bluuebunny/crossref_metadata_2025 huggingface dataset:
Daily QA of linear accelerators using only EPID and OBI
Authors: Sun Baozhou , Goddu S. Murty , Yaddanapudi Sridhar , Noel Camille , Li Hua , Cai Bin , Kavanaugh James , Mutic Sasa
Published: September 2015

Purpose:

As treatment delivery becomes more complex, there is a pressing need for robust quality assurance (QA) tools to improve efficiency and comprehensiveness while simultaneously maintaining high accuracy and sensitivity. This work aims to present the hardware and software tools developed for comprehensive QA of linear accelerator (LINAC) using only electronic portal imaging devices (EPIDs) and kV flat panel detectors.

Methods:

A daily QA phantom, which includes two orthogonally positioned phantoms for QA of MV‐beams and kV onboard imaging (OBI) is suspended from the gantry accessory holder to test both geometric and dosimetric components of a LINAC and an OBI. The MV component consists of a 0.5 cm water‐equivalent plastic sheet incorporating 11 circular steel plugs for transmission measurements through multiple thicknesses and one resolution plug for MV‐image quality testing. The kV‐phantom consists of a Leeds phantom (TOR‐18 FG phantom supplied by Varian) for testing low and high contrast resolutions. In the developed process, the existing LINAC tools were used to automate daily acquisition of MV and kV images and software tools were developed for simultaneous analysis of these images. A method was developed to derive and evaluate traditional QA parameters from these images [output, flatness, symmetry, uniformity, TPR20/10, and positional accuracy of the jaws and multileaf collimators (MLCs)]. The EPID‐based daily QA tools were validated by performing measurements on a detuned 6 MV beam to test its effectiveness in detecting errors in output, symmetry, energy, and MLC positions. The developed QA process was clinically commissioned, implemented, and evaluated on a Varian TrueBeam LINAC (Varian Medical System, Palo Alto, CA) over a period of three months.

Results:

Machine output constancy measured with an EPID (as compared against a calibrated ion‐chamber) is shown to be within ±0.5%. Beam symmetry and flatness deviations measured using an EPID and a 2D ion‐chamber array agree within ±0.5% and ±1.2% for crossline and inline profiles, respectively. MLC position errors of 0.5 mm can be detected using a picket fence test. The field size and phantom positioning accuracy can be determined within 0.5 mm. The entire daily QA process takes ∼15 min to perform tests for 5 photon beams, MLC tests, and imaging checks.

Conclusions:

The exclusive use of EPID‐based QA tools, including a QA phantom and simultaneous analysis software tools, has been demonstrated as a viable, efficient, and comprehensive process for daily evaluation of LINAC performance.
Angular dependence of dose sensitivity of nanoDot optically stimulated luminescent dosimeters in different radiation geometries
Authors: Jursinic Paul A.
Published: September 2015

Purpose:

A type of in vivo dosimeter, an optically stimulated luminescent dosimeter, OSLD, may have dose sensitivity that depends on the angle of incidence of radiation. This work measures how angular dependence of a nanoDot changes with the geometry of the phantom in which irradiation occurs and with the intrinsic structure of the nanoDot.

Methods:

The OSLDs used in this work were nanoDot dosimeters (Landauer, Inc., Glenwood, IL), which were read with a MicroStar reader (Landauer, Inc., Glenwood, IL). Dose to the OSLDs was delivered by 6 MV x‐rays. NanoDots with various intrinsic sensitivities were irradiated in numerous phantoms that had geometric shapes of cylinders, rectangles, and a cube.

Results:

No angular dependence was seen in cylindrical phantoms, cubic phantoms, or rectangular phantoms with a thickness to width ratio of 0.3 or 1.5. An angular dependence of 1% was observed in rectangular phantoms with a thickness to width of 0.433–0.633. A group of nanoDots had sensitive layers with mass density of 2.42–2.58 g/cm3 and relative sensitivity of 0.92–1.09 and no difference in their angular dependence. Within experimental uncertainty, nanoDot measurements agree with a parallel‐plate ion chamber at a depth of maximum dose.

Conclusions:

When irradiated in cylindrical, rectangular, and cubic phantoms, nanoDots show a maximum angular dependence of 1% or less at an incidence angle of 90°. For a sample of 78 new nanoDots, the range of their relative intrinsic sensitivity is 0.92–1.09. For a sample of ten nanoDots, on average, the mass in the sensitive layer is 73.1% Al2O3:C and 26.9% polyester. The mass density of the sensitive layer of a nanoDot disc is between 2.42 and 2.58 g/cm3. The angular dependence is not related to Al2O3:C loading of the nanoDot disc. The nanoDot at the depth of maximum dose has no more angular dependence than a parallel‐plate ion chamber.
Three‐dimensional reconstruction of a vascular network by dynamic tracking of magnetite nanoparticles
Authors: Olamaei Nina , Cheriet Farida , Deschênes Sylvain , Sharafi Azadeh , Martel Sylvain
Published: September 2015

Purpose:

Visualization of small blood vessels feeding tumor sites provides important information on the tumors and their microenvironment. This information plays an important role in targeted drug therapies using magnetic gradients. However, capabilities of current clinical imaging modalities may be insufficient to resolve complex microvascular networks. The purpose of this study is to map the vascular network, 3D, based on the magnetic susceptibility contrast.

