bluuebunny/crossref_metadata_2025 huggingface dataset:
Auditory exostosis: Exploring the daily life at an early sedentary population (Körtik Tepe, Turkey)
Authors: Koruyucu M. M. , Şahin F. S. , Delibaş D. , Erdal Ö. D. , Benz M. , Özkaya V. , Erdal Y. S.
Published: May 2018

Auditory exostosis (AE) is a bony anomaly located on the tympanic portion of the temporal bone. Cold water, wind chill, and the effects of temperature are considered to be contributors to the development of AE. It is frequently encountered among surfers, lifeguards, whitewater kayakers, swimmers, and divers. Accordingly, there is a strong relationship between prolonged exposure to cold water and the frequency and grade of AE. For this reason, AE can be accepted as an occupational anomaly.

In this study, AE from Körtik Tepe, Turkey, were analysed to understand the lifestyle of early hunter gatherer populations from Anatolia. One hundred twenty‐eight individuals and 174 temporal bones from Körtik Tepe were examined for the frequency and severity (graded) of AE. Forty‐five individuals (35.2%) have exostosis of various sizes. Half of 40 male individuals and 42.5% of females (n: 40) have AE with no statistically significant difference between the sexes. First observed in individuals 7 years of age, severity and frequency of AE increase with age. Besides increasing in frequency, the increase in size of AE suggest a continuous and prolonged exposure to cold water.

The people of Körtik Tepe, which is surrounded by numerous freshwater sources, must have been subjected to cold water through activities such as bathing, cleaning, swimming, and playing in the water, as well as fishing. Our results suggest that the lifestyle of early sedentary people in Körtik Tepe was rather egalitarian with little or no gender differences and was closely connected to aquatic sources. Bioarchaeological data suggest that Körtik Tepe can be accepted as a community of hunter‐gatherer‐fishermen.
Imposed registries within the European postmarketing surveillance system: Extended analysis and lessons learned for regulators
Authors: Pacurariu Alexandra , Plueschke Kelly , Olmo Carla Alonso , Kurz Xavier
Published: May 2018

Purpose

Building on previous research, we examined whether delayed study start and low patient accrual rates found in 31 postauthorization registry‐based studies requested by European Medicines Agency (EMA) are maintained after 2 additional years of follow‐up.

Method

The registries identified in the previous EMA study and the same methodology were used. The follow‐up was extended from June 2015 to November 2017. The information available for the following variables was updated: marketing authorization status, study and registry status, study end date, planned duration, number of patients planned to be enrolled, and actual patients enrolled. Data were collected from several nonpublic in‐house sources such as the study protocols, interim and final study reports, risk management plans, and periodic safety update reports.

Results

As of November 2017, 10 (32.2%) studies were finalized (vs. 9.7% as of June 2015), 14 (45.2%) were still ongoing (vs. 64.5%). Four of the ongoing studies had patients' accrual lower than 50%. Six of the finalized studies had a delayed completion, with a median delay of 3 years. As of November 2017, the median patients' accrual percentages were 24% for ongoing studies (vs. 8.5%) and 101% for finalized studies (vs. 24%).

Conclusion

Overall, the rate of recruitment and timely finalization were improved after 2 years of additional follow‐up but show that further work is needed to facilitate use of registry data for regulatory purposes, a work that has started via the EMA registry initiative.
Identification of an IDR peptide formulation candidate that prevents peptide aggregation and retains immunomodulatory activity
Authors: Haney Evan F. , Wuerth Kelli C. , Rahanjam Negin , Safaei Nikouei Nazila , Ghassemi Arvin , Alizadeh Noghani Mahsa , Boey Anthony , Hancock Robert E. W.
Published: May 2018

Synthetic peptides derived from naturally occurring host defence peptides (HDPs) have garnered significant attention as novel pharmaceuticals, particularly as alternatives to antibiotics and for immunomodulatory applications. One of the barriers to advancing synthetic peptides for therapeutic applications is their tendency to aggregate under specific ionic conditions similar to those they would encounter in vivo. Formulating peptides with biocompatible excipients that prevent solvent‐induced peptide aggregation represents a possible solution to this aggregation issue; however, this strategy has not been systematically explored. In the present work, we describe the screening of various polymeric substances (including hyaluronic acid, carboxymethyl cellulose and hydroxypropyl methyl cellulose) as formulation candidates for HDPs and identified derivatized hyperbranched polyglycerols (dHPGs) as a biocompatible excipient that limits peptide aggregation. Notably, the immunomodulatory activity of a synthetic innate defence regulator peptide, IDR‐1018, formulated with dHPG was retained when evaluated against both peripheral blood mononuclear cells and human bronchiolar epithelial cells in vitro. Further characterization of dHPG polymers revealed that decreasing the negative charge density on the polymer surface potentiated the cytotoxic effects of IDR‐1018, emphasizing the need to optimize this parameter for future peptide delivery formulations. Importantly, the dHPG formulated IDR‐1018 inhibited peptide aggregation in vitro in the presence of mucin as well as in vivo when injected subcutaneously into CD1 mice. This study highlights the potential use of dHPGs as formulation candidates for synthetic HDPs and identifies important considerations regarding their physico‐chemical properties and relevance to immunomodulatory applications.
Molecular identification of cultivable bacteria in the gut of adult Bactrocera tau (Walker) and their trapping effect
Authors: Luo Mijuan , Zhang Hehe , Du Yinggang , Idrees Atif , He Longyan , Chen Jiahua , Ji Qing′e
Published: May 2018

BACKGROUND

It has been shown that some bacteria can attract their hosts. Our research aimed to identify cultivable bacterial isolates in the guts of sexually mature adult female and male Bactrocera tau and to evaluate their utility in trapping of B. tau.

