inlet pressure, the intensity of cavitation and CCSDD is gradually enhanced. But when the inlet pressure increases to 7.0 MPa, the cavitation is saturated and the cavitation suppression by the drainage device begins to decrease. On the other hand, the effect of cavitation suppression decreases significantly when the outlet pressure increases from 1.4 MPa to 3.8 MPa.
Hierarchies in light sensing and dynamic interactions between ocular and extraocular sensory networks in a flatworm
Authors: Shettigar Nishan , Joshi Asawari , Dalmeida Rimple , Gopalkrishna Rohini , Chakravarthy Anirudh , Patnaik Siddharth , Mathew Manoj , Palakodeti Dasaradhi , Gulyani Akash
Published: July 2017

Light matters! Flatworms reveal stunning complexity in light-induced behaviors and comparative processing.
ALMA detection and astrobiological potential of vinyl cyanide on Titan
Authors: Palmer Maureen Y. , Cordiner Martin A. , Nixon Conor A. , Charnley Steven B. , Teanby Nicholas A. , Kisiel Zbigniew , Irwin Patrick G. J. , Mumma Michael J.
Published: July 2017

We have discovered vinyl cyanide—a molecule that may be able to form cell-like membranes in lakes of hydrocarbon—on Titan.
Buried shallow fault slip from the South Napa earthquake revealed by near-field geodesy
Authors: Brooks Benjamin A. , Minson Sarah E. , Glennie Craig L. , Nevitt Johanna M. , Dawson Tim , Rubin Ron , Ericksen Todd L. , Lockner David , Hudnut Kenneth , Langenheim Victoria , Lutz Andrew , Mareschal Maxime , Murray Jessica , Schwartz David , Zaccone Dana
Published: July 2017

Mobile laser scans of vine rows deformed by the South Napa earthquake record shallow fault slip that does not breach the surface.
Gallium isotopic evidence for extensive volatile loss from the Moon during its formation
Authors: Kato Chizu , Moynier Frédéric
Published: July 2017

The Moon is depleted in volatile elements compared to Earth. Gallium isotopes indicate a global-scale evaporation event.
Giant Rashba splitting in 2D organic-inorganic halide perovskites measured by transient spectroscopies
Authors: Zhai Yaxin , Baniya Sangita , Zhang Chuang , Li Junwen , Haney Paul , Sheng Chuan-Xiang , Ehrenfreund Eitan , Vardeny Zeev Valy
Published: July 2017

Transient and CW spectroscopies unravel giant Rashba splitting in 2D hybrid perovskite multilayers.
A spongy nickel-organic CO
2
reduction photocatalyst for nearly 100% selective CO production
Authors: Niu Kaiyang , Xu You , Wang Haicheng , Ye Rong , Xin Huolin L. , Lin Feng , Tian Chixia , Lum Yanwei , Bustillo Karen C. , Doeff Marca M. , Koper Marc T. M. , Ager Joel , Xu Rong , Zheng Haimei
Published: July 2017

A spongy nickel-organic photocatalyst with nearly 100% selective CO
2
to CO conversion.
Tumor-derived exosomes modulate PD-L1 expression in monocytes
Authors: Haderk Franziska , Schulz Ralph , Iskar Murat , Cid Laura Llaó , Worst Thomas , Willmund Karolin V. , Schulz Angela , Warnken Uwe , Seiler Jana , Benner Axel , Nessling Michelle , Zenz Thorsten , Göbel Maria , Dürig Jan , Diederichs Sven , Paggetti Jérôme , Moussay Etienne , Stilgenbauer Stephan , Zapatka Marc , Lichter Peter , Seiffert Martina
Published: July 2017

Transfer of exosomal RNA from leukemic cells to monocytes induces immunosuppression.
Repression of Salmonella Host Cell Invasion by Aromatic Small Molecules from the Human Fecal Metabolome
Authors: Peixoto Rafael J. M. , Alves Eduardo S. , Wang Melody , Ferreira Rosana B. R. , Granato Alessandra , Han Jun , Gill Hira , Jacobson Kevan , Lobo Leandro A. , Domingues Regina M. C. P. , Borchers Christoph H. , Davies Julian E. , Finlay B. Brett , Antunes L. Caetano M.
Published: July 2017

The human microbiome is a collection of microorganisms that inhabit every surface of the body that is exposed to the environment, generally coexisting peacefully with their host. These microbes have important functions, such as producing vitamins, aiding in maturation of the immune system, and protecting against pathogens. We have previously shown that a small-molecule extract from the human fecal microbiome has a strong repressive effect on
Salmonella enterica
serovar Typhimurium host cell invasion by modulating the expression of genes involved in this process. Here, we describe the characterization of this biological activity. Using a series of purification methods, we obtained fractions with biological activity and characterized them by mass spectrometry. These experiments revealed an abundance of aromatic compounds in the bioactive fraction. Selected compounds were obtained from commercial sources and tested with respect to their ability to repress the expression of
hilA
, the gene encoding the master regulator of invasion genes in
Salmonella
. We found that the aromatic compound 3,4-dimethylbenzoic acid acts as a strong inhibitor of
hilA
expression and of invasion of cultured host cells by
Salmonella
. Future studies should reveal the molecular details of this phenomenon, such as the signaling cascades involved in sensing this bioactive molecule.

