bluuebunny/crossref_metadata_2025 huggingface dataset:
To Consent or Decline HPV Vaccination: A Pilot Study at the Start of the National School‐Based Vaccination Program in Sweden
Authors: Grandahl Maria , Tydén Tanja , Westerling Ragnar , Nevéus Tryggve , Rosenblad Andreas , Hedin Erik , Oscarsson Marie
Published: December 2016

ABSTRACT

BACKGROUND

Parents' beliefs about human papillomavirus (HPV) vaccination influence whether they allow their daughters to be vaccinated. We examined the association between parents' refusal and sociodemographic background, knowledge and beliefs about HPV, and the HPV vaccination in relation to the Health Belief Model.

METHODS

The sample consisted of 200 (55%) parents of children aged 11‐12 years in the Swedish national vaccination program. Data were collected using a self‐reported questionnaire. Most parents (N = 186) agreed to the vaccination. Pearson's chi‐square, Fisher's exact test, and the Mann‐Whitney U test were used to analyze data.

RESULTS

Declining parents saw more risks and fewer benefits of HPV vaccination but no differences in beliefs regarding the severity or young girls' susceptibility to HPV were found. There was an association between refusing the HPV vaccine and lower acceptance of previous childhood vaccinations, and their main source of information was the Internet. Parents who declined the vaccine believed it could adversely affect condom use, the age of their daughter's sexual debut, and the number of sexual partners.

CONCLUSION

Parents should have the possibility to discuss HPV and HPV vaccine with a school nurse or other health care professionals, and should have access to evidence‐based information on the Internet.
Clinical and pathological features of hair coat abnormalities in curly coated retrievers from UK and Sweden
Authors: Bond R. , Varjonen K. , Hendricks A. , Chang Y. M. , Brooks Brownlie H.
Published: December 2016

Objectives

To gain information on hair loss amongst curly coated retrievers by questionnaire and to define the clinical and pathological features of hair coat abnormalities in affected dogs in the United Kingdom and Sweden.

Materials and Methods

Questionnaires were completed by members of the Curly Coated Retriever Clubs. Fourteen dogs (six in the United Kingdom, eight in Sweden) were clinically examined and skin/hair samples collected for microscopy and histopathology. Blood was collected for haematological, biochemical and endocrine assays.

Results

Of 90 dogs surveyed, 39 had current or previous episodes of symmetrical, non‐pruritic alopecia and or frizzy coat changes, usually affecting caudal thighs, axillae, dorsum and neck before 18 months of age; 23 dogs had a waxing/waning course. Examined dogs generally matched the pattern described in questionnaires. Hair shaft anomalies comprised occasional distorted anagen bulbs (10 dogs) and transverse fractures (8 dogs). Vertical histopathological sections showed infundibular hyperkeratosis (28 of 30 sections) and low‐grade pigment clumping (17 of 30). Subtle telogenisation of hair follicles was unequivocally confirmed by transverse histomorphometric analyses.

Clinical Significance

The follicular dysplasia of curly coated retriever reported here is similar to that of Irish water spaniels and Chesapeake Bay retrievers but distinct from that of Portuguese water dogs. The genetic basis requires further assessment.
Stage beauties: Actresses and celebrity culture in the long eighteenth century
Authors: Engel Laura
Published: December 2016

Over the past 20 years, the study of eighteenth‐century British actresses has blossomed into an emerging interdisciplinary field. Early works on actresses in the 1990's coincided with a heightened interest in recovering non‐canonical eighteenth‐century texts by female authors as well as the publication of Judith Butler's ground breakingGender Troublein 1992. Actresses became, in many ways, the perfect vehicle for looking at how ideologies of femininity, performance, and embodiment materialized in eighteenth‐century culture. The publication of Felicity Nussbaum'sRival Queensin 2010 signaled a new phase in actress studies. This article looks closely at the ways in which scholarship on eighteenth‐century actresses and celebrity produced since 2010 responds to and/or complicates Nussbaum's invitation to move beyond the parameters of the lady/prostitute divide in actress studies towards more “productive frames of reference” and methodologies. In 2016, actress studies is a truly interdisciplinary field intersecting with art, music, literature, history, economics, psychology, anthropology, sociology, and fashion. Scholars in actress studies have pioneered new theoretical approaches to theater history, archives and evidence, re‐enactment and performance, as well as studies of sound and material culture. Studies of actresses have contributed significantly to the history of early modern women specifically focusing on maternity, professionalism, marriage, domestic life, and kinship networks. Considering “Actress Studies” as a distinct field highlights an important legacy of paradoxical ideologies about women, power, and fame that still operate today.
The transactional interpretation and its evolution into the 21st century: An overview
Authors: Kastner Ruth E.
Published: December 2016

This essay provides a historical, philosophical, and critical overview of the development of the transactional interpretation (TI) of quantum mechanics. It is separated into two parts. Part I presents the history and development of TI from 1986 up to 2016 (the time of writing). Part II lays out current areas of divergence among researchers in TI.
Property Identity
Authors: Audi Paul
Published: December 2016