RESULTS

Forty‐one strains of bacteria were isolated and identified from B. tau with morphological, physiological, biochemical and 16S rDNA analysis. The dominant bacterial genera shared by both females and males were Enterobacter, Providencia and Serratia. Thirteen bacterial isolates selected from female and male B. tau adults were cultured, and the attractiveness of bacterial fermented liquid and autoclaved supernatants from these strains to B. tau adults was tested. The laboratory test showed that both the autoclaved supernatants and fermented liquid could attract male and female B. tau, and the former was substantially more effective, with the autoclaved supernatants from all strains being significantly more attractive to adult B. tau. BF16, BF(12), BF23 and BF(32) were the most attractive bacteria to 8‐day‐old and sexually mature B. tau. Furthermore, the results of a subsequent field cage test showed that BF(12), BF23, and BF(32) were significantly more attractive to B. tau adults.

CONCLUSION

These results provide useful information for the development of bacterial biocontrol agents and their application as insecticides. © 2018 Society of Chemical Industry
Effects of Doping States of Polyaniline Thin Films on Their Photo‐Responsive Properties under Visible and Near‐Infrared Irradiation
Authors: Choi Jongwan , Jang Sung K. , Kim Felix Sunjoo
Published: May 2018

The photo‐responsive characteristics of polyaniline (PANI) thin films are investigated as a function of the doping states. The doping levels are controlled by treating as‐prepared, acid‐doped PANI with aqueous ammonia solutions. Spectroscopic analyses confirm the changes in the doping states by evolution or decrease of characteristic peaks. The electrical and photo‐responsive properties are significantly affected by the doping states of the PANI thin films. The photocurrent and photovoltage under irradiation of controlled wavelengths from various laser sources are measured. While the photocurrent follows the trends of electrical conductivity upon dedoping, the photovoltage is related to the absorption and photocharge generation of the PANI samples.
Paeonol extracted from Paeonia suffruticosa Andr. ameliorated UVB‐induced skin photoaging via DLD/Nrf2/ARE and MAPK/AP‐1 pathway
Authors: Sun ZhengWang , Du Juan , Hwang Eunson , Yi Tae‐Hoo
Published: May 2018

Paeonia suffruticosa Andr. (PS) has been used in traditional Chinese medicine for a long time. However, there are no studies that investigate the preventive effects of PS on ultraviolet B (UVB)‐induced photoaging. In this study, paeonol (PA) was detected the main compound in PS root. In vitro, PS and PA significantly inhibited UVB‐induced phosphorylation of mitogen‐activated protein kinase and activator protein 1 in keratinocytes, which consequently led to degradation of procollagen type I. On the other hand, PS and PA increased NAD(P)H:quinone oxidoreductase 1 and heme oxygenase‐1 expression, confirmed by greater nuclear accumulation of nuclear factor E2‐releated factor 2 (Nrf2). Furthermore, this study proved that the endogenous antioxidant system Nrf2/antioxidant response element was regulated by dihydrolipoamide dehydrogenase, a tricarboxylic acid (TCA) cycle‐associated protein whose level was decreased after UVB exposure. PS and PA promoted the production of dihydrolipoamide dehydrogenase, as well as the activation of Nrf2 and antioxidant response element, resulting in preventing procollagen type I ruined caused by UVB. In vivo, topical application of PS and PA attenuated UVB‐induced matrix metalloproteinase‐1 production and promoted procollagen type I in hairless mice. These results suggested PA a promising botanical in protecting skin from UVB‐induced photoaging.
Rapid analysis of fentanyls and other novel psychoactive substances in substance use disorder patient urine using paper spray mass spectrometry
Authors: Kennedy Joseph H. , Palaty Jan , Gill Chris G. , Wiseman Justin M.
Published: May 2018

Rationale

Drug overdose deaths due to fentanyls and other novel psychoactive substances (NPS) are on the rise. The higher potencies of fentanyl analogs compared with morphine require new technologies to identify and quantitate NPS.

Methods

Paper spray tandem mass spectrometry (MS/MS) and high‐resolution mass spectrometry were used to identify and measure fentanyl analogs as well as common drugs of abuse in urine samples from substance use disorder clinics. Ten‐microliter urine samples were deposited directly on paper spray cartridges previously loaded with internal standards, dried, and analyzed with no other sample treatment. Quantitative results were obtained using MS/MS. Individual drugs were identified using high‐resolution accurate mass spectrometry, and confirmed by data‐dependent MS/MS.

Results

Calibration curves in urine were linear over a range of 0.5–50 ng/mL with R2 of 0.99 or better for eight representative fentanyl analogs. Cartridges preloaded with internal standards demonstrated satisfactory quantitative results compared with LC/MS. Direct identification and confirmation of fentanyl analogs and other common drugs of abuse in urine using high‐resolution accurate mass and MS/MS fragmentation were demonstrated at low picogram levels.