IMPORTANCE
Microbes constantly sense and adapt to their environment. Often, this is achieved through the production and sensing of small extracellular molecules. The human body is colonized by complex communities of microbes, and, given their biological and chemical diversity, these ecosystems represent a platform where the production and sensing of molecules occur. In previous work, we showed that small molecules produced by microbes from the human gut can significantly impair the virulence of the enteric pathogen
Salmonella enterica
. Here, we describe a specific compound from the human gut that produces this same effect. The results from this work not only shed light on an important biological phenomenon occurring in our bodies but also may represent an opportunity to develop drugs that can target these small-molecule interactions to protect us from enteric infections and other diseases.
Coronafacoyl Phytotoxin Biosynthesis and Evolution in the Common Scab Pathogen Streptomyces scabiei
Authors: Bown Luke , Li Yuting , Berrué Fabrice , Verhoeven Joost T. P. , Dufour Suzanne C. , Bignell Dawn R. D.
Published: July 2017

Coronafacoyl phytotoxins are an important family of plant toxins that are produced by several different phytopathogenic bacteria, including the gammaproteobacterium
Pseudomonas syringae
and the actinobacterium
Streptomyces scabiei
(formerly
Streptomyces scabies
). The phytotoxins consist of coronafacic acid (CFA) linked via an amide bond to different amino acids or amino acid derivatives. Previous work suggested that
S. scabiei
and
P. syringae
use distinct biosynthetic pathways for producing CFA, which is subsequently linked to its amino acid partner to form the complete phytotoxin. Here, we provide further evidence that the
S. scabiei
CFA biosynthetic pathway is novel by characterizing the role of CYP107AK1, a predicted cytochrome P450 that has no homologue in
P. syringae
. Deletion of the
CYP107AK1
gene abolished production of coronafacoyl-isoleucine (CFA-Ile), the primary coronafacoyl phytotoxin produced by
S. scabiei
. Structural elucidation of accumulated biosynthetic intermediates in the Δ
CYP107AK1
mutant indicated that CYP107AK1 is required for introducing the oxygen atom that ultimately forms the carbonyl group in the CFA backbone. The
CYP107AK1
gene along with two additional genes involved in CFA-Ile biosynthesis in
S. scabiei
were found to be associated with putative CFA biosynthetic genes in other actinobacteria but not in other organisms. Analysis of the overall genetic content and organization of known and putative CFA biosynthetic gene clusters, together with phylogenetic analysis of the core biosynthetic genes, indicates that horizontal gene transfer has played an important role in the dissemination of the gene cluster and that rearrangement, insertion, and/or deletion events have likely contributed to the divergent biosynthetic evolution of coronafacoyl phytotoxins in bacteria.

IMPORTANCE
The ability of plants to defend themselves against invading pathogens relies on complex signaling pathways that are controlled by key phytohormones such as jasmonic acid (JA). Some phytopathogenic bacteria have evolved the ability to manipulate JA signaling in order to overcome host defenses by producing coronatine (COR), which functions as a potent JA mimic. COR and COR-like molecules, collectively referred to as coronafacoyl phytotoxins, are produced by several different plant-pathogenic bacteria, and this study provides supporting evidence that different biosynthetic pathways are utilized by different bacteria for production of these phytotoxins. In addition, our study provides a greater understanding of how coronafacoyl phytotoxin biosynthesis may have evolved in phylogenetically distinct bacteria, and we demonstrate that production of these compounds may be more widespread than previously recognized and that their role for the producing organism may not be limited to host-pathogen interactions.
Critical Knowledge Gaps in Our Understanding of Environmental Cycling and Transmission of Leptospira spp
Authors: Barragan Veronica , Olivas Sonora , Keim Paul , Pearson Talima
Published: July 2017

Exposure to soil or water contaminated with the urine of
Leptospira
-infected animals is the most common way in which humans contract leptospirosis. Entire populations can be at high risk of leptospirosis while working in inundated fields, when engaging in aquatic sports, or after periods of heavy rainfall. The risk of infection after contact with these environmental sources depends on the ability of
Leptospira
bacteria to survive, persist, and infect new hosts. Multiple variables such as soil and water pH, temperature, and even environmental microbial communities are likely to shape the environmental conditions needed by the pathogen to persist. Here we review what is known about the environmental phase of the infectious
Leptospira
transmission cycle and identify knowledge gaps that will serve as a guide for future research.
The Sortase-Dependent Fimbriome of the Genus Bifidobacterium: Extracellular Structures with Potential To Modulate Microbe-Host Dialogue
Authors: Milani Christian , Mangifesta Marta , Mancabelli Leonardo , Lugli Gabriele Andrea , Mancino Walter , Viappiani Alice , Faccini Andrea , van Sinderen Douwe , Ventura Marco , Turroni Francesca
Published: July 2017