The question of how properties are individuated is extremely important. Consider the following proposals. To be in pain is to be in a certain neurological state. To be red is to appear red to normal observers in standard conditions. To be obligatory is to maximize the good. Each makes a claim of property identity. Each is a substantive metaphysical thesis of wide interest. None can be studied with due scrutiny in the absence of a general account of property identity. Here, I will survey existing accounts and suggest a new account in terms of grounding that has some advantages over the other candidates.
God and gratuitous evil (Part II)
Authors: Kraay Klaas J.
Published: December 2016

In contemporary analytic philosophy, the problem of evil refers to a family of arguments that attempt to show, by appeal to evil, that God does not (or probably does not) exist. Some very important arguments in this family focus on gratuitous evil. Most participants in the relevant discussions, including theists and atheists, agree that God is able to prevent all gratuitous evil, and that God would do so. On this view, of course, the occurrence of even a single instance of gratuitous evil falsifies theism. The most common response to such arguments attempts to cast doubt on the claim that gratuitous evil really occurs. The focus of these two survey papers will be a different response – one that has received less attention in the literature. This response attempts to show that God and gratuitous evil are compatible. If it succeeds, then the occurrence of gratuitous evil does not, after all, count against theism. In the prequel to this paper, I surveyed the literature surrounding the attempts by Michael Peterson and John Hick to execute this strategy. Here, I survey the attempts due to William Hasker, Peter van Inwagen, and Michael Almeida, respectively.
The status and factions theory of influence
Authors: Savage Scott V. , Melamed David
Published: December 2016

We review a relatively new theoretical research program on the joint effects of status and the distribution of opinions on social influence. The status and factions theory of influence combines sociological insights about status generalization with psychological research on how the distribution of opinions promotes social influence. To date, several published studies support the logic of the theory, including how the effect of status varies with the distribution of opinions and the intervening theoretical mechanism. The former has been replicated a number of times, but only one study to date has truly tested the mechanism. Uncertainty reduction has been found to explain some of the joint effects of status and the distribution of opinions on social influence, but there is room for improvement. Consequently, after we discuss the existing literature, we identify additional mechanisms that may be worth pursuing in the future and also some applications of the theory's utility.
Breadwinning and bread‐losing: Exploring opportunities to rework manhood
Authors: Myers Kristen , Demantas Ilana
Published: December 2016

Manhood in the USA today is at a crossroads. There are more models of how to be a man than ever before. And yet, despite myriad changes to the structures of work and family, the breadwinner ideology, or the heterogendered ideal that husbands should be the sole or primary earners in their families, persists in US society. This ideology affects the structure of work and family, regardless of whether individual people agree with it. Here, we discuss the breadwinner ideology and the ways that this meaning system tethers employment to masculinity and vice versa. We examine strategies for decoupling manhood from work and family and suggest ways to facilitate the undoing of gender.
Teachers’ Practices in High School Chemistry Just Prior to the Adoption of the Next Generation Science Standards
Authors: Boesdorfer Sarah B. , Staude Kristin D.
Published: December 2016

Effective professional development that influences teachers’ classroom practices starts with what teachers know, understand, and do in their classroom. The Next Generation Science Standards (NGSS) challenge teachers to make changes to their classroom; to help teachers make these changes, it is necessary to know what they are doing in their classrooms just prior to NGSS adoption. An online survey was distributed to high school chemistry teachers to understand their teaching practices before NGSS was adopted as state standards. This article presents the findings of the survey in terms of the chemistry content, science and engineering practices, and engineering content currently taught in chemistry. Gaps in the current teaching practices as they relate to the standards at the time of the study and NGSS are discussed, which show a challenge for the transformation of science education, which the implementation of NGSS hopes to achieve. Implications for professional development are included.
Investigating a Seven-Day Baseline While Establishing Healthy SCAT3 Symptom Frequency and Severity
Authors: Robinson Michael , Mc Elhiney Danielle
Published: December 2016

Second only to a clinical exam, symptom checklists are used to aid in the evaluation of concussions. The validity of symptom checklists can become compromised by nonconcussed linked conditions that can vary day to day and are not taken into consideration during a baseline test. The purpose of this study was to assess the day-to-day reliability of the SCAT3 Symptom Evaluation and to determine the frequency and severity of the 22 symptoms in a nonconcussed, adult, athletic population. This study used a repeated-measure observational design and required participants to complete an online version of the SCAT3 Symptom Evaluation multiple times over a 7-day period. Moderate day-to-day reliability was found for the frequency and severity of symptoms and all of the 22 symptoms were reported by at least one participant. The results of the study suggest that the current practice of collecting the baseline symptoms once does not account for any day-to-day variation in symptoms and also demonstrates that all of the 22 symptoms listed on the SCAT3 Symptom Checklist can be present in nonconcussed, adult athletes.
Eccentric-Overload Training in Team-Sport Functional Performance: Constant Bilateral Vertical Versus Variable Unilateral Multidirectional Movements
Authors: Gonzalo-Skok Oliver , Tous-Fajardo Julio , Valero-Campo Carlos , Berzosa César , Bataller Ana Vanessa , Arjol-Serrano José Luis , Moras Gerard , Mendez-Villanueva Alberto
Published: December 2016

Purpose:

To analyze the effects of 2 different eccentric-overload training (EOT) programs, using a rotational conical pulley, on functional performance in team-sport players. A traditional movement paradigm (ie, squat) including several sets of 1 bilateral and vertical movement was compared with a novel paradigm including a different exercise in each set of unilateral and multi-directional movements.

