bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutrient-Regulated Proteolysis of MrpC Halts Expression of Genes Important for Commitment to Sporulation during Myxococcus xanthus Development
Authors: Rajagopalan Ramya , Kroos Lee
Published: May 2014

Starved
Myxococcus xanthus
cells glide to aggregation centers and form fruiting bodies in which rod-shaped cells differentiate into ovoid spores. Commitment to development was investigated by adding nutrients at specific times after starvation and determining whether development halted or proceeded. At 24 h poststarvation, some rod-shaped cells were committed to subsequent shape change and to becoming sonication-resistant spores, but nutrients caused partial disaggregation of fruiting bodies. By 30 h poststarvation, 10-fold more cells were committed to becoming sonication-resistant spores, and compact fruiting bodies persisted after nutrient addition. During the critical period of commitment around 24 to 30 h poststarvation, the transcription factors MrpC and FruA cooperatively regulate genes important for sporulation. FruA responds to short-range C-signaling, which increases as cells form fruiting bodies. MrpC was found to be highly sensitive to nutrient-regulated proteolysis both before and during the critical period of commitment to sporulation. The rapid turnover of MrpC upon nutrient addition to developing cells halted expression of the
dev
operon, which is important for sporulation. Regulated proteolysis of MrpC appeared to involve ATP-independent metalloprotease activity and may provide a mechanism for monitoring whether starvation persists and halting commitment to sporulation if nutrients reappear.
Identification of Regulatory Elements That Control Expression of the
tbpBA
Operon in Neisseria gonorrhoeae
Authors: Vélez Acevedo Rosuany N. , Ronpirin Chalinee , Kandler Justin L. , Shafer William M. , Cornelissen Cynthia Nau
Published: May 2014

Iron is an essential nutrient for survival and establishment of infection by
Neisseria gonorrhoeae
. The neisserial transferrin binding proteins (Tbps) comprise a bipartite system for iron acquisition from human transferrin. TbpA is the TonB-dependent transporter that accomplishes iron internalization. TbpB is a surface-exposed lipoprotein that makes the iron uptake process more efficient. Previous studies have shown that the genes encoding these proteins are arranged in a bicistronic operon, with the
tbpB
gene located upstream of
tbpA
and separated from it by an inverted repeat. The operon is under the control of the ferric uptake regulator (Fur); however, promoter elements necessary for regulated expression of the genes have not been experimentally defined. In this study, putative regulatory motifs were identified and confirmed by mutagenesis. Further examination of the sequence upstream of these promoter/operator motifs led to the identification of several novel repeats. We hypothesized that these repeats are involved in additional regulation of the operon. Insertional mutagenesis of regions upstream of the characterized promoter region resulted in decreased
tbpB
and
tbpA
transcript levels but increased protein levels for both TbpA and TbpB. Using RNA sequencing (RNA-Seq) technology, we determined that a long RNA was produced from the region upstream of
tbpB
. We localized the 5′ endpoint of this transcript to between the two upstream insertions by qualitative RT-PCR. We propose that expression of this upstream RNA leads to optimized expression of the gene products from within the
tbpBA
operon.
Control of Natural Transformation in Salivarius Streptococci through Specific Degradation of σ
X
by the MecA-ClpCP Protease Complex
Authors: Wahl Astrid , Servais Florence , Drucbert Anne-Sophie , Foulon Catherine , Fontaine Laetitia , Hols Pascal
Published: May 2014

Competence for natural DNA transformation is a tightly controlled developmental process in streptococci. In mutans and salivarius species, the abundance of the central competence regulator σ
X
is regulated at two levels: transcriptional, by the ComRS signaling system via the σ
X
/ComX/SigX-inducing peptide (XIP), and posttranscriptional, by the adaptor protein MecA and its associated Clp ATPase, ClpC. In this study, we further investigated the mechanism and function of the MecA-ClpC control system in the salivarius species
Streptococcus thermophilus
. Using
in vitro
approaches, we showed that MecA specifically interacts with both σ
X
and ClpC, suggesting the formation of a ternary σ
X
-MecA-ClpC complex. Moreover, we demonstrated that MecA ultimately targets σ
X
for its degradation by the ClpCP protease in an ATP-dependent manner. We also identify a short sequence (18 amino acids) in the N-terminal domain of σ
X
as essential for the interaction with MecA and subsequent σ
X
degradation. Finally, increased transformability of a MecA-deficient strain in the presence of subinducing XIP concentrations suggests that the MecA-ClpCP proteolytic complex acts as an additional locking device to prevent competence under inappropriate conditions. A model of the interplay between ComRS and MecA-ClpCP in the control of σ
X
activity is proposed.
Psychometric properties of the Knee injury and Osteoarthritis Outcome Score for Children (KOOS-Child) in children with knee disorders
Authors: Örtqvist Maria , Iversen Maura D , Janarv Per-Mats , Broström Eva W , Roos Ewa M
Published: May 2014

Background

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered valid and reliable questionnaire for adults with joint injury or degenerative disease. Recent data indicate a lack of comprehensibility when this is used with children. Thus, a preliminary KOOS-Child was developed. This study aims to evaluate psychometric properties of the final KOOS-Child when used in children with knee disorders.

