bluuebunny/crossref_metadata_2025 huggingface dataset:
Histopathologic Characteristics of Intestinal Biopsy Samples from Dogs With Chronic Inflammatory Enteropathy With and Without Hypoalbuminemia
Authors: Jablonski Wennogle Sara A. , Priestnall S.L. , Webb C.B.
Published: March 2017

Background

Previous studies have identified hypoalbuminemia as a risk factor for negative outcome in dogs with chronic enteropathy (CE), but it has not been determined whether histopathology differs betweenCEdogs with and without hypoalbuminemia.

Objective

To compare histopathologic findings in dogs with biopsy‐diagnosed inflammatoryCEwith and without hypoalbuminemia.

Animals

83 dogs that had intestinal biopsy performed between January 2010–July 2015. Dogs had signs compatible withCEof at least 3‐weeks' duration and no evidence of clinically relevant extra‐gastrointestinal (GI) disease or potential non‐GIcauses of hypoalbuminemia. Dogs had primary diagnosis of inflammatory enteritis based on histopathology.

Methods

Dogs were grouped intoCEwith normoalbuminemia (CEN; serum albumin concentration ≥3.0 g/dL, N = 46) or chronic enteropathy with hypoalbuminemia (CEH; serum albumin concentration <3.0 g/dL, N = 37). A pathologist (SLP) blinded to the groups reviewed biopsy samples and applied the World Small Animal Veterinary Association scoring system to all samples.

Results

Intestinal biopsy samples from dogs in theCEHgroup were significantly more likely to display villous stunting, epithelial injury, crypt distension, and lacteal dilatation, and were more likely to have intraepithelial lymphocytes and lamina propria neutrophils than biopsy samples from dogs in theCENgroup. Additionally, higher scores for each of the above listed histopathologic criteria were associated with a lower serum albumin concentration.

Conclusions and Clinical Importance

Histopathologic features of chronic inflammatory enteropathy differ between dogs that are hypo‐ versus normoalbuminemic. Additional work is needed to elucidate the clinical relevance of these differences.
Urethral Sphincter Mechanism Incompetence in 163 Neutered Female Dogs: Diagnosis, Treatment, and Relationship of Weight and Age at Neuter to Development of Disease
Authors: Byron J.K. , Taylor K.H. , Phillips G.S. , Stahl M.S.
Published: March 2017

Background

Urethral sphincter mechanism incompetence (USMI) is the most common cause of urinary incontinence in neutered bitches and is most common in dogs weighing >20 kg.

Objectives

To describe a population of neutered bitches with USMI and investigate their initial presentation, the relationship between weight and age at neuter, and treatment.

Animals

One hundred and sixty‐three female dogs with USMI (UI) diagnosed between January 2009 and December 2012, and 193 continent neutered control (C) bitches.

Methods

Retrospective data were collected from neutered female dogs with USMI and healthy, continent neutered females presented between January 2009 and December 2012.

Results

Urinary incontinent dogs weighed more than C dogs (P = .003), and there was no difference in age at neuter. The relationship between weight at diagnosis and age at neuter was found to impact the hazard of USMI. A decrease in the hazard of USMI was found in dogs weighing >25 kg for every month delay of neuter in the first year. The hazard did not change for dogs <15 kg. Median time from neuter to development of incontinence was 3.73 years. Phenylpropanolamine was prescribed in 75.5%, diethylstilbestrol in 21.5%, and both in 3.1% of dogs.

Conclusions and Clinical Importance

Neutering bitches expected to be >25 kg adult weight later in their first year may decrease the hazard of developing USMI, whereas age at neutering of bitches <25 kg may not impact continence. Heavier dogs have increased risk of USMI, and onset occurs within a few years of neuter.
The Use of Darbepoetin to Stimulate Erythropoiesis in the Treatment of Anemia of Chronic Kidney Disease in Dogs
Authors: Fiocchi E.H. , Cowgill L.D. , Brown D.C. , Markovich J.E. , Tucker S. , Labato M.A. , Callan M.B.
Published: March 2017

Background

Darbepoetin alfa (darbepoetin) is an erythropoiesis‐stimulating agent used for the treatment of anemia secondary to chronic kidney disease (CKD) in dogs, but reports describing response are lacking.

Hypothesis/Objectives

To evaluate the effectiveness of darbepoetin in dogs with anemia secondary toCKD, dosing protocols, and adverse events.

Animals

Thirty‐three client‐owned dogs with naturally occurringCKD, including 26 with comorbidities.