Methods:

Forty-eight amateur or semiprofessional team-sport players were randomly assigned to an EOT program including either the same bilateral vertical (CBV, n = 24) movement (squat) or different unilateral multidirectional (VUMD, n = 24) movements. Training programs consisted of 6 sets of 1 exercise (CBV) or 1 set of 6 exercises (VUMD) × 6–10 repetitions with 3 min of passive recovery between sets and exercises, biweekly for 8 wk. Functional-performance assessment included several change-of-direction (COD) tests, a 25-m linear-sprint test, unilateral multidirectional jumping tests (ie, lateral, horizontal, and vertical), and a bilateral vertical-jump test.

Results:

Within-group analysis showed substantial improvements in all tests in both groups, with VUMD showing more robust adaptations in pooled COD tests and lateral/horizontal jumping, whereas the opposite occurred in CBV respecting linear sprinting and vertical jumping. Between-groups analyses showed substantially better results in lateral jumps (ES = 0.21), left-leg horizontal jump (ES = 0.35), and 10-m COD with right leg (ES = 0.42) in VUMD than in CBV. In contrast, left-leg countermovement jump (ES = 0.26) was possibly better in CBV than in VUMD.

Conclusions:

Eight weeks of EOT induced substantial improvements in functional-performance tests, although the force-vector application may play a key role to develop different and specific functional adaptations.
The Effect of Whole-Body Vibration on Subsequent Sprint Performance in Well-Trained Cyclists
Authors: Rønnestad Bent R. , Falch Gunnar Slettaløkken , Ellefsen Stian
Published: December 2016

Postactivation-potentiation exercise with added whole-body vibration (WBV) has been suggested as a potential way to acutely improve sprint performance. In cycling, there are many competitions and situations where sprinting abilities are important.

Purpose:

To investigate the effect of adding WBV to warm-up procedures on subsequent cycle sprint performance.

Methods:

Eleven well-trained cyclists participated in the study. All cyclists performed a familiarization session before 2 separate test sessions in randomized order. Each session included a standardized warm-up followed by 1 of the following preconditioning exercises: 30 s of half-squats without WBV or 30 s of half-squats with WBV at 40 Hz. A 15-s Wingate sprint was performed 1 min after the preconditioning exercise.

Results:

Performing preconditioning exercise with WBV at 40 Hz resulted in superior peak power output compared with preconditioning exercise without WBV (1413 ± 257 W vs 1353 ± 213 W, P = .04) and a tendency toward superior mean power output during a 15-second all-out sprint (850 ± 119 W vs 828 ± 101 W, P = .08). Effect sizes showed a moderate practical effect of WBV vs no WBV on both peak and mean power output.

Conclusions:

Preconditioning exercise performed with WBV at 40 Hz seems to have a positive effect on cycling sprint performance in young well-trained cyclists. This suggests that athletes can incorporate body-loaded squats with WBV in preparations to specific sprint training to improve the quality of the sprint training and also to improve sprint performance in relevant competitions.
Early changes in CSF sTREM2 in dominantly inherited Alzheimer’s disease occur after amyloid deposition and neuronal injury
Authors: Suárez-Calvet Marc , Araque Caballero Miguel Ángel , Kleinberger Gernot , Bateman Randall J. , Fagan Anne M. , Morris John C. , Levin Johannes , Danek Adrian , Ewers Michael , Haass Christian ,   for the Dominantly Inherited Alzheimer Network
Published: December 2016

CSF sTREM2 increases in early stages of autosomal dominant Alzheimer’s disease, but the increase occurs after changes in Aβ and tau.
Bystander Host Cell Killing Effects of Clostridium perfringens Enterotoxin
Authors: Shrestha Archana , Hendricks Matthew R. , Bomberger Jennifer M. , McClane Bruce A.
Published: December 2016

Clostridium perfringens
enterotoxin (CPE) binds to claudin receptors, e.g., claudin-4, and then forms a pore that triggers cell death. Pure cultures of host cells that do not express claudin receptors, e.g., fibroblasts, are unaffected by pathophysiologically relevant CPE concentrations
in vitro
. However, both CPE-insensitive and CPE-sensitive host cells are present
in vivo
. Therefore, this study tested whether CPE treatment might affect fibroblasts when cocultured with CPE-sensitive claudin-4 fibroblast transfectants or Caco-2 cells. Under these conditions, immunofluorescence microscopy detected increased death of fibroblasts. This cytotoxic effect involved release of a toxic factor from the dying CPE-sensitive cells, since it could be reproduced using culture supernatants from CPE-treated sensitive cells. Supernatants from CPE-treated sensitive cells, particularly Caco-2 cells, were found to contain high levels of membrane vesicles, often containing a CPE species. However, most cytotoxic activity remained in those supernatants even after membrane vesicle depletion, and CPE was not detected in fibroblasts treated with supernatants from CPE-treated sensitive cells. Instead, characterization studies suggest that a major cytotoxic factor present in supernatants from CPE-treated sensitive cells may be a 10- to 30-kDa host serine protease or require the action of that host serine protease. Induction of caspase-3-mediated apoptosis was found to be important for triggering release of the cytotoxic factor(s) from CPE-treated sensitive host cells. Furthermore, the cytotoxic factor(s) in these supernatants was shown to induce a caspase-3-mediated killing of fibroblasts. This bystander killing effect due to release of cytotoxic factors from CPE-treated sensitive cells could contribute to CPE-mediated disease.