Methods:

Magnetic particles induce an inhomogeneity in the MRI's magnetic field in an order much larger than their real size. This is an approach to compensate the spatial resolution insufficiency of a clinical MR scanner. Micron‐sized agglomerations of magnetite nanoparticles were injected in a 3D phantom vascular network, and a fast multislice, multiacquisition MR sequence was applied to track the agglomerations along their trajectories. The experiment was performed twice for two different imaging planes: coronal and transversal. The susceptibility artifact in the images indicated the presence and the position of the agglomerations. The calculated positions through multiple images were assembled to build up the 3D distribution of the vascular network.

Results:

The calculated points were compared with the centerline of the channels, extracted from the 3D reference image, to determine the absolute measurement error. The mean error was measured to be approximately half of the pixel's size. It was found that the positioning error on the axis perpendicular to the imaging slice was nearly twice as high as on the imaging plane axes due to the slice thickness. In order to compensate for the lack of resolution on the perpendicular axis, the reconstruction was performed using a combination of coronal and transversal data. The combination of the coordinates led to a significant decrease in the mean measurement error at each segment in the vascular network (p < 0.001).

Conclusions:

A method for 3D reconstruction of a microvascular network based on the susceptibility contrast in MRI and using a clinical scanner and a commercial receiver coil was proposed. The method presents a novel approach for reconstruction of vascular networks using the susceptibility effect. The proposed method may be applied to resolve vascular networks at a micrometric scale.
Assessment of Body Composition and Sport Performance of Brazilian Paralympic Swim Team Athletes
Authors: Medeiros Radamés M.V. , Alves Eduardo S. , Lemos Valdir A. , Schwingel Paulo A. , da Silva Andressa , Vital Roberto , Vieira Alexandre S. , Barreto Murilo M. , Rocha Edilson A. , Tufik Sergio , de Mello Marco T.
Published: September 2015

Context:

Body-composition assessments of high-performance athletes are very important for identifying physical performance potential. Although the relationship between the kinanthropometric characteristics and performance abilities of Olympic swimmers is extremely important, this subject is not completely understood for Paralympic swimmers.

Objective:

To investigate the relationship between body composition and sport performance in Brazilian Paralympic swimmers 6 mo after training.

Design:

Experimental pre/posttest design.

Setting:

Research laboratory and field evaluations of swimming were conducted to verify the 50-m freestyle time of each athlete.

Participants:

17 Brazilian Paralympic swim team athletes (12 men, 5 women).

Main Outcome Measures:

Body-composition assessments were performed using a BOD POD, and swimming performance was assessed using the 50-m freestyle, which was performed twice: before and after 6 mo of training.

Results:

Increased lean mass and significantly reduced relative fat mass and swimming time (P < .05) were observed 6 mo after training. Furthermore, a positive correlation between body-fat percentage and performance (r = .66, P < .05) was observed, but there was no significant correlation between body density and performance (r = –.14, P > .05).

Conclusions:

After a 6-mo training period, Paralympic swimmers presented reduced fat mass and increased lean body mass associated with performance, as measured by 50-m freestyle time. These data suggest that reduced fat-mass percentage was significantly correlated with improved swimming performance in Paralympic athletes.
The Effectiveness of Cervical Strengthening in Decreasing Neck-Injury Risk in Wrestling
Authors: Lee Katherine , Onate James , McCann Samar , Hunt Tamerah , Turner Wilbert , Merrick Mark
Published: September 2015

Clinical Scenario:

In wrestling, athletes often support a large amount of weight on their heads or are forced into extreme ranges of motion. These suboptimal movement conditions lead to a high prevalence of neck injuries in wrestlers. A large portion of the work done by the cervical musculature in wrestling is theorized to be eccentric or isometric types of contractions. Strengthening of these cervical muscles is clinically considered to play a vital role in being competitive on the wrestling mat. The cervical stability provided by strengthening these muscles may also play a part in injury prevention among wrestlers.

Focused Clinical Question:

Does increased cervical strength lead to a decreased risk of injury in wrestling?

Summary of Search, “Best Evidence” Appraised, and Key Findings:

The literature was searched for studies of level 4 evidence or higher using the Oxford Centre for Evidence-Based Medicine level of evidence system that investigated the relationship between cervical strength and injury risk in wrestling. No studies were found comparing cervical strength to injury risk in wrestling, but 2 related studies were found and have been included in this critically appraised topic.

Clinical Bottom Line:

There is poor evidence to support a relationship between cervical strength and injury risk in wrestling.

Strength of Recommendation:

There is grade C evidence to indicate that increased cervical strength decreases the risk of injury in wrestling.
Excessive caloric intake acutely causes oxidative stress, GLUT4 carbonylation, and insulin resistance in healthy men
Authors: Boden Guenther , Homko Carol , Barrero Carlos A. , Stein T. Peter , Chen Xinhua , Cheung Peter , Fecchio Chiara , Koller Sarah , Merali Salim
Published: September 2015

Acute overnutrition in healthy men caused rapid weight gain and insulin resistance, as well as oxidative stress.
The mitotic kinesin KIF11 is a driver of invasion, proliferation, and self-renewal in glioblastoma
Authors: Venere Monica , Horbinski Craig , Crish James F. , Jin Xun , Vasanji Amit , Major Jennifer , Burrows Amy C. , Chang Cathleen , Prokop John , Wu Quilian , Sims Peter A. , Canoll Peter , Summers Matthew K. , Rosenfeld Steven S. , Rich Jeremy N.
Published: September 2015