Methods

Multi‐institutional retrospective study.

Results

The median starting dosage and highest dosage of darbepoetin administered were 0.5 and 0.8 μg/kgSConce weekly, respectively. Response to treatment was defined as achieving a packed cell volume (PCV) ≥30% or an increase inPCV≥10%. Twenty‐eight of 33 dogs (85%) achieved aPCV≥30% and 22 of 33 (67%) dogs achieved an increase inPCV≥10%. Median time to achieve aPCV≥30% was 29 days. A higher starting dosage was associated with achieving an increase inPCV≥10% (P= .01). No dog sustained a response at a dosing interval >q21d. Potential adverse events included increased blood pressure requiring treatment (n = 12), seizures (n = 5), vomiting (n = 3), diarrhea (n = 3), and possible pure red cell aplasia (PRCA) (n = 2).

Conclusions and Clinical Importance

Darbepoetin, when combined with treatment of comorbidities, is an effective treatment for anemia secondary toCKDin dogs. A dosing interval >q21d was ineffective at maintaining a response to treatment. PRCA was a possible adverse event in 2 of 33 dogs (6%).
Assessing children's written texts: a framework for equity
Authors: Bearne Eve
Published: March 2017

In this article, I confine myself to the situation in England that offers a paradigm example of one of the fundamental tensions besetting teaching and assessing writing: the stranglehold of an individualistic view of writing development as opposed to a more socio‐cultural perspective. Examining the uses of summative assessment for accountability purposes and the exclusion of students' multimodal text knowledge and experience, I propose a descriptive framework that can support formative assessment. It encompasses the English national curriculum programmes of study for writing and the associated assessment criteria as well as the features of multimodal texts. Two case studies exemplify using the framework to analyse the writing of students whose accomplishments cannot be fully given value by the current assessment and accountability regime. Finally, I suggest that professional development and respect for professionalism are needed to give teachers the means to reconcile some of the tensions between the urge to teach creatively and imaginatively and their responsibility to their students to cover curricular requirements.
UWIN (Urgency, Weak stream, Incomplete Void, Nocturia) Score for Assessment of Lower Urinary Tract Symptoms: Could it Replace the American Urology Association Symptom Index Score? An Open Label Randomized Cross over Trial
Authors: MALLYA Ashwin , KESHAVAMURTHY Ramaiah , KARTHIKEYAN Vilvapathy S. , KUMAR Sumit , NAGABHUSHANA Mahadevappa , KAMATH Ananth J.
Published: March 2017

Objective

The American Urology Association symptom index (AUASI) is the most accepted tool to assess lower urinary tract symptoms (LUTS). UWIN (urgency, weak stream, incomplete void, nocturia) score is a simplified questionnaire with fewer and more distinctive options omitting three questions from AUASI. We sought to identify if UWIN is equally efficient in capturing LUTS and could replace the gold‐standard AUASI.

Methods

Consecutive consenting male patients with benign prostatic hyperplasia (BPH)‐LUTS were randomized to receive either UWIN/AUASI questionnaire first followed by the other. Education levels, time taken to complete, need for assistance, ease of comprehension and satisfaction to symptom assessment were assessed for each questionnaire. Correlation analysis was done for corresponding items, total and QoL scores on both questionnaires.

Results

Total of 294 completely filled questionnaire pairs were analyzed. Between corresponding UWIN and AUASI items, there was 93–97% correlation. When obstructive and irritative scores were added, correlation was 85% and for QOL scores 89%. Overall, AUASI required more assistance (58 vs 34%, P < 0.001), took longer to complete (11.2 vs 4.8 min, P < 0.001) and required higher educational level for comprehension (P = 0.02). Significantly higher percentage of patients preferred the UWIN and more comprehensible.

Conclusion

UWIN is as effective in capturing LUTS as the gold‐standard AUASI in spite of three questions of AUASI being omitted in UWIN. Severity of obstructive and irritative nature of LUTS and quality of life are interpreted similar to AUASI. UWIN is easier to comprehend and rapid, needing lesser assistance even with lower educational status.
Francisella tularensis prevalence and load in Dermacentor reticulatus ticks in an endemic area in Central Europe
Authors: HUBÁLEK Z. , RUDOLF I.
Published: March 2017