IMPORTANCE
In susceptible host cells,
Clostridium perfringens
enterotoxin (CPE) binds to claudin receptors and then forms pores that result in cell death. Using cocultures of CPE receptor-expressing sensitive cells mixed with CPE-insensitive cells lacking receptors for this toxin, the current study determined that CPE-treated sensitive cells release soluble cytotoxic factors, one of which may be a 10- to 30-kDa serine protease, to cause apoptotic death of cells that are themselves CPE insensitive. These findings suggest a novel bystander killing mechanism by which a pore-forming toxin may extend its damage to affect cells not directly responsive to that toxin. If confirmed to occur
in vivo
by future studies, this bystander killing effect may have significance during CPE-mediated disease and could impact the translational use of CPE for purposes such as cancer therapy.
Use of thromboelastography in the management of liver cirrhosis and accelerated intravascular coagulation and fibrinolysis (AICF)
Authors: Peterson Thomas Joseph , Webb Allison Margaret Brown , Vipler Benjamin Samuel
Published: December 2016

In the presented case, the authors describe an obese middle-aged man that presented to the emergency department for persistent oedema, scleral icterus and fatigue. He was admitted to the hospital and diagnosed with liver cirrhosis via transjugular liver biopsy. He continued to bleed from the biopsy site for 5 days from accelerated intravascular coagulation and fibrinolysis (AICF) requiring multiple transfusions of packed red blood cells, fresh-frozen plasma and cryoprecipitate. The authors then used thromboelastography (TEG) to further characterise the patient's coagulopathy, which revealed platelet inhibition. The results of the TEG significantly changed future transfusion management. Finally, the authors conducted a literature review to summarise the current literature available for the use of TEG in the management of liver cirrhosis with AICF.
Evaluation of exposure to pioglitazone and risk of prostate cancer: a nested case–control study
Authors: Boxall Naomi , Bennett Dimitri , Hunger Matthias , Dolin Paul , Thompson Paula L
Published: December 2016

Objectives

Investigate potential association between pioglitazone exposure and risk of prostate cancer.

Research design and methods

Nested, matched case–control study. UK primary care data (Clinical Practice Research Datalink (CPRD) GOLD) linked to inpatient (Hospital Episode Statistics (HES)) and cancer registry (National Cancer Information Network (NCIN)) data. English men aged ≥40 years diagnosed with type 2 diabetes mellitus, January 1, 2001 to January 5, 2015. Cases, with prostate cancer diagnosis, matched with up to 4 controls by age, cohort entry date and region. ORs for association of exposure to pioglitazone to incident prostate cancer, adjusted for potential confounders.

Results

From a cohort of 47 772 men with 243 923 person-years follow-up, 756 definite cases of prostate cancer were identified. Incidence was 309.9/100 000 person-years (95% CI 288.6 to 332.8). Pioglitazone use was not associated with prostate cancer risk; adjusted OR 0.759, 95% CI 0.502 to 1.148. Analyses showed no difference when possible cases, prostate cancer in CPRD GOLD only, included (adjusted OR 0.726, 95% CI 0.510 to 1.034). No association when adjusted for channeling bias (OR 0.778, 95% CI 0.511 to 1.184) or limited to an index date prior to July 1, 2011 (adjusted OR 0.508, 95% CI 0.294 to 0.879), despite prostate-specific antigen screening occurring more frequently among cases than controls (81.6% of 756 definite cases cf. 24.2% of 2942 controls (p<0.01)). No association with duration of pioglitazone use, increasing pioglitazone dose or increasing time since initiation.

Conclusions

In this real-world, nested matched case–control study, exposure to pioglitazone was not associated with increased risk of prostate cancer.
Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study
Authors: Gombotz Hans , Schreier Günter , Neubauer Sandra , Kastner Peter , Hofmann Axel
Published: December 2016

Objectives

A post hoc gender comparison of transfusion-related modifiable risk factors among patients undergoing elective surgery.

Settings

23 Austrian centres randomly selected and stratified by region and level of care.

Participants

We consecutively enrolled in total 6530 patients (3465 women and 3065 men); 1491 underwent coronary artery bypass graft (CABG) surgery, 2570 primary unilateral total hip replacement (THR) and 2469 primary unilateral total knee replacement (TKR).

Main outcome measures

Primary outcome measures were the number of allogeneic and autologous red blood cell (RBC) units transfused (postoperative day 5 included) and differences in intraoperative and postoperative transfusion rate between men and women. Secondary outcomes included perioperative blood loss in transfused and non-transfused patients, volume of RBCs transfused, perioperative haemoglobin values and circulating red blood volume on postoperative day 5.