Bifidobacteria are important gut commensals of mammals, including humans, of any age. However, the molecular mechanisms by which these microorganisms establish themselves in the mammalian gut and persist in this environment are largely unknown. Here, we analyzed the genetic diversity of the predicted arsenal of sortase-dependent pili of known and sequenced members of the
Bifidobacterium
genus and constructed a bifidobacterial sortase-dependent fimbriome database. Our analyses revealed considerable genetic variability of the sortase-dependent fimbriome among bifidobacterial (sub)species, which appears to have been due to horizontal gene transfer events and for which we were able to perform evolutionary mapping. Functional assessment by transcriptome analysis and binding assays involving different substrates demonstrates how bifidobacterial pili are pivotal in promoting various abilities for adhesion to glycans and extracellular matrix proteins, thereby supporting the ecological success of bifidobacteria in the mammalian gut.

IMPORTANCE
Adhesion of bifidobacterial cells to the mucosa of the large intestine is considered a hallmark for the persistence and colonization of these bacteria in the human gut. In this context, we analyzed the genetic diversity of the predicted arsenal of sortase-dependent pili of known and sequenced members of the
Bifidobacterium
genus, and constructed a bifidobacterial sortase-dependent fimbriome database. Our analyses revealed considerable genetic variability of the sortase-dependent fimbriome among bifidobacterial (sub)species, which appears to have been due to horizontal gene transfer events. In addition, functional assessment by transcriptome analysis and binding assays involving different substrates demonstrates how bifidobacterial pili are crucial in promoting various abilities for adhesion to glycans and extracellular matrix proteins, thereby supporting the ecological success of bifidobacteria in the mammalian gut. This study represents a complete genomic study regarding the presence of fimbriae in the genus
Bifidobacterium
.
In VivoRoles of Fatty Acid Biosynthesis Enzymes in Biosynthesis of Biotin and α-Lipoic Acid in Corynebacterium glutamicum
Authors: Ikeda Masato , Nagashima Takashi , Nakamura Eri , Kato Ryosuke , Ohshita Masakazu , Hayashi Mikiro , Takeno Seiki
Published: July 2017

For fatty acid biosynthesis,Corynebacterium glutamicumuses two type I fatty acid synthases (FAS-I), FasA and FasB, in addition to acetyl-coenzyme A (CoA) carboxylase (ACC) consisting of AccBC, AccD1, and AccE. Thein vivoroles of the enzymes in supplying precursors for biotin and α-lipoic acid remain unclear. Here, we report genetic evidence demonstrating that the biosynthesis of these cofactors is linked to fatty acid biosynthesis through the FAS-I pathway. For this study, we used wild-typeC. glutamicumand its derived biotin vitamer producer BFI-5, which was engineered to expressEscherichia coli bioBFandBacillus subtilis bioI. Disruption of eitherfasAorfasBin strain BFI-5 led to decreased production of biotin vitamers, whereas its amplification contributed to increased production, with a larger impact offasAin both cases. Double disruptions offasAandfasBresulted in no biotin vitamer production. Theaccgenes showed a positive effect on production when amplified simultaneously. Augmented fatty acid biosynthesis was also reflected in pimelic acid production when carbon flow was blocked at the BioF reaction. These results indicate that carbon flow down the FAS-I pathway is destined for channeling into the biotin biosynthesis pathway, and that FasA in particular has a significant impact on precursor supply. In contrast,fasBdisruption resulted in auxotrophy for lipoic acid or its precursor octanoic acid in both wild-type and BFI-5 strains. The phenotypes were fully complemented by plasmid-mediated expression offasBbut notfasA. These results reveal that FasB plays a specific physiological role in lipoic acid biosynthesis inC. glutamicum.