Conclusions

Paper spray mass spectrometry can reliably identify and quantitate fentanyl analogs and other drugs of abuse in urine. Using paper spray cartridges as collection devices reduces exposure and transportation risks associated with biological fluids. Cartridges preloaded with labeled internal standards can be effective for targeted screening of fentanyl analogs and other drugs of abuse.
Coupling trapped ion mobility spectrometry to mass spectrometry: trapped ion mobility spectrometry–time‐of‐flight mass spectrometry versus trapped ion mobility spectrometry–Fourier transform ion cyclotron resonance mass spectrometry
Authors: Tose Lilian V. , Benigni Paolo , Leyva Dennys , Sundberg Abigail , Ramírez César E. , Ridgeway Mark E. , Park Melvin A. , Romão Wanderson , Jaffé Rudolf , Fernandez‐Lima Francisco
Published: May 2018

Rationale

There is a need for fast, post‐ionization separation during the analysis of complex mixtures. In this study, we evaluate the use of a high‐resolution mobility analyzer with high‐resolution and ultrahigh‐resolution mass spectrometry for unsupervised molecular feature detection. Goals include the study of the reproducibility of trapped ion mobility spectrometry (TIMS) across platforms, applicability range, and potential challenges during routine analysis.

Methods

A TIMS analyzer was coupled to time‐of‐flight mass spectrometry (TOF MS) and Fourier transform ion cyclotron resonance mass spectrometry (FT‐ICR MS) instruments for the analysis of singly charged species in the m/z 150–800 range of a complex mixture (Suwannee River Fulvic Acid Standard). Molecular features were detected using an unsupervised algorithm based on chemical formula and IMS profiles.

Results

TIMS‐TOF MS and TIMS‐FT‐ICR MS analysis provided 4950 and 7760 m/z signals, 1430 and 3050 formulas using the general CxHyN0–3O0–19S0–1 composition, and 7600 and 22 350 [m/z; chemical formula; K; CCS] features, respectively.

Conclusions

TIMS coupled to TOF MS and FT‐ICR MS showed similar performance and high reproducibility. For the analysis of complex mixtures, both platforms were able to capture the major trends and characteristics; however, as the chemical complexity at the level of nominal mass increases with m/z (m/z >300–350), only TIMS‐FT‐ICR MS was able to report the lower abundance compositional trends.
Fragmentation pathways arising from protonation at different sites in aminoalkyl‐substituted 3‐hydroxy‐1,2,5‐oxadiazoles (3‐hydroxyfurazans)
Authors: Grossert J. Stuart , Boschi Donatella , Lolli Marco L. , White Robert L.
Published: May 2018

Rationale

The gas‐phase fragmentation chemistry of multifunctional cations is highly influenced by the site of protonation. Possible relationships between protonation site and fragmentation processes were studied using 4‐aminoalkyl‐3‐hydroxyfurazans. For these heterocyclic amines, the starting points for competing fragmentation pathways varied with protonation at multiple sites in two tautomers.

Methods

Mass spectra were acquired using electrospray ionization (positive mode) coupled to triple quadrupole and ion trap mass spectrometers; precursor–product ion relationships were studied by collision‐induced dissociation. Quantum mechanical computations were performed at the MP2/6–311++G(2d,p)//ωB97X‐D/6–311+G(d) level of theory.

Results

Prominent successive losses of NO and CO and competing losses of CH2=NH or NH3 were observed as fragmentation processes. The lowest barrier computed for the initial step in a fragmentation pathway was associated with the [M + H]+ ion protonated at N5 in the heterocyclic ring, whereas an alternative ring cleavage leading to complementary product ions was initiated by protonation of the ring at N2. Side‐chain protonation led to loss of NH3 without cleavage of the 3‐hydroxyfurazan ring.

Conclusions

The product ions obtained by the competing fragmentation processes varied with the site of protonation. Interestingly, the most abundant product ions observed at low collision energies were formed by cleavage of protonated molecules possessing more internal energy than other isomers.
Hydrodynamic behaviour of European black poplar (Populus nigra L.) under coppice management along Mediterranean river ecosystems
Authors: Pasquino V. , Saulino L. , Pelosi A. , Allevato E. , Rita A. , Todaro L. , Saracino A. , Chirico G.B.
Published: May 2018

This study examined the hydrodynamic behaviour of European black poplar (Populus nigra L.) under coppice management in riparian areas with a multidisciplinary approach. An innovative procedure on the basis of the combination of plant allometric relations and hydrodynamic models was applied to assess drag forces and plant hydrodynamic bending as function of the basal diameter and module of elasticity, with a probabilistic approach. Cuttings of European black poplar from 2 close riverine environments of Southern Italy have been planted and subjected to the same coppice management strategy. The 2 different 3‐year‐old shoot poplar ensembles exhibited statistically similar morphological traits but stems with different module of elasticity. Drag forces were simulated with a model on the basis of the vegetative Cauchy number. Plant deformation under the hydrodynamic load was modelled as a base‐mounted cantilever beam. The differences in the observed elasticity were verified to be also significant from a hydrodynamic perspective. Diagrams were drawn to describe plant bending, drag forces, and basal momentum as function of basal diameter, accounting for the uncertainty in the module of elasticity. These results can be exploited for identifying objective hydrodynamic criteria to be adopted for coppice management of riparian woody vegetation in human controlled river ecosystems.
Effects of Sodium Hydroxyethyl Sulfonate on Improving the Ductility of the Copper Films Deposited by Electroless Plating from High‐Speed Plating Baths
Authors: Wu Minxian , Xu Chao , Wang Wenchang , Mitsuzaki Naotoshi , Chen Zhidong
Published: May 2018