Results

In all surgical groups, the transfusion rate was significantly higher in women than in men (CABG 81 vs 49%, THR 46 vs 24% and TKR 37 vs 23%). Intransfusedpatients, the absolute blood loss was higher among men in all surgical categories while the relative blood loss was higher among women in the CABG group (52.8 vs 47.8%) but comparable in orthopaedic surgery. The relative RBC volume transfused was significantly higher among women in all categories (CABG 40.0 vs 22.3; TKR 25.2 vs 20.2; THR 26.4 vs 20.8%). On postoperative day 5, the relative haemoglobin values and the relative circulating RBC volume were higher in women in all surgical categories.

Conclusions

The higher transfusion rate and volume in women when compared with men in elective surgery can be explained by clinicians applying the same absolute transfusion thresholds irrespective of a patient's gender. This, together with the common use of a liberal transfusion strategy, leads to further overtransfusion in women.
Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units: a register study over 10 years
Authors: Ericson Jenny , Flacking Renée , Hellström-Westas Lena , Eriksson Mats
Published: December 2016

Objective

There are indications that the prevalence of exclusively breastfed preterm infants is decreasing in Sweden. The objective was to investigate trends in exclusive breast feeding at discharge from Swedish neonatal units and associated factors in preterm infants.

Design, setting and participants

This is a register study with data from the Swedish Neonatal Quality Register. Data from 29 445 preterm infants (gestational age (GA) <37 weeks) who were born during the period 2004–2013 were retrieved. Data included maternal, perinatal and neonatal characteristics. Data were analysed for the whole population as well as for 3 GA groups.

Results

From 2004 to 2013, the prevalence of exclusive breast feeding decreased, in extremely preterm (GA 22–27 weeks) from 55% to 16%, in very preterm (GA 28–31 weeks) from 41% to 34% and in moderately preterm infants (GA 32–36 weeks) from 64% to 49%. The decline was statistically significant (p<0.001) in all 3 GA groups. This decline remained significant when adjustments were made for factors negatively associated with exclusive breast feedingandwhich became more prevalent during the study period, that is, small for GA (all groups) and maternal mental illness (very preterm and moderately preterm infants).

Conclusions

In the past 10 years, Sweden has experienced a lower rate of exclusive breast feeding in preterm infants, especially in extremely preterm infants. The factors analysed in this study explain only a small proportion of this decline. The decline in exclusive breast feeding at discharge from neonatal units raises concern and present challenges to the units to support and promote breast feeding.
A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships
Authors: Bell Sigall K , Gerard Macda , Fossa Alan , Delbanco Tom , Folcarelli Patricia H , Sands Kenneth E , Sarnoff Lee Barbara , Walker Jan
Published: December 2016

Background

OpenNotes, a national movement inviting patients to read their clinicians' notes online, may enhance safety through patient-reported documentation errors.

Objective

To test an OpenNotes patient reporting tool focused on safety concerns.

Methods

We invited 6225 patients through a patient portal to provide note feedback in a quality improvement pilot between August 2014 and 2015. A link at the end of the note led to a 9-question survey. Patient Relations personnel vetted responses, shared safety concerns with providers and documented whether changes were made.

Results

2736/6225(44%) of patients read notes; among these, 1 in 12 patients used the tool, submitting 260 reports. Nearly all (96%) respondents reported understanding the note. Patients and care partners documented potential safety concerns in 23% of reports; 2% did not understand the care plan and 21% reported possible mistakes, including medications, existing health problems, something important missing from the note or current symptoms. Among these, 64% were definite or possible safety concerns on clinician review, and 57% of cases confirmed with patients resulted in a change to the record or care. The feedback tool exceeded the reporting rate of our ambulatory online clinician adverse event reporting system several-fold. After a year, 99% of patients and care partners found the tool valuable, 97% wanted it to continue, 98% reported unchanged or improved relationships with their clinician, and none of the providers in the small pilot reported worsening workflow or relationships with patients.

Conclusions

Patients and care partners reported potential safety concerns in about one-quarter of reports, often resulting in a change to the record or care. Early data from an OpenNotes patient reporting tool may help engage patients as safety partners without apparent negative consequences for clinician workflow or patient-clinician relationships.
Improving oxygen prescribing rates by tailoring interventions for specific healthcare professional groups
Authors: Helliar Sebastian
Published: December 2016

Oxygen prescription remains a nationwide problem. The dangers associated with unregulated oxygen administration are well described in the literature with the potential for serious harm in patients with chronic hypercapnia, as well as potentially delaying discharge in patients who are administered it without a prescription. This project identifies poor compliance with regional and national standards and sets out to improve the frequency of oxygen prescribing on a cardiology ward. By studying the problem at a Somerset district general hospital we identified two main groups of professionals responsible for the poor compliance, nursing staff (who administer the oxygen) and junior doctors (who should prescribe it). A series of interventions was designed to firstly raise awareness of the problem within these two groups before going on to target each group with a further intervention over 24 weeks. At baseline we found only 11.3% of patients receiving oxygen had it prescribed. At the end of the project this had improved to 69.6%. We also found that following raised awareness in the nursing staff and introduction of a bedside warning the number of patients receiving oxygen on the ward fell by 35%. In conclusion, this project outlines a strategy for improving oxygen prescribing rates on a medical ward. By targeting different populations we had hoped to see a cumulative improvement after each improvement cycle, however, some resistance from junior doctors in engaging with our third intervention was reflected with a slight decrease in prescribing rates. Further work should address this issue and look to apply this strategy across a wider clinical area with a greater sample size to see if the results are replicable on a larger scale.
Abstracts from international Emergency Medicine journals
Authors: Weber Ellen J
Published: December 2016

