bluuebunny/crossref_metadata_2025 huggingface dataset:
Constitutive Stiffness Characteristics of Cement Paste as a Multiphase Composite System—A Molecular Dynamics-Based Model
Authors: Padilla Espinosa Ingrid M. , Hodo Wayne , Rivas Murillo John S. , Rajendran A. M. , Mohan Ram V.
Published: April 2017

Cement paste is a material with heterogeneous composite structure consisting of hydrated and unhydrated phases at all length scales that varies depending upon the degree of hydration. In this paper, a method to model cement paste as a multiphase system at molecular level for predicting constitutive properties and for understanding the constitutive mechanical behavior characteristics using molecular dynamics is presented. The proposed method creates a framework for molecular level models suitable for predicting constitutive properties of heterogeneous cement paste that could provide potential for comparisons with low length scale experimental characterization techniques. The molecular modeling method followed two approaches: one involving admixed molecular phases and the second involving clusters of the individual phases. In particular, in the present study, cement paste is represented as two-phase composite systems consisting of the calcium silicate hydrate (CSH) phase combined with unhydrated phases tricalcium silicate (C3S) or dicalcium silicate (C2S). Predicted elastic stiffness constants based on molecular model representations employed for the two phases showed that, although the individual phases have anisotropic characteristics, the composite system behaves as an isotropic material. The isotropic characteristics seen from two-phase molecular models mimic the isotropic material nature of heterogeneous cement paste at engineering scale. Further, predicted bulk modulus of the composite system based on molecular modeling is found to be high compared to the elastic modulus, which concurs with the high compression strength of cement paste seen at engineering length scales.
One-Dimensional Analysis of Gas Diffusion-Induced Cassie to Wenzel State Transition
Authors: Kadoko Jonah , Karamanis Georgios , Kirk Toby , Hodes Marc
Published: April 2017

We develop a one-dimensional model for transient diffusion of gas between ridges into a quiescent liquid suspended in the Cassie state above them. In the first case study, we assume that the liquid and gas are initially at the same pressure and that the liquid column is sealed at the top. In the second one, we assume that the gas initially undergoes isothermal compression and that the liquid column is exposed to gas at the top. Our model provides a framework to compute the transient gas concentration field in the liquid, the time when the triple contact line begins to move down the ridges, and the time when menisci reach the bottom of the substrate compromising the Cassie state. At illustrative conditions, we show the effects of geometry, hydrostatic pressure, and initial gas concentration on the Cassie to Wenzel state transition.
Toward continuous-wave operation of organic semiconductor lasers
Authors: Sandanayaka Atula S. D. , Matsushima Toshinori , Bencheikh Fatima , Yoshida Kou , Inoue Munetomo , Fujihara Takashi , Goushi Kenichi , Ribierre Jean-Charles , Adachi Chihaya
Published: April 2017

Organic semiconductor laser operating in the quasi-CW regime at 80 MHz and under 30 ms long pulse photoexcitation is demonstrated.
Crystal structure of 2C helicase from enterovirus 71
Authors: Guan Hongxin , Tian Juan , Qin Bo , Wojdyla Justyna Aleksandra , Wang Bei , Zhao Zhendong , Wang Meitian , Cui Sheng
Published: April 2017

Structure of EV71 2C unveils the structural basis of the functional mechanism of carboxyl terminus–mediated self-oligomerization.
Optical identification of sulfur vacancies: Bound excitons at the edges of monolayer tungsten disulfide
Authors: Carozo Victor , Wang Yuanxi , Fujisawa Kazunori , Carvalho Bruno R. , McCreary Amber , Feng Simin , Lin Zhong , Zhou Chanjing , Perea-López Néstor , Elías Ana Laura , Kabius Bernd , Crespi Vincent H. , Terrones Mauricio
Published: April 2017

Bound exciton is a signature of sulfur vacancies, and thus, it can be used to investigate defects in atomically thin materials.
The lung is a host defense niche for immediate neutrophil-mediated vascular protection
Authors: Yipp Bryan G. , Kim Jung Hwan , Lima Ronald , Zbytnuik Lori D. , Petri Bjӧrn , Swanlund Nick , Ho May , Szeto Vivian G. , Tak Tamar , Koenderman Leo , Pickkers Peter , Tool Anton T. J. , Kuijpers Taco W. , van den Berg Timo K. , Looney Mark R. , Krummel Matthew F. , Kubes Paul
Published: April 2017

Pulmonary capillaries provide a home for neutrophil surveillance to capture bloodstream bacteria.
Complement factor P is a ligand for the natural killer cell–activating receptor NKp46
Authors: Narni-Mancinelli Emilie , Gauthier Laurent , Baratin Myriam , Guia Sophie , Fenis Aurore , Deghmane Ala-Eddine , Rossi Benjamin , Fourquet Patrick , Escalière Bertrand , Kerdiles Yann M. , Ugolini Sophie , Taha Muhamed-Kheir , Vivier Eric
Published: April 2017

Cross-talk between innate lymphoid cells and the alternative complement pathway protects against invasive bacterial infections.
Coxiella burnetii Circulation in a Naturally Infected Flock of Sheep: Individual Follow-Up of Antibodies in Serum and Milk
Authors: Joulié A. , Rousset E. , Gasqui P. , Lepetitcolin E. , Leblond A. , Sidi-Boumedine K. , Jourdain E.
Published: April 2017