The copper films that electroless plated from the formaldehyde‐based solutions frequently suffer from the internal stress. The internal stress leads to a poor ductility of the plated films. To lower internal stress and improve ductility of copper films, sodium hydroxyethyl sulfonate was used as a surfactant to promote the detachment of hydrogen bubbles. The folding tests showed that the copper film deposited from the solution containing 3 mL L−1 25% sodium hydroxyethyl sulfonate (EHS) had the best ductility. The internal stresses of the copper films were measured using X‐ray diffraction technique and the stress decreased from 100 MPa to 30 MPa as the EHS concentration increased from 0 to 3 mL L−1. Sodium hydroxyethyl sulfonate had little influence on the film morphology and crystal size. High plating rates (> 8 μm h−1) were obtained from the solution containing sodium hydroxyethyl sulfonate.
Investigation of the Enzyme‐Catalysed Transesterification of Methyl Acrylate and Sterically Hindered Alcohol Substrates
Authors: Bauwelinck Jordy , Cornet Iris , Wijnants Marc , Dams Rudolf , Tavernier Serge
Published: May 2018

For industrial production of valuable building blocks, the use of enzymes as green catalysts has gained a lot of interest recently. In this paper, research on the enzymatic transesterification of methyl esters with different alcohols for the production of high valuable monomers is presented. After screening for the most suitable enzyme catalyst, the influence of the molecular structure of both substrates on the reaction kinetics was investigated. For the best performing substrate, the reaction was optimised. Novozym 435 displays the highest activity for linear as well as for bulkier substrates and has therefore been chosen for the optimisation experiments. Enzymatic transesterification with highly branched and bulky alcohol substrates (e. g. 2‐hexyl‐1‐decanol) resulted in much lower conversion and reaction rates compared to linear and shorter substrates (e. g. octanol). Similar effects were observed when various methyl ester substrates were compared. Furthermore, it was observed that a molar substrate ratio of 3:1 methyl acrylate to alcohol and a substrate to enzyme ratio of 0.1 mol.g−1 resulted in an optimal conversion. It was also found that reactions using nonpolar solvents (e. g. hexane, heptane, toluene) reached the highest conversion rates. Generally, it can be concluded that enzymatic synthesis of highly specific and bulky alkyl acrylates is possible. However, the structures of both the alcohol and acrylate substrate have an important impact on the reaction rate.
Computational Design of Quaterpyridine‐Based Fe/Mn–Complexes for the Direct Hydrogenation of CO2 to HCOOH: A Direction for Atom‐Economic Approach
Authors: Biswas Santu , Pramanik Anup , Sarkar Pranab
Published: May 2018

On the basis of first principle calculations, we propose a new class of earth‐abundant quaterpyridine complexes for the direct hydrogenation of CO2 to HCOOH. The mechanistic studies reveal that the complexes are advantageous in many aspects. First of all, they can perform both in added‐base and base‐free conditions, the latter being atom‐economic as well as a greener way. Most effectively, the energy barrier for the heterolytic hydrogen cleavage and hydride transfer processes could easily be monitored by changing the π‐acidic character of the axial ligand, solvent polarity of the medium and also by ligand modification through substitution.
Oxygen Evolution Reaction on Ni‐based Two‐dimensional (2D) Titanate Nanosheets: Investigation on Effect of Fe Co‐doping and Fe Incorporation from Electrolyte on the Activity
Authors: Ramesh Rahul , Lee Seonggyu , Kim Seongbeen , Park Jinkyu , Lee Seunghyun , Kim Min Su , Baek Minki , Yong Kijung , Ye Youngjin , Lee Jinwoo
Published: May 2018

In this paper, Ni‐based titanate nanosheets are used as a model system to reveal how incorporation of Fe affects their catalytic ability for the oxygen evolution reaction (OER). The Fe incorporation effects are studied without structural and morphological changes due to the rigid framework of TiO2 based nanosheets. Transition metal doped titanate nanosheets are prepared by cation‐assisted exfoliation of protonated layered potassium titanate. Fe incorporation within the lattice of Ni doped titanate nanosheets by co‐doping stabilizes nickel ions in lower oxidation state by charge transfer effect, caused increased OER activity at Ni sites by the electronic interaction. In contrast, incorporation of Fe from the electrolyte, highly‐active Fe sites at edges or corners of Ni doped titanate nanosheets are formed by electrochemical cycling in Fe‐containing electrolyte rather than electronic effects on Ni. Through this work, Fe incorporation effects are experimentally revealed without crystal structural or morphological changes, and a method to produce a highly active and stable OER catalyst is provided.
A Domino Reaction of Pyridinium Salts: Efficient Synthesis of 4,5‐Disubstituted 1,2,3‐(NH)‐Triazoles
Authors: Wu Guang‐Long , Wu Qin‐Pei
Published: May 2018