Editor's note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors.
A study of correlation of angioarchitecture of intracranial blood vessels with difficulty during endovascular coiling of aneurysms
Authors: Patel Ketan , Singh Daljit , Singh Hukum , Narang Poonam , Tandon Monica , Ganjoo Pragati
Published: December 2016

Objective

The duration and complications of coiling are dependent on several factors. These include experience with the armamentarium and the expertise of the operator. Also, the angioarchitecture of the blood vessel can play an important role in the duration of the procedure and outcome.

Methods

41 patients underwent endovascular coiling. The angioarchitecture of the vessels in terms of the course of the blood vessels from the arch of the aorta to the aneurysm, and the angles between the arch and its branches, between the parent and feeding arteries, and between the feeding artery and the aneurysm were measured. During coiling, duration, attempts, complications, and outcome were recorded. A correlation was made between angioarchitecture and difficulty during coiling.

Results

Based on number of attempts of coiling, two groups were defined. In group I, 26 patients underwent a single attempt with a mean duration of 61 min and in group II, 15 patients had more than one attempt with a mean duration of 98 min. The mean angle between the arch and its branches, between the internal carotid artery and the anterior cerebral artery, and between the anterior communicating artery and the aneurysm was more acute in group II compared with group I. Spearman's correlation suggested that as the angle at different vessel levels decreased, duration, attempt, and complications increased, and vice versa.

Conclusions

Angioarchitecture analysis revealed that the sharper the angle (acute angle) between various vessels, the greater the difficulty in negotiating a microcatheter through the vessels and the more complications, duration, number of attempts, and poor outcome. We therefore feel that angioarchitecture analysis should be done carefully in all patients in whom the decision to undergo coiling is taken.
Opercular Index Score: a CT angiography-based predictor of capillary robustness and neurological outcomes in the endovascular management of acute ischemic stroke
Authors: Copelan Alexander , Chehab Monzer , Brinjikji Waleed , Wilseck Zachary , Kallmes David F , Wilseck Jeffery
Published: December 2016

Background

Many CT angiography (CTA) collateral scoring systems are either subjective or complex and time consuming.

Objective

To evaluate the correlation between a CTA collateral scoring system—the Opercular Index Score (OIS)—with neurological outcomes at 90 days following endovascular treatment for acute ischemic stroke (AIS) secondary to large vessel occlusion.

Methods

Fifty-five patients with AIS due to distal internal carotid artery, M1, or proximal M2 occlusions who underwent endovascular treatment were included. OIS was retrospectively calculated from CTA images, reconstructed from CT perfusion imaging, as the ratio of opacified M3 opercular branches in the Sylvian fissure on the unaffected side to those on the stroke side and dichotomized into favorable (OIS≤2) and poor (OIS>2). The ability of OIS to predict good neurological outcomes (modified Rankin Scale score ≤2 at 90 days) was assessed using sensitivity, specificity, and area under the curve (AUC) with receiver operating characteristic analysis.

Results

Thirty-five patients had a favorable OIS and 20 patients had a poor OIS. Patients with favorable OIS had an 80.0% (n=28) rate of good neurological outcomes compared with 15.0% (n=3) of patients with a poor OIS (p<0.0001). On multivariate logistic regression analysis adjusting for baseline National Institutes of Health Stroke Scale score, OIS, and device used, favorable OIS was the only variable independently associated with good neurological outcome (OR=17.2, 95% CI 3.8 to 104.3) and demonstrated a sensitivity of 90.3% and specificity of 70.8% with an AUC of 0.822.

Conclusions

OIS is a simple and practical non-invasive scoring system that can be used to predict collateral robustness and good neurological outcome among patients with AIS undergoing endovascular treatment.
Predictors for venous sinus stent retreatment in patients with idiopathic intracranial hypertension
Authors: El Mekabaty Amgad , Obuchowski Nancy A , Luciano Mark G , John Seby , Chung Charlotte Y , Moghekar Abhay , Jones Stephen , Hui Ferdinand K
Published: December 2016

Background

Venous sinus stenting for dural sinus stenoses is an emerging alternative to cerebrospinal fluid diversion in cases of medically refractory idiopathic intracranial hypertension. Juxta-stent ‘re-stenoses’ have been reported and managed alternatively with ventricular shunting or stent revision. Identification of factors that might predispose patients to recurrent narrowing may help to select or exclude patients with idiopathic intracranial hypertension for venous sinus stenting.

Methods

We retrospectively reviewed a prospectively maintained database spanning December 2011 to May 2015 of all patients with idiopathic intracranial hypertension who were screened for possible venous sinus stenting, including only patients who received a stent, noting symptomatic improvements, changes in opening lumbar puncture pressure, demographic characteristics, and any subsequent intervention after stent placement. Fisher's exact test and logistic regression were used to test each of seven potential predictors for retreatment.