IMPORTANCEFor thede novobiosynthesis of fatty acids,C. glutamicumexceptionally uses a eukaryotic multifunctional type I fatty acid synthase (FAS-I) system comprising FasA and FasB, in contrast to most bacteria, such asE. coliandB. subtilis, which use an individual nonaggregating type II fatty acid synthase (FAS-II) system. In this study, we reported genetic evidence demonstrating that the FAS-I system is the source of the biotin precursorin vivoin the engineered biotin-prototrophicC. glutamicumstrain. This study also uncovered the important physiological role of FasB in lipoic acid biosynthesis. Here, we present an FAS-I enzyme that functions in supplying the lipoic acid precursor, although its biosynthesis has been believed to exclusively depend on FAS-II in organisms. The findings obtained here provide new insights into the metabolic engineering of this industrially important microorganism to produce these compounds effectively.
Glucosylglycerate Phosphorylase, an Enzyme with Novel Specificity Involved in Compatible Solute Metabolism
Authors: Franceus Jorick , Pinel Denise , Desmet Tom
Published: July 2017

Family GH13_18 of the carbohydrate-active enzyme database consists of retaining glycoside phosphorylases that have attracted interest with their potential for synthesizing valuable α-sugars and glucosides. Sucrose phosphorylase was believed to be the only enzyme with specificity in this subfamily for many years, but recent work revealed an enzyme with a different function and hinted at an even broader diversity that is left to discover. In this study, a putative sucrose phosphorylase from
Meiothermus silvanus
that resides in a previously unexplored branch of the family's phylogenetic tree was expressed and characterized. Unexpectedly, no activity on sucrose was observed. Guided by a thorough inspection of the genomic landscape surrounding other genes in the branch, the enzyme was found to be a glucosylglycerate phosphorylase, with a specificity never before reported. Homology modeling, docking, and mutagenesis pinpointed particular acceptor site residues (Asn275 and Glu383) involved in the binding of glycerate. Various organisms known to synthesize and accumulate glucosylglycerate as a compatible solute possess a putative glucosylglycerate phosphorylase gene, indicating that the phosphorylase may be a regulator of its intracellular levels. Moreover, homologs of this novel enzyme appear to be distributed among diverse bacterial phyla, a finding which suggests that many more organisms may be capable of assimilating or synthesizing glucosylglycerate than previously assumed.

IMPORTANCE
Glycoside phosphorylases are an intriguing group of carbohydrate-active enzymes that have been used for the synthesis of various economically appealing glycosides and sugars, and they are frequently subjected to enzyme engineering to further expand their application potential. The novel specificity discovered in this work broadens the diversity of these phosphorylases and opens up new possibilities for the efficient production of glucosylglycerate, which is a remarkably potent and versatile stabilizer for protein formulations. Finally, it is a new piece of the puzzle of glucosylglycerate metabolism, being the only known enzyme capable of catalyzing the breakdown of glucosylglycerate in numerous bacterial phyla.
Longitudinal Midline Sacral Split Fracture – A Rare Entity
Authors: Vijayan Sandeep , Basani Viksheth , Naik Monappa , Rao Sharath Kumar
Published: July 2017

Fractures involving the central canal of the sacrum are rare injuries and can be transverse or longitudinal. Transverse fractures are by far common and associated with high incidence of neurological injuries. On the contrary, longitudinal midline split fracture is an extremely rare injury with minimal or no neurological injury. They are always associated with anterior pelvic ring fracture and are vertically stable needing only fixation of the anterior pelvic injury. Plating of the anterior pelvic ring in two planes would be beneficial than single plate to prevent gradual loss of reduction.
Acquired haemophilia A with a recalcitrant high-titre factor VIII inhibitor in the setting of interstitial lung disease
Authors: Sun Lova , Sykes David B
Published: July 2017

Acquired haemophilia A (AHA) is a bleeding disorder that results from autoantibodies against factor VIII (FVIII). A 70-year-old man with a history of interstitial lung disease presented with spontaneous bleeding into his thigh. He had undetectable FVIII levels and a high-titre FVIII inhibitor (>2000Ã¢â‚¬â€°Bethesda units/mL) and was diagnosed with AHA. He had several relapses, required multiple haemostatic and immunosuppressive treatments but eventually achieved a stable remission after 2Ã¢â‚¬â€°years of therapy.

Our patient matches the typical elderly male demographic of AHA. His relapsing course with remarkably high and persistent inhibitor titre highlights the need for close monitoring and aggressive upfront treatment. Whereas cyclophosphamide and steroids are often used first line in AHA, rituximab has also shown efficacy in refractory patients with high inhibitor levels. The FVIII and inhibitor concentration on presentation have been associated with treatment response and may be used as prognostic factors to tailor immunosuppressive regimens.
Assessing value-for-money in maternal and newborn health
Authors: Banke-Thomas Aduragbemi , Madaj Barbara , Kumar Shubha , Ameh Charles , van den Broek Nynke
Published: July 2017