KIF11 is necessary for both proliferation and invasion in glioblastoma and is a promising target for antiglioblastoma therapy.
NS1: A corner piece in the dengue pathogenesis puzzle?
Authors: Thomas Stephen J.
Published: September 2015

Dengue virus NS1 protein induces inflammation via Toll-like receptor 4 and disrupts endothelial cell integrity to cause vascular leakage (Beatty
et al
. and Modhiran
et al
., this issue).
Cyclopalladated Compound 7a Induces Apoptosis- and Autophagy-Like Mechanisms in Paracoccidioides and Is a Candidate for Paracoccidioidomycosis Treatment
Authors: Arruda Denise C. , Matsuo Alisson L. , Silva Luiz S. , Real Fernando , Leitão Natanael P. , Pires Jhon H. S. , Caires Antonio Carlos F. , Garcia Daniel M. , Cunha Fernanda F. M. , Puccia Rosana , Longo Larissa V. G.
Published: September 2015

Paracoccidioidomycosis (PCM), caused by
Paracoccidioides
species, is the main cause of death due to systemic mycoses in Brazil and other Latin American countries. Therapeutic options for PCM and other systemic mycoses are limited and time-consuming, and there are high rates of noncompliance, relapses, toxic side effects, and sequelae. Previous work has shown that the cyclopalladated 7a compound is effective in treating several kinds of cancer and parasitic Chagas disease without significant toxicity in animals. Here we show that cyclopalladated 7a inhibited the
in vitro
growth of
Paracoccidioides
lutzii
Pb01 and
P. brasiliensis
isolates Pb18 (highly virulent), Pb2, Pb3, and Pb4 (less virulent) in a dose-response manner. Pb18 was the most resistant. Opportunistic
Candida albicans
and
Cryptococcus neoformans
were also sensitive. BALB/c mice showed significantly lighter lung fungal burdens when treated twice a day for 20 days with a low cyclopalladated 7a dose of 30 μg/ml/day for 30 days after intratracheal infection with Pb18. Electron microscopy images suggested that apoptosis- and autophagy-like mechanisms are involved in the fungal killing mechanism of cyclopalladated 7a. Pb18 yeast cells incubated with the 7a compound showed remarkable chromatin condensation, DNA degradation, superoxide anion production, and increased metacaspase activity suggestive of apoptosis. Autophagy-related killing mechanisms were suggested by increased autophagic vacuole numbers and acidification, as indicated by an increase in LysoTracker and monodansylcadaverine (MDC) staining in cyclopalladated 7a-treated Pb18 yeast cells. Considering that cyclopalladated 7a is highly tolerated
in vivo
and affects yeast fungal growth through general apoptosis- and autophagy-like mechanisms, it is a novel promising drug for the treatment of PCM and other mycoses.
Augmented Renal Clearance Implies a Need for Increased Amoxicillin-Clavulanic Acid Dosing in Critically Ill Children
Authors: De Cock Pieter A. J. G. , Standing Joseph F. , Barker Charlotte I. S. , de Jaeger Annick , Dhont Evelyn , Carlier Mieke , Verstraete Alain G. , Delanghe Joris R. , Robays Hugo , De Paepe Peter
Published: September 2015

There is little data available to guide amoxicillin-clavulanic acid dosing in critically ill children. The primary objective of this study was to investigate the pharmacokinetics of both compounds in this pediatric subpopulation. Patients admitted to the pediatric intensive care unit (ICU) in whom intravenous amoxicillin-clavulanic acid was indicated (25 to 35 mg/kg of body weight every 6 h) were enrolled. Population pharmacokinetic analysis was conducted, and the clinical outcome was documented. A total of 325 and 151 blood samples were collected from 50 patients (median age, 2.58 years; age range, 1 month to 15 years) treated with amoxicillin and clavulanic acid, respectively. A three-compartment model for amoxicillin and a two-compartment model for clavulanic acid best described the data, in which allometric weight scaling and maturation functions were added
a priori
to scale for size and age. In addition, plasma cystatin C and concomitant treatment with vasopressors were identified to have a significant influence on amoxicillin clearance. The typical population values of clearance for amoxicillin and clavulanic acid were 17.97 liters/h/70 kg and 12.20 liters/h/70 kg, respectively. In 32% of the treated patients, amoxicillin-clavulanic acid therapy was stopped prematurely due to clinical failure, and the patient was switched to broader-spectrum antibiotic treatment. Monte Carlo simulations demonstrated that four-hourly dosing of 25 mg/kg was required to achieve the therapeutic target for both amoxicillin and clavulanic acid. For patients with augmented renal function, a 1-h infusion was preferable to bolus dosing. Current published dosing regimens result in subtherapeutic concentrations in the early period of sepsis due to augmented renal clearance, which risks clinical failure in critically ill children, and therefore need to be updated. (This study has been registered at Clinicaltrials.gov as an observational study [NCT02456974].)
Interactions of Klebsiella pneumoniae with the Innate Immune System Vary in Relation to Clone and Resistance Phenotype
Authors: Pantelidou Iliana-Maria , Galani Irene , Georgitsi Marianna , Daikos George L. , Giamarellos-Bourboulis Evangelos J.
Published: September 2015