A total of 7778 host‐seeking adult Dermacentor reticulatus (Ixodida: Ixodidae) ticks were examined for the prevalence of Francisella tularensis holarctica (Thiotrichales: Francisellaceae) in a natural focus of tularaemia in the floodplain forest–meadow ecosystem along the lower reaches of the Dyje (Thaya) river in South Moravia (Czech Republic) between 1995 and 2013. Ticks were pooled (10 specimens per pool) and their homogenates inoculated subcutaneously in 4‐week‐old specific pathogen‐free mice. Dead mice were sectioned, their spleens cultivated on thioglycollate–glucose–blood agar and impression smears from the spleen, liver and heart blood were Giemsa‐stained. Sixty‐four pools were positive for F. tularensis: the overall minimum infection rate (MIR) was 0.82%. Overall MIRs for the 4714 female and 3064 male D. reticulatus examined were 0.89 and 0.72%, respectively; MIRs fluctuated across years between 0.0 and 2.43%. The estimated bacterial load in infected ticks varied from 0.84 to 5.34 log10 infectious F. tularensis cells per tick (i.e. from about seven to 220 000 cells). Ticks with low loads were more prevalent; more than 1000 infectious cells were detected in 24 ticks (0.3% of all ticks and 37.5% of infected ticks). Monitoring of D. reticulatus for the presence and cell numbers of F. tularensis may be a valuable tool in the surveillance of tularaemia.
Upper airway in infants—a computed tomography‐based analysis
Authors: Wani Tariq M. , Rafiq Mahmood , Akhter Nahida , AlGhamdi Faris Saeed , Tobias Joseph D.
Published: March 2017

Background

Recent studies suggest that the pediatric airway is elliptical with the subglottis rather than the cricoid as the narrowest part contrary to the old belief of a funnel‐shaped airway. The shape of the airway in neonates and infants has not been studied separately. This study seeks to define the shape of the upper airway in neonates and infants, and determine if there are differences in airway shape between infants and older children.

Methods

We studied 40 computed tomographic scans of children from birth to 12 months of age undergoing radiological evaluation unrelated to airway symptomatology. The computed tomographic scans were obtained during either natural sleep or with sedation and spontaneous ventilation without airway devices in place. Transverse and anteroposterior diameters were measured at the subglottic level and at the cricoid ring.

Results

The mean age was 5.9 ± 3.4 months. The mean transverse and anteroposterior diameters were 5.3 ± 0.83 mm and 7.2 ± 0.89 mm at the subglottic region and 6.1 ± 0.86 mm and 6.7 ± 0.79 mm at the cricoid level. An increase in the transverse dimension of the airway was observed from the subglottic region to the cricoid ring. Although the anteroposterior dimension decreased from the subglottis to the cricoid ring, the airway remained wider in the anteroposterior dimension compared to the transverse dimension from the subglottis to the cricoid ring.

Conclusion

The present study demonstrates that the airway in neonates and infants between the subglottic area and the cricoid remains elliptical. The cricoid is not round as has been observed in older children. The airway is wider anteroposteriorly and narrows in the transverse dimension from the subglottis to the cricoid in infants.
Cloning and functional characterization of quinolinic acid phosphoribosyl transferase (QPT) gene of Nicotiana tabacum
Authors: Khan Sana , Pandey Shiv Shanker , Jyotshna  , Shanker Karuna , Khan Feroz , Rahman Laiq ur
Published: March 2017

The quinolinate phosphoribosyl transferase (QPT) is a key enzyme that converts quinolinic acid into nicotinic acid mononucleotide. The QPT gene plays an essential role in the pyridine nucleotide cycle as well as in the biosynthetic pathway of the alkaloid nicotine. However, a clear role for QPT is yet to be characterized to validate the actual function of this gene in planta. In this study, an RNA interference (RNAi) approach was used to reveal the functional role of QPT. Transformation and analysis of the hairy roots (HRs) of the Nicotiana leaf explants was used, followed by plant regeneration and analysis. High‐performance liquid chromatography (HPLC) analysis of the HRs and of the regenerated plants both revealed altered alkaloid biosynthetic cycle, with a substantially reduced content of nicotine and anabasine. The transgenic plants exhibited a significantly altered phenotype and growth pattern. Also, silencing of QPT led to a decrease in chlorophyll content, maximum quantum efficiency of PSII, net CO2 assimilation and starch content. Results clearly demonstrated that QPT was not only involved in the biosynthetic pathway of the alkaloids but also affected plant growth and development. Our results provide information to be considered when trying to engineer the secondary metabolite quality and quantity.
Monetary Policy Implementation and Volatility Transmission Along the Yield Curve: The Case of Kenya
Authors: Alper C. Emre , Armando Morales R. , Yang Fan
Published: March 2017