A one‐pot mild and metal‐free procedure for efficient synthesis of 4,5‐disubstituted 1,2,3‐(NH)‐triazoles has been developed through the sequentially reaction of pyridinium salts with aldehydes and sodium azide. In the presence of L‐proline, a key intermediate, an olefinic pyridinium‐salt, is in situ generated via coupling of pyridinium salts with aldehydes and cyclizes with azide ion to form a triazole ring.
New remains of the aquatic turtle Hydromedusa casamayorensis (Pleurodira, Chelidae) from the middle Eocene of Patagonia: taxonomic validation and phylogenetic relationships
Authors: Maniel Ignacio J. , de la Fuente Marcelo S. , Sterli Juliana , Jannello Juan M. , Krause J. Marcelo
Published: May 2018

Twenty‐seven new specimens recovered from lower levels of the Sarmiento Formation (Casamayoran SALMA, middle Eocene) in the ‘Cañadón Hondo’ area, Chubut (Argentina), bring new information on the Palaeogene long‐necked chelid Hydromedusa casamayorensis. The discovery of cranial and postcranial remains allows a complete description of the only known extinct species of the genus Hydromedusa recognizing diagnostic characters that revalidate the taxonomic status of this species. Hydromedusa casamayorensis is incorporated into a cladistic framework of chelid turtles. The unconstrained and constrained phylogenetic analyses recovered H. casamayorensis as a sister taxon of Hydromedusa maximiliani plus H. tectifera. A Danian age is proposed at least for the origin of the Hydromedusa clade, while a Late Cretaceous age is suggested for the split from the Yaminuechelys clade. Great differences in size are documented for H. casamayorensis based on the various specimens recovered from this study. The osteohistological study in H. casamayorensis and H. tectifera shows similarities in the internal cortex and cancellous bone of both taxa, but some differences are observed in the external cortex of H. casamayorensis (e.g. a parallel fibred bone on the more external surface of this cortex).
Ist die ausdrückliche Regelung sozialrechtlicher Leistungsansprüche für Personen mit hohen und moderaten Risiken geboten?
Authors: Meier Friedhelm , Harney Anke , Rhiem Kerstin , Neumann Anja , Neusser Silke , Braun Matthias , Wasem Jürgen , Schmutzler Rita , Huster Stefan , Dabrock Peter
Published: May 2018

In diesem Kapitel wird aus medizinischer, sozialrechtlicher, gesundheitsökonomischer und ethischer Perspektive erörtert, warum überhaupt ein sozialrechtlicher Leistungsanspruch für Personen mit hohen und moderaten Risiken geboten ist.
Empfehlungen
Authors: Meier Friedhelm , Harney Anke , Rhiem Kerstin , Neumann Anja , Neusser Silke , Braun Matthias , Wasem Jürgen , Schmutzler Rita , Huster Stefan , Dabrock Peter
Published: May 2018

Dieses Kapitel leitet aus der dargelegten Argumentation konkrete Empfehlungen für die Entscheidungsträgerinnen und Entscheidungsträger ab und kann somit erste Schritte zur Realisierung einer adäquaten sozialrechtlichen Berücksichtigung von Personen mit hohen und moderaten (Brustkrebs-)Risiken aufzeigen.
Effect of 0.25 and 2.0 MeV He-Ion Irradiation on Short-Range Ordering in Model (EFDA) Fe-Cr Alloys
Authors: Dubiel Stanisław M. , Żukrowski Jan , Serruys Yves
Published: May 2018

The effects of He+ irradiation on a distribution of Cr atoms in Fe100−x
Cr
x
(x = 5.8, 10.75, 15.15) alloys were studied by 57Fe Conversion Electron Mössbauer Spectroscopy (CEMS). The alloys were irradiated with doses up to 12 × 1016 ions/cm2 with 0.25 and 2.0 MeV He+ ions. The distribution of Cr atoms within the first two coordination shells around Fe atoms was expressed with short-range order parameters α
1 (first-neighbor shell, 1NN), α
2 (second-neighbor shell, 2NN), and α
12 (1NN + 2NN). In non-irradiated alloys, α
1 >0 and α
2 <0 was revealed for all three samples. The value of α
12 ≈0, i.e., the distribution of Cr atoms averaged over 1NN and 2NN, was random. The effect of the irradiation of the Fe94.2Cr5.8 alloy was similar for the two energies of He+, viz., increase of number of Cr atoms in 1NN and decrease in 2NN. Consequently, the degree of ordering increased. For the other two samples, the effect of the irradiation depends on the composition, and is stronger for the less energetic ions where, for Fe89.25Cr10.75 alloy, the disordering disappeared and some traces of Cr clustering appeared. In Fe84.85Cr15.15 alloy, the clustering was clear. In the samples irradiated with 2. 0 MeV He+ ions, the ordering also survived in the samples with x = 10.75 and 15.15, yet its degree became smaller than in the Fe94.2Cr5.8 alloy.
The Predictive Value of Arteriogenic Erectile Dysfunction for Coronary Artery Disease in Men
Authors: Azab Sherif Salah , El Din Hosni Hossam , El Far Taha A. , Ismail Nashaat Nabil , El Bakdady Yasser K. , Mohamed Ahmed F.
Published: May 2018

Background

Erectile dysfunction (ED) is assumed to be connected with vascular disease caused by endothelial dysfunction, and characterized by the incapability of the smooth muscle cells lining the arterioles to relax, therefore, inhibit vasodilatation.