Apart from inadequate antimicrobial treatment, specific virulence factors contribute to the high attributable mortality of infections caused by multidrug-resistant (MDR)
Klebsiella pneumoniae
. We explored the roles of MDR and clones as virulence determinants of
K. pneumoniae
and their interaction with innate immunity. Twenty isolates were studied and characterized by resistance phenotype and multilocus sequence type (MLST). Human peripheral blood mononuclear cells (PBMCs) were stimulated for the production of proinflammatory cytokines by live and heat-killed isolates and plasmid DNA; modulation by cellular pathway inhibitors was explored. Survival of 30 mice was recorded after intraperitoneal challenge with susceptible and
K. pneumoniae
carbapenemase (KPC)-producing isolates. Splenocytes of mice were stimulated for the production of pro- and anti-inflammatory cytokines. Isolates were divided into different patterns of production of tumor necrosis factor alpha (TNF-α) and interleukin-1β (IL-1β) poststimulation in relation to both the MLST clone and resistance phenotype. The sequence type 383 (ST383) clone producing Verona integron-encoded metallo-β-lactamase (VIM) stimulated high production of both TNF-α and IL-1β. Clone ST17 producing KPC elicited low TNF-α production; this was reversed by Toll-like receptor 9 (TLR9) antagonists, indicating an effect of plasmid DNA. This isolate was linked with early death of mice compared to high-TNF-α-producing isolates. We conclude that KPC-producing isolates seem to be highly virulent in a low-TNF-α-release environment, suggesting an immunoparalysis induction mechanism. KPC plasmids may directly contribute to the immune system stimulation.
Role of Host Cell-Derived Amino Acids in Nutrition of Intracellular Salmonella enterica
Authors: Popp Jasmin , Noster Janina , Busch Kim , Kehl Alexander , zur Hellen Gero , Hensel Michael
Published: September 2015

The facultative intracellular pathogen
Salmonella enterica
resides in a specific membrane-bound compartment termed the
Salmonella
-containing vacuole (SCV). Despite being segregated from access to metabolites in the host cell cytosol,
Salmonella
is able to efficiently proliferate within the SCV. We set out to unravel the nutritional supply of
Salmonella
in the SCV with focus on amino acids. We studied the availability of amino acids by the generation of auxotrophic strains for alanine, asparagine, aspartate, glutamine, and proline in a macrophage cell line (RAW264.7) and an epithelial cell line (HeLa) and examined access to extracellular nutrients for nutrition. Auxotrophies for alanine, asparagine, or proline attenuated intracellular replication in HeLa cells, while aspartate, asparagine, or proline auxotrophies attenuated intracellular replication in RAW264.7 macrophages. The different patterns of intracellular attenuation of alanine- or aspartate-auxotrophic strains support distinct nutritional conditions in HeLa cells and RAW264.7 macrophages. Supplementation of medium with individual amino acids restored the intracellular replication of mutant strains auxotrophic for asparagine, proline, or glutamine. Similarly, a mutant strain deficient in succinate dehydrogenase was complemented by the extracellular addition of succinate. Complementation of the intracellular replication of auxotrophic
Salmonella
by external amino acids was possible if bacteria were proficient in the induction of
Salmonella
-induced filaments (SIFs) but failed in a SIF-deficient background. We propose that the ability of intracellular
Salmonella
to redirect host cell vesicular transport provides access of amino acids to auxotrophic strains and, more generally, is essential to continuously supply bacteria within the SCV with nutrients.
The Fibronectin-Binding Protein EfbA Contributes to Pathogenesis and Protects against Infective Endocarditis Caused by Enterococcus faecalis
Authors: Singh Kavindra V. , La Rosa Sabina Leanti , Somarajan Sudha R. , Roh Jung Hyeob , Murray Barbara E.
Published: September 2015

EfbA is a PavA-like fibronectin adhesin of
Enterococcus faecalis
previously shown to be important in experimental urinary tract infection. Here, we expressed and purified the
E. faecalis
OG1RF EfbA and confirmed that this protein binds with high affinity to immobilized fibronectin, collagen I, and collagen V. We constructed an
efbA
deletion mutant and demonstrated that its virulence was significantly attenuated (
P
< 0.0006) versus the wild type in a mixed inoculum rat endocarditis model. Furthermore,
efbA
deletion resulted in diminished ability to bind fibronectin (
P
< 0.0001) and reduced biofilm (
P
< 0.001). Reintroduction of
efbA
into the original chromosomal location restored virulence, adherence to fibronectin, and biofilm formation to wild-type levels. Finally, vaccination of rats with purified recombinant EfbA protein protected against OG1RF endocarditis (
P
= 0.008
versus
control). Taken together, our results demonstrate that EfbA is an important factor involved in
E. faecalis
endocarditis and that rEfbA immunization is effective in preventing such infection, likely by interfering with bacterial adherence.
LL-37 Immunomodulatory Activity during Mycobacterium tuberculosis Infection in Macrophages
Authors: Torres-Juarez Flor , Cardenas-Vargas Albertina , Montoya-Rosales Alejandra , González-Curiel Irma , Garcia-Hernandez Mariana H. , Enciso-Moreno Jose A. , Hancock Robert E. W. , Rivas-Santiago Bruno
Published: September 2015

