bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunosuppression Is Associated With Clinical Features and Relapse Risk of B Cell Posttransplant Lymphoproliferative Disorder: A Retrospective Analysis Based on the Prospective, International, Multicenter PTLD-1 Trials
Authors: Zimmermann Heiner , Babel Nina , Dierickx Daan , Morschhauser Franck , Mollee Peter , Zaucha Jan M. , Dreyling Martin H. , Dührsen Ulrich , Reinke Petra , Verhoef Gregor , Subklewe Marion , Hüttmann Andreas , Tousseyn Thomas , Bachy Emmanuel , Hauser Ingeborg A. , Tarella Corrado , Van Den Neste Eric , Gheysens Olivier , Anagnostopoulos Ioannis , Leblond Veronique , Riess Hanno , Choquet Sylvain , Trappe Ralf U.
Published: May 2018

Background

Current guideline recommendations for immunosuppression reduction after diagnosis of posttransplant lymphoproliferative disorder (PTLD) include stopping antimetabolites, reducing calcineurin inhibitors, and maintaining corticosteroids. However, the effect of immunosuppression on PTLD relapse risk after up-to-date therapy is unclear.

Methods

This is a retrospective analysis of immunosuppression, patient baseline characteristics, and relapse risk measured as landmark time to progression (TTP) starting 1 year after start of therapy in 159 patients with B cell PTLD after solid organ transplantation treated in the prospective, international, multicenter PTLD-1 trials with either sequential treatment (rituximab followed by cyclophosphamide (CHOP-21 chemotherapy) 750 mg/m2 intravenously [IV] day (d) 1, doxorubicin 50 mg/m2 IV d1, vincristine 1.4 mg/m2 (maximum, 2 mg) IV d1, and prednisone 50 mg/m2 PO d1-5, every 21 days) or risk-stratified sequential treatment (rituximab followed by rituximab or rituximab (R-CHOP-21 immunochemotherapy) 375 mg/m2 IV day (d) 1, cyclophosphamide 750 mg/m2 IV d1, doxorubicin 50 mg/m2 IV d1, vincristine 1.4 mg/m2 (max. 2 mg) IV d1, and prednisone 50 mg/m2 PO d1-5, every 21 days).

Results

Patient baseline characteristics at diagnosis of PTLD differed significantly depending on immunosuppression before diagnosis. Compared with immunosuppression before diagnosis, significantly fewer patients received an antimetabolite or a calcineurin inhibitor (CNI) after diagnosis of PTLD. Relapse risk measured as landmark TTP was significantly higher for patients on corticosteroids compared to all others (P = 0.010) as well as for patients on ciclosporin compared with those on tacrolimus (P = 0.002), but similar for those on antimetabolites compared with all others (P = 0.912). In a Cox regression analysis of landmark TTP, corticosteroid-containing immunosuppression after diagnosis of PTLD (P = 0.002; hazard ratio, 11.195) and age (P = 0.001; hazard ratio, 1.076/year) were identified as independent, significant risk factors for PTLD relapse.

Conclusions

In the prospective PTLD-1 trials, corticosteroid use after diagnosis of PTLD is associated with an increased risk of relapse, whereas the use of antimetabolites is not. These findings require prospective validation.
Impact of Early Initiated Everolimus on the Recurrence of Hepatocellular Carcinoma After Liver Transplantation
Authors: Rodríguez-Perálvarez Manuel , Guerrero Marta , Barrera Lydia , Ferrín Gustavo , Álamo Jose M. , Ayllón María D. , Artacho Gonzalo Suarez , Montero José L. , Briceño Javier , Bernal Carmen , Padillo Javier , Marín-Gómez Luis M. , Pascasio Juan M. , Poyato Antonio , Gómez-Bravo Miguel A. , De la Mata Manuel
Published: May 2018

Background

Many centers implement everolimus-based immunosuppression in liver transplant patients with hepatocellular carcinoma. We aimed to explore the potential impact of early initiated everolimus on tumor recurrence after liver transplantation.

Methods

This study included 192 patients with hepatocellular carcinoma undergoing liver transplantation among who 64 individuals were prospectively enrolled (2012-2015) and received early initiated everolimus (ie, started between postoperative day 15 to 21), whereas the remaining 128 patients acted as historical controls without everolimus. Propensity score matching was performed to ensure comparability. Multivariate Cox regression and competing risks analysis were used to control for potential confounders.

Results

Patients with and without everolimus were comparable in terms of number of nodules (P = 0.37), total tumor diameter (P = 0.44), Milan criteria fulfillment (P = 0.56), and histological differentiation (P = 0.61), but there were increased microvascular invasion rates in the everolimus group (26.5% vs 13.3%; P = 0.026). Tumor recurrence rates were similar with and without everolimus (10.9% vs 9.9% at 36 months respectively; P = 0.18). After controlling for microvascular invasion among other potential confounders, everolimus had no significant impact on tumor recurrence, neither in the multivariate Cox regression (relative risk = 3.23; P = 0.09), nor in the competing risks analysis for tumor recurrence-death (relative risk = 1.02; P = 0.94). Patients receiving everolimus had reduced tacrolimus trough concentrations and lower serum creatinine within the first 18 months postliver transplantation.