Methods

115 children (boys/girls 51/64, 7–16 years) with knee disorders were recruited. All children (n=115) completed the KOOS-Child, the Child-Health Assessment Questionnaire (CHAQ) and the EQ-5D-Youth version (EQ-5D-Y) at baseline to evaluate construct validity. Two additional administrations (1–3 weeks and 3 months) were performed for analyses of reliability (internal consistency and test–retest; n=72) and responsiveness (n=91). An anchor-based approach was used to evaluate responsiveness and interpretability.

Results

After item reduction, the final KOOS-Child consists of 39 items divided into five subscales. No floor or ceiling effects (≤15%) were found. An exploratory factor analysis on subscale level demonstrated that items in all subscales except for Symptoms loaded on one factor (Eigenvalues 3.1–5.5, Symptom: 2 factors, Eigenvalue >1). Sufficient homogeneity was found for all subscales (Cronbach's α = 0.80–0.90) except for the Symptoms subscale (α = 0.59). Test–retest reliability was substantial to excellent for all subscales (Intraclass Correlation Coefficient 0.78–0.91, Smallest Detectable Change (SDC)ind14.6–22.6, SDCgroup1.7–2.7). Construct validity was confirmed, and greater effect sizes were seen in those reporting improved clinical status. Minimal important changes greater than the SDCs were found for patients reporting to be better and much better.

Conclusions

The final KOOS-Child demonstrates good psychometric properties and supports the use of the KOOS-Child when evaluating children with knee disorders.
Risk factors, testing and preventative strategies for non-contact injuries in professional football: current perceptions and practices of 44 teams from various premier leagues
Authors: McCall Alan , Carling Chris , Nedelec Mathieu , Davison Michael , Le Gall Franck , Berthoin Serge , Dupont Gregory
Published: May 2014

Purpose

Little is known about injury prevention practices in professional football clubs. The purpose of this study was therefore to determine the current perceptions and practices of premier league football clubs internationally concerning risk factors, testing and preventative exercises for non-contact injuries.

Methods

A survey was administered to 93 premier league football clubs internationally. The survey included four sections: (1) persons involved in the injury prevention programme: position, quantity, role, qualification; (2) perceptions regarding non-contact injury risk factors; (3) tests used to identify non-contact injury risk and (4) non-contact injury prevention exercises used, their perceived effectiveness and implementation strategies.

Results

44 surveys were successfully returned (47%). The position of physiotherapist was the most represented position in the injury prevention programme. The top five perceived risk factors in rank order were previous injury, fatigue, muscle imbalance, fitness and movement efficiency. The five most commonly used tests to identify injury risk (in rank order) were functional movement screen, questionnaire, isokinetic dynamometry, physical tests and flexibility. The top five exercises used by clubs were (also in rank order) eccentric exercise, balance/proprioception, hamstring eccentric, core stability and, sharing the fifth position, Nordic hamstring and gluteus activation.

Conclusions

The survey revealed the most common perceptions and practices of premier league football clubs internationally regarding risk factors, testing and preventative exercises. The findings can enable reduction of the gap between research and practice.
Objectively measured physical activity trajectories predict adolescent bone strength: Iowa Bone Development Study
Authors: Janz Kathleen F , Letuchy Elena M , Burns Trudy L , Eichenberger Gilmore Julie M , Torner James C , Levy Steven M
Published: May 2014

Background

Physical activity improves bone strength and reduces the risk for osteoporotic fractures. However, there are substantial gaps in our knowledge as to when, how and how much activity is optimal for bone health.

Purpose

In this cohort study, we examined developmental trajectories of objectively measured physical activity from childhood to adolescence to discern if moderate-and-vigorous intensity physical activity (MVPA) predicts bone strength.

Methods

Starting at age 5 and continuing at 8, 11, 13, 15 and 17 years, Iowa Bone Development Study participants (n=530) wore an accelerometer for 3–5 days. At age 17, we assessed dual X-ray energy absorptiometry outcomes of mass and estimated geometry (femoral neck cross-sectional area and section modulus). We also assessed geometric properties (bone stress index and polar moment of inertia) of the tibia using peripheral computer quantitative tomography. Latent class modelling was used to construct developmental trajectories of MVPA from childhood to late adolescence. General linear models were used to examine the trajectory groups as predictors of age 17 bone outcomes.

Results

Girls and boys who accumulated the most MVPA had greater bone mass and better geometry at 17 years when compared to less active peers. The proportion of participants achieving high levels of MVPA throughout childhood was very low (<6% in girls) and by late adolescence almost all girls were inactive.

Conclusions

Bone health benefits of physical activity are not being realised due to low levels of activity for most youth, especially in girls.
Increased utilisation of eye disorder-related ambulatory medical services prior to the diagnosis of Sjögren's syndrome in female patients: a longitudinal population-based study in Taiwan
Authors: Lu Ming-Chi , Fa Wen-Hsiung , Tsai Tzung-Yi , Koo Malcolm , Lai Ning-Sheng
Published: May 2014

Objectives

To investigate the utilisation of eye disorder-related ambulatory medical services prior to the diagnosis of primary Sjögren's syndrome in female Taiwanese patients.