Responding to increasing demands to demonstrate value-for-money (VfM) for maternal and newborn health interventions, and in the absence of VfM analysis in peer-reviewed literature, this paper reviews VfM components and methods, critiques their applicability, strengths and weakness and proposes how VfM assessments can be improved. VfM comprises four components: economy, efficiency, effectiveness and cost-effectiveness. Both ‘economy’ and ‘efficiency’ can be assessed with detailed cost analysis utilising costs obtained from programme accounting data or generic cost databases. Before-and-after studies, case–control studies or randomised controlled trials can be used to assess ‘effectiveness’. To assess ‘cost-effectiveness’, cost-effectiveness analysis (CEA), cost-utility analysis (CUA), cost-benefit analysis (CBA) or social return on investment (SROI) analysis are applicable. Generally, costs can be obtained from programme accounting data or existing generic cost databases. As such ‘economy’ and ‘efficiency’ are relatively easy to assess. However, ‘effectiveness’ and ‘cost-effectiveness’ which require establishment of the counterfactual are more difficult to ascertain. Either a combination of CEA or CUA with tools for assessing other VfM components, or the independent use of CBA or SROI are alternative approaches proposed to strengthen VfM assessments. Cross-cutting themes such as equity, sustainability, scalability and cultural acceptability should also be assessed, as they provide critical contextual information for interpreting VfM assessments. To select an assessment approach, consideration should be given to the purpose, data availability, stakeholders requiring the findings and perspectives of programme beneficiaries. Implementers and researchers should work together to improve the quality of assessments. Standardisation around definitions, methodology and effectiveness measures to be assessed would help.
Successes and challenges of the millennium development goals in Ethiopia: lessons for the sustainable development goals
Authors: Assefa Yibeltal , Damme Wim Van , Williams Owain D , Hill Peter S
Published: July 2017

We analysed the performance of Ethiopia in achieving the health-related millennium development goals (MDGs) with the aim of acquiring lessons for the sustainable development goals (SDGs). Ethiopia achieved most of the health MDGs: a 67% reduction in under-five mortality, a 71% decline in maternal mortality ratio, a 90% decline in new HIV infections, a decrease in malaria-related deaths by 73% and a more than 50% decline in mortality due to tuberculosis. We argue that these achievements are due to implementation of a mix of comprehensive strategies within the health system and across other sectors of the government. Scaling up of interventions by disease control programmes (including the health extension programme) and strengthening of the health system have played important roles towards the achievements. These health gains could not have been realised without progress in the other MDGs: poverty reduction, education, access to safe drinking-water and peace and stability of the country. However, the gains were not equitable, with differences between urban and rural areas, among regions and socioeconomic strata. Ethiopia's remarkable success in meeting most of the targets of the health-related MDGs could be explained by its comprehensive and multisectoral approach for health development. The inequity gap remains a challenge that achieving the health-related SDGs requires the country to implement strategies, which specifically target more marginal populations and geographic areas. This also needs peace and stability, without which it is almost impossible to improve health.
Leaving no one behind: lessons on rebuilding health systems in conflict- and crisis-affected states
Authors: Martineau Tim , McPake Barbara , Theobald Sally , Raven Joanna , Ensor Tim , Fustukian Suzanne , Ssengooba Freddie , Chirwa Yotamu , Vong Sreytouch , Wurie Haja , Hooton Nick , Witter Sophie
Published: July 2017

Conflict and fragility are increasing in many areas of the world. This context has been referred to as the ‘new normal’ and affects a billion people. Fragile and conflict-affected states have the worst health indicators and the weakest health systems. This presents a major challenge to achieving universal health coverage. The evidence base for strengthening health systems in these contexts is very weak and hampered by limited research capacity, challenges relating to insecurity and apparent low prioritisation of this area of research by funders. This article reports on findings from a multicountry consortium examining health systems rebuilding post conflict/crisis in Sierra Leone, Zimbabwe, northern Uganda and Cambodia. Across the ReBUILD consortium's interdisciplinary research programme, three cross-cutting themes have emerged through our analytic process: communities, human resources for health and institutions. Understanding the impact of conflict/crisis on the intersecting inequalities faced by households and communities is essential for developing responsive health policies. Health workers demonstrate resilience in conflict/crisis, yet need to be supported post conflict/crisis with appropriate policies related to deployment and incentives that ensure a fair balance across sectors and geographical distribution. Postconflict/crisis contexts are characterised by an influx of multiple players and efforts to support coordination and build strong responsive national and local institutions are critical. The ReBUILD evidence base is starting to fill important knowledge gaps, but further research is needed to support policy makers and practitioners to develop sustainable health systems, without which disadvantaged communities in postconflict and postcrisis contexts will be left behind in efforts to promote universal health coverage.
Derivation and validation of a universal vital assessment (UVA) score: a tool for predicting mortality in adult hospitalised patients in sub-Saharan Africa
Authors: Moore Christopher C , Hazard Riley , Saulters Kacie J , Ainsworth John , Adakun Susan A , Amir Abdallah , Andrews Ben , Auma Mary , Baker Tim , Banura Patrick , Crump John A , Grobusch Martin P , Huson Michaëla A M , Jacob Shevin T , Jarrett Olamide D , Kellett John , Lakhi Shabir , Majwala Albert , Opio Martin , Rubach Matthew P , Rylance Jamie , Michael Scheld W , Schieffelin John , Ssekitoleko Richard , Wheeler India , Barnes Laura E
Published: July 2017

Background

Critical illness is a leading cause of morbidity and mortality in sub-Saharan Africa (SSA). Identifying patients with the highest risk of death could help with resource allocation and clinical decision making. Accordingly, we derived and validated a universal vital assessment (UVA) score for use in SSA.