This paper analyses the degree to which volatility in interbank interest rates leads to volatility in financial instruments with longer maturities (e.g. T‐bills) in Kenya since 2012, year in which the monetary policy framework switched to a forward‐looking approach, relative to seven other inflation targeting (IT) countries (Ghana, Hungary, Poland, South Africa, Sweden, Thailand and Uganda). Kenya shows strong volatility transmission and high persistence similar to other countries in transition to a more forwardlooking monetary policy framework. These results emphasize the importance of a strong commitment to an interbank rate as an operational target and suggest that the central bank could reduce uncertainty in short‐term yields significantly by smoothing out the overnight interest rates around the policy rate.
McGee's Counterexample to the Ramsey Test
Authors: Cantwell John , Lindström Sten , Rabinowicz Wlodek
Published: March 2017

Vann McGee has proposed a counterexample to the Ramsey Test. In the counterexample, a seemingly trustworthy source has testified that p and that if not‐p, then q. If one subsequently learns not‐p (and so learns that the source is wrong about p), then one has reason to doubt the trustworthiness of the source (perhaps even the identity of the source) and so, the argument goes, one has reason to doubt the conditional asserted by the source. Since what one learns is that the antecedent of the conditional holds, these doubts are contrary to the Ramsey Test. We argue that the counterexample fails. It rests on a principle of testimonial dependence that is not applicable when a source hedges his or her claims.
Laparoscopic cryptorchidectomy with a vessel‐sealing device in dorsal recumbent horses: 43 cases
Authors: Bracamonte José L. , Thomas Keri L.
Published: March 2017

Objective

To document laparoscopic cryptorchidectomy with a vessel‐sealing device in dorsal recumbent horses.

Study Design

Retrospective study.

Animals

Forty‐three male horses.

Methods

Food was withheld for 36 hours before horses were placed under general anesthesia and positioned in dorsal recumbency. One laparoscopic portal and 2 instrument portals were placed for the laparoscopic procedure. A third instrument portal was created in bilateral cryptorchid horses. A vessel‐sealing device was used for hemostasis and transection of retained testes. Descended testes were removed via closed castration with primary closure of the scrotal incision. Time required for removal of the retained testis and perioperative complications were recorded. Short‐term (14, 30, 60 days) and long‐term follow‐up (>1.5 years) consisted of telephone interview with owners and referring veterinarians.

Results

Forty‐three male horses underwent laparoscopic cryptorchidectomy. Thirteen horses were bilateral cryptorchids, 19 were unilateral cryptorchids with a descended testis, and 11 were unilateral cryptorchids with 1 testis previously removed. Inguinal testes, identified in 5 horses, were pulled into the abdomen prior to excision. The vaginal ring was apposed with endoscopic staples in 3 of 5 horses. Mean surgery time was 31.34 ± 7.41 minutes. No intraoperative or immediate postoperative complications were encountered. No short‐term or long‐term complications were reported.

Conclusion

Laparoscopic cryptorchidectomy can be safely performed with a vessel sealing‐device in dorsal recumbent horses. This method was effective and did not result in any complication in our case series.
Effects of Quercetin Supplementation on Lipid and Protein Metabolism after Classic Boxing Training
Authors: Demirci Nevzat , Ziyagil Mehmet Akif
Published: March 2017

The metabolic fitness (MF) is a component of athletes’ physical conditioning. This study aims to investigate the effects of quercetin supplementation on Turkish Junior athletes’ lipid and protein metabolism relating to MF after one month classic boxing training. Totally 20 voluntary junior male athletes were separated into two equal groups as the experimental group (EG) and control group (CG). The participants were supplemented with 500 mg quercetin fifteen minutes before each workout in one month boxing training program. Blood samples during pre and post training were taken from athletes in order to determine metabolic fitness related parameters. Lipid profile contains low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), trigliserid (TG), total cholesterol (TC) variables while protein metabolism includes the albumin, total protein, direct bilirubin and total bilirubin parameters. The Mann Whitney U analyzes were used for comparison of the means between experimental and control groups during pre and posttest and between pre and post test results in experimental and control groups. This study showed that EG had a similar physical characteristic with CG. There were significant decrease in TC and LDL-C and an increase in HDL-C in EG while there was only significant increase in HDL-C of in controls. A significant difference of HDL-C was observed between EG and CG during pretest. In other side, TC and LDL-C and HDL-C were significantly differentiated between EG and CG during posttest. Conclusion: it can be concluded that quercetin plays an important role on lipid metabolism not protein.
Modification of the Classical Boundary Integral Equation for Two-Dimensional Transient Heat Conduction With Internal Heat Source, With the Use of NURBS for Boundary Modeling
Authors: Zieniuk Eugeniusz , Sawicki Dominik
Published: March 2017