Design

A nationwide, population-based case–control study.

Setting

Taiwan's National Health Insurance Research Database.

Participants

A total of 347 patients with a diagnosis of primary Sjögren's syndrome from 2005 to 2010 and 1735 controls frequency matched on 10-year age interval and index year were identified from Taiwan's National Health Insurance Research Database. Diagnoses of eye disorder (International Classification of Diseases, Ninth Revision, clinical modification (ICD-9-CM) codes from 360 to 370) were retrospectively screened to 1997.

Main outcome measure

The utilisation of eye disorder-related medical service over different intervals prior to diagnosis of Sjögren's syndrome between cases and controls were compared using generalised estimating equations with negative binomial distribution and log link function.

Results

A significantly higher proportion of patients with Sjögren's syndrome (7.5%) utilised eye disorder-related ambulatory medical services over an 8-year interval prior to the diagnosis of the disease compared with controls (4.8%). The annual frequency of utilisation of eye disorder-related ambulatory medical services increased significantly faster when closer to the index date in patients with Sjögren's syndrome compared with controls (interaction effect, p=0.010). Subgroup analyses indicated that the changes over time in the utilisation of services related to disorders of lacrimal system (interaction effect, p=0.019) and conjunctiva (interaction effect, p=0.066) were significantly greater in patients with Sjögren's syndrome compared with controls.

Conclusions

An increase in the utilisation of eye disorder-related ambulatory medical services was observed in patients with Sjögren's syndrome several years prior to the diagnosis of the disease. General practitioners and ophthalmologists can play an important role by including Sjögren's syndrome in the diagnostic evaluation of their patients afflicted with relevant symptoms.
Clinical outcomes and resource utilisation in Medicare patients with chronic liver disease: a historical cohort study
Authors: Younossi Zobair M , Zheng Li , Stepanova Maria , Venkatesan Chapy , Mishra Alita
Published: May 2014

Objective

The aim of this study is to assess recent trends in health resource utilisation and patient outcomes of Medicare beneficiaries with chronic liver disease (CLD).

Setting

Liver-related mortality is the 10th leading cause of death in the USA, and hepatitis C virus (HCV) and obesity-related non-alcoholic fatty liver disease are the major causes of CLD. As the US population ages and becomes more obese, the impact of CLD is expected to become more prominent for the Medicare population.

Participants

This is a retrospective cohort study of Medicare beneficiaries with a diagnosis of CLD based on inpatient (N=21 576; 14 977 unique patients) and outpatient (N=515 990; 244 196 patients) claims from 2005 to 2010.

Primary and secondary outcome measures

The study outcomes included hospital length of stay (LOS) and inpatient mortality as well as inpatient and outpatient inflation-adjusted payments.

Results

Between 2005 and 2010, there was an annual decrease in LOS of 3.17% for CLD-related hospitalisations. Risk-adjusted in-hospital mortality decreased (OR 0.90, 95% CI 0.87 to 0.94), while short-term postdischarge mortality remained stable (1.00, 0.98 to 1.03). Inpatient per-claim payment increased from $11 769 in 2005 to $12 347 in 2010 (p=0.0006). Similarly, the average yearly payments for outpatient care increased from $366 to $404 (p<0.0001). This change in payment was observed together with a consistent decrease in the proportion of beneficiary-paid amount (25.4–20%, p<0.0001) as opposed to Medicare-paid amount (73.1–80%, p<0.0001). The major predictors of higher outpatient payments were younger age, Asian race or Hispanic ethnicity, living in California, and having more diagnoses and outpatient procedures per claim. The predictors of inpatient spending also included younger age, location and the number of inpatient procedures.

Conclusions

Length of inpatient stay and inpatient mortality among Medicare beneficiaries with CLD decreased, while inpatient and outpatient spending increased.
Food insecurity among Dutch food bank recipients: a cross-sectional study
Authors: Neter Judith E , Dijkstra S Coosje , Visser Marjolein , Brouwer Ingeborg A
Published: May 2014

Objective

To determine the prevalence of (very) low food security among Dutch food bank recipients, and to identify potential demographic, lifestyle and nutrition-related factors associated with (very) low food security.

Setting

11 of 135 Dutch food banks were selected throughout the Netherlands.

Participants

251 Dutch food bank recipients participated in the study (93 men and 158 women). Inclusion criteria for participation were: (1) at least 18 years of age, (2) sufficiently fluent in Dutch to participate in oral and written interviews, (3) recipient of a Dutch food bank for at least 1 month and (4) collect own food parcel at the food bank. A single member per household was included.

Primary outcome

Level of food security.