Methods

We pooled data from hospital-based cohort studies conducted in six countries in SSA spanning the years 2009–2015. We derived and internally validated a UVA score using decision trees and linear regression and compared its performance with the modified early warning score (MEWS) and the quick sepsis-related organ failure assessment (qSOFA) score.

Results

Of 5573 patients included in the analysis, 2829 (50.8%) were female, the median (IQR) age was 36 (27–49) years, 2122 (38.1%) were HIV-infected and 996 (17.3%) died in-hospital. The UVA score included points for temperature, heart and respiratory rates, systolic blood pressure, oxygen saturation, Glasgow Coma Scale score and HIV serostatus, and had an area under the receiver operating characteristic curve (AUC) of 0.77 (95% CI 0.75 to 0.79), which outperformed MEWS (AUC 0.70 (95% CI 0.67 to 0.71)) and qSOFA (AUC 0.69 (95% CI 0.67 to 0.72)).

Conclusion

We identified predictors of in-hospital mortality irrespective of the underlying condition(s) in a large population of hospitalised patients in SSA and derived and internally validated a UVA score to assist clinicians in risk-stratifying patients for in-hospital mortality. The UVA score could help improve patient triage in resource-limited environments and serve as a standard for mortality risk in future studies.
The use of patient feedback by hospital boards of directors: a qualitative study of two NHS hospitals in England
Authors: Lee Robert , Baeza Juan I , Fulop Naomi J
Published: July 2017

Background

Although previous research suggests that different kinds of patient feedback are used in different ways to help improve the quality of hospital care, there have been no studies of the ways in which hospital boards of directors use feedback for this purpose.

Objectives

To examine whether and how boards of directors of hospitals use feedback from patients to formulate strategy and to assure and improve the quality of care.

Methods

We undertook an in-depth qualitative study in two acute hospital National Health Service foundation trusts in England, purposively selected as contrasting examples of the collection of different kinds of patient feedback. We collected and analysed data from interviews with directors and other managers, from observation of board meetings, and from board papers and other documents.

Results

The two boards used in-depth qualitative feedback and quantitative feedback from surveys in different ways to help develop strategies, set targets for quality improvement and design specific quality improvement initiatives; but both boards made less subsequent use of any kinds of feedback to monitor their strategies or explicitly to assure the quality of services.

Discussion and conclusions

We have identified limitations in the uses of patient feedback by hospital boards that suggest that boards should review their current practice to ensure that they use the different kinds of patient feedback that are available to them more effectively to improve, monitor and assure the quality of care.
Outpatient CPOE orders discontinued due to ‘erroneous entry’: prospective survey of prescribers’ explanations for errors
Authors: Hickman Thu-Trang T , Quist Arbor Jessica Lauren , Salazar Alejandra , Amato Mary G , Wright Adam , Volk Lynn A , Bates David W , Schiff Gordon
Published: July 2017

Background

Computerised prescriber order entry (CPOE) systems users often discontinue medications because the initial order was erroneous.

Objective

To elucidate error types by querying prescribers about their reasons for discontinuing outpatient medication orders that they had self-identified as erroneous.

Methods

During a nearly 3 year retrospective data collection period, we identified 57 972 drugs discontinued with the reason ‘Error (erroneous entry).” Because chart reviews revealed limited information about these errors, we prospectively studied consecutive, discontinued erroneous orders by querying prescribers in near-real-time to learn more about the erroneous orders.

Results

From January 2014 to April 2014, we prospectively emailed prescribers about outpatient drug orders that they had discontinued due to erroneous initial order entry. Of 2 50 806 medication orders in these 4 months, 1133 (0.45%) of these were discontinued due to error. From these 1133, we emailed 542 unique prescribers to ask about their reason(s) for discontinuing these mediation orders in error. We received 312 responses (58% response rate). We categorised these responses using a previously published taxonomy. The top reasons for these discontinued erroneous orders included: medication ordered for wrong patient (27.8%, n=60); wrong drug ordered (18.5%, n=40); and duplicate order placed (14.4%, n=31). Other common discontinued erroneous orders related to drug dosage and formulation (eg, extended release versus not). Oxycodone (3%) was the most frequent drug discontinued error.