Results

There were eight revisions in 31 patients (25.8%). Among Caucasians, 8.0% required a revision compared with 100% of African-Americans (p<0.001). The c-index for race was 0.857. Body mass index (BMI) was also a significant predictor of revision (p=0.031): among class III obese patients the revision rate was 46.2% compared with 16.7% among class I and II obese patients and 0% among overweight to normal weight patients.

Conclusions

BMI was a significant predictor of revision, suggesting that higher BMI may have a higher risk of revision. The small number of African-Americans in the study makes interpretation of the practical significance of the revision rate in these patients uncertain. None of the other studied factors was statistically significant.
Mechanical thrombectomy in patients with M1 occlusion and NIHSS score ≤5: a single-centre experience
Authors: Bhogal P , Bücke P , Ganslandt O , Bäzner H , Henkes H , Pérez M Aguilar
Published: December 2016

Background

The recent success of several mechanical thrombectomy trials has resulted in a significant change in management for patients presenting with stroke. However, it is still unclear how to manage patients that present with stroke and low National Institutes of Health Stroke Scale (NIHSS) ≤5. We sought to review our experience of mechanical thrombectomy in patients with low NIHSS and confirmed M1 occlusion.

Methods

We retrospectively analysed our prospectively maintained database of all patients undergoing mechanical thrombectomy between January 2008 and August 2016. We identified 41 patients with confirmed M1 occlusion and low NIHSS (≤5) on admission to our hospital. We collected demographic, radiological, procedural and outcome data.

Results

The mean age of patients was 72±14, with 20 male patients. Associated medical conditions were common with hypertension seen in ∼80%. Just over 50% presented with NIHSS 4 or 5. The average ASPECTS score on admission was 8.8 (range 6–10), and the average clot length 10 mm. Angiographically Thrombolysis in Cerebral Infarction (TICI) ≥2b was obtained in 87.8% of patients. 7 patients had haemorrhage on follow-up, 2 of which were symptomatic. Of 40 patients with 90-day follow-up, 75% had modified Rankin Scale (mRS) score 0–2. There were 3 deaths at 90 days.

Conclusions

Mechanical thrombectomy in patients with low NIHSS and proximal large vessel occlusion is technically possible and carries a high degree of success with good safety profile. Patients with low NIHSS and confirmed occlusion should be considered for mechanical thrombectomy.
How to share the process of graduate advising
Authors: Wagner H.H. , Boyd C. , Napper R.
Published: December 2016

This paper starts a two-part series on graduate advising that integrates concepts from adult learning, leadership, and psychology into a conceptual framework for graduate advising. A companion paper provides guidance on how to communicate effectively in graduate advising. Here, we present concepts and tools that enable advisors and graduate students to collaborate effectively and share the responsibility for the student’s learning. We specifically discuss (1) how to promote learning about learning to help students make sense of their experience and identify their supervision needs; (2) how to clarify roles and address conflicts of interest between different roles; and (3) how to establish an effective, learning-centered working relationship. By making the advising process explicit, using the concepts and worksheets presented here, advisors will contribute to the training of the next generation of graduate advisors.
U.S. Involvement in the LHC
Authors: Green Dan
Published: December 2016

The demise of the SSC in the U.S. created an upheaval in the U.S. high energy physics (HEP) community. The subsequent redirection of HEP efforts to the CERN Large Hadron Collider (LHC) can perhaps be seen as informing on possible future paths for worldwide collaboration on future HEP megaprojects.
The International Committee for Future Accelerators (ICFA): 1976 to the present
Authors: Rubinstein Roy
Published: December 2016

The origins of the International Committee for Future Accelerators (ICFA) are described, together with its role in the particle physics community; also discussed are some of its past and current major activities.
NEUROLOGICAL OUTCOME IN ASSOCIATION WITH COLUMN RESTORATION AND CONSOLIDATION OF UNSTABLE THORACIC AND LUMBAR SPINE FRACTURES — ASSESSMENT BY CLINICAL EXAMINATION AND IMAGE STUDIES
Authors: Moon Myung-Sang , Kim Dong-Hyeon , Kim Sang-Jae , Yoon Min-Geun
Published: December 2016