Results

The prevalence of food insecurity was 72.9% (N=183), of which 40.4% (N=74) reported very low food security. Of the very low food secure participants, 56.8% (N=42) reported they were ever hungry but did not eat because they could not afford enough food in the previous 3 months. Adjusted multinomial logistic regression analyses showed that households without children were less likely to experience low food security (OR 0.39 (95% CI 0.18 to 0.88)) and men (OR 0.24 (95% CI 0.11 to 0.51)) were less likely to experience very low food security, while low-educated recipients (OR 5.05 (95% CI 1.37 to 18.61)) were more likely to experience very low food security. Furthermore, recipients with high satisfaction with overall food intake (OR 0.46 (95% CI 0.27 to 0.78)), high perceived healthiness of overall food intake (OR 0.34 (95% CI 0.19 to 0.62)) or high self-efficacy of eating healthy (OR 0.62 (95% CI 0.40 to 0.96)) were less likely to experience very low food security.

Conclusions

Our study showed high prevalence rates of food insecurity among Dutch food bank recipients, and identified subgroups at increased risk of food insecurity. More research is urgently needed on the underlying determinants of food insecurity and the effectiveness of food assistance by food banks.
Living with pulmonary hypertension: unique insights from an international ethnographic study
Authors: Kingman Martha , Hinzmann Barbara , Sweet Oliver , Vachiéry Jean-Luc
Published: May 2014

Objectives

To better understand the patient's perspective of pulmonary hypertension (PH), including the impact of living with PH, disease management and treatment.

Design

This qualitative ethnographic study collected observational video footage, supplemented by field notes and patient diaries to assess the impact of PH on the patient's life.

Setting

Patients were observed and filmed in their home for up to 6 h, capturing the environment, interactions and activities of everyday life.

Participants

Patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic PH who were receiving PAH-specific medication were recruited through healthcare professionals (HCPs) and patient associations in seven countries across four continents. Sampling was purposive and subgroup analysis was not intended.

Results

Overall, 39 patients with PH were enrolled. Many patients had a poor understanding of PH and found their ‘invisible’ disease difficult to explain to others. An important finding was the secrecy surrounding PH. Feelings of insecurity and isolation were regularly reported, and many patients admitted to hiding their symptoms. The marked improvement in symptoms after therapy initiation made assessment of disease progression more difficult as patients compared their quality of life (QoL) against pretreatment levels. Extensive planning and adherence to daily routines were required in patients’ everyday life.

Conclusions

Ethnography was used for the first time, in several countries, to evaluate the patient's perception of living with PH. This approach revealed key findings that would not typically be uncovered using other qualitative techniques, including the secrecy surrounding PH, the difficulties in describing the disease and the challenges in assessing disease progression. A more tailored dissemination of information from HCPs and development of a simple and understandable PH definition may be beneficial in alleviating the secrecy reported by patients. A greater appreciation of how patients perceive their disease and QoL has the potential to improve PH management.
‘Saying it without words’: a qualitative study of oncology staff's experiences with speaking up about safety concerns
Authors: Schwappach D L B , Gehring K
Published: May 2014

Objectives

To explore the experiences of oncology staff with communicating safety concerns and to examine situational factors and motivations surrounding the decision whether and how to speak up using semistructured interviews.

Setting

7 oncology departments of six hospitals in Switzerland.

Participants

Diverse sample of 32 experienced oncology healthcare professionals.

Results

Nurses and doctors commonly experience situations which raise their concerns and require questioning, clarifying and correcting. Participants often used non-verbal communication to signal safety concerns. Speaking-up behaviour was strongly related to a clinical safety issue. Most episodes of ‘silence’ were connected to hygiene, isolation and invasive procedures. In contrast, there seemed to exist a strong culture to communicate questions, doubts and concerns relating to medication. Nearly all interviewees were concerned with ‘how’ to say it and in particular those of lower hierarchical status reflected on deliberate ‘voicing tactics’.

Conclusions

Our results indicate a widely accepted culture to discuss any concerns relating to medication safety while other issues are more difficult to voice. Clinicians devote considerable efforts to evaluate the situation and sensitively decide whether and how to speak up. Our results can serve as a starting point to develop a shared understanding of risks and appropriate communication of safety concerns among staff in oncology.
A simple measure to improve the rates of thromboprophylaxis prescription post surgical fixation of neck of femur fractures in a district general hospital
Authors: Sinha Pranab , Najefi Ali-Asgar , Hambidge John
Published: May 2014

Neck of femur (NOF) fractures are a major public health concern because of the ageing population and higher incidence of fragility fractures. NOF fractures are associated with high mortality and morbidity rates, and there is a high risk of venous thromboembolism (VTE) after hip fractures (Ref 1). Therefore thromboprophylaxis is vital. Current NICE guidelines advocate 28 – 35 days of thromboprophylaxis after NOF fractures (Ref 1, 2).

It came to our attention that patients post NOF fixation were getting variable prescriptions in regards to their thromboprophylaxis. Therefore a retrospective study on prescription of thromboprophylaxis was conducted from October 2012 to February 2013 within the trauma and orthopaedics department at Queens Hospital, Romford.