Conclusion

Drugs are not infrequently discontinued ‘in error.’ Wrong patient and wrong drug errors constitute the leading types of erroneous prescriptions recognised and discontinued by prescribers. Data regarding erroneous medication entries represent an important source of intelligence about how CPOE systems are functioning and malfunctioning, providing important insights regarding areas for designing CPOE more safely in the future.
Enhancing problem list documentation in electronic health records using two methods: the example of prior splenectomy
Authors: McEvoy Dustin , Gandhi Tejal K , Turchin Alexander , Wright Adam
Published: July 2017

Background

Quality improvement professionals often choose between patient-specific interventions, like clinical decision support (CDS), and population-based interventions, like registries or care management. In this paper, we explore the synergy of these two strategies, targeting the problem of procedure documentation for patients with a history of splenectomy.

Methods

We developed a population health documentation (PHD) intervention and a CDS intervention to improve splenectomy documentation within our electronic health record. Rates of splenectomy documentation were collected before and after the implementation of both interventions to assess their impact on the rate of procedure documentation.

Results

Both the PHD and CDS interventions led to statistically significant (p<0.001) increases in the baseline rate of splenectomy documentation of 27.4 documentations per month. During the PHD intervention, 444.7 splenectomies were documented per month, while 40.8 splenectomies per month were documented during the CDS intervention.

Discussion

Both approaches were successful, with the PHD intervention leading to a larger number of incremental procedure documentations, in batches, and the CDS intervention augmenting procedure documentation on an ongoing basis. Our results suggest that population health and CDS strategies complement each other and, where possible, should be used in conjunction.

Conclusions

PHD and CDS strategies may best be used in conjunction to create a symbiotic relationship in which current problem and procedure documentation gaps are closed using PHD strategies, while new gaps are prevented through ongoing CDS interventions
Consistency of pressure injury documentation across interfacility transfers
Authors: Squitieri Lee , Ganz David A , Mangione Carol M , Needleman Jack , Romano Patrick S , Saliba Debra , Ko Clifford Y , Waxman Daniel A
Published: July 2017

Background

Hospital-acquired pressure injuries (HAPIs) are publicly reported in the USA and used to adjust Medicare payment to acute inpatient facilities. Current methods used to identify HAPIs in administrative claims rely on hospital-reported present-on-admission (POA) data instead of prior patient health information.

Objective

To study the reliability of claims data for HAPIs and pressure injury (PI) stage by evaluating diagnostic coding agreement across interfacility transfers.

Methods

Using the 2012 100% Medicare Provider and Analysis Review file, we identified all fee-for-service acute inpatient discharge records with a PI diagnosis among Medicare patients 65 years and older. We then identified additional facility claims (eg, acute inpatient, long-stay inpatient or skilled nursing facility) belonging to the same patient who had either (1) admission within 1day of hospital discharge or (2) discharge within 1day of hospital admission. Multivariable logistic regression and stratified kappa statistics were used to measure coding agreement between transferring and receiving facilities in the presence or absence of a PI diagnosis at the time of patient transfer and PI stage category (early vs advanced).

Results

In our comparison of claims data between transferring and receiving facilities, we observed poor agreement in the presence or absence of a PI diagnosis at the time of transfer (36.3%, kappa=0.03) and poor agreement in PI stage category (74.3%, kappa=0.17). Among transfers with a POA PI reported by the receiving hospital, only 34.0% had a PI documented at the prior transferring facility.

Conclusions

The observed discordance in PI documentation and staging between transferring and receiving facilities may indicate inaccuracy of HAPI identification in claims data. Future research should evaluate the accuracy of hospital-reported POA data and its impact on PI quality measurement.
The HLF/IL-6/STAT3 feedforward circuit drives hepatic stellate cell activation to promote liver fibrosis
Authors: Xiang Dai-Min , Sun Wen , Ning Bei-Fang , Zhou Teng-Fei , Li Xiao-Feng , Zhong Wei , Cheng Zhuo , Xia Ming-Yang , Wang Xue , Deng Xing , Wang Wei , Li Heng-Yu , Cui Xiu-Liang , Li Shi-Chao , Wu Bin , Xie Wei-Fen , Wang Hong-Yang , Ding Jin
Published: July 2017

Background and aims

Liver fibrosis is a wound-healing response that disrupts the liver architecture and function by replacing functional parenchyma with scar tissue. Recent progress has advanced our knowledge of this scarring process, but the detailed mechanism of liver fibrosis is far from clear.

Methods

The fibrotic specimens of patients and HLF (hepatic leukemia factor)PB/PB mice were used to assess the expression and role of HLF in liver fibrosis. Primary murine hepatic stellate cells (HSCs) and human HSC line Lx2 were used to investigate the impact of HLF on HSC activation and the underlying mechanism.