Tuberculosis is one of the most important infectious diseases worldwide. The susceptibility to this disease depends to a great extent on the innate immune response against mycobacteria. Host defense peptides (HDP) are one of the first barriers to counteract infection. Cathelicidin (LL-37) is an HDP that has many immunomodulatory effects besides its weak antimicrobial activity. Despite advances in the study of the innate immune response in tuberculosis, the immunological role of LL-37 during
M. tuberculosis
infection has not been clarified. Monocyte-derived macrophages were infected with
M. tuberculosis
strain H37Rv and then treated with 1, 5, or 15 μg/ml of exogenous LL-37 for 4, 8, and 24 h. Exogenous LL-37 decreased tumor necrosis factor alpha (TNF-α) and interleukin-17 (IL-17) while inducing anti-inflammatory IL-10 and transforming growth factor β (TGF-β) production. Interestingly, the decreased production of anti-inflammatory cytokines did not reduce antimycobacterial activity. These results are consistent with the concept that LL-37 can modulate the expression of cytokines during mycobacterial infection and this activity was independent of the P2X7 receptor. Thus, LL-37 modulates the response of macrophages during infection, controlling the expression of proinflammatory and anti-inflammatory cytokines.
Field Science—the Nature and Utility of Scientific Fields
Authors: Casadevall Arturo , Fang Ferric C.
Published: September 2015

Fields are the fundamental sociological units of science. Despite their importance, relatively little has been written about their emergence, composition, structure, and function in the scientific enterprise. This essay considers the nature of fields and their important role in maintaining information and providing normative standards for scientific work. We suggest that fields arise naturally as a consequence of increasing information and scientific specialization. New fields tend to emerge as research communities grow, which may reflect biologically determined optima for the size of human groups. The benefits of fields include the organization of scientists with similar interests into communities that collectively define the next important problems to pursue. In the discipline of microbiology, fields are often organized on the basis of phylogenetic differences between microorganisms being studied. Although fields are essential to the proper functioning of science, their emergence can restrict access by outsiders and sustain dogmas that hinder progress. We suggest mechanisms to improve the functioning of scientific fields and to promote interdisciplinary interaction between fields.
Reservoirs of Extraintestinal Pathogenic
Escherichia coli
Authors: Manges Amee R. , Johnson James R.
Published: September 2015

Several potential reservoirs for the
Escherichia coli
strains that cause most human extraintestinal infections (extraintestinal pathogenic
E. coli
; ExPEC) have been identified, including the human intestinal tract and various non-human reservoirs, such as companion animals, food animals, retail meat products, sewage, and other environmental sources. Understanding ExPEC reservoirs, chains of transmission, transmission dynamics, and epidemiologic associations will assist greatly in finding ways to reduce the ExPEC-associated disease burden. The need to clarify the ecological behavior of ExPEC is all the more urgent because environmental reservoirs may contribute to acquisition of antimicrobial resistance determinants and selection for and amplification of resistant ExPEC. In this chapter, we review the evidence for different ExPEC reservoirs, with particular attention to food and food animals, and discuss the public health implications of these reservoirs for ExPEC dissemination and transmission.
Splenic injury as a complication of colonoscopy: more common than we think?
Authors: Ng Peter
Published: September 2015

Splenic injury during colonoscopy is thought to be rare. The case reported here would not have been diagnosed if the patient had not presented with a pleural effusion. It is likely that this complication may present with differing severities of clinical features with a significant proportion being thought to be due to expected postcolonoscopy insufflation discomfort. This complication is under-recognised and under-reported and therefore is unlikely to be thought of as a diagnosis. A 63-year-old woman had an elective day case colonoscopy but did not seek medical attention for the abdominal pain following the procedure. She presented to hospital 6 weeks after the procedure with dyspnoea and hypoxia. She was diagnosed with a parapneumonic pleural effusion but the CT scan also discovered a splenic haematoma for which there was no other cause in her history other than the colonoscopy 6 weeks prior.
Counting the costs of accreditation in acute care: an activity-based costing approach
Authors: Mumford Virginia , Greenfield David , Hogden Anne , Forde Kevin , Westbrook Johanna , Braithwaite Jeffrey
Published: September 2015

Objectives

To assess the costs of hospital accreditation in Australia.

Design

Mixed methods design incorporating: stakeholder analysis; survey design and implementation; activity-based costs analysis; and expert panel review.

Setting

Acute care hospitals accredited by the Australian Council for Health Care Standards.

Participants

Six acute public hospitals across four States.

Results

Accreditation costs varied from 0.03% to 0.60% of total hospital operating costs per year, averaged across the 4-year accreditation cycle. Relatively higher costs were associated with the surveys years and with smaller facilities. At a national level these costs translate to $A36.83 million, equivalent to 0.1% of acute public hospital recurrent expenditure in the 2012 fiscal year.

Conclusions

This is the first time accreditation costs have been independently evaluated across a wide range of hospitals and highlights the additional cost burden for smaller facilities. A better understanding of the costs allows policymakers to assess alternative accreditation and other quality improvement strategies, and understand their impact across a range of facilities. This methodology can be adapted to assess international accreditation programmes.
Smoking in the home after childbirth: prevalence and determinants in an English cohort
Authors: Orton Sophie , Coleman Tim , Jones Laura L , Cooper Sue , Lewis Sarah
Published: September 2015

Objectives

Children's exposure to secondhand smoke (SHS) is causally linked to childhood morbidity and mortality. Over 38% of English children (aged 4–15) whose parents are smokers are exposed to SHS in the home. Little is known about the prevalence of SHS exposure in the homes of young infants (≤3 months). This study aimed to estimate maternal self-reported prevalence of SHS exposure among infants of women who smoked just before or during pregnancy, and identify factors associated with exposure.

Setting

Primary Care, Nottingham, England.

Participants

Current and recent ex-smoking pregnant women (n=850) were recruited in Nottingham, England. Women completed questionnaires at 8–26 weeks gestation and 3 months after childbirth. Data on smoking in the home 3 months after childbirth was available for 471 households.