Conclusion

Everolimus may not be universally prescribed to prevent tumor recurrence in liver transplant patients with hepatocellular carcinoma. Future randomized trials should be focused on patients with histological features of increased tumor aggressiveness, in whom the potential benefit would be higher.
Does internal metabolic state determine our motor coordination strategy?
Authors: Taylor Scott V. , Faisal A. Aldo
Published: May 2018

Motor coordination requires the orchestration of multiple degrees of freedom in order to perform actions. Humans display characteristic and predictable reaching trajectories even though multiple trajectories are possible. Computational theories of motor control can explain these reaching trajectories by assuming that subjects orchestrate their movements to minimise a cost function, such as end-point variability or movement effort. However, how internal metabolic states influence decision making and sensorimotor control is not well understood. Here we measure human behaviour during a centre out reaching task in two distinct metabolic conditions in the morning – after having had breakfast and not. We find that humans alter their patterns of motor coordination according to their internal metabolic state and that this change in behaviour results in a 20% lower task-related energy expenditure when fasted. We suggest that movements are orchestrated according to different criteria in different metabolic states so that metabolic costs are reduced in low metabolic states. We also predict that motor coordination strategies take the metabolic costs of specific muscle groups into account when planning and executing movements. Thus, metabolic state may alter the computational strategies of decision making between animal-based experiments (in typically low metabolic conditions) and human psychophysics experiments (in typically high metabolic conditions).
Palaeobiological inferences based on long bone epiphyseal and diaphyseal structure - the forelimb of xenarthrans (Mammalia)
Authors: Amson Eli , Nyakatura John A
Published: May 2018

Trabecular architecture (i.e., the main orientation of the bone trabeculae, their number, mean thickness, spacing, etc.) has been shown experimentally to adapt with great accuracy and sensitivity to the loadings applied to the bone during life. However, the potential of trabecular parameters used as a proxy for the mechanical environment of an organism’s organ to help reconstruct the lifestyle of extinct taxa has only recently started to be exploited. Furthermore, these parameters are rarely combined to the long-used mid-diaphyseal parameters to inform such reconstructions. Here we investigate xenarthrans, for which functional and ecological reconstructions of extinct forms are particularly important in order to improve our macroevolutionary understanding of their main constitutive clades, i.e., the Tardigrada (sloths), Vermilingua (anteaters), and Cingulata (armadillos and extinct close relatives). The lifestyles of modern xenarthrans can be classified as fully terrestrial and highly fossorial (armadillos), arboreal (partly to fully) and hook-and-pull digging (anteaters), or suspensory (fully arboreal) and non-fossorial (sloths). The degree of arboreality and fossoriality of some extinct forms, “ground sloths” in particular, is highly debated. We used high-resolution computed tomography to compare the epiphyseal 3D architecture and mid-diaphyseal structure of the forelimb bones of extant and extinct xenarthrans. The comparative approach employed aims at inferring the most probable lifestyle of extinct taxa, using phylogenetically informed discriminant analyses. Several challenges preventing the attribution of one of the extant xenarthran lifestyles to the sampled extinct sloths were identified. Differing from that of the larger “ground sloths”, the bone structure of the small-sized Hapalops (Miocene of Argentina), however, was found as significantly more similar to that of extant sloths, even when accounting for the phylogenetic signal.
On Signalling and Estimation Limits for Molecular Birth-Processes
Authors: Parag Kris V
Published: May 2018

Understanding and uncovering the mechanisms or motifs that molecular networks employ to regulate noise is a key problem in cell biology. As it is often difficult to obtain direct and detailed insight into these mechanisms, many studies instead focus on assessing the best precision attainable on the signalling pathways that compose these networks. Molecules signal one another over such pathways to solve noise regulating estimation and control problems. Quantifying the maximum precision of these solutions delimits what is achievable and allows hypotheses about underlying motifs to be tested without requiring detailed biological knowledge. The pathway capacity, which defines the maximum rate of transmitting information along it, is a widely used proxy for precision. Here it is shown, for estimation problems involving elementary yet biologically relevant birth-process networks, that capacity can be surprisingly misleading. A time-optimal signalling motif, called birth-following, is derived and proven to better the precision expected from the capacity, provided the maximum signalling rate constraint is large and the mean one above a certain threshold. When the maximum constraint is relaxed, perfect estimation is predicted by the capacity. However, the true achievable precision is found highly variable and sensitive to the mean constraint. Since the same capacity can map to different combinations of rate constraints, it can only equivocally measure precision. Deciphering the rate constraints on a signalling pathway may therefore be more important than computing its capacity.
GLMdenoise improves multivariate pattern analysis of fMRI data
Authors: Charest Ian , Kriegeskorte Nikolaus , Kay Kendrick N.
Published: May 2018