The most popular methods used for solving transient heat conduction problems, like finite element method (FEM) and boundary element method (BEM), require discretization of the domain or the boundary. The discretization problem escalates for unsteady issues, because an iterative process is required to solve them. An alternative to avoid the mentioned problem is parametric integral equations systems (PIESs), which do not require classical discretization of the boundary and the domain, while being numerically solved. PIES have been previously used with success to solve steady-state problems. Moreover, they have been recently tested also with success for transient heat conduction problems, without internal heat sources. The purpose of this paper is to generalize PIES based on analytical modification of classical boundary integral equation (BIE) for transient heat conduction with internal heat source and nonuniform rational basis spline (NURBS) for boundary modeling. The obtained generalization of PIES is tested on examples, mostly with defined exact solution.
High frequency ultrasonography of the hand versus anti-RA33 evaluation in early rheumatoid arthritis - a pilot study
Authors: Barbulescu Andreea Lili , Ciurea Paulina Lucia , Mitran Carmen , Chisalau Beatrice Andreea , Parvanescu Cristina Dorina , Firulescu Sineta Cristina , Balasoiu Maria , Boldeanu Mihail Virgil , Popoviciu Horatiu , Vreju Florentin Ananu
Published: March 2017

Aim: Accurate diagnosis and early treatment in rheumatoid arthritis (RA) can lead to a good outcome and a correct management of the disease. We aimed toinvestigate the prognostic value of anti-RA33 antibodies, by evaluating the relationship with ultrasonographic (US) findings in patients with early RA.Material and methods: We performed a prospective study which included 29 patients, diagnosed with early RA according to the ACR/EULAR 2010 criteria and 21 sex and age-matched control subjects. All patients underwent clinical and biological assessment, followed by US examination in grayscale (GS) and power Doppler (PD) at baseline and after 12 months [from the second to the fifth metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints and wrists (RCC), in dorsal aspect]. The second and fifth MCP joints were scanned also in lateral aspects.Results: The initial GS evaluation revealed the presence of synovitis in all 29 patients; PD found at least one joint with a PD grade higher than 1 in 23 patients, higher than 2 in 20 patients, and grade 3 in 6 patients; at 12 months, we revealed the presence of GSUS synovitis in 25 patients and PDUS examination found active synovitis in 12 subjects. In those patients, the anti-RA33 titre was significantly lower compared to those without PDUS active synovitis (p=0.031), with a moderately negative correlation (r=-0.519, p=0.0039).Conclusions: The current study shows that anti-RA33 antibodies might constitute an additional tool for diagnosing early RA patients and can help identify patients with mild disease and a low level of activesynovitis.
The safety and feasibility of diagnostic acoustic radiation force impulse elastography used for eyes. A preliminary in vivo study
Authors: Zha Li , Chen Ke Qi , Zheng Xiao Zhi , Wu Jing
Published: March 2017

Aims: To assess the safety and feasibility of acoustic radiation force impulse (ARFI) elastography in the eyes of rats. Material and methods: One hundred and twenty-six SD rats were divided into 7 groups. Group 1 was the control group and Group 2 to Group 7 were investigated by ARFI elastography using increased powers of 5%, 10%, 20%, 50%, and 100% and repetitions of 5 or 10. The changes of ocular architecture structures and functions were examined by phthalmoscopic, histopathologic, and light reflex examination, and the expression level of IL-6, IL-8, and TNF-α was determined in days 1, 3, and 7 after ARFI elastography, respectively.Results: A satisfactory ARFI elastography was obtained in all SD rats. The shear wave velocity (SWV) values of soft tissues behind the eyeball were significantly greater than those of the eyes (1.89±0.95 vs. 0.84±0.36 m/s, p<0.05). The SWV values of eyes and the soft tissues behind the eyeball did not differ among any groups at any time-point (p>0.05). The SD rats of each group showed good light perception, pupillary light reflex, and avoidance reaction induced by the sudden bright light from the dark environment at any time. In each group, ocular architecture structures were well preserved, and with a normal expression level of IL-6, IL-8, and TNF-α (p>0.05).Conclusions: Diagnostic ARFI elastography is a safe and feasible ultrasonic imaging mode and may potentially be applied for human eyes in its present form.
Notch-Jagged complex structure implicates a catch bond in tuning ligand sensitivity
Authors: Luca Vincent C. , Kim Byoung Choul , Ge Chenghao , Kakuda Shinako , Wu Di , Roein-Peikar Mehdi , Haltiwanger Robert S. , Zhu Cheng , Ha Taekjip , Garcia K. Christopher
Published: March 2017