Primary and secondary outcome measures

Maternal-reported smoking in the home 3 months after childbirth.

Results

The prevalence of smoking in the home 3 months after childbirth was 16.3% (95% CI 13.2% to 19.8%) and after multiple imputation controlling for non-response 18.2% (95% CI 14.0% to 22.5%). 59% of mothers were current smokers; of these, 24% reported that smoking occurred in their home compared to 4.7% of non-smokers. In multivariable logistic regression, mothers smoking ≥11 cigarettes per day were 8.2 times (95% CI 3.4 to 19.6) more likely to report smoking in the home. Younger age, being of non-white ethnicity, increased deprivation and less negative attitudes towards SHS were also associated with smoking in the home.

Conclusions

This survey of smoking in the home 3 months after childbirth found a lower prevalence than has been reported in older children. Interventions to support smoking mothers to quit, or to help them restrict smoking in the home, should target attitudinal change and address inequality relating to social disadvantage, younger age and non-white ethnic groups.
The influence of snoring, mouth breathing and apnoea on facial morphology in late childhood: a three-dimensional study
Authors: Al Ali Ala , Richmond Stephen , Popat Hashmat , Playle Rebecca , Pickles Timothy , Zhurov Alexei I , Marshall David , Rosin Paul L , Henderson John , Bonuck Karen
Published: September 2015

Objective

To explore the relationship between the prevalence of sleep disordered breathing (SDB) and face shape morphology in a large cohort of 15-year-old children.

Design

Observational longitudinal cohort study

Setting

Avon Longitudinal Study of Parents and Children (ALSPAC), South West of England.

Participants

Three-dimensional surface laser scans were taken for 4784 white British children from the ALSPAC during a follow-up clinic. A total of 1724 children with sleep disordered breathing (SDB) and 1862 healthy children were identified via parents’ report of sleep disordered symptoms for their children. We excluded from the original cohort all children identified as having congenital abnormalities, diagnoses associated with poor growth and children with adenoidectomy and/or tonsillectomy.

Main outcome measures

Parents in the ALSPAC reported sleep disordered symptoms (snoring, mouth breathing and apnoea) for their children at 6, 18, 30, 42, 57, 69 and 81 months. Average facial shells were created for children with and without SDB in order to explore surface differences.

Results

Differences in facial measurements were found between the children with and without SDB throughout early childhood. The mean differences included an increase in face height in SDB children of 0.3 mm (95% CI −0.52 to −0.05); a decrease in mandibular prominence of 0.9° (95% CI −1.30 to −0.42) in SDB children; and a decrease in nose prominence and width of 0.12 mm (95% CI 0.00 to 0.24) and 0.72 mm (95% CI −0.10 to −0.25), respectively, in SDB children. The odds of children exhibiting symptoms of SDB increased significantly with respect to increased face height and mandible angle, but reduced with increased nose width and prominence.

Conclusions

The combination of a long face, reduced nose prominence and width, and a retrognathic mandible may be diagnostic facial features of SBD that may warrant a referral to specialists for the evaluation of other clinical symptoms of SDB.
A retrospective analysis of the effect of discussion in teleconference and face-to-face scientific peer-review panels
Authors: Carpenter Afton S , Sullivan Joanne H , Deshmukh Arati , Glisson Scott R , Gallo Stephen A
Published: September 2015

Objective

With the use of teleconferencing for grant peer-review panels increasing, further studies are necessary to determine the efficacy of the teleconference setting compared to the traditional onsite/face-to-face setting. The objective of this analysis was to examine the effects of discussion, namely changes in application scoring premeeting and postdiscussion, in these settings. We also investigated other parameters, including the magnitude of score shifts and application discussion time in face-to-face and teleconference review settings.

Design

The investigation involved a retrospective, quantitative analysis of premeeting and postdiscussion scores and discussion times for teleconference and face-to-face review panels. The analysis included 260 and 212 application score data points and 212 and 171 discussion time data points for the face-to-face and teleconference settings, respectively.

Results

The effect of discussion was found to be small, on average, in both settings. However, discussion was found to be important for at least 10% of applications, regardless of setting, with these applications moving over a potential funding line in either direction (fundable to unfundable or vice versa). Small differences were uncovered relating to the effect of discussion between settings, including a decrease in the magnitude of the effect in the teleconference panels as compared to face-to-face. Discussion time (despite teleconferences having shorter discussions) was observed to have little influence on the magnitude of the effect of discussion. Additionally, panel discussion was found to often result in a poorer score (as opposed to an improvement) when compared to reviewer premeeting scores. This was true regardless of setting or assigned reviewer type (primary or secondary reviewer).

Conclusions

Subtle differences were observed between settings, potentially due to reduced engagement in teleconferences. Overall, further research is required on the psychology of decision-making, team performance and persuasion to better elucidate the group dynamics of telephonic and virtual ad-hoc peer-review panels.
Reducing the number and impact of outbreaks of nosocomial viral gastroenteritis: time-series analysis of a multidimensional quality improvement initiative
Authors: Mitchell Caroline , Meredith Paul , Richardson Matthew , Greengross Peter , Smith Gary B
Published: September 2015

Background

Nosocomial norovirus infections and their control measures disrupt patient care, increase staff workload and raise healthcare costs.