The control of Q fever, a zoonotic disease caused by the
Coxiella burnetii
bacterium, remains a scientific challenge. Domestic ruminants are considered the main reservoir, shedding
C. burnetii
essentially through parturition products during abortion or birth. Sheep are particularly frequently associated with human outbreaks, but there are insufficient field data to fully understand disease dynamics and to instigate efficient control measures. A longitudinal follow-up study of a naturally infected sheep flock was performed (i) to investigate relationships between seropositivity and bacterial shedding in the vaginal mucus, (ii) to describe the kinetics of antibodies, including responses to vaccination, (iii) to monitor maternal antibodies in ewe lambs, and (iv) to compare serological results for milk and serum samples. For 8 months, we collected blood samples every 3 weeks from 11 aborting and 26 nonaborting dairy ewes, 20 nonaborting suckler ewes, and 9 ewe lambs. Individual milk samples were also obtained from lactating females. All serum and milk samples were tested by enzyme-linked immunosorbent assay (ELISA), whereas vaginal swabs were tested by quantitative PCR. We found that some dairy females did not seroconvert despite shedding
C. burnetii
in their vaginal mucus. Overall, antibody levels in adult females were found to remain stable over time, with exceptions during the mating and lambing periods. Maternal antibodies decreased during the first month after birth. Interestingly, antibody levels in milk were correlated with those in serum. This study provides valuable field data that will help improve Q fever surveillance and within-flock management measures.

IMPORTANCE
Field data are necessary to improve the surveillance, diagnosis, and sanitary management of Q fever in livestock. Here, we provide extensive serological data obtained from serum and milk samples from infected and vaccinated ewes belonging to a naturally infected flock of sheep. We show that antibody levels are stable over time and seropositivity and vaginal shedding are not clearly correlated, whereas antibody levels in milk are strongly correlated with those in serum. Accordingly, we find that antibody levels in bulk tank milk are consistent with the variations observed in the serum of dairy females over time. We report the existence of maternal antibody transmission to ewe lambs and we show that the presence of maternal antibodies at birth does not prevent the development of a serological response to vaccination at the age of 4 months. Finally, we report that adult ewes generally seroconvert after vaccination, including during pregnancy.
Approaches for Reverse Line Blot-Based Detection of Microbial Pathogens in Ixodes ricinus Ticks Collected in Austria and Impact of the Chosen Method
Authors: Schötta Anna-Margarita , Wijnveld Michiel , Stockinger Hannes , Stanek Gerold
Published: April 2017

Ticks transmit a large number of pathogens capable of causing human disease. In this study, the PCR-reverse line blot (RLB) method was used to screen for pathogens in a total of 554
Ixodes ricinus
ticks collected from all provinces of Austria. These pathogens belong to the genera
Borrelia
,
Rickettsiae
,
Anaplasma
/
Ehrlichia
(including “
Candidatus
Neoehrlichia”),
Babesia
, and
Coxiella
. The pathogens with the highest detected prevalence were spirochetes of the
Borrelia burgdorferi
sensu lato
complex, in 142 ticks (25.6%).
Borrelia afzelii
(80/142) was the most frequently detected species, followed by
Borrelia burgdorferi
sensu stricto
(38/142) and
Borrelia valaisiana
(36/142).
Borrelia garinii/Borrelia bavariensis
,
Borrelia lusitaniae
, and
Borrelia spielmanii
were found in 28 ticks, 5 ticks, and 1 tick, respectively.
Rickettsia
spp. were detected in 93 ticks (16.8%):
R. helvetica
(39/93),
R. raoultii
(38/93),
R. monacensis
(2/93), and
R. slovaca
(1/93). Thirteen
Rickettsia
samples remain uncharacterized. “
Candidatus
Neoehrlichia mikurensis,”
Babesia
spp. (
B. venatorum
,
B. divergens
,
B. microti
), and
Anaplasma phagocytophilum
were found in 4.5%, 2.7%, and 0.7%, respectively.
Coxiella burnetii
was not detected. Multiple microorganisms were detected in 40 ticks (7.2%), and the cooccurrence of
Babesia
spp. and “
Candidatus
Neoehrlichia mikurensis” showed a significant positive correlation. We also compared different PCR-RLBs for detection of
Borrelia burgdorferi
sensu lato
and
Rickettsia
spp. and showed that different detection approaches provide highly diverse results, indicating that analysis of environmental samples remains challenging.

IMPORTANCE
This study determined the wide spectrum of tick-borne bacterial and protozoal pathogens that can be encountered in Austria. Surveillance of (putative) pathogenic microorganisms occurring in the environment is of medical importance, especially when those agents can be transmitted by ticks and cause disease. The observation of significant coinfections of certain microorganisms in field-collected ticks is an initial step to an improved understanding of microbial interactions in ticks. In addition, we show that variations in molecular detection methods, such as in primer pairs and target genes, can considerably influence the final results. For instance, detection of certain genospecies of borreliae may be better or worse by one method or the other, a fact of great importance for future screening studies.
Regulation of Botulinum Neurotoxin Synthesis and Toxin Complex Formation by Arginine and Glucose in Clostridium botulinum ATCC 3502
Authors: Fredrick Chase M. , Lin Guangyun , Johnson Eric A.
Published: April 2017