Forces on Notch receptors can modulate receptor signaling.
Complete Genome Sequence of the BeAn 58058 Virus Isolated from
Oryzomys
sp. Rodents in the Amazon Region of Brazil
Authors: Wanzeller A. L. M. , Souza A. L. P. , Azevedo R. S. S. , Júnior E. C. Sousa , Filho L. C. F. , Oliveira R. S. , Lemos P. S. , Júnior J. V. , Vasconcelos P. F. C.
Published: March 2017

Here, we report the complete genome sequence of the BeAn 58058 virus (prototype) strain, isolated from a wild rodent
Oryzomys
sp. in the Utinga forest, Belém, state of Pará, Brazil in 1963. The genome of this virus showed similarity to the
Poxviridae
family, suggesting its inclusion in a possible new genus.
Draft Genome Sequence of Anoxybacillus mongoliensis Strain MB4, a Sulfur-Utilizing Aerobic Thermophile Isolated from a Hot Spring in Tattapani, Central India
Authors: Mittal Parul , Saxena Rituja , Sharma Vineet K.
Published: March 2017

Anoxybacillus mongoliensis
strain MB4, an aerobic thermophile, was isolated from a hot spring located in central India. Its first draft genome sequence reported in this study comprises 2,807,516 bp and 2,853 protein-coding genes. Detailed genomic analysis indicates that it is capable of performing sulfur metabolism.
Complete Genome Sequence of a Novel Hypovirus from the Phytopathogenic Fungus
Fusarium langsethiae
Authors: Li Pengfei , Chen Xiaoguang , He Hao , Qiu Dewen , Guo Lihua
Published: March 2017

We describe a novel positive single-stranded RNA virus, termed
Fusarium langsethiae
hypovirus 1 (FlHV1), from the isolate AH32 of the phytopathogenic fungus
Fusarium langsethiae
. The properties of FlHV1 permit assignment to the genus
Alphahypovirus
in the family
Hypoviridae
. This is the first report of a mycovirus identified in
F. langsethiae
.
Draft Genome Sequence of
Bacillus obstructivus
VT-16-70 Isolated from the Bronchoalveolar Lavage Fluid of a Patient with Chronic Obstructive Pulmonary Disease
Authors: Tetz Victor , Tetz George
Published: March 2017

We report here the draft genome sequence of
Bacillus obstructivus
VT-16-70, a novel spore-forming bacterium isolated from the lungs of a patient with chronic obstructive pulmonary disease. The genome comprised 5,220,753 bp, with 35.2% G+C content. There were 4,972 predicted protein-coding genes, including those associated with antibiotic resistance and virulence.
What strategies can be used to effectively reduce the risk of concussion in sport? A systematic review
Authors: Emery Carolyn A , Black Amanda M , Kolstad Ash , Martinez German , Nettel-Aguirre Alberto , Engebretsen Lars , Johnston Karen , Kissick James , Maddocks David , Tator Charles , Aubry Mark , Dvořák Jiří , Nagahiro Shinji , Schneider Kathryn
Published: March 2017

Aim or objective

To examine the effectiveness of concussion prevention strategies in reducing concussion risk in sport.

Design

Systematic review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines.

Data sources

Eleven electronic databases searched and hand-search of references from selected studies.

Eligibility criteria for selecting studies

The following were the study inclusion criteria: (1) contained original human research data; (2) investigated an outcome of concussion or head impact; (3) evaluated a concussion prevention intervention; (4) included sport participants; (5) analytical study designand (6) peer-reviewed. The following were the exclusion criteria: (1) review articles, case series or case studies and (2) not in English.

Results

The studies selected (n=48) provided evidence related to protective gear (helmets, headgear, mouthguards) (n=25), policy and rule changes (n=13) and other interventions (training, education, facilities) (n=10). Meta-analyses demonstrate a combined effect of a 70% reduction (incidence rate ratio (IRR)=0.3 (95% CI: 0.22 to 0.41)) in concussion risk in youth ice hockey leagues where policy disallows body checking, and the point estimate (IRR=0.8 (95% CI: 0.6 to 1.1)) suggests a protective effect of mouthguards in contact and collision sport (basketball, ice hockey, rugby).