Aim

To assess the predictive value of arteriogenic ED for coronary artery disease in men above the age of 40 years.

Methods

75 Patients reporting arteriogenic ED and 25 men with normal erectile function were enrolled in the study. Both patients and controls were subjected to the following investigations: lipid profile, fasting blood sugar, body mass index (BMI), waist circumference, penile duplex study, stress electrocardiography (ECG) test, International Index of Erectile Function (IIEF) Type 5 (Arabic version), and cardiovascular (CV) 10-year risk assessment using Framingham and Prospective Cardiovascular Münster (PROCAM) scoring systems.

Outcomes

We compare between the study groups regarding the interpretation of exercise testing.

Results

We observed significant increase in the mean value of age, systolic blood pressure, BMI, weight, height, and waist circumference in the cases; significant prevalence of obesity and overweight in the cases (P < .001); significant increase in the mean value of total cholesterol, triglycerides (TG), and low-density lipoprotein; and decrease in mean value of high-density lipoprotein in the cases (P < .001). Additionally, there was high incidence of positive stress ECG in the cases (25.3%) vs that in controls (12%), and significant difference between patients with positive stress ECG test and those with negative stress ECG test regarding their lipid profile, age, BMI, and waist circumference with higher values in positive stress ECG for total cholesterol, TG, and low-density lipoprotein, and lower value for high-density lipoprotein (P < .001). According to PROCAM and Framingham scoring systems 10-year risk assessment, there was a high significant difference between the cases and control groups with a higher score in cases than the control group with 30.7% of cases having ≥ 30% risk of developing coronary heart disease, and significant positive correlations between CV risk and BMI, and negative correlations with IIEF-5 cases (P < .001).

Clinical Translation

Ischemic heart disease events were higher in men with documented arteriogenic ED than those without ED.

Conclusions

All items of metabolic syndrome were investigated and analyzed and we evaluated our groups using both PROCAM and Framingham scoring system. An exercise ECG is suggested before starting treatment of vasculogenic ED at least in patients with CV risk factors.
LO41: Competency-based learning of pediatric musculoskeletal radiographs
Authors: Boutis K. , Lee M. , Pusic M. , Pecarcic M. , Carrier B. , Dixon A. , Stimec J.
Published: May 2018

Introduction: Pediatric musculoskeletal (MSK) image interpretation has been identified as a knowledge gap among emergency medicine trainees. The main objective of this study was to implement a validated on-line pediatric MSK radiograph interpretation system with a performance-based competency endpoint into pediatric emergency fellowship programs and examine the number of cases needed to achieve a competency threshold of 80% accuracy, sensitivity and specificity. We further determined proportion who successfully achieved competency in a given module and the change in accuracy from baseline to competency. Methods: This was a prospective cohort multi-centre study. There were seven MSK radiograph modules, each containing 200-400 cases (demo-https://imagesim.com/course-information/demo/). Thirty-seven pediatric emergency medicine fellows participated for 12 months. Participants did cases until they reached competency, defined as at least 80% accuracy, sensitivity and specificity. We calculated the overall and per module median number of cases required to achieve competency, proportion of participants who achieved competency, median time on case, and the mean change in accuracy from baseline to competency. Results: Overall, the median number of cases required to achieve competency was 76 (min 54, max 756). Between different body parts, there was a significant difference in the median number of cases needed to achieve competency, p <0.0001, with ankle and knee being among the most challenging modules. Proportions of those who started a module and completed it to competency varied significantly, and ranged from 32.4% in the ankle module to 97.1% in the forearm/hand, p<0.0001. The overall median time on each case was 34.1 (min 7.6, max 89.5) seconds. The overall change in accuracy from baseline to 80% competency was 13.5% (95% CI 12.1, 14.8), with the respective Cohens effect size of 1.98. The change in accuracy was different between modules, p=0.001, with post-hoc analyses demonstrating that the ankle/foot radiograph module had a greater increase in accuracy relative to elbow (p=0.009) and pelvis/femur (p=0.006). Conclusion: It was feasible for pediatric emergency medicine fellows to complete each learning pediatric MSK learning module to competency within approximately one hour, with the exception of the ankle module. Learners who completed the modules to competency demonstrated very significant increases in interpretation skill.
LO82: Normal bedside ultrasound of growth plates in healthy children
Authors: Beatty E. , Audette L. , Paré A. , Simonyan D. , Dion V. , Berthelot S. , Parent M.
Published: May 2018