Botulinum neurotoxin (BoNT), produced by neurotoxigenic clostridia, is the most potent biological toxin known and the causative agent of the paralytic disease botulism. The nutritional, environmental, and genetic regulation of BoNT synthesis, activation, stability, and toxin complex (TC) formation is not well studied. Previous studies indicated that growth and BoNT formation were affected by arginine and glucose in
Clostridium botulinum
types A and B. In the present study,
C. botulinum
ATCC 3502 was grown in toxin production medium (TPM) with different levels of arginine and glucose and of three products of arginine metabolism, citrulline, proline, and ornithine. Cultures were analyzed for growth (optical density at 600 nm [OD
600
]), spore formation, and BoNT and TC formation by Western blotting and immunoprecipitation and for BoNT activity by mouse bioassay. A high level of arginine (20 g/liter) repressed BoNT production approximately 1,000-fold, enhanced growth, slowed lysis, and reduced endospore production by greater than 1,000-fold. Similar effects on toxin production were seen with equivalent levels of citrulline but not ornithine or proline. In TPM lacking glucose, levels of formation of BoNT/A1 and TC were significantly decreased, and extracellular BoNT and TC proteins were partially inactivated after the first day of culture. An understanding of the regulation of
C. botulinum
growth and BoNT and TC formation should be valuable in defining requirements for BoNT formation in foods and clinical samples, improving the quality of BoNT for pharmaceutical preparations, and elucidating the biological functions of BoNTs for the bacterium.

IMPORTANCE
Botulinum neurotoxin (BoNT) is a major food safety and bioterrorism concern and is also an important pharmaceutical, and yet the regulation of its synthesis, activation, and stability in culture media, foods, and clinical samples is not well understood. This paper provides insights into the effects of critical nutrients on growth, lysis, spore formation, BoNT and TC production, and stability of BoNTs of
C. botulinum
. We show that for
C. botulinum
ATCC 3502 cultured in a complex medium, a high level of arginine repressed BoNT expression by ca. 1,000-fold and also strongly reduced sporulation. Arginine stimulated growth and compensated for a lack of glucose. BoNT and toxin complex proteins were partially inactivated in a complex medium lacking glucose. This work should aid in optimizing BoNT production for pharmaceutical uses, and furthermore, an understanding of the nutritional regulation of growth and BoNT formation may provide insights into growth and BoNT formation in foods and clinical samples and into the enigmatic function of BoNTs in nature.
Draft Genome Sequences of Salmonella enterica subsp.
enterica
Serovar Typhimurium Strains Isolated from Chicken and Swine Carcasses in Two Distinct Geographical Regions from Rio de Janeiro State, Brazil
Authors: Panzenhagen Pedro Henrique N. , Cabral Claudius C. , Suffys Philip N. , Aquino Maria Helena C. , Franco Robson M. , Pereira Virgínia L. A. , Rodrigues Dalia P. , Conte-Junior Carlos A.
Published: April 2017

Salmonella enterica
subsp.
enterica
serovar Typhimurium is a surveyed worldwide serotype with well-characterized genomes for several different strains. In Brazil, very few studies have submitted whole-genome sequences to GenBank. This genome may be useful to analyze the genetic mechanisms comparable to those of other related studies conducted in Brazil and globally.
Forensic Approaches to Detect Possible Agents of Bioterror
Authors: González Alfredo A. , Rivera-Pérez Jessica I. , Toranzos Gary A.
Published: April 2017

Many biological agents have been strategic pathogenic agents throughout history. Some have even changed history as a consequence of early discoveries of their use as weapons of war. Many of these bioagents can be easily isolated from the environment, and some have recently been genetically manipulated to become more pathogenic for biowarfare. However, it is difficult to determine accidental outbreaks of disease from intentional exposures. In this review, we examine how molecular tools have been used in combination with forensic research to resolve cases of unusual outbreaks and trace the source of the biocrime. New technologies are also discussed in terms of their crucial role impacting forensic science. The anthrax event of 2001 serves as an example of the real threat of bioterrorism and the employment of bioagents as weapons against a population. The Amerithrax investigation has given us lessons of the highest resolution possible with new technologies capable of distinguishing isolates at the base-pair level of sensitivity. In addition, we discuss the implications of proper sanitation to avoid waterborne diseases. The use of new methods in forensic science and health-related surveillance will be invaluable in determining the source of any new disease outbreak, and these data will allow for a quick response to any type of public health threat, whether accidental or purposely initiated.
What is the difference in concussion management in children as compared with adults? A systematic review
Authors: Davis Gavin A , Anderson Vicki , Babl Franz E , Gioia Gerard A , Giza Christopher C , Meehan William , Moser Rosemarie Scolaro , Purcell Laura , Schatz Philip , Schneider Kathryn J , Takagi Michael , Yeates Keith Owen , Zemek Roger
Published: April 2017

Aim

To evaluate the evidence regarding the management of sport-related concussion (SRC) in children and adolescents. The eight subquestions included the effects of age on symptoms and outcome, normal and prolonged duration, the role of computerised neuropsychological tests (CNTs), the role of rest, and strategies for return to school and return to sport (RTSp).

Design

Systematic review.

Data sources

MEDLINE (OVID), Embase (OVID) and PsycInfo (OVID).

Eligibility criteria for selecting studies

Studies were included if they were original research on SRC in children aged 5 years to 18 years, and excluded if they were review articles, or did not focus on childhood SRC.

Results

A total of 5853 articles were identified, and 134 articles met the inclusion criteria. Some articles were common to multiple subquestions. Very few studies examined SRC in young children, aged 5–12 years.