Results

Expression of HLF was detected in fibrotic livers of patients, but it was absent in the livers of healthy individuals. Intriguingly, HLF expression was confined to activated HSCs rather than other cell types in the liver. The loss of HLF impaired primary HSC activation and attenuated liver fibrosis in HLFPB/PB mice. Consistently, ectopic HLF expression significantly facilitated the activation of human HSCs. Mechanistic studies revealed that upregulated HLF transcriptionally enhanced interleukin 6 (IL-6) expression and intensified signal transducer and activator of transcription 3 (STAT3) phosphorylation, thus promoting HSC activation. Coincidentally, IL-6/STAT3 signalling in turn activated HLF expression in HSCs, thus completing a feedforward regulatory circuit in HSC activation. Moreover, correlation between HLF expression and alpha-smooth muscle actin, IL-6 and p-STAT3 levels was observed in patient fibrotic livers, supporting the role of HLF/IL-6/STAT3 cascade in liver fibrosis.

Conclusions

In aggregate, we delineate a paradigm of HLF/IL-6/STAT3 regulatory circuit in liver fibrosis and propose that HLF is a novel biomarker for activated HSCs and a potential target for antifibrotic therapy.
Ventricular function and vascular dimensions after Norwood and hybrid palliation of hypoplastic left heart syndrome
Authors: Latus Heiner , Nassar Mohamed S , Wong James , Hachmann Pauline , Bellsham-Revell Hannah , Hussain Tarique , Apitz Christian , Salih Caner , Austin Conal , Anderson David , Yerebakan Can , Akintuerk Hakan , Bauer Juergen , Razavi Reza , Schranz Dietmar , Greil Gerald
Published: July 2017

Objective

Norwood and hybrid procedure are two options available for initial palliation of patients with hypoplastic left heart syndrome (HLHS). Our study aimed to assess potential differences in right ventricular (RV) function and pulmonary artery dimensions using cardiac magnetic resonance (CMR) in survivors with HLHS.

Methods

42 Norwood (mean age 2.4±0.8) and 44 hybrid (mean age 2.0±1.0 years) patients were evaluated by CMR after stage II palliation prior to planned Fontan completion. Initial stage I Norwood procedure was performed using a modified Blalock-Taussig shunt, while the hybrid procedure consisted of bilateral pulmonary artery banding and arterial duct stenting. Need for reinterventions and subsequent outcomes were also assessed.

Results

Norwood patients had larger RV end-diastolic dimensions (91±23 vs 80±31 mL/m2, p=0.004) and lower heart rate (90±15 vs 102±13, p<0.001) than hybrid patients. Both Norwood and hybrid patients showed preserved global RV pump function (59±9 vs 59%±10%, p=0.91), while RV strain, strain rate and intraventricular synchrony were superior in the Norwood group. Pulmonary artery size was reduced (lower lobe index 135±74 vs 161±62 mm2/m2, p=0.02), and reintervention rate was significantly higher in the hybrid group whereas subsequent outcome did not differ significantly (p=0.24).

Conclusions

Norwood and hybrid strategy were associated with equivalent and preserved global RV pump function while development of the pulmonary arteries and reintervention rate were superior using the Norwood approach. Impaired RV myocardial deformation as a potential marker of early RV dysfunction in the hybrid group may have a negative long-term impact in this population.
Infective endocarditis in adults with congenital heart disease remains a lethal disease
Authors: Tutarel Oktay , Alonso-Gonzalez Rafael , Montanaro Claudia , Schiff Renee , Uribarri Aitor , Kempny Aleksander , Grübler Martin R , Uebing Anselm , Swan Lorna , Diller Gerhard-Paul , Dimopoulos Konstantinos , Gatzoulis Michael A
Published: July 2017

Objective

Infective endocarditis (IE) is associated with significant morbidity and mortality. Patients with adult congenital heart disease (ACHD) have an increased risk of developing IE. The aim of this study is to describe the incidence, predictors of outcome and mortality associated with IE in ACHD in a contemporary cohort.

Methods

All episodes of IE in adults with congenital heart disease referred to our tertiary centre between 1999 and 2013 were included in the study. Patients were identified from the hospital database. The diagnosis of endocarditis was established according to the modified Duke criteria. The primary endpoint of the study was endocarditis-associated mortality.

Results

There were 164 episodes of IE in 144 patients (male 102, 70.8%). Mean age at presentation was 32.3±22.7 years. Out of these, 43% had a simple, 23% a moderate and 32% a complex lesion. It was at least the second bout of IE in 37 episodes (23%). A predisposing event could be identified in only 26.2% of episodes. Surgical intervention during the same admission was performed in 61 episodes (37.2%). During a median follow-up of 6.7 years (IQR 2.9–11.4), 28 (19.4%) patients died. Out of these, 10 deaths were related to IE (IE mortality 6.9%). On unvariate regression analysis, the development of an abscess (OR: 7.23; 95% CI 1.81 to 28.94, p<0.01) and age (OR: 1.05; 95% CI 1.01 to 1.10, p=0.03) were the only predictors of IE-associated mortality. There was no increase in IE cases at our centre during the period of the study.

Conclusions

IE-associated morbidity and mortality in a contemporary cohort of ACHD patients is still high in the current era.