Data was collected on all NOF fractures from electronic discharge summaries. Basic descriptive statistics were used to analysis the data. There were 110 cases of NOF fractures during this period. 100 patients were included since two were discounted as they were already on long term anticoagulants and eight patients died in hospital. No thromboprophylaxis was prescribed for 15 patients (15%). Three patients (3%) were prescribed less than 28 days (mean 14 days, range (14 – 14 days)). 69 patients (69%) received 28 - 35 days of thromprophylaxis, whilst five patients (5%) received more than 35 days (mean 42 days, range 40 – 42 days).

Formal departmental teaching and presentation of the findings was given after the initial study and a small label with the message, ‘POST NOF #: 28-35 days Enoxaparin’, was attached to the back of all the junior doctor work phones. After the intervention, data was collected from the period of 7th of January to 7th of February 2013. The second study showed that 50 patients were admitted with NOF fractures in this time period. Four patients died in hospital and three patients were discounted as they were on Warfarin. Two patients were not prescribed thromboprophylaxis (5%). 34 (79%) patients received 28 - 35 days, whereas seven patients (16%) received 42 days of thromboprophylaxis.

The older patients with multiple co-morbidities and reduced mobility are at high risk of developing thromboembolism post NOF fixation. Our initial study identified inadequate prescription of thromboprophylaxis post NOF fractures. After introduction of simple measures such as the reminder label attached to phones, our repeat study found that there was improvement in prescription rates. Our study highlights that simple measures can increase awareness and improve patient safety.
Impact of the Marie Curie Cancer Care Delivering Choice Programme in Somerset and North Somerset on place of death and hospital usage: a retrospective cohort study
Authors: Purdy Sarah , Lasseter Gemma , Griffin Thomas , Wye Lesley
Published: May 2014

Objectives

The Marie Curie Cancer Care Delivering Choice Programme (DCP) aims to help palliative patients be cared for in their place of choice. In this study, new palliative care services delivered in two counties in England included end-of-life care coordination centres, an out-of-hours telephone line and discharge in-reach nurses. The study aimed to investigate the impact of DCP on place of death and hospital usage (emergency department (ED) and admissions).

Methods

Retrospective cohort of all eligible palliative patients who died over a 6-month period in two counties (n=3594). Participants were those who died of conditions considered to be eligible for end-of-life care, as defined by the Public Health England National End of Life Care Intelligence Network. The sample included people who did and did not access DCP services. DCP service, hospital admission and ED use data, demographic and death data were collected on all eligible participants. Data were analysed using descriptive statistics and logistic regression.

Results

After adjusting for potential confounders, those using Delivering Choice were at least 30% less likely to die in hospital or have an emergency hospital admission or ED visit in the last 30 or 7 days of life than those who did not.

Conclusions

Recipients of DCP services were less likely to die in or use hospital services. Those considering new ways of providing end-of-life care could explore the possibility of adopting similar services and evaluating the outcomes from patient, carer and system perspectives.
ABG needle study: a randomised control study comparing 23G versus 25G needle success and pain scores
Authors: Yee Kenny , Shetty Amith L , Lai Kevin
Published: May 2014

Objective

To determine whether a narrower gauge needle used in ABG sampling is associated with lower pain scores and complication rates without increasing the level of difficulty of the procedure.

Methods

We performed a prospective single-blinded randomised control study of patients from a tertiary-level emergency department in Sydney who required an ABG analysis over the period of June 2010–July 2012. Patients were randomised to either a 23G or 25G needle and the primary outcome that included pain experienced by these patient were recorded as pain scores on a 10 cm hatched visual analogue scale. The difficulty scores and complications were also noted from the operator.

Results

Data for 119 consenting eligible patients were included in the analysis. 63 patients were allocated to the 23G needle group and 56 to the 25G needle group. The mean pain score was 3.5 (SD=2.7) for the 23G group and 3.4 (SD=2.7) for the 25G group with a mean difference between the pain scores of 0.1 (95% CI −0.9 to 1.1, p=0.83). The 23G and 25G mean difficulty score was 3.4 (SD=2.6) and 4.3 (SD=2.4), respectively, with a mean difference of 0.9 (95% CI −0.03 to 1.7, p=0.06). 21.6% of patient in the 23G needle group experienced some complication with regard to the sampling in the form of haematoma, tenderness or paraesthesia in comparison to 5.4% of patients in the 25G needle group (p=0.03).

Conclusions

There was no significant difference in pain scores experienced by patients undertaking ABG sampling with either a 23G or 25G needle.

Trial registration number

ACTRN12609000957291.
Risk communication in the hyperacute setting of stroke thrombolysis: an interview study of clinicians
Authors: Lie M L S , Murtagh M J , Burges Watson D , Jenkings K N , Mackintosh J , Ford G A , Thomson R G
Published: May 2014

Objective

Communicating treatment risks and benefits to patients and their carers is central to clinical practice in modern healthcare. We investigated the challenges of risk communication by clinicians offering thrombolytic therapy for hyperacute stroke where treatment must be administered rapidly to maximise benefit.

Method

Semistructured interviews with 13 clinicians from three acute stroke units involved in decision making and/or information provision about thrombolysis. We report on clinicians’ accounts of communicating risks and benefits to patients and carers. Framework analysis was employed.