Summary/conclusions

This systematic review recommends that in children: child and adolescent age-specific paradigms should be applied; child-validated symptom rating scales should be used; the widespread routine use of baseline CNT is not recommended; the expected duration of symptoms associated with SRC is less than 4 weeks; prolonged recovery be defined as symptomatic for greater than 4 weeks; a brief period of cognitive and physical rest should be followed with gradual symptom-limited physical and cognitive activity; all schools be encouraged to have a concussion policy and should offer appropriate academic accommodations and support to students recovering from SRC; and children and adolescents should not RTSp until they have successfully returned to school, however early introduction of symptom-limited physical activity is appropriate.

Systematic review registration

PROSPERO 2016:CRD42016039184
A systematic review of potential long-term effects of sport-related concussion
Authors: Manley Geoff , Gardner Andrew J , Schneider Kathryn J , Guskiewicz Kevin M , Bailes Julian , Cantu Robert C , Castellani Rudolph J , Turner Michael , Jordan Barry D , Randolph Christopher , Dvořák Jiří , Hayden K. Alix , Tator Charles H , McCrory Paul , Iverson Grant L
Published: April 2017

Objective

Systematic review of possible long-term effects of sports-related concussion in retired athletes.

Data sources

Ten electronic databases.

Study selection

Original research; incidence, risk factors or causation related to long-term mental health or neurological problems; individuals who have suffered a concussion; retired athletes as the subjects and possible long-term sequelae defined as>10 years after the injury.

Data extraction

Study population, exposure/outcome measures, clinical data, neurological examination findings, cognitive assessment, neuroimaging findings and neuropathology results. Risk of bias and level of evidence were evaluated by two authors.

Results

Following review of 3819 studies, 47 met inclusion criteria. Some former athletes have depression and cognitive deficits later in life, and there is an association between these deficits and multiple prior concussions. Former athletes are not at increased risk for death by suicide (two studies). Former high school American football players do not appear to be at increased risk for later life neurodegenerative diseases (two studies). Some retired professional American football players may be at increased risk for diminishment in cognitive functioning or mild cognitive impairment (several studies), and neurodegenerative diseases (one study). Neuroimaging studies show modest evidence of macrostructural, microstructural, functional and neurochemical changes in some athletes.

Conclusion

Multiple concussions appear to be a risk factor for cognitive impairment and mental health problems in some individuals. More research is needed to better understand the prevalence of chronic traumatic encephalopathy and other neurological conditions and diseases, and the extent to which they are related to concussions and/or repetitive neurotrauma sustained in sports.
Can care staff accurately assess health-related quality of life of care home residents? A secondary analysis of data from the OPERA trial
Authors: Parker Ben , Petrou Stavros , Underwood Martin , Madan Jason
Published: April 2017

Objectives

To compare assessments of health-related quality of life outcomes of care home residents reported by residents and care staff acting as proxies.

Design

Linear regression and bivariate modelling of paired assessments from care home residents and care staff.

Setting

78 care homes in 2 regions in England.

Participants

556 care home residents aged 65 years or older and care staff.

Main outcome measures

EQ-5D utility scores and responses to individual EQ-5D dimensions.

Results

The depression status, cognitive function, physical function, activities of daily living, social engagement, pain and dementia diagnosis of care home residents all predicted discrepancies in EQ-5D reporting. For residents with no depressive symptoms, care staff underestimated residents' mean EQ-5D utility score by 0.134 (95% CI 0.097 to 0.171) and for those with severe depressive symptoms they overstated mean utility scores by 0.222 (95% CI 0.104 to 0.339). With increasing levels of pain in residents the care staff progressively estimated EQ-5D utilities above self-reported values; by 0.236 (95% CI 0.003 to 0.469) in those with the second highest pain scores. For those with no cognitive impairment, proxies overstated mean utility scores by 0.097 (95% CI 0.049 to 0.146), while for those with severe cognitive impairment they underestimated mean utility scores by 0.192 (95% CI 0.143 to 0.241).

Conclusions

Care home residents and staff appear to differ fundamentally in their assessment of the health-related quality of life, as measured by the EQ-5D, of residents with different levels of depression, pain and/or cognitive impairment. This could lead to interventions evaluated using proxy-based quality-adjusted life year estimates being wrongly rejected on cost-effectiveness grounds and may also make it difficult for carers to act as advocates with health and social care professionals for certain groups of residents. A more resident-focussed approach to assessment of health-related quality of life is needed.
Accuracy of testing for anti-Helicobacter pyloriIgG in urine forH. pyloriinfection diagnosis: a systematic review and meta-analysis
Authors: Gong Yuehua , Li Qiuping , Yuan Yuan
Published: April 2017

Objectives

This meta-analysis aims to systematically measure the potential diagnostic value of anti-Helicobacter pyloriIgG in urine for infection diagnosis, using all eligible studies published in English and Chinese languages.

Design

The random effect model was used to analyse the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative LR (NLR), diagnostic OR (DOR), together with the summary receiver operator characteristic curve.

Setting

Literature searches of databases including PubMed, EMBASE, MEDLINE, Web of Science, Chinese National Knowledge Infrastructure and Wanfang databases were performed to retrieve studies evaluating the diagnostic value of urine IgG antibody forH.pyloriinfection.

Primary outcome measure

Twenty-three studies with 4963 subjects were included in the current meta-analysis.