Summary/conclusions

Highlights include a protective effect of helmets in skiing/snowboarding and the effectiveness of policy eliminating body checking in youth ice hockey. Future research should examine mouthguards in contact sport, football helmet padding, helmet fit in collision sport, policy limiting contact practice in youth football, rule enforcement to reduce head contact in ice hockey and soccer, ice surface size and board/glass flexibility in ice hockey and training strategies targeting intrinsic risk factors (eg, visual training).

Systematic review registration

PROSPERO 2016:CRD42016039162
Retrospective observational study of emergency admission, readmission and the ‘weekend effect’
Authors: Shiue Ivy , McMeekin Peter , Price Christopher
Published: March 2017

Objectives

Excess mortality following weekend hospital admission has been observed but not explained. As readmissions have greater age, comorbidity and social deprivation, outcomes following emergency index admission and readmission were examined for temporal and demographic associations to confirm whether weekend readmissions contribute towards excess mortality.

Design

A retrospective observational study. Individual patient Hospital Episode Statistics were linked and 2 categories created: index admissions (not within 60 days of discharge from an emergency hospitalisation) and readmissions (within 60 days of discharge from an emergency hospitalisation). Logistic regression examined associations between admission category, weekend and weekday mortality, age, gender, season, comorbidity and social deprivation.

Setting

A single acute National Health Service (NHS) trust serving a population of 550 000 via 3 emergency departments.

Participants

Emergency admissions between 1 January 2010 and 31 March 2015.

Outcome measure

All-cause 30-day mortality.

Results

Over 5 years there were 128 966 index admissions (74.7% weekday/25.3% weekend) and 20 030 readmissions (74.9% weekday/25.1% weekend). Adjusted 30-day death rates for weekday/weekend admissions were 6.93%/7.04% for index cases and 12.26%/13.27% for readmissions. Weekend readmissions had a higher mortality risk relative to weekday readmissions (OR 1.10 (95% CI 1.01 to 1.20)) without differences in comorbidity or deprivation. Weekend index admissions did not have a significantly increased mortality risk (OR 1.04 (95% CI 0.98 to 1.11)) but deaths which did occur were associated with lower deprivation (OR 1.24 (95% CI 1.11 to 1.38)) and an absence of comorbidities (OR 1.17 (1.02 to 1.34)).

Conclusions

Associations with emergency hospitalisation were not identical for index admissions and readmissions. Further research is needed to confirm what factors are responsible for the ‘weekend effect’.
Improving Surgical and Anaesthesia Practice: Review of the Use of the WHO Safe Surgery Checklist in Felege Hiwot Referral Hospital, Ethiopia
Authors: Ellis Ryan , Izzuddin Mohamad Nor Ahmad , Pimentil Iona , Bitew Zebenaye , Moore Jolene
Published: March 2017

Development of surgical and anaesthetic care globally has been consistently reported as being inadequate. The Lancet Commission on Global Surgery highlights the need for action to address this deficit. One such action to improve global surgical safety is the introduction of the WHO Surgical Checklist to Operating Rooms (OR) around the world. The checklist has a growing body of evidence supporting its ability to assist in the delivery of safe anaesthesia and surgical care. Here we report the introduction of the Checklist to a major Ethiopian referral hospital and low-resource setting and highlight the success and challenges of its implementation over a one year period.

This project was conducted between July 2015 and August 2016, within a wider partnership between Felege Hiwot Hospital and The University of Aberdeen. The WHO Surgical Checklist was modified for appropriate and locally specific use within the OR of Felege Hiwot. The modified Checklist was introduced to all OR's and staff instructed on its use by local surgical leaders. Assessment of use of the Checklist was performed for General Surgical OR in three phases and Obstetric OR in two phases via observational study and case note review. Training was conduct between each phase to address challenges and promote use.

Checklist utilisation in the general OR increased between Phase I and 2 from 50% to 97% and remained high at 94% in Phase 3. Between Phase I and 2 partial completion rose from 27% to 77%, whereas full completion remained unchanged (23% to 20%). Phase 3 resulted in an increase in full completion from 20% to 60%. After 1 year the least completed section was “Sign In” (53%) and “Time Out” was most completed (87%). The most poorly checked item was “Site Marked” (60%). Use of the checklist in Obstetrics OR increased between Phase I and Phase II from 50% to 100% with some improvement in partial completion (50% to 60%) and a notable increase in full completion (0% to 40%). The least completed section was “Time Out” (50%) and “Sign In” was the most completed (90%). The most poorly checked item was “Recovery Concerns” (70%). There was considerable enthusiasm for use of the checklist among staff. The greatest challenge was communication difficulties between teams and high staff turnover.