Results

We identified the major challenges facing clinicians in communicating risk in this context that is, disease complexity, patients’ capacity and time constraints, and communicating quality of life after stroke. We found significant variation in the data on risks and benefits that clinicians provide, and ways these were communicated to patients. Clinicians’ communication strategies varied and included practices such as: a phased approach to communicating information, being responsive to the patient and family and documenting information they gave to patients.

Conclusions

Risk communication about thrombolysis involves complex uncertainties. We elucidate the challenges of effective risk communication in a hyperacute setting and identify the issues regarding variation in risk communication and the use of less effective formats for the communication of numerical risks and benefits. The paper identifies good practice, such as the phased transfer of information over the care pathway, and ways in which clinicians might be supported to overcome challenges. This includes standardised risk and benefit information alongside appropriate personalisation of risk communication.

Effective risk communication in emergency settings requires presentation of high-quality data which is amenable to tailoring to individual patients’ circumstances. It necessitates clinical skills development supported by personalised risk communication tools.
Crash fatality and vehicle incompatibility in collisions between cars and light trucks or vans
Authors: Ossiander Eric M , Koepsell Thomas D , McKnight Barbara
Published: May 2014

Background

In crashes between a car and a light truck or van (LTV), car occupants are more likely to be killed than LTV occupants. The extent this is due to the greater harm imposed by LTVs on cars or the greater protection they offer their own occupants is not known.

Methods

We conducted a case-control study of collisions between two passenger vehicles in the USA during 1990–2008. Cases were all decedents in fatal crashes (N=157 684); one control was selected from each crash in a national probability sample of crashes (N=379 458).

Results

Adjusted for the type of vehicle they were riding in and other confounders, occupants of vehicles colliding with any type of LTVs (categorised as compact sport utility vehicles (SUV), full-size SUVs, minivans, full-size vans, compact pickups and full-size pickups) were at higher risk of death compared with occupants colliding with cars. Adjusted for the type of vehicle they crashed with and other confounders, occupants of LTVs in a collision with any vehicle were at lower risk of death compared with car occupants. Compared with a crash between two cars, the overall RR of death in a crash between any of the other 27 different combinations of vehicle types was 1.0 or greater, except for crashes between two full-size pickups, where the RR of death was 0.9.

Conclusions

Although LTVs protect their own occupants better than cars do, LTVs are associated with an excess total risk of death in crashes with cars or other LTVs.
Estimated GFR. Comparison of five algorithms:implications for drug dosing
Authors: Kallner Anders
Published: May 2014

Aims

‘Clearance’ is an accepted surrogate for glomerular filtration rate (GFR) that describes the relation between the serum/plasma concentration of a substance, for example, creatinine, and its urinary excretion rate. On a population level the GFR can be estimated from the creatinine concentration by regression analysis. Such estimates inevitably increase the uncertainty compared with the measured quantity, for example, creatinine. Reliable estimates of GFR (eGFR) are crucial for proper administration of drugs with small therapeutic ‘windows’ and require a transformation of ‘normalised’ GFR to ‘individual’ GFR using the individual's anthropometric data. By simulation we compare some common algorithms and discuss their feasibility for drug dosing.

Methods

We compared four algorithms fornormalisedeGFR and one forindividualeGFR in a Caucasian man defined by age and simulated the outcome of different S-Creatinine concentrations. Normalised and individual eGFR were interconverted using published anthropometric data of a national average man.

Results

Differences between results by the algorithms for eGFR were less than the uncertainty within the diagnostically important interval. Three of the four algorithms were non-continuous at extreme S-Creatinine concentrations. Normalised eGFR values, converted to individual eGFR resulted in an underestimation of 5–40% compared with that by Cockcroft-Gault.

Conclusions

The use of algorithms will increase the uncertainty of results. The difference between different algorithms is small. A global staging recommendation is in jeopardy due to the large interindividual biological variation. Dosage of critical drugs, based on conversion of normalised eGFR, may lead to an underdosage compared with the dosage estimated by Cockroft-Gault.
Traumatic brain injury: considering collaborative strategies for early detection and interventional research
Authors: Charleswell Cherise , Ross Brian , Tran Thao , Walsh Eric
Published: May 2014

Mild traumatic brain injury (mTBI) is a graded sequence of injuries, which is clinically defined based on subjective symptoms observed by clinicians and/or those reported by patients. Much of the focus on research and prevention of mTBI has been on professional or collegiate-level athletes, despite children and young teenagers being at greatest risk for mTBI. Further, continued involvement in sports across the lifespan, increases the likelihood that youth athletes may sustain repetitive brain trauma, which may result in permanent neurological and psychological deficits. Thus, there is a clear need for a population health initiative and research efforts that focus on the juvenile athlete population; in order to fill in the gap in knowledge about the long-term physiological effects of injury and social outcomes, as well as devise strategies that can help in early detection, prevention and treatment; and in the setting of evidence-based Return-To-Play guidelines.
Republished: Paget’s disease of bone: clinical review and update
Authors: Bolland Mark J , Cundy Tim
Published: May 2014