Results

The pooled sensitivity, specificity, PLR, NLR, DOR and area under the curve (AUC) were 0.83 (95% CI 0.82 to 0.85), 0.89 (95% CI 0.88 to 0.90), 8.81 (95% CI 6.37 to 12.2), 0.13 (95% CI 0.09 to 0.2), 73 (95% CI 46.45 to 114.74) and 0.9551, respectively. Subgroup analyses showed that diagnostic accuracy of the urine IgG assay was no different in age, region, study population and assay method.

Conclusions

Anti-H. pyloriantibody in urine might serve as a good marker in diagnosingH. pyloriinfection. However, further validation based on a larger sample is still required.
Improving antimicrobial prescribing practice for sore throat symptoms in a general practice setting
Authors: Razai Mohammad , Hussain Kamal
Published: April 2017

Acute sore throat is a common presentation in primary care settings. We aimed to improve our compliance with national antibiotic guidelines for sore throat symptoms to 90% in 3 months' time period. The national guidelines are based on Centor criteria. A retrospective audit of 102 patient records with sore throat symptoms presenting between 1 January to 30 December 2015 showed that over 50% were given antibiotics. Those who were prescribed antibiotics, 27% did not meet NICE criteria and 85% of patients were given immediate antibiotic prescription. Centor criteria was documented in just 2% of cases. Compliance with correct antibiotic course length was 15%. Antibiotic choice and dose was correct in 94% and 92% of cases respectively. Antibiotic frequency was correctly prescribed in 100% of patients.

We introduced interventions that included oral and poster presentations to multidisciplinary team, dissemination of guidelines through internal e-mail and systemic changes to GP electronic patient record system EMIS. This involved creating an automated sore throat template and information page. On re-auditing of 71 patients, after two PDSA cycles, compliance with NICE criteria was 87% with a significant reduction in immediate prescribing (66%). Centor criteria documentation was 42%. Correct antibiotic course length was prescribed in over 30% of cases. Other antibiotic regimen parameters (choice, dose and frequency) were correct in 100% of cases.

The initial results demonstrated that significant changes were needed. In particular, reducing the amount of antibiotics prescribed by increasing compliance with NICE criteria and ensuring all parameters of antibiotic prescription were correct. We showed that significant sustainable improvement is achievable through carefully devised automated systemic changes that provides critical information in readily accessible format, and does not solely rely on prescribers' knowledge and initiative. The outcome of these interventions are a decrease in immediate antibiotic prescription, significant increase in Centor criteria documentation and an increase in compliance with the correct course length of antibiotics. All these measures would contribute to reduction in antimicrobial resistance and improvement in patient care in the community. Future work must focus on improving compliance with correct antibiotic course length.
Introducing a New Junior Doctor Electronic Weekend Handover on an Orthopaedic Ward
Authors: Maroo Siddharth , Raj Dipak
Published: April 2017

Junior Doctors working on the Orthopaedic wards at a district general hospital identified the lack of a formal weekend handover. The Royal Colleges,GMC and Foundation Programme curriculum all emphasise the importance of a safe and effective handover. Doctors found that the current system of using a written, paper-based handover was unreliable, un-legible, and inefficient. Baseline measurements were sought in the form of a questionnaire which allowed us to obtain the limitations to the current handover. After this and a focus group, a new electronic, ‘Microsoft Word’ based handover was created and a repeat surgery issued in 2 weeks. Further PDSA cycles over the course of 8 weeks helped to improve and implement the new handover. The overall rating, out of 10, of the new handover increased from 3.4 to 8. Doctors felt the new handover was safer for patients and could be used as a tool for reviewing or referring patients. This project describes the use of a simple, cost-effective intervention that helped to improve patient safety and staff satisfaction.
Reducing returns to theatre for neck of femur fracture patients
Authors: Graham Selina , Dahill Mark , Robinson Derek
Published: April 2017

The Royal United Hospital, Bath, admits approximately 550 patients with neck of femur fractures per year. The risks from returning to theatre for this patient group are often life-threatening. Post-operative wound ooze was noted to cause a significant rate of return to theatre, with increased lengths of stay and patient morbidity.

A wound closure protocol was agreed by the consultant body. This information was disseminated by email and teaching sessions to all members of the multidisciplinary team, including surgeons, theatre staff and ortho-geriatricians. The plan-do-study-act model for improvement was used to reduce rates of returns to theatre for wound ooze. Interventions included cyclical teaching during each trainee rotation, updated inductions, posters, email reminders and scrub team involvement to open the protocol sutures unprompted.

The primary outcome measure was returns to theatre for wound complications. Baseline data showed 4 returns to theatre over a two month period (4.40% of patients). Length of stay for each patient affected by wound ooze was also compared to the departmental mean. In the 6 month intervention period there was one return to theatre (0.36% of patients). The observed reduction saved the department an estimated £13,831 in length of stay alone.

The standardisation of wound closure protocol, with continued reinforcement to all members of the multidisciplinary team, improves patient outcome in this group. Mobilising a group of clinicians across a variety of specialities, with one common goal, is highly effective for patients, improves multidisciplinary working and reduces cost.
Left atrial strain predicts recurrence of atrial arrhythmias after catheter ablation of persistent atrial fibrillation
Authors: Parwani Abdul Shokor , Morris Daniel-Armando , Blaschke Florian , Huemer Martin , Pieske Burkert , Haverkamp Wilhelm , Boldt Leif-Hendrik
Published: April 2017

Introduction

Success rates of catheter ablation (CA) of persistent atrial fibrillation (AF) are very variable. Identifying patients in whom sinus rhythm maintenance cannot be achieved after CA is a critical issue.