Introduction: The diagnosis of Salter-Harris Type 1 fractures in the Emergency Department (ED) is primarily clinical, as radiographs are usually unrevealing. We hypothesize that bilateral asymmetry of the growth plate, detected using bedside ultrasound (US), could improve the accuracy of this diagnosis in the ED. This study seeks to determine growth plate size according to age, and to establish normal variation in bilateral symmetry of growth plate cartilage, for the ulna, radius, tibia, and fibula, using bedside US in normal healthy children. Methods: This prospective observational study was conducted in a convenience sample of children ages 0-17 during planned visits to an elementary school, high school, and an outpatient pediatric clinic. A sample size of 177 was determined with a linear regression model using previously published data on the subject. The study was approved by the hospital and universitys ethics board. After a medical questionnaire with a research nurse, the participants underwent ultrasound evaluation of bilateral ulnae, radii, fibulae, and tibiae, to obtain still images of the physes from two orthogonal views. The evaluations were performed by 3 medical residents, 1 medical student, and by the supervising emergency physician. All ultrasonographers were EDE1 certified and specifically trained for growth plate imagery. The still images were evaluated ulteriorly and measurements taken of the physeal cartilage. Ten percent of the patients had their images re-evaluated by the supervising physician to determine inter-rater reliability. Results: A total of 227 patients were recruited. The median age was 8 years old with an interquartile range of (3;14). Mean growth plate size by age was determined, confirming decreasing growth plate size with advancing age for all articulations. The percentage of absolute difference between right and left, for all growth plates together, was a mean of 17% with a 95% CI of 16-19%. The overall inter-rater reliability was excellent at 0.84. Conclusion: This study establishes a reproducible technique of measuring growth plates with ultrasound. We suspect that increased asymmetry at the growth plate, beyond this established normal variation, may signify a physis widening or hematoma consistent with a Salter-Harris Type 1 fracture; this will be evaluated in a second study.
LO88: Bronchiolitis management in Calgary emergency departments
Authors: Dowling S. K. , Stang A. , Gjata I. , Law S. , Burak K. , Buna R. , Duncan D. , Smart K.
Published: May 2018

Introduction: Bronchiolitis is a viral respiratory infection and the most common reason for hospitalization of infants. Despite evidence that few interventions are beneficial in patients with bronchiolitis, other studies would have shown that a significant proportion of patients undergo various forms of low value care. This objective of this project was to 1. establish baseline management of bronchiolitis in the Calgary Zone, and 2. deliver audit and feedback (A&F) reports to pediatric emergency physicians (PEP) to identify opportunities and strategies for practice improvement. Methods: This retrospective cohort study included all patients 12 months old that presented to a Calgary emergency department or urgent care center with a diagnosis of bronchiolitis from April 1, 2013 to March 31, 2017. Using data from various electronic health data sources, we captured age, vital signs, CTAS, common therapeutic interventions (bronchodilators, steroids, antibiotics) and investigations (chest x-ray (CXR), viral studies, antibiotics). Results were stratified by site and by admission status. Descriptive statistics were used to report baseline characteristics and interventions. Interhospital ranges (IHR) were provided to compare different hospitals in the zone. For the A&F component of the project, consenting PEP received a report of both their individual and peer comparator data and an in-person multi-disciplinary facilitated feedback session. Results: We included 4023 patients from all 6 sites (range from 28 to 3316 patients). Admission rates were 21.7% (IHR 0-29%). Mean age was 5.4 months old. Bronchodilator use was 27.0% (IHR 21-41%). 22.0% of patients received a CXR (IHR 0-57%) and 30.3% had viral studies done (IHR range 0.8-33%). PEP had higher usage of viral studies (30% vs 5.7%), whereas non-PEP had higher CXR usage (46.2% vs 23.4%). 41 of 66 PEP consented to receive their individual A&F reports (62%). In the facilitated feedback session PEP 1. identified two areas (bronchodilators and viral studies) where improvements could be made and 2. discussed specific strategies to decrease practice variation and minimize low value care including development of a multi-disciplinary care pathway, alignment with in-patient management, education and repeated A&F reports. Conclusion: Significant variability exists in management of patients with bronchiolitis across different hospitals in our zone. A facilitated feedback session identified areas for improvement and multi-disciplinary strategies to reduced low value care for patients with bronchiolitis. Future phases of this project include repeated data in 6 months and implementation of a provincial care pathway for the management of bronchiolitis.
MP03: The epidemiology of mortality in patients transported by emergency medical services (EMS)
Authors: Blanchard I. E. , Lane D. , Williamson T. , Vogelaar G. , Hagel B. , Lazarenko G. , Lang E. , Doig C.
Published: May 2018

Introduction: Outside of key conditions such as cardiac arrest and trauma, little is known about the epidemiology of mortality of all transported EMS patients. The objective of this study is to describe characteristics of EMS patients who after transport die in a health care facility. Methods: EMS transport events over one year (April, 2015-16) from a BLS/ALS system serving an urban/rural population of approximately 2 million were linked with in-hospital datasets to determine proportion of all-cause in-hospital mortality by Medical Priority Dispatch System (MPDS) determinant (911 call triage system), age in years (>=18 yrs. - adult, <=17 yrs. - pediatric), sex, day of week, season, time (in six hour periods), and emergency department Canadian Triage and Acuity Scale (CTAS). The MPDS card, patient chief complaint, and ED diagnosis category (International Classification of Disease v.10 - Canadian) with the highest proportion of mortality are also reported. Analyses included two-sided t-test or chi-square with alpha <0.05. Results: A total of 239,534 EMS events resulted in 159,507 patient transports; 141,114 were included for analysis after duplicate removal (89.1% linkage), with 127,867 reporting final healthcare system outcome. There were 4,269 who died (3.3%; 95%CI 3.2%, 3.4%). The proportion of mortality by MPDS determinant was, from most to least critical 911 call, Echo (7.3%), Delta (37.2%), Charlie (31.3%), Bravo (5.8%), Alpha (18.3%), and Omega (0.3%). For adults the mean age of survivors was less than non-survivors (57.7 vs. 75.8; p<0.001), but pediatric survivors were older than non-survivors (8.7 vs. 2.8; p<0.001). There were more males that died than females (53.0% vs. 47.0%; p<0.001). There was no statistically significant difference in the day of week (p=0.592), but there was by season with the highest mortality in winter (27.1%; p=0.045). The highest mortality occurred with patients presenting to EMS between 0600-1200 hours (34.6%), and the lowest between 0000-0600 hours (11.8%; p<0.001). Mortality by CTAS was category 1 (27.1%), 2 (36.7%), 3 (29.9%), 4 (4.3%), and 5 (0.5%). The highest mortality was seen in MPDS card 26-Sick Person (specific diagnosis) (19.1%), chief complaint shortness of breath (19.3%), and ED diagnoses pertaining to the circulatory system (31.1%). Conclusion: Significant all-cause in-hospital mortality differences were found between event, patient, and clinical characteristics. These data provide foundational and hypothesis generating knowledge regarding mortality in transported EMS patients that can be used to guide research and training. Future research should further explore the characteristics of those that access health care through the EMS system.
MP08: A novel measure to capture transactional stress in paramedic services
Authors: Davis M. , Donnelly E. A. , Bradford P. , Hedges C. , Socha D. , Morassutti P.
Published: May 2018