A total of 116 surgically treated patients with unstable fractures of the thoracic and lumbar spines were subjected to this study on basis of the simple radiographic and CT findings of the injured spinal column and neurological changes at the injured cord and/or roots level. Among them 50 patients were paraplegics and 66 patients were non-paraplegics. Spine fracture patterns shown on axial CT images were classified into five types on the basis of the fracture severity of vertebral body associating the canal compromise by the encroached fracture fragments from middle column and posterior element. Type I: vertical linear fracture through mid-anterior and posterior elements; Type II: retropulsed fragment in the canal with intact posterior element; Type III: retropulsed fragment in the canal with fracture of the posterior element; Type IV: severe comminution of body and disruption of posterior element around the canal; Type V: fracture-dislocation of comminuted vertebral body and neural arch (with or without double margin sign and with or without vacant facet sign). Displacement of vertebral body on lateral plane radiograms showed significant difference ([Formula: see text] < 0.001) between the non-paralytics and paralytics, but there were no differences in kyphotic angles and anterior body height loss between the two groups. Neurological injury was highly complicated in cases of the fracture-dislocation (20 out of 22 patients: 90.9%). Unstable fracture which occurred in the thoracic level showed high incidence of neurological injuries [24 out of 28 patients (85.7%)]; complete paralysis in 20 (71.4%) out of 28 patients in comparison with that of the thoracolumbar and lumbar fractures. Anteroposterior (AP) diameter of the compromised neural canal and percentile surface area of the compromised canal showed significant differences between the paralytics and non-paralytics (canal diameter: [Formula: see text] < 0.05, canal compromise: [Formula: see text] < 0.05). Neural deficit was highly complicated in type IV and V fractures. In conclusion, it was found that clinical neurological assessment and CT-based fracture classification were the valid approaches in managing the fractured spine.
Myostatin propeptide mutation of the hypermuscularCompactmice decreases the formation of myostatin and improves insulin sensitivity
Authors: Kocsis Tamas , Trencsenyi Gyorgy , Szabo Kitti , Baan Julia Aliz , Muller Geza , Mendler Luca , Garai Ildiko , Reinauer Hans , Deak Ferenc , Dux Laszlo , Keller-Pinter Aniko
Published: December 2016

The TGFβ family member myostatin (growth/differentiation factor-8) is a negative regulator of skeletal muscle growth. The hypermuscular Compact mice carry the 12-bp Mstn(Cmpt-dl1Abc) deletion in the sequence encoding the propeptide region of the precursor promyostatin, and additional modifier genes of the Compact genetic background contribute to determine the full expression of the phenotype. In this study, by using mice strains carrying mutant or wild-type myostatin alleles with the Compact genetic background and nonmutant myostatin with the wild-type background, we studied separately the effect of the Mstn(Cmpt-dl1Abc) mutation or the Compact genetic background on morphology, metabolism, and signaling. We show that both the Compact myostatin mutation and Compact genetic background account for determination of skeletal muscle size. Despite the increased musculature of Compacts, the absolute size of heart and kidney is not influenced by myostatin mutation; however, the Compact genetic background increases them. Both Compact myostatin and genetic background exhibit systemic metabolic effects. The Compact mutation decreases adiposity and improves whole body glucose uptake, insulin sensitivity, and18FDG uptake of skeletal muscle and white adipose tissue, whereas the Compact genetic background has the opposite effect. Importantly, the mutation does not prevent the formation of mature myostatin; however, a decrease in myostatin level was observed, leading to altered activation of Smad2, Smad1/5/8, and Akt, and an increased level of p-AS160, a Rab-GTPase-activating protein responsible for GLUT4 translocation. Based on our analysis, the Compact genetic background strengthens the effect of myostatin mutation on muscle mass, but those can compensate for each other when systemic metabolic effects are compared.
Nonlinear Modeling and Identification of an Aluminum Honeycomb Panel with Multiple Bolts
Authors: Chu Yongpeng , Wen Hao , Chen Ti
Published: December 2016

This paper focuses on the nonlinear dynamics modeling and parameter identification of an Aluminum Honeycomb Panel (AHP) with multiple bolted joints. Finite element method using eight-node solid elements is exploited to model the panel and the bolted connection interface as a homogeneous, isotropic plate and as a thin layer of nonlinear elastic-plastic material, respectively. The material properties of a thin layer are defined by a bilinear elastic plastic model, which can describe the energy dissipation and softening phenomena in the bolted joints under nonlinear states. Experimental tests at low and high excitation levels are performed to reveal the dynamic characteristics of the bolted structure. In particular, the linear material parameters of the panel are identified via experimental tests at low excitation levels, whereas the nonlinear material parameters of the thin layer are updated by using the genetic algorithm to minimize the residual error between the measured and the simulation data at a high excitation level. It is demonstrated by comparing the frequency responses of the updated FEM and the experimental system that the thin layer of bilinear elastic-plastic material is very effective for modeling the nonlinear joint interface of the assembled structure with multiple bolts.
Urban Biodiversity: Perception, Preference, General Awareness, and Threats in Two Cities (Niamey and Maradi) of Niger
Authors: Abdourahamane Illiassou Salamatou , Amadou Oumani Abdoulaye , Abdou Laouali , Mahamane Ali , Saadou Mahamane
Published: December 2016

This study was undertaken to obtain direct and useful data that support biodiversity awareness and management in two cities of Niger. 800 questionnaires were administrated to the populations of Niamey and Maradi. The results show that 99% of respondents are aware of the importance of biodiversity in urban areas. They assign multiple roles to it; however, climatic and managerial reasons explain why plants are most preferred to animals in these cities. Furthermore, shade and fruits are the criteria for plant species selection, and that explains the abundance of Azadirachta indica A. Juss. and Mangifera indica L. Even though plants are preferred to animals in houses, 47% of the respondents practice animal husbandry. Most of the animals are left wandering with risks of destruction of green areas, road unsafety, and zoonotic contamination. The results of this study also showed the ignorance of 55% of the respondents about the presence of wildlife in urban areas. The proliferation of cockroaches and rats could be an indication of insanitary conditions that are faced in some areas of the cities as mentioned by 81% of the respondents. This study shows the importance of local knowledge in the identification process of urban problems.