Methods

2D speckle-tracking echocardiography was performed before the first CA procedure in consecutive patients with persistent AF. Left atrial (LA) strain was correlated with recurrence of atrial arrhythmias during the follow-up period of 15 months after one CA procedure with or without antiarrhythmic drugs (primary endpoint). In a secondary analysis, recurrences after two CA procedures were analysed.

Results

102 patients were included. Patients with recurrence of atrial arrhythmias after one CA procedure (n=55) had significantly lower LA strain than those without recurrence (LA strain 9.7±2.4% vs 16.2±3.0%; p<0.001). Recurrence rate was significantly higher in patients with LA strain <10% than in those with LA strain between 10% and 14.5% and >14.5% (97.7%, 42.1% and 10.3%, respectively; p<0.001). In Cox regression analysis including age, comorbidities, left ventricular dysfunction and LA enlargement, low LA strain (<10%) was the strongest factor associated with recurrence of AF (HR 6.4 (2.4–16.9), p<0.001). Even after inclusion of a second CA procedure, LA strain <10% maintained a high predictive value for recurrence of atrial arrhythmias (86.4% (95% CI 73.3% to 93.6%)).

Conclusion

In patients with persistent AF, LA strain imaging could be very useful to select those patients who have a high risk of not benefiting from CA.
Liver stiffness assessed by Fibrosis-4 index predicts mortality in patients with heart failure
Authors: Sato Yu , Yoshihisa Akiomi , Kanno Yuki , Watanabe Shunsuke , Yokokawa Tetsuro , Abe Satoshi , Misaka Tomofumi , Sato Takamasa , Suzuki Satoshi , Oikawa Masayoshi , Kobayashi Atsushi , Yamaki Takayoshi , Kunii Hiroyuki , Nakazato Kazuhiko , Saitoh Shu-ichi , Takeishi Yasuchika
Published: April 2017

Objective

Liver dysfunction due to heart failure (HF) is known as congestive hepatopathy. It has recently been reported that liver stiffness assessed by transient elastography reflects increased central venous pressure. The Fibrosis-4 (FIB4) index (age (years) × aspartate aminotransferase (IU/L)/platelet count (109/L) × square root of alanine aminotransferase (IU/L)) is expected to be useful for evaluating liver stiffness in patients with non-alcoholic fatty liver disease. We aimed to investigate the impact of the FIB4 index on HF prognosis, with consideration for liver fibrosis markers and underlying cardiac function.

Methods

Consecutive 1058 patients with HF who were admitted to our hospital were divided into three groups based on their FIB4 index: first (FIB4 index <1.72, n=353), second (1.72≤FIB4 index <3.01, n=353) and third tertiles (3.01≤FIB4 index, n=352). We prospectively followed for all-cause mortality.

Results

During the follow-up period (mean 1047 days), 246 deaths occurred. In the Kaplan-Meier analysis, all-cause mortality progressively increased from the first to third groups (12.2%, 21.0% and 36.6%, p<0.01). In the Cox proportional hazard analysis, FIB4 index was an independent predictor of all-cause mortality in patients with HF (p<0.05). In comparisons of laboratory and echocardiographic findings, the third tertile had higher levels of type IV collagen 7S, procollagen type III peptide, hyaluronic acid, left atrial volume, mitral valve E/e’, inferior vena cava diameter and right atrial end systolic area (p<0.01, respectively).

Conclusion

The FIB4 index, a marker of liver stiffness, is associated with higher all-cause mortality in patients with HF.
Association of HLA-DQB1 polymorphisms with rheumatoid arthritis: a meta-analysis
Authors: Wu Jun , Li Jun , Li Si , Zhang Tian-Ping , Li Lian-Ju , Lv Tian-Tian , Pan Hai-Feng , Ye Dong-Qing
Published: April 2017

Aim

Studies investigating the association between HLA-DQB1 alleles and rheumatoid arthritis (RA) have reported conflicting results. The purpose of this study was to evaluate whether DQB1 alleles confer susceptibility to RA.

Design

A comprehensive literature search up to May 2016 was conducted to identify case-control studies on the association of HLA-DQB1 alleles with RA. Pooled ORs with 95% CIs were used to assess the strength of association.

Setting

The literature indicates that HLA-DQB1 is associated with susceptibility to RA.

Main outcome measures

Frequencies of HLA-DQB1 alleles and phenotype in RA patients and healthy controls.

Results

Fifteen studies with 1250 cases and 1621 controls were included in this meta-analysis. DQB1 alleles were associated with RA susceptibility. The frequencies of DQB1*06 were lower in RA (p-value for comparability=0.007, OR 0.726,95% CI 0.576 to 0.916; p=0.004, OR 0.611,95% CI 0.438 to 0.852). The frequencies of DQB1*02 were lower in RA (p=0.044, OR 0.731,95% CI 0.597 to 0.895). A higher frequency of DQB1*04 was observed in RA (p=0.023, OR 1.604,95% CI 1.067 to 2.410).

Conclusions

This meta-analysis demonstrates that DQB1*02 and DQB1*06 may be negatively associated with RA. Conversely, DQB1*04 may confer susceptibility to RA.
A multidisciplinary approach to reducing alarm fatigue and cost through appropriate use of cardiac telemetry
Authors: Alsaad Ali A , Alman Carly R , Thompson Kristine M , Park Shin H , Monteau Rebecca E , Maniaci Michael J
Published: April 2017

Background

Alarm fatigue (AF) is a distressing factor for staff and patients in the hospital. Using cardiac telemetry (CT) without clinical indications can create unnecessary alarms, and increase AF and cost of healthcare. We sought to reduce AF and cost associated with CT monitoring.