Objective

To determine the impact on outbreaks of nosocomial viral gastroenteritis, staff and patients affected, and bed closures of a multidimensional quality improvement (QI) initiative focused on education; improved patient surveillance; early automated recognition and notification of infection of index patients; and proactive care and control measures.

Methods

In a pragmatic, retrospective, observational study, we compared numbers of suspected/confirmed norovirus outbreaks at Portsmouth Hospitals National Health Service Trust (PHT) with regional and national data, before and after a multidimensional QI initiative. We also compared mean daily bed closures due to norovirus-like symptoms. At PHT only we recorded patient and staff numbers with norovirus-like symptoms, and days of disruption due to outbreaks.

Results

Annual outbreak numbers fell between 2009–2010 and 2010–2014 by 91% at PHT compared with 15% and 28% for Wessex and England, respectively. After April 2010, recorded outbreaks were 8 (PHT), 383 (Wessex) and 5063 (England). For the winter periods from 2010/2011 to 2013/2014, total bed closures due to norovirus were 38 (PHT; mean 0.5 per week), 3565 (Wessex hospitals; mean 48.8 per hospital per week) and 2730 (England; mean 37.4 per hospital per week). At PHT, patients affected by norovirus-like symptoms fell by 92%, affected staff by 81% and days of disruption by 88%.

Conclusions

A multiyear QI programme, including use of real-time electronic identification of patients with norovirus-like symptoms, and an early robust response to suspected infection, resulted in virtual elimination of outbreaks. The ability to identify index cases of infection early facilitates prompt action to prevent ongoing transmission and appears to be a crucial intervention.
Impact of frailty on outcomes after percutaneous coronary intervention: a prospective cohort study
Authors: Murali-Krishnan Rachel , Iqbal Javaid , Rowe Rebecca , Hatem Emer , Parviz Yasir , Richardson James , Sultan Ayyaz , Gunn Julian
Published: September 2015

Background

Average life expectancy is rising, resulting in increasing numbers of elderly, frail individuals presenting with coronary artery disease and requiring percutaneous coronary intervention (PCI). PCI can be of value for this population, but little is known about the balance of benefit versus risk, particularly in the frail.

Objective

To determine the relationship between frailty and clinical outcomes in patients undergoing PCI.

Methods

Patients undergoing PCI, for either stable angina or acute coronary syndrome, were prospectively assessed for frailty using the Canadian Study of Health and Ageing Clinical Frailty Scale. Demographics, clinical and angiographic data were extracted from the hospital database. Mortality was obtained from the Office of National Statistics.

Results

Frailty was assessed in 745 patients undergoing PCI. The mean age of patients was 62±12 years and 70% were males. The median frailty score was 3 (IQR 2–4). A frailty score ≥5, indicating significant frailty, was present in 81 (11%) patients. Frail patients required longer hospitalisation after PCI. Frailty was also associated with increased 30-day (HR 4.8, 95% CI 1.4 to 16.3, p=0.013) and 1 year mortality (HR 5.9, 95% CI 2.5 to 13.8, p<0.001). Frailty was a predictor of length of hospital stay and mortality, independent of age, gender and comorbidities.

Conclusions

A simple assessment of frailty can help predict mortality and the length of hospital stay, and may therefore guide healthcare providers to plan PCI and appropriate resources for frail patients.
Classification and environmental correlates of tidal wetland vegetation in Nova Scotia, Canada
Authors: Porter Caitlin , Lundholm Jeremy , Bowron Tony , Lemieux Ben , van Proosdij Danika , Neatt Nancy , Graham Jennie
Published: September 2015

We numerically classified tidal wetland vegetation and determined the relationships between variation in plant species composition and environmental factors. Sampling was conducted at eight sites along a range of tidal magnitudes (<2 to >14 m). Cluster analysis revealed seven distinct salt or brackish marsh plant associations, usually dominated by a single graminoid species. Redundancy analysis showed continuous variation among community units and identified inundation time, elevation, soil salinity, and organic matter content as key correlates of plant community patterns. Associations detected were similar to those found in New Brunswick’s Bay of Fundy and Northumberland Strait wetlands, and to those farther south in northern New England, but two new brackish associations were also identified within this study (Juncus balticus Willd. – Festuca rubra L. and Spartina pectinata Link). Although elevation is understood to drive vegetation types in salt marshes in the region, here we show that salinity can differentiate vegetation types at the same elevation. These data provide a quantitative baseline and allow for better predictions of tidal wetland ecological restoration trajectories in Nova Scotia.
Episodic adaptive diversification of classical swine fever virus RNA-dependent RNA polymerase NS5B
Authors: Li Yan , Yang Zexiao
Published: September 2015

Classical swine fever virus (CSFV) is the pathogen that causes a highly infectious disease of pigs and has led to disastrous losses to pig farms and related industries. The RNA-dependent RNA polymerase (RdRp) NS5B is a central component of the replicase complex (RC) in some single-stranded RNA viruses, including CSFV. On the basis of genetic variation, the CSFV RdRps could be clearly divided into 2 major groups and a minor group, which is consistent with the phylogenetic relationships and virulence diversification of the CSFV isolates. However, the adaptive signature underlying such an evolutionary profile of the polymerase and the virus is still an interesting open question. We analyzed the evolutionary trajectory of the CSFV RdRps over different timescales to evaluate the potential adaptation. We found that adaptive selection has driven the diversification of the RdRps between, but not within, CSFV major groups. Further, the major adaptive divergence-related sites are located in the surfaces relevant to the interaction with other component(s) of RC and the entrance and exit of the template-binding channel. These results might shed some light on the nature of the RdRp in virulence diversification of CSFV groups.
Experimental study on the effect of applying a crossed magnetic field on the insulator flashover behavior in high vacuum
Authors: Abu-Elabass K.
Published: September 2015