Paget’s disease (PD) is a focal disorder of bone remodelling that occurs commonly in older people. In this article, we review clinical aspects of PD with an emphasis on recent findings. The epidemiology of PD appears to be changing rapidly, with several groups in different parts of the world reporting a marked reduction in the prevalence and incidence of PD, as well as in the severity of disease seen by clinicians. These findings seem most likely to be caused by changes in exposure to unknown environmental factors that have a role in the development of PD. However, genetic factors are also important. Mutations in SQSTM1 occur in 25–50% of familial PD. Genotype–phenotype relationships are present, as PD develops at an earlier age and is more extensive and severe in those with SQSTM1 mutations, and these findings are more pronounced in those with truncating mutations. However, the prevalence of PD in adults with SQSTM1 mutations is uncertain, and it is not known how such mutations might cause PD. Ultimately, if the cause of PD is determined, it seems likely that it will include both genetic and environmental factors. Lastly, clinical trials have shown that potent bisphosphonates are highly effective treatments for active PD, and reduce pain, improve quality of life, normalise bone turnover and heal lytic lesions on radiographs. They can also induce sustained remission that persists for many years.
Recent spatial changes in bovine tuberculosis in the Republic of Ireland
Authors: McGrath G. , Clegg T. A , More S. J
Published: May 2014

There has been a steady reduction in the levels of bovine tuberculosis (bTB) in Ireland for some years. This paper presents a number of methods employing geographical information systems to examine how this reduction is manifested in space and time. The focus of disease mapping has traditionally been placed on identifying areas with problems. There has been limited work done in visualising improvements. The authors describe recent spatial changes in the relative incidence of bTB in Ireland across an uniform hexagonal grid, comparing the mean of the annual animal level bTB incidence during the 10‐year period from 1998 to 2007 to the years 2008 to 2012. The authors map bTB incidence trends for three successive five‐year periods (1998–2002, 2003–2007 and 2008–2012). Finally, the authors investigate the change in extent and severity of interpolated bTB reactor density over time.
Comparison of depopulation and S19‐RB51 vaccination strategies for control of bovine brucellosis in high prevalence areas
Authors: Saez J. L. , Sanz C. , Durán M. , García P. , Fernandez F. , Minguez O. , Carbajo L. , Mardones F. , Perez A. , Gonzalez S. , Dominguez L. , Alvarez J.
Published: May 2014

RB51 vaccination can minimise the diagnostic problems associated with S19 vaccination of adult cattle, but its use for bovine brucellosis (BB) control remains controversial. Here, the evolution of BB prevalence in five high prevalence areas in Spain subjected to different control measures is described: herd depopulation of infected herds (I–III) or mass vaccination with RB51 and S19‐RB51 vaccination of replacement heifers (IV–V). Annual data from the eradication campaigns were analysed at the special incidence area (SIA) level and the time to obtain herd prevalence levels of <1 per cent (‘controlled status’) was obtained at the local veterinary unit (LVU) level and compared using Cox's proportional hazard model. A higher annual rate of decrease in herd prevalence was observed in the SIAs subjected to vaccination (46.9%, 95% CI 43.5% to 50.0%) compared with those managed using stamping out (14.9%, 95% CI 9.6% to 19.9%). No significant differences in the time to achieve controlled status were observed between the stamping‐out and vaccination strategies used at the LVU level, with median times of 60 (stamping‐out LVUs) and 63 (vaccination LVUs) months. These results suggest that RB51 mass vaccination, in combination with the S19‐RB51 vaccination of replacement heifers and strict implementation of other eradication measures, may provide results at least comparable with those resulting from a herd depopulation based strategy.
Phenobarbitone‐induced haematological abnormalities in idiopathic epileptic dogs: prevalence, risk factors, clinical presentation and outcome
Authors: Bersan E. , Volk H. A. , Ros C. , Risio L. De
Published: May 2014

The aim of this retrospective study was to assess prevalence, risk factors, clinical presentation and outcome of phenobarbitone induced haematological abnormalities (PBIHA) in dogs. The medical records of two veterinary referral institutions were searched for dogs diagnosed with idiopathic epilepsy and treated with PB as monotherapy or polytherapy between March 2003 and September 2010. Sixteen dogs had PBIHA; the median age at diagnosis was 69.5 months. Phenobarbitone was administered at a median dose of 3 mg/kg twice a day for a median period of 100.5 days and the median serum phenobarbitone level was 19 μg/ml. Two dogs had neutropenia, three had anaemia and thrombocytopenia, two had anaemia and neutropenia; the remaining nine had pancytopenia. All dogs were referred for non‐specific clinical signs. Phenobarbitone was discontinued after diagnosis, and the median time to resolution of PBIHA was 17 days. The prevalence and risk factors for PBIHA were evaluated from a questionnaire survey of referring practices to obtain more detailed follow‐up on cases diagnosed with idiopathic epilepsy. The prevalence rate of PBIHA was 4.2%, and the condition occurred in dogs treated with standard therapeutic doses often within the first three months after starting treatment. Serial haematological evaluations should be therefore considered from the beginning of phenobarbitone therapy to allow early diagnosis and treatment of PBIHA.
Smothering in UK free‐range flocks. Part 1: incidence, location, timing and management
Authors: Barrett J. , Rayner A. C. , Gill R. , Willings T. H. , Bright A.
Published: May 2014