Methods

After implementing a new protocol for CT placement, data were collected on telemetry orders, alarms and bed cost for 13 weeks from 1 January 2015 through 31 March 2015. We also retrospectively collected data on the same variables for the 13 weeks prior to the intervention. A survey was administered to nurses to assess past and present perceptions of AF. Interventions included protocol creation and education for participants.

Results

At baseline, 77% of patients were monitored with CT. A total of 145 (31%) order discrepancies were discovered during data collection, of which 72% had no indication for CT, so CT was discontinued. The other 28% had indications, so orders were placed. A total of 8336 alarms were recorded during 4 weeks of data collection, of which 333 (4%) were classified as true actionable alarms. Postintervention data showed 67% CT assignment with 10% reduction in CT usage, with no increase in mortality (p<0.001 and >0.05, respectively). A 42% cost reduction was achieved after adjusting the patient status. Nurses reported 27% perceived reduction in AF. One-year follow-up revealed that 69% of patients were being monitored by CT, and the rate of order discrepancies due to lack of indication was 9%.

Conclusion

All hospital units may benefit from the protocols created during this study. If applied appropriately, these protocols can lead to reduced AF and cost per episode of care.
Dietary intake and cardiometabolic biomarkers in relation to insulin resistance and hypertension in a middle-aged and elderly population in Beijing, China
Authors: Wang Jia , Hong Zhongxin , Wu Li , Ding Bingjie , Bi Yanxia , Gu Zhongyi , Li Wei
Published: April 2017

This study investigated the relationships of dietary intake and cardiometabolic biomarkers with insulin resistance and hypertension in rural middle-aged and elderly people in China. One hundred and eight middle-aged and elderly adults were recruited in Zhangfang village in May 2014. We measured blood pressure, anthropometric parameters, and biochemical indexes, including high-sensitivity C-reactive protein (hsCRP), soluble intercellular adhesion molecule-1 (sICAM-1), glucose, insulin, and blood lipids. Homeostasis model assessment of insulin resistance index (HOMA-IR) was assessed on the basis of fasting glucose and insulin. We recorded participant demographic characteristics, dietary intake, and lifestyle using questionnaires. Hypertensive participants had higher levels of triglycerides (TG), hsCRP, sICAM-1, body fat percentage (BF%), arm muscle circumference (AMC) and HOMA-IR than nonhypertensive individuals. Hypertensive participants had higher carbohydrate intake but lower intakes of protein and fat. Carbohydrate intake was positively correlated with hsCRP, sICAM-1, TG, BF%, and HOMA-IR, and was negatively correlated with AMC. Protein and fat intakes were negatively correlated with hsCRP and sICAM-1. Protein intake was also significantly negatively correlated with TG and HOMA-IR, and positively correlated with AMC. HOMA-IR was positively correlated with hsCRP, sICAM-1, TG and BF%, and negatively correlated with AMC. Multivariable linear regression indicated that TG, sICAM-1, and hsCRP were significantly associated with HOMA-IR. In conclusion, in a rural Chinese population, high intake of carbohydrate and low intake of fat and protein were associated with insulin resistance and hypertension, possibly by increasing inflammatory factors such as sICAM-1 and hsCRP, increasing BF% and increasing the level of plasma TG.
Infliximab alleviates the mortality, mesenteric hypoperfusion, aortic dysfunction, and multiple organ damage in septic rats
Authors: Ozer Erdem Kamil , Goktas Mustafa Tugrul , Kilinc Ibrahim , Toker Aysun , Bariskaner Hulagu , Ugurluoglu Ceyhan , Iskit Alper Bektas
Published: April 2017

Tumor necrosis factor-alpha (TNF-α) is a pivotal mediator that triggers inflammatory process, oxidative stress, and multiple organ injury in sepsis. We investigated the effects of infliximab on survival, mesenteric artery blood flow (MBF), vascular reactivity, and oxidative and inflammatory injuries in cecal ligation and puncture (CLP)-induced sepsis. Wistar rats were divided into Sham, CLP, Sham+infliximab, and CLP+infliximab subgroups. Twenty-four hours before the operations, rats were injected intraperitoneally with infliximab (7 mg/kg) or vehicle (saline; 1 mL/kg). Twenty hours after the operations, MBF and phenylephrine responses of isolated aortic rings were measured. Tissue damages were examined biochemically and histopathologically. Furthermore, survival rates were monitored throughout 96 h. Infliximab improved survival, mesenteric perfusion, and aortic function after CLP. Increases of serum AST, ALT, LDH, BUN, Cr, and inflammatory cytokines (tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-6) induced by CLP were blocked by infliximab. Infliximab prevented malondialdehyde elevations in septic liver, lung, spleen, and kidney tissues, as well as glutathione reductions in septic liver, spleen, and kidney tissues. Protective effects of infliximab on multiple organ damage were also observed histopathologically. Infliximab showed protective effects in sepsis due to its improvement effects on mesenteric perfusion, aortic function, and its anti-inflammatory and antioxidative effects.
Energy efficiency quantitative analysis method of discrete manufacturing system
Authors: Wang Yan , Ji Zhicheng
Published: April 2017