GLMdenoise is a denoising technique for task-based fMRI. In GLMdenoise, estimates of spatially correlated noise (which may be physiological, instrumental, motion-related, or neural in origin) are derived from the data and incorporated as nuisance regressors in a general linear model (GLM) analysis. We previously showed that GLMdenoise outperforms a variety of other denoising techniques in terms of cross-validation accuracy of GLM estimates (Kay et al., 2013a). However, the practical impact of denoising for experimental studies remains unclear. Here we examine whether and to what extent GLMdenoise improves sensitivity in the context of multivariate pattern analysis of fMRI data. On a large number of participants (31 participants across 4 experiments; 3 T, gradient-echo, spatial resolution 2–3.75 mm, temporal resolution 1.3–2 s, number of conditions 32–75), we perform representational similarity analysis (Kriegeskorte et al., 2008a) as well as pattern classification (Haxby et al., 2001). We find that GLMdenoise substantially improves replicability of representational dissimilarity matrices (RDMs) across independent splits of each participant’s dataset (average RDM replicability increases from r = 0.46 to r = 0.61). Additionally, we find that GLMdenoise substantially improves pairwise classification accuracy (average classification accuracy increases from 79% correct to 84% correct). We show that GLMdenoise often improves and never degrades performance for individual participants and that GLMdenoise also improves across-participant consistency. We conclude that GLMdenoise is a useful tool that can be routinely used to maximize the amount of information extracted from fMRI activity patterns.
RAVEN 2.0: a versatile toolbox for metabolic network reconstruction and a case
study on Streptomyces coelicolor
Authors: Wang Hao , Marcišauskas Simonas , Sánchez Benjamín J , Domenzain Iván , Hermansson Daniel , Agren Rasmus , Nielsen Jens , Kerkhoven Eduard J
Published: May 2018

RAVEN is a commonly used MATLAB toolbox for genome-scale metabolic model (GEM) reconstruction, curation and constraint-based modelling and simulation. Here we present RAVEN Toolbox 2.0 with major enhancements, including: (i) de novo reconstruction of GEMs based on the MetaCyc pathway database; (ii) a redesigned KEGG-based reconstruction pipeline; (iii) convergence of reconstructions from various sources; (iv) improved performance, usability, and compatibility with the COBRA Toolbox. Capabilities of RAVEN 2.0 are here illustrated through de novo reconstruction of GEMs for the antibiotic-producing bacterium Streptomyces coelicolor. Comparison of the automated de novo reconstructions with the iMK1208 model, a previously published high-quality S. coelicolor GEM, exemplifies that RAVEN 2.0 can capture most of the manually curated model. The generated de novo reconstruction is subsequently used to curate iMK1208 resulting in Sco4, the most comprehensive GEM of S. coelicolor, with increased coverage of both primary and secondary metabolism. This increased coverage allows the use of Sco4 to predict novel genome editing targets for optimized secondary metabolites production. As such, we demonstrate that RAVEN 2.0 can be used not only for de novo GEM reconstruction, but also for curating existing models based on up-to-date databases. Both RAVEN 2.0 and Sco4 are distributed through GitHub to facilitate usage and further development by the community.

Author summary

Cellular metabolism is a large and complex network. Hence, investigations of metabolic networks are aided by in silico modelling and simulations. Metabolic networks can be derived from whole-genome sequences, through identifying what enzymes are present and connecting these to formalized chemical reactions. To facilitate the reconstruction of genome-scale models of metabolism (GEMs), we have developed RAVEN 2.0. This versatile toolbox can reconstruct GEMs fast, through either metabolic pathway databases KEGG and MetaCyc, or from homology with an existing GEM. We demonstrate RAVEN’s functionality through generation of a metabolic model of Streptomyces coelicolor, an antibiotic-producing bacterium. Comparison of this de novo generated GEM with a previously manually curated model demonstrates that RAVEN captures most of the previous model, and we subsequently reconstructed an updated model of S. coelicolor: Sco4. Following, we used Sco4 to predict promising targets for genetic engineering, which can be used to increase antibiotic production.
Selectively increased autofluorescence at fingernails and certain regions of skin: A potential novel diagnostic biomarker for Parkinson’s disease
Authors: Wu Danhong , Tao Yue , Zhang Mingchao , Li Yujia , Shen Liwei , Li Yuzhen , Ying Weihai
Published: May 2018

Diagnosis of Parkinson’s disease (PD) mainly relies on the judgment of experienced neurologists on the clinical symptoms of patients. Quantitative and specific biomarker tests for PD is greatly needed. In this study we tested our hypothesis that increased autofluorescence (AF) of skin and fingernails may become a novel diagnostic biomarker for PD. Our study has indicated that PD patients have a distinct pattern of AF changes, compared with that of acute ischemic stroke (AIS) patients: First, the AF intensity of PD patients in the fingernails and a part of the examined regions of skin is significantly higher than that of the healthy and Low-Risk group, while the AF intensity of AIS patients is significantly higher than that of the healthy and Low-Risk group in most regions examined; second, there is AF asymmetry at the index fingernails and two regions of the skin of PD patients, while there is AF asymmetry at all examined regions of AIS patients; and third, both the AF intensity and AF asymmetry at Centremetacarpus of PD patients is significantly lower than those of AIS patients. The increased AF may result from the altered keratins’ AF induced by the oxidative stress in the plasma of PD patients. Collectively, our study has indicated that PD patients have a distinct pattern of AF changes compared with those of healthy and Low-Risk persons as well as AIS patients, which may become a novel diagnostic biomarker for PD.
A novel LC system embeds analytes in pre-formed gradients for rapid, ultra-robust proteomics
Authors: Bache Nicolai , Geyer Philipp E. , Bekker-Jensen Dorte B. , Hoerning Ole , Falkenby Lasse , Treit Peter V. , Doll Sophia , Paron Igor , Meier Florian , Olsen Jesper V. , Vorm Ole , Mann Matthias
Published: May 2018