In this study, a possible method of reducing the flashover stress is achieved by the effect of an additional magnetic field in the transverse direction on the main applied electric field. The degree of vacuum used in this study was [Formula: see text] Pa. The magnetic flux density B employed in this study extends from [Formula: see text] to [Formula: see text] T. From the results obtained throughout this work, the transverse magnetic field increases the flashover voltage and decreases the leakage current. The effect of the transverse magnetic field on the surface flashover of the dielectric solid in vacuum shows a marked dependence on the material and the thickness of the test specimen, the vacuum degree, the type of electric field (AC or DC) as well as the type of magnetic field (AC or DC).
On the Computation of the Survival Probability of Brownian Motion with Drift in a Closed Time Interval When the Absorbing Boundary Is a Step Function
Authors: Guillaume Tristan
Published: September 2015

This paper provides explicit formulae for the probability that an arithmetic or a geometric Brownian motion will not cross an absorbing boundary defined as a step function during a finite time interval. Various combinations of downward and upward steps are handled. Numerical computation of the survival probability is done quasi-instantaneously and with utmost precision. The sensitivity of the survival probability to the number and the ordering of the steps in the boundary is analyzed.
Cardiac Tamponade Associated with the Presentation of Anaplastic Large Cell Lymphoma in a 2-Year-Old Child
Authors: Mira-Perceval Juan Gema , Alcalá Minagorre Pedro J. , Huertas Sánchez Ana M. , Segura Sánchez Sheila , López Iniesta Silvia , De León Marrero Francisco J. , Costa Navarro Estela , Niveiro de Jaime María
Published: September 2015

The anaplastic large cell lymphoma is a rare entity in pediatric patients. We present an unusual case of pericardial involvement, quite uncommon as extranodal presentation of this type of disorder, that provoked a life-risk situation requiring an urgent pericardiocentesis. To our knowledge, this is the first report on a child with pericardial involvement without an associated cardiac mass secondary to anaplastic large cell lymphoma in pediatric age. We report the case of a 21-month-old Caucasian male infant with cardiac tamponade associated with the presentation of anaplastic large cell lymphoma. Initially, the child presented with 24-day prolonged fever syndrome, cutaneous lesions associated with hepatomegaly, inguinal adenopathies, and pneumonia. After a 21-day asymptomatic period, polypnea and tachycardia were detected in a clinical check-up. Chest X-ray revealed a remarkable increase of the cardiothoracic index. The anaplastic large cell lymphoma has a high incidence of extranodal involvement but myocardial or pericardial involvements are rare. For this reason, we recommend a close monitoring of patients with a differential diagnosis of anaplastic large cell lymphoma.
Culture Negative Stent Infection in an Infant with Hypoplastic Left Heart and Persistent Fever
Authors: Piggott Kurt D. , Laham Federico , Jordan Villegas Alejandro , Fakioglu Harun , Blanco Carlos , Suguna Narasimhulu Sukumar
Published: September 2015

We present an infant with hypoplastic left heart with persistent fever despite two courses of antibiotics and repeatedly negative blood cultures. He eventually underwent surgical extraction of two stents. The stent cultures became positive; he was treated with 4 weeks of antibiotics and the fever resolved.
Mathematical Model of Innate and Adaptive Immunity of Sepsis: A Modeling and Simulation Study of Infectious Disease
Authors: Shi Zhenzhen , Wu Chih-Hang J. , Ben-Arieh David , Simpson Steven Q.
Published: September 2015

Sepsis is a systemic inflammatory response (SIR) to infection. In this work, a system dynamics mathematical model (SDMM) is examined to describe the basic components of SIR and sepsis progression. Both innate and adaptive immunities are included, and simulated resultsin silicohave shown that adaptive immunity has significant impacts on the outcomes of sepsis progression. Further investigation has found that the intervention timing, intensity of anti-inflammatory cytokines, and initial pathogen load are highly predictive of outcomes of a sepsis episode. Sensitivity and stability analysis were carried out using bifurcation analysis to explore system stability with various initial and boundary conditions. The stability analysis suggested that the system could diverge at an unstable equilibrium after perturbations ifrt2max(maximum release rate of Tumor Necrosis Factor- (TNF-)αby neutrophil) falls below a certain level. This finding conforms to clinical findings and existing literature regarding the lack of efficacy of anti-TNF antibody therapy.
Stereotactic Body Radiotherapy for Localized Ureter Transitional Cell Carcinoma: Three Case Reports
Authors: Maehata Yoshiyasu , Kuriyama Kengo , Aoki Shinichi , Araya Masayuki , Marino Kan , Onishi Hiroshi
Published: September 2015

The gold standard management for ureter transitional cell carcinoma (UTCC) is radical nephroureterectomy with excision of the bladder cuff. However, some patients cannot undergo this procedure for several reasons. In the case reports described herein, we performed stereotactic body radiotherapy (SBRT) on three patients with inoperable or surgery-rejected localized UTCC. Two out of the three patients did not develop local recurrence or distant metastasis during the observation period. However, recurrence was detected in the bladder of one patient 22 months after the treatment. No acute or late adverse events occurred in any of the three patients. SBRT may become one of the treatment options for inoperable or surgery-rejected UTCC patients.