The difficulty in the energy efficiency analysis of discrete manufacturing system is the lack of evaluation index system. In this paper, a novel evaluation index system with three layers and 10 indexes was presented to analyze the overall energy consumption level of the discrete manufacturing system. Then, with the consideration of the difficulties in directly obtaining machine energy efficiency, a prediction method based on recursive variable forgetting factor identification was put forward to calculate it. Furthermore, a comprehensive quantitative evaluation method of rough set and attribute hierarchical model was designed based on the index structure to evaluate the energy efficiency level. Finally, an experiment was used to illustrate the effectiveness of our evaluation index system and method.
Visual Simple Transformations
Authors: Akiki Pierre A. , Bandara Arosha K. , Yu Yijun
Published: April 2017

Empowering end-users to wire Internet of Things (IoT) objects (things and services) together would allow them to more easily conceive and realize interesting IoT solutions. A challenge lies in devising a simple end-user development approach to support the specification of transformations, which can bridge the mismatch in the data being exchanged among IoT objects. To tackle this challenge, we present Visual Simple Transformations (ViSiT) as an approach that allows end-users to use a jigsaw puzzle metaphor for specifying transformations that are automatically converted into underlying executable workflows. ViSiT is explained by presenting meta-models and an architecture for implementing a system of connected IoT objects. A tool is provided for supporting end-users in visually developing and testing transformations. Another tool is also provided for allowing software developers to modify, if they wish, a transformation's underlying implementation. This work was evaluated from a technical perspective by developing transformations and measuring ViSiT's efficiency and scalability and by constructing an example application to show ViSiT's practicality. A study was conducted to evaluate this work from an end-user perspective, and its results showed positive indications of perceived usability, learnability, and the ability to conceive real-life scenarios for ViSiT.
Designing for Transformative Play
Authors: Back Jon , Segura Elena Márquez , Waern Annika
Published: April 2017

Numerous studies have foregrounded how play is only partially shaped by the artifacts that their designers design. The play activity can change the structures framing it, turning players into co-designers through the mere act of playing.

This article contributes to our understanding of how we can design for play taking into account that play has this transformative power. We describe four ways that players can engage with framing structures, which we classify in terms of whether players conform to explore, transgress, or (re)create them. Through the examples of three case studies, we illustrate how this model has been useful in design: as an analytical tool for deconstructing player behavior, to articulate design goals and support specific design choices, and for shaping the design process.
Comparison of the Performance of Skin Prick, ImmunoCAP, and ISAC Tests in the Diagnosis of Patients with Allergy
Authors: Griffiths Rebecca L.M. , El-Shanawany Tariq , Jolles Stephen R.A. , Selwood Clive , Heaps Adrian G. , Carne Emily M. , Williams Paul E.
Published: April 2017

Background: Allergy is diagnosed from typical symptoms, and tests are performed to incriminate the suspected precipitant. Skin prick tests (SPTs) are commonly performed, inexpensive, and give immediate results. Laboratory tests (ImmunoCAP) for serum allergen-specific IgE antibodies are usually performed more selectively. The immuno-solid phase allergen chip (ISAC) enables testing for specific IgE against multiple allergen components in a multiplex assay. Methods: We retrospectively analysed clinic letters, case notes, and laboratory results of 118 patients attending the National Adult Allergy Service at the University Hospital of Wales who presented diagnostic difficulty, to evaluate which testing strategy (SPT, ImmunoCAP, or ISAC) was the most appropriate to use to confirm the diagnosis in these complex patients, evaluated in a “real-life” clinical service setting. Results: In patients with nut allergy, the detection rates of SPTs (56%) and ISAC (65%) were lower than those of ImmunoCAP (71%). ISAC had a higher detection rate (88%) than ImmunoCAP (69%) or SPT (33%) in the diagnosis of oral allergy syndrome. ImmunoCAP test results identified all 9 patients with anaphylaxis due to wheat allergy (100%), whereas ISAC was positive in only 6 of these 9 (67%). Conclusions: In this difficult diagnostic group, the ImmunoCAP test should be the preferred single test for possible allergy to nuts, wheat, other specific foods, and anaphylaxis of any cause. In these conditions, SPT and ISAC tests give comparable results. The most useful single test for oral allergy syndrome is ISAC, and SPT should be the preferred test for latex allergy.
Heterozygous Nonsense Mutation in the Androgen Receptor Gene Associated with Partial Androgen Insensitivity Syndrome in an Individual with 47,XXY Karyotype
Authors: Batista Rafael L. , Rodrigues Andresa S. , Nishi Mirian Y. , Feitosa Alina C.R. , Gomes Nathália L.R.A. , Junior José Antonia F. , Domenice Sorahia , Costa Elaine M.F. , de Mendonça Berenice B.
Published: April 2017

There are only 2 patients with 47,XXY karyotype and androgen receptor (AR) gene mutation reported in the literature, and both are diagnosed as complete androgen insensitivity syndrome (CAIS). We report a 22-year-old female with 47,XXY karyotype and atypical external genitalia. Sequencing of AR revealed the heterozygous p.Asn849Lys*32 mutation, and extensive X chromosome microsatellite analysis showed homozygosity for Xp and heterozygosity for Xq, suggesting partial X maternal isodisomy. Partial androgen insensitivity syndrome (PAIS) developed in this case, probably because of the presence of the heterozygous AR mutation and random X- inactivation of the healthy allele. This is the first report of a female patient with 47,XXY karyotype and PAIS phenotype.