To further integrate mass spectrometry (MS)-based proteomics into biomedical research and especially into clinical settings, high throughput and robustness are essential requirements. They are largely met in high-flow rate chromatographic systems for small molecules but these are not sufficiently sensitive for proteomics applications. Here we describe a new concept that delivers on these requirements while maintaining the sensitivity of current nano-flow LC systems. Low-pressure pumps elute the sample from a disposable trap column, simultaneously forming a chromatographic gradient that is stored in a long storage loop. An auxiliary gradient creates an offset, ensuring the re-focusing of the peptides before the separation on the analytical column by a single high-pressure pump. This simplified design enables robust operation over thousands of sample injections. Furthermore, the steps between injections are performed in parallel, reducing overhead time to a few minutes and allowing analysis of more than 200 samples per day. From fractionated HeLa cell lysates, deep proteomes covering more than 130,000 sequence unique peptides and close to 10,000 proteins were rapidly acquired. Using this data as a library, we demonstrate quantitation of 5200 proteins in only 21 min. Thus, the new system-termed Evosep One-analyzes samples in an extremely robust and high throughput manner, without sacrificing in depth proteomics coverage.
Assessing the Gene-Disease Association of 19 Genes with the RASopathies using the ClinGen Gene Curation Framework
Authors: Grant Andrew , Cushman Brandon , Cavé Hélène , Dillon Mitchell W. , Gelb Bruce D. , Gripp Karen W. , Lee Jennifer A. , Mason-Suares Heather , Rauen Katherine A. , Vincent Lisa M. , Zenker Martin
Published: May 2018

The RASopathies are a complex group of diseases regarding phenotype and genetic etiology. The ClinGen RASopathy Expert Panel assessed published and other publicly available evidence supporting the association of 19 genes with RASopathy conditions. Using the semi-quantitative literature curation method developed by the ClinGen Gene Curation Working Group, evidence for each gene was curated and scored for Noonan syndrome, Costello syndrome, cardiofaciocutaneous (CFC) syndrome, Noonan syndrome with multiple lentigines (NSML), and Noonan-like syndrome with loose anagen hair (NS/LAH).

The curated evidence supporting each gene-disease relationship was then discussed and approved by the ClinGen RASopathy Expert Panel. Each association’s strength was classified as Definitive, Strong, Moderate, Limited, Disputed, or No Evidence. Eleven genes were classified as definitively associated with at least one RASopathy condition. Two genes classified as strong for association with at least one RASopathy condition while one gene was moderate and three were limited. The RAS EP also refuted the association of two genes for a RASopathy condition. Overall, our results provide a greater understanding of the different gene-disease relationships within the RASopathies and can help guide and direct clinicians, patients and researchers who are identifying variants in individuals with a suspected RASopathy

GRANT NUMBERS:

Research reported in this publication was supported by the National Human Genome Research Institute (NHGRI) under award number U41HG006834. MZ received support from German Federal Ministry of Education and Research (BMBF): NSEuroNet (FKZ 01GM1602A), GeNeRARe (FKZ 01GM1519A).
Diisopropylammonium hydrogen phthalate
Authors: Seye Dame , Diop Libasse , Diop Cheikh Abdoul Khadir , Geiger David K.
Published: May 2018

In the crystal of the title molecular salt, C6H16N+·C8H5O4
−, the cation and anions are linked into [010] chains by N—H...O hydrogen bonds. The chains are connected to their neighbours through weak C—H...O hydrogen bonds, leading to a layered supramolecular architecture. The hydrogen phthalate anion exhibits an intramolecular O—H...O hydrogen bond in which the H atom is approximately equidistant to the two O atoms.
Home to work spillover and turnover intentions
Authors: Sok Jenny , Blomme Robert Jan , De Ruiter Melanie , Tromp Debbie , Lub X.D.
Published: May 2018

Purpose

This paper aims to investigate the relationship between home-to-work spillover, measured as positive and negative home–work interference (HWI) and turnover intentions, as well as the mediating role of perceptions concerning training and development practices.

Design/methodology/approach

Data were collected among 418 respondents who were working at two business schools. A confirmative structural equation modeling analysis was conducted for the analysis.

Findings

As expected, positive HWI showed negative relationships with turnover intentions, while negative HWI related positively to turnover intentions. Training and development practices mediated the relationship between positive HWI and turnover intentions; the mediation effect was stronger for women than it was for men. Training and development practices did not mediate the relationship between negative HWI and turnover intentions, however.

Practical implications

The outcomes suggest that helping employees to balance their work and home lives can be beneficial for employees, as well as for employers in terms of reducing turnover intentions.

Originality/value

As contributions, additional insight into the relationship between positive and negative non-work factors and turnover intentions by examining the ways in which both positive as well as negative HWI are related to turnover intentions. Furthermore, the research considers the mediating role played by perceptions concerning human resource (HR) practices, and particularly training and development practices as perceived by the employee, in the relationship between positive and negative HWI and turnover intentions.
Investigating social media consumption, sports enthusiasm, and gender on sponsorship outcomes in the context of Rio Olympics
Authors: Hazari Sunil
Published: May 2018

Purpose

Using the context of Rio Olympic games, the purpose of this paper is to investigate attitude toward sponsorship outcome as it relates to purchase behavior, gender, sponsor patronage, sports enthusiasm, and social media consumption.