Smothering in poultry is an economic and welfare‐related concern. This study presents the first results from a questionnaire addressing the incidence, location, timing and management of smothering of free‐range farm managers from two commercial egg companies (representing 35 per cent of the UK free‐range egg supply). Overall, nearly 60 per cent of farm mangers experienced smothering in their last flock, with an average of 25.5 birds lost per incidence, although per cent mortality due to smothering was low (x̄=1.6 per cent). The majority of farm managers also reported that over 50 per cent of all their flocks placed had been affected by smothering. The location and timing of smothering (excluding smothering in nest boxes) tended to be unpredictable and varied between farms. Blocking off corners/nest boxes and walking birds more frequently were identified as popular smothering reduction measures, although there was a wide variety of reduction measures reported overall. The motivation to implement reduction measures was related to a farm manager's previous experience of smothering. To our knowledge, this is the first study to provide a representative industry estimate on the incidence, location, timing and management of smothering. The results suggest that smothering is a common problem, unpredictable between flocks with no clear, effective reduction strategies. A follow‐up study will investigate the correlations among smothering, disease and other welfare problems and may shed further light on management solutions.
Stakeholder consultation on tracking in UK veterinary degrees: part 1
Authors: Crowther E. , Hughes K. , Handel I. , Whittington R. , Pryce M. , Warman S. , Rhind S. , Baillie S.
Published: May 2014

There is on‐going debate regarding whether veterinary students should focus on one (or a small number of) species during their undergraduate training (ie, track). The aims of this study were to: evaluate UK stakeholders’ opinion on partial tracking (whereby students continue to qualify able to practise in all species) and full tracking (students qualify in a limited number of species necessitating restricted registration); and evaluate students’ career aspirations in relation to the UK veterinary profession's employment profile. This paper presents the quantitative results of surveys completed by practitioners, students and university staff. The majority of respondents (69.4 per cent) disagreed or strongly disagreed with full tracking, however, there was widespread support for partial tracking (79.0 per cent agreed or strongly agreed). Students favoured partial tracking more so than practitioners (P<0.001). Univariate analysis of demographic factors did not identify differences in opinion regarding tracking within stakeholder groups. Students’ knowledge of the UK veterinary employment profile appeared accurate. However, their career aspiration changed with year of the course, and only final year students’ intentions were aligned with the profession's current profile. Qualitative data from these surveys are presented in a second paper and include the advantages, disadvantages and implications of partial and full tracking.
Automated measuring of cyclist – motor vehicle post encroachment time at signalized intersections
Authors: Kassim Ali , Ismail Karim , Hassan Yasser
Published: May 2014

Conflicts between motor vehicle and cyclists at a signalized intersection were characterized in this study using an objective conflict indicator; post encroachment time (PET). A total of 384 conflict events for PET (0, 3] seconds between cyclists and vehicles were analyzed in this study. An automated video analysis technique was developed to measure the PET between cyclists and motor vehicles. The results of the conflict analysis showed that the average absolute error of PET between the frame count measurement (MFCM) and automated measurement (AM) methods was 0.12 s and the standard deviation was 0.10 s. The evaluation result showed that the coefficient of determination between the AM and MFCM methods was found to be 0.938 and there was a very good agreement in the PET classification of individual conflicts between the MFCM and AM methods. This study includes procedures to better interpret the conflict point of the motor vehicle and the cyclist in an automated manner (based on the geometry of the bounding box and direction of the travel), which appears to be a contribution for the analysis of cyclist – motor vehicle collisions.
The influence of forage fish abundance on the aggregation of Gulf of Maine Atlantic cod (Gadus morhua) and their catchability in the fishery
Authors: Richardson David E. , Palmer Michael C. , Smith Brian E.
Published: May 2014

Shifts in the distribution and aggregation patterns of exploited fish populations can affect the behavior and success of fishermen and can complicate the interpretation of fisheries-dependent data. Starting in 2006, coinciding with an increase in sand lance (Ammodytes spp.) abundance, Gulf of Maine Atlantic cod (Gadus morhua) concentrated on Stellwagen Bank, a small (405 km2) underwater plateau located in the southwestern portion of the larger (52 461 km2) stock area. The cod fishery in turn concentrated on Stellwagen Bank. Specifically, the proportion of Gulf of Maine cod landings caught in a single 10-minute square area (260 km2) encompassing the tip of Stellwagen Bank increased from 12% in 2005 to 45% in 2010. An increase in landings per unit effort in the fishery coincided with the concentration of the fleet on Stellwagen Bank. Overall, both fisheries-independent and fisheries-dependent data indicate that an increase in sand lance abundance resulted in cod aggregating in a small and predictable area where they were easily caught by the fishery. More broadly, this work illustrates how changes in the distribution patterns of fish and fisherman can decouple trends in abundance and fisheries catch per unit effort.