Introduction: In the past few years, there has been an increase in awareness of the challenge of managing work related stress in EMS. Extant research has liked different types of chronic and critical incident stress to stress reactions like posttraumatic stress. However, there is no tool to capture the transactional stresses which are associated with the day to day provision of service (e.g., dealing with offload delays or mandatory overtime) and interacting with allied professions (e.g., emergency department staff) or allied agencies (e.g., law enforcement). The purpose of this study was to develop and validate a measure which captured transactional stresses in paramedics Methods: An online survey was conducted with ten Canadian Paramedic Services with a 40.5% response rate (n= 717). Factor analysis was used to identify variation in responses related to the latent factor of transactional stress. The scale was validated using both exploratory and confirmatory factor analyses. Results: The sample of transactional stress questions was split to allow for multiple analyses (EFA n=360/ CFA n=357). In the exploratory factor analysis, principal axis factoring with an oblique rotation revealed a two-factor, twelve item solution, (KMO=.832, x2=1440.19, df=66, p<.001). Confirmatory factor analysis also endorsed a two factor, 12 item solution, (x2 =130.39, df=51, p<.001, CFI=.95, TLI= .93, RMSEA= .07, SRMR= .06). Results supported two groups of six-item factors that captured transactional stress in the provision of service. The factors, clearly aligned with transactional stress issues internal to the ambulance and transactional stress relationships external to the ambulance. Both subscales demonstrated good internal reliability (= .843/ =.768) and were correlated (p.01) with a convergent validity measure. Conclusion: This study successfully validated a two-factor scale which captures stress associated with the day to day provision of EMS and the interaction with allied professions. The development of this measure of transactional stresses further expands the potential that paramedics, Paramedic Services, employers, and prehospital physicians may understand the dynamics that influence provider health and safety. As a result, there may be greater opportunities to intervene holistically to improve paramedic health and well-being.
MP23: A collaborative quality improvement initiative to improve the time to electrocardiogram in patients with chest pain presenting to the emergency department
Authors: Lindsay H. C. , Gallaher J. , Wright C. , Korchinski L. , Sing C. Kim
Published: May 2018

Introduction: For patients with chest pain, the target time from first medical contact to obtaining an electrocardiogram (ECG) is 10 minutes, as reperfusion within 120 minutes can reduce the risk of death and adverse outcomes in patients with ST elevation myocardial infarction (STEMI). In 2007, Vancouver Coastal Health (VCH) began tracking key indicators including time to first ECG. The Vancouver General Hospital (VGH) Emergency Department (ED) has been troubled with the longest door to ECG times in the region since 2014. In 2016, the VGH ED Quality Council developed a strategy to address this issue, with an aim of obtaining ECGs on 95% of patients presenting to the VGH ED with active chest pain within 10 minutes of presentation within a 6 month period. Methods: The VGH ED Quality Council brought together frontline clinicians, ECG technicians, and other stakeholders and completed a process map. We obtained baseline data regarding the median time to ECG in both patients with STEMI and all patients presenting with chest pain. Root cause analysis determined two main barriers: access to designated space to obtain ECGs, and the need for patients to be registered in the computer system before an ECG could be ordered. The team identified strategies to eliminate these barriers, identifying a dedicated space and undergoing multiple PDSA cycles to change the workflow to stream patients to this space before registration. Results: Our median times in patients with STEMI have gone from 33 minutes to 8 minutes as of June 2017. In all patients presenting with chest pain, we improved from a median of 36 to 17 minutes. As of April 2017 we are obtaining an ECG within 10 minutes in 27% of our patients, compared to 3% in 2016. Given the limitations in our data extraction process, we were not able to differentiate between patients with active chest pain versus those whose chest pain had resolved. Conclusion: By involving frontline staff, and having frontline champions providing real time support, we were able to make significant changes to the culture at triage. We cultivated sustainability by changing the workflow and physical space, and not relying on education only. While we have improved the times for our walk-in patients, we have not perfected the process when a patient moves immediately to a bed or presents via ambulance. Implementing small changes and incorporating feedback has allowed us to identify these new challenges early.