Design/methodology/approach

Data were collected using an online survey of 265 participants. Questions regarding demographics, viewing habits, sports participation, enthusiasm, attitude toward Olympic events were included in the survey. The four sub-scales were sponsorship attitude, sponsor patronage, social media consumption, and sports enthusiasm.

Findings

The findings of the study showed that social media consumption is positively related to attitude toward event and sports patronage. There was a significant gender difference on attitude toward event, social media consumption, and sports enthusiasm. Predictors for making a purchase as a result of seeing a social media advertisement were gender, playing competitive sport, and social media consumption.

Practical implications

This study will add to the body of academic and practitioner research on sponsorship outcomes, and provides an opportunity for marketers to leverage social media networks for sponsorship communication.

Originality/value

As the use of social media networks has increased over the past few years, no previous study has investigated association of sports enthusiasm, gender, or social media consumption toward sponsor patronage which relates to consumers seeking out sponsors and being influenced to make a purchase as a result of marketing communication of sponsors.
Sustainability reporting: an empirical evaluation of emerging and developed economies
Authors: Bhatia Aparna , Tuli Siya
Published: May 2018

Purpose

This paper aims to investigate and compare the sustainability reporting practices of companies in developing nations (BRIC) with those in the developed economies (the UK and USA) as per GRI framework.

Design/methodology/approach

Content analysis has been applied on a sample of 232 companies listed on the Stock Exchanges of developing and developed countries (Brazil – BOVESPA index, 39 companies; Russia – RTS index, 21 companies; India – SENSEX, 17 companies; China – SSE 50, 19 companies; the USA – NASDAQ 100 and Amex major market index, 58 companies and the UK – FTSE100, 78 companies). It uses descriptive statistics and independent sample t-test to identify significant comparisons.

Findings

The findings of this paper suggest that developing nations are providing more information on sustainability practices as compared to the companies in the developed nations. Overall mean disclosure score of developing countries is 59.04 per cent followed by that of the developed countries at 36.47 per cent. The result of independent sample t-test shows these differences significant at 1 per cent level.

Practical implications

The results of the current paper implicate that the corporate managers of the developing nations should prefer rational and purposive reporting. They should work on the quality of reporting rather than just filling pages because social and environmental issues are more gross in the developing nations as compared to the developed countries.

Originality/value

Developing and developed nations jointly use the scarce resources and provide output to the world, thereby raising sustenance issues. However, not even a single study was found while reviewing the literature that studied and compared the sustainability reporting practices of these countries.
Smart LED high CRI lighting systems
Authors: Grzesiak Wojciech , Guzdek Piotr , Maćków Piotr , Zaraska Krzysztof , Zbieć Michal , Jakubowski Mariusz , Obrębski Dariusz , Boguszewicz Piotr , Solnica Dariusz , Iwanicki Pawel , Linke Sebastian , Mahlkow Adrian
Published: May 2018

Purpose

The purpose of this paper is to present issues related to the design of a modern lighting system based on LED technology. The developed system provides lighting with a high colour rendering index (up to 98); it also has many innovative functions, which make its implementation bring significant energy savings and increase the comfort of work.

Design/methodology/approach

In contrast to typical solutions, the dynamic synthesis of white light from six component colours was used in the presented project. This process is controlled by a microcontroller, and there is a colour temperature sensor in the feedback loop. The communication between smart luminaires and sensor modules is provided by means of a ZigBee wireless network.

Findings

The correctness of the proposed methodology has been proved by measurements and laboratory tests.

Research limitations/implications

The process of improving the lighting system is continued and significant changes in the spectrum of used sensors are expected.

Practical implications

The proposed system based on mixing light from six components is an innovative solution that besides undoubted advantages entails a more elaborate electronic circuitry. However, good characteristics of the obtained light, as well as the possibility of compensating for changes in colour temperature of natural light and reducing the impact of aging of LEDs, in the authors’ opinion, make the proposed solution find its place on the market.

Originality/value

The proposed solution is original, both in terms of the light mixing technique and advanced functionality offered by the system.
Integrating Point‐of‐care Testing Into a Community Emergency Department: A Mixed‐methods Evaluation
Authors: Pines Jesse M. , Zocchi Mark S. , Carter Caitlin , Marriott Charles Z. , Bernard Matthew , Warner Leah H.
Published: May 2018

Objective

Point‐of‐care testing (POCT) is a commonly used technology that hastens the time to laboratory results in emergency departments (ED). We evaluated an ED‐based POCT program on ED length of stay (LOS) and time to care, coupled with qualitative interviews of local ED stakeholders.

Methods

We conducted a mixed‐methods study (2012–2016) to examine the impact of POCT in a single, community ED. The quantiative analysis involved an observational before–after study comparing time to laboratory test result (POC troponin or POC chemistry) and ED LOS after implementation of POCT, using a propensity‐weighted interrupted time series analysis (ITSA). A complementary qualitative analysis involved five semistructured interviews with staff using grounded theory on the benefits and challenges to ED POCT.

Results

A total of 47,399 ED visits were included in the study (24,705 in the preintervention period and 22,694 in the postintervention period). After POCT implementation, overall laboratory testing increased marginally from 61% to 62%. Central laboratory troponin and chemistry declined by > 50% and was replaced by POCT. Prior to POCT implementation, time to troponin and chemistry had declined steadily due to other improvements in laboratory efficiency. After POCT implementation, there was an immediate 20‐minute further decline (p < 0.001) in both time to troponin and time to chemistry results using the propensity‐weighted comparisons. However, the declining trend observed prior to POCT implementation did not continue at the same rate after implementation. Similarly, prior to POCT implementation, ED LOS declined due to other quality improvements. After POCT implementation, LOS continued declined at a similar rate. Because of this prior trend, the ITSA did not show a significant decline in LOS attributable to POCT. Common benefits of POCT perceived by staff in qualitative interviews included improved quality of care (64%) and reductions in time to test results (44%). Common challenges included concerns over POCT accuracy (32%) and technical barriers (29%).

Conclusion

In the study ED, implementation of POCT was associated with a reduction in time to test result for both troponin and chemistry. Local staff felt that faster time to test result improved quality of care; however, concerns were raised with POCT accuracy.
Current prescribing trends of antibiotics by dentists in Australia from 2013 to 2016. Part 1.
Authors: Teoh L , Stewart K , Marino RJ , McCullough MJ
Published: May 2018

Background

Literature has shown dentists tend to overprescribe antibiotics and do not always prescribe in accordance with recommended guidelines. Unnecessary prescribing is one major factor that contributes to the development of antibiotic resistance. The aim of the present study was to assess the antibacterial prescribing patterns of dentists in Australia from 2013 to 2016.

Methods

Data on dental antibacterial prescriptions dispensed under the Pharmaceutical Benefits Scheme (PBS) from 2013 to 2016 was accessed and prescribing trends analysed. The prescribing rates were standardized to the dose and population.

Results

There was a slight decrease in the dispensed use of most antibacterials from 2013 to 2016, but there was a significant increase in the dispensed use of amoxicillin/clavulanic acid of 11.2%. Amoxicillin was the most commonly dispensed antibiotic, accounting for approximately 65% of all antibacterials from 2013 to 2016, while phenoxymethylpenicillin accounted for only 1.4% of prescriptions in 2016. There were low but significant quantities of dispensed antibiotic prescriptions that do not fit with current guidelines.

Conclusions

The data suggest that dentists in Australia are prescribing some antibiotics inappropriately and there is a preference for moderate‐ to broad‐spectrum agents. The current PBS dental schedule is inconsistent with prescribing guidelines and may contribute to inappropriate prescribing.
‘One size does not fit all’: Perspectives on diversity in community aged care
Authors: Meyer Claudia , Appannah Arti , McMillan Sally , Browning Colette , Ogrin Rajna
Published: May 2018

Objectives

Typically, older people are viewed via a single health condition, yet health outcomes are likely impacted by the intersection of many individual characteristics. Promoting inclusive health care is underpinned by reducing bias, respectful communication and supporting individual needs and preferences. This study explores perspectives of community aged care workers on diversity training and implementing training into practice.

Methods

Ninety community aged care workers were telephone‐interviewed three months after a one‐day diversity training workshop. Interviews were audio‐recorded, transcribed verbatim and analysed thematically.

Results

Five themes emerged: ‘raising awareness’; ‘reserving judgement’; ‘confidence and empowerment to embed diversity into practice’; ‘communicating effectively’; and ‘thinking about change … but’.

Conclusions

Diversity concepts were positively received, but applying diversity principles into practice is more difficult. Recommendations to promote inclusive health care included raising awareness of bias, communicating with inclusive language and embedding diversity concepts into community aged care practice by addressing individual, organisational and wider system constraints.
Comparison of transvaginal ultrasound and saline contrast sonohysterography in evaluation of cesarean scar defect: a prospective cohort study
Authors: Antila‐Långsjö Riitta , Mäenpää Johanna U. , Huhtala Heini , Tomás Eija , Staff Synnöve
Published: May 2018

Introduction

The aim of this study was to investigate the prevalence of post‐cesarean isthmocele and to measure agreement between transvaginal ultrasonography and saline contrast sonohysterography in assessment of isthmocele.

Material and methods

A prospective observational cohort study was carried out at Tampere University Hospital, Finland. Non‐pregnant women delivered by cesarean section (n = 371) were examined with transvaginal ultrasonography (TVUS) and sonohysterography (SHG) six months after cesarean section. The main outcome measure was the prevalence of isthmocele using TVUS and SHG. Secondary outcome measures were characteristics of isthmocele.

Results

In all, 371 women were included. The prevalence of isthmocele was 22.4% based on TVUS and 45.6% based on SHG. Sensitivity and specificity for TVUS was 49.1 and 100%, respectively, when compared with SHG. Therefore, half of the defects (50.9%) diagnosed with SHG remained undiagnosed with TVUS. Bland–Altman analysis showed an underestimation of 1.1 mm (range 0.00–7.90) for TVUS compared with SHG, with 95% limits of agreement from −1.9 to 4.1 mm.

Conclusions

This methodological study provides confirmatory data that TVUS and SHG are not in good agreement in the isthmocele diagnostics and the use of only TVUS may lead to an underestimation of the prevalence of isthmocele. Thus, SHG should be considered as a method of choice in diagnostics of isthmocele.
Predicting stress urinary incontinence during pregnancy: combination of pelvic floor ultrasound parameters and clinical factors
Authors: Chen Ling , Luo Dan , Yu Xiajuan , Jin Mei , Cai Wenzhi
Published: May 2018

Introduction

The aim of this study was to develop and validate a predictive tool that combines pelvic floor ultrasound parameters and clinical factors for stress urinary incontinence during pregnancy.

Material and methods

A total of 535 women in the first or second trimester of pregnancy were included for an interview and transperineal ultrasound assessment from two hospitals. Imaging data sets were analyzed offline to assess for bladder neck vertical position, urethra angles (α, β and γ angles), hiatal area and bladder neck funneling. All significant continuous variables at univariable analysis were analyzed by receiver operating characteristics. Three multivariable logistic models were built on clinical factors, and combined with ultrasound parameters. The final predictive model with best performance and fewest variables was selected to establish a nomogram. Internal and external validation of the nomogram was performed by both discrimination represented by C‐index and calibration measured by Hosmer–Lemeshow test. A decision curve analysis was conducted to determine the clinical utility of the nomogram.

Results

After excluding 14 women with invalid data, 521 women were analyzed. β angle, γ angle and hiatal area had limited predictive value for stress urinary incontinence during pregnancy, with area under curves of 0.558–0.648. The final predictive model included body mass index gain since pregnancy, constipation, previous delivery mode, β angle at rest, and bladder neck funneling. The nomogram based on the final model showed good discrimination with a C‐index of 0.789 and satisfactory calibration (p = 0.828), both of which were supported by external validation. Decision curve analysis showed that the nomogram was clinically useful.

Conclusions

The nomogram incorporating both the pelvic floor ultrasound parameters and clinical factors has been validated to show good discrimination and calibration, and could be an important tool for stress urinary incontinence risk prediction at an early stage of pregnancy.
Questionnaire‐based evaluation of sexual life after laparoscopic surgery for endometriosis: a systematic review of prospective studies
Authors: Franck Cecilie , Poulsen Marlene H. , Karampas Grigorios , Giraldi Annamaria , Rudnicki Martin
Published: May 2018

Introduction

Endometriosis is a benign disease that affects women of reproductive age. Laparoscopic excision of endometriotic implants is considered one of the most effective therapeutic options. The disease and its treatment can have a major impact on psychosexual well‐being but this is often overlooked as most studies focus on pain instead of sexuality in a holistic approach. The aim of this study was to review the current literature regarding the effect of laparoscopic surgery for endometriosis on quality of sexual life (QoSL).

Material and methods

Following the “Preferred Reporting Items for Systematic Reviews and Meta‐Analyses” guidelines we conducted a systematic review that involved searching PubMed and Embase databases for prospective studies evaluating the effect of laparoscopic surgery for endometriosis on QoSL, using validated questionnaires.

Results

Of 357 papers, 17 were selected for full text evaluation. Twelve studies using seven different questionnaires fulfilled the inclusion criteria. All studies reported improvements in QoSL following laparoscopic surgery for endometriosis. A meta‐analysis could not be performed due to substantial heterogeneity among the included studies arising from differences in questionnaires, follow‐up duration, stages of endometriosis, use of hormonal treatment, and missing data.

Conclusions

Laparoscopic excision of endometriosis can improve QoSL. However, there is a need for randomized controlled trials based on a new validated questionnaire regarding specifically QoSL in association with endometriosis. As sexual functioning is a complex phenomenon driven by multiple physical, psychological and social factors, QoSL should be holistically evaluated by a team of different healthcare providers, implementing treatment programs that are individualized to each woman.
Predictors of outcome of prematurely born infants with pulmonary interstitial emphysema
Authors: Williams Emma , Dassios Theodore , Clarke Paul , Chowdhury Olie , Greenough Anne
Published: May 2018

Aim

To determine how oxygenation, ventilation efficiency and tidal volume requirements changed with the development of pulmonary interstitial emphysema (PIE) and whether in affected patients a composite gas exchange index predicted death or bronchopulmonary dysplasia (BPD).

Methods

Infants who developed PIE from 2010 to 2016 were identified. The oxygenation index (OI), ventilation efficiency index (VEI), ventilation to perfusion ratio and inspiratory tidal volume were calculated before radiological evidence of PIE (pre‐PIE) and at the worst PIE radiographic appearance (PIE‐worst).

Results

Thirty infants, median (IQR) gestational age of 24.6 (24.3–26.7) weeks were assessed. Their age at pre‐PIE was 11 (6–19) days and 23 (13–42) days at PIE‐worst. Compared to pre‐PIE, at PIE‐worst, the OI was higher [14.5 (10.7–19.2) vs 4.8 (3.1–6.1), respectively, p < 0.001], VEI was lower [0.01 (0.01–0.11) vs 0.16 (0.13–0.19), respectively, p < 0.001], ventilation to perfusion ratio was lower [0.15 (0.11–0.40) vs 0.26 (0.20–0.37), p = 0.033] and tidal volume was higher [9.9 (7.2–13.1) vs 6.4 (5.5–6.8) mL/kg, p = 0.007]. An OI >11.4 at PIE‐worst predicted death or BPD with 80% sensitivity and 100% specificity.

Conclusion

Development of PIE was associated with poorer oxygenation and ventilation efficiency despite increased tidal volumes. The OI at PIE‐worst predicted death or BPD.
Intestinal failure: the evolving demographic and patient outcomes on home parenteral nutrition
Authors: Brown Sarah Kate , Davies Natalie , Smyth Enda , Heather Nicky , Cole Caroline , Keys Simon Charles , Beattie Robert Mark , Batra Akshay
Published: May 2018

Aim

We performed this study to examine and understand the evolving demographics and changing outcomes of intestinal failure (IF) and its implications for healthcare delivery.

Method

We conducted a retrospective analysis of outcome data of children on home parenteral nutrition (HPN), over a 15‐year period.

Results

A total of 31 patients received HPN: 15 for short bowel syndrome (SBS), eight neuromuscular disease (NMD) and eight for other causes. The HPN prevalence increased from 1.54 per million children in 2000 to 21.5 in 2016. The outcomes over last 5 years were better than those of previous 10 years. The rate of catheter‐related bloodstream infection (CRBSI) had fallen from 4 to 1.3 and IF liver disease (IFALD) from 20% to 7.7%. The aetiology changed over years from SBS being the main cause to NMD contributing 43% to the total in 2016. This was especially relevant as NMD was associated with greater numbers of IFALD (38% vs 6.7%), CRBSI (1.51 vs 0.64/1000 PN days) and mortality.

Conclusion

The outcome of long‐term parenteral nutrition (PN) has improved. The increasing number of patients with NMD, coupled with their higher burden of care, results in an increasing health care burden, and the planning of intestinal rehabilitation services needs to reflect this.
Cardioprotective role of IGF‐1 in the hypertrophied myocardium of the spontaneously hypertensive rats: A key effect on NHE‐1 activity
Authors: Yeves A. M. , Burgos J. I. , Medina A. J. , Villa‐Abrille M. C. , Ennis I. L.
Published: May 2018

Aim

Myocardial Na+/H+ exchanger‐1 (NHE‐1) hyperactivity and oxidative stress are interrelated phenomena playing pivotal roles in the development of pathological cardiac hypertrophy and heart failure. Exercise training is effective to convert pathological into physiological hypertrophy in the spontaneously hypertensive rats (SHR), and IGF‐1—key humoral mediator of exercise training—inhibits myocardial NHE‐1, at least in normotensive rats. Therefore, we hypothesize that IGF‐1 by hampering NHE‐1 hyperactivity and oxidative stress should exert a cardioprotective effect in the SHR.

Methods

NHE‐1 activity [proton efflux () mmol L−1 min−1], expression and phosphorylation; H2O2 production; superoxide dismutase (SOD) activity; contractility and calcium transients were measured in SHR hearts in the presence/absence of IGF‐1.

Results

IGF‐1 significantly decreased NHE‐1 activity ( at pHi 6.95: 1.39 ± 0.32, n = 9 vs C 3.27 ± 0.3, n = 20, P < .05); effect prevented by AG1024, an antagonist of IGF‐1 receptor (2.7 ± 0.4, n = 7); by the PI3K inhibitor wortmannin (3.14 ± 0.41, n = 7); and the AKT inhibitor MK2206 (3.37 ± 0.43, n = 14). Moreover, IGF‐1 exerted an antioxidant effect revealed by a significant reduction in H2O2 production accompanied by an increase in SOD activity. In addition, IGF‐1 improved cardiomyocyte contractility as evidenced by an increase in sarcomere shortening and a decrease in the relaxation constant, underlined by an increase in the amplitude and rate of decay of the calcium transients.

Conclusion

IGF‐1 exerts a cardioprotective role on the hypertrophied hearts of the SHR, in which the inhibition of NHE‐1 hyperactivity, as well as the positive inotropic and antioxidant effects, emerges as key players.
Maternal exercise, season and sex modify the daily fetal heart rate rhythm
Authors: Sletten J. , Cornelissen G. , Assmus J. , Kiserud T. , Albrechtsen S. , Kessler J.
Published: May 2018

Aim

The knowledge on biological rhythms is rapidly expanding. We aimed to define the longitudinal development of the daily (24‐hour) fetal heart rate rhythm in an unrestricted, out‐of‐hospital setting and to examine the effects of maternal physical activity, season and fetal sex.

Methods

We recruited 48 women with low‐risk singleton pregnancies. Using a portable monitor for continuous fetal electrocardiography, fetal heart rate recordings were obtained around gestational weeks 24, 28, 32 and 36. Daily rhythms in fetal heart rate and fetal heart rate variation were detected by cosinor analysis; developmental trends were calculated by population‐mean cosinor and multilevel analysis.

Results

For the fetal heart rate and fetal heart rate variation, a significant daily rhythm was present in 122/123 (99.2%) and 116/121 (95.9%) of the individual recordings respectively. The rhythms were best described by combining cosine waves with periods of 24 and 8 hours. With increasing gestational age, the magnitude of the fetal heart rate rhythm increased, and the peak of the fetal heart rate variation rhythm shifted from a mean of 14:25 (24 weeks) to 20:52 (36 weeks). With advancing gestation, the rhythm‐adjusted mean value of the fetal heart rate decreased linearly in females (P < .001) and nonlinearly in males (quadratic function, P = .001). At 32 and 36 weeks, interindividual rhythm diversity was found in male fetuses during higher maternal physical activity and during the summer season.

Conclusion

The dynamic development of the daily fetal heart rate rhythm during the second half of pregnancy is modified by fetal sex, maternal physical activity and season.