This study records a locally driven, successful introduction of the WHO Surgical Safety Checklist modified for the specific locale and illustrates an increase in use of the checklist over a one year period in both General Surgical and Obstetric OR's. Local determination and ownership of the Checklist with regular intervention to promote use and train users contributed to this success.
Reducing falls in a care home
Authors: Cooper Rosie
Published: March 2017

Care home residents are 3 times more likely to fall than their community dwelling peers and 10 times more likely to sustain a significant injury as a result. 2 A project commenced at a care home in Aberdeen with the aim of reducing the number of falls by 20% by 30st April 2016 using the model for improvement. Qualitative data was gathered to establish staff belief about falls and their level of knowledge& understanding about falls risks and how to manage these. This informed the training which was delivered and iterative testing commenced with the introduction of the Lanarkshire Falls Risk/Intervention tool – where the multifactorial nature of a resident's falls risks are explored and specific actions to manage these are identified and implemented. Failure to meet PDSA predictions about sharing risk reducing actions with staff and length of time to complete the tool prompted a focus on communication and the processes whereby the tool is completed. “Teach back” was employed to highlight communication difficulties and ultimately the introduction of Huddles out improved the flow of information about residents and informed the Falls Risk/Intervention tool. 5 PDSAs were completed and within them multiple tests of change. The improvement shift came following a root cause analysis of the nature & cause of one resident's falls and applying the tool & communication processes. The average falls rate fell from 49 per 1000 occupied bed days to 23.6 and was sustained because of the attention to the importance of communication. The aim was achieved with a 36.6% reduction in Falls rate.

Care home residents are 3 times more likely to fall than their community dwelling peers and 10 times more likely to sustain a significant injury as a result. 2 A project commenced at a care home in Aberdeen with the aim of reducing the number of falls by 20% by 30th April 2016 using the model for improvement. Qualitative data was gathered to establish staff belief about falls and their level of knowledge& understanding about falls risks and how to manage these. This informed the training which was delivered and iterative testing commenced with the introduction of the Lanarkshire Falls Risk/Intervention tool - where the multifactorial nature of a resident's falls risks are explored and specific actions to manage these are identified and implemented. Failure to meet PDSA predictions about sharing risk reducing actions with staff and length of time to complete the tool prompted a focus on communication and the processes whereby the tool is completed. “Teach back” was employed to highlight communication difficulties and the introduction of Huddles improved the flow of information. 5 PDSAs were completed and within them multiple tests of change. The improvement shift came following a root cause analysis of the nature & cause of one resident's falls and applying the tool & communication processes. The average falls rate fell from 49 per 1000 occupied bed days to 23.6 and was sustained because of the attention to the importance of communication. The aim was achieved with a 36.6% reduction in Falls rate.
Sexual well-being in cancer and palliative care: an assessment of healthcare professionals’ current practice and training needs
Authors: Gleeson Aoife , Hazell Emily
Published: March 2017

Sexual well-being is often significantly affected by cancer and its treatments. Previous research shows that a patient's sexual well-being is often overlooked in clinical practice.

Objectives

The aims of this study were twofold. First, to determine the current practice of healthcare professionals (HCPs) working with cancer and palliative care patients in primary and secondary care settings in relation to sexual well-being. Second, to determine the education requirements of HCPs regarding the management of sexual well-being concerns of cancer/palliative care patients.

Methods

An anonymous electronic questionnaire was sent to assess current practice and education needs relating to the management of sexual well-being in cancer and palliative care.

Results

The majority of HCPs did not routinely assess sexual well-being in cancer and palliative care patients, with only 13.8% of secondary care staff, 7.9% of district nurses and 4% of general practitioners (GPs) routinely assessing it. The most frequent reason for non-assessment was that it was not the presenting symptom. The majority of respondents felt further support and training would be of benefit, including knowledge of specialist services patients could be referred to, written information for patients and access to assessment tools.

Conclusions

This survey identified that sexual well-being in cancer and palliative care patients is not routinely assessed with the majority of respondents stating that further support and training would be beneficial. The results of this questionnaire will be used to inform and develop sexual well-being training for HCPs working with cancer and palliative care patients.
Cosmetic surgery and conscientious objection
Authors: Minerva Francesca
Published: March 2017

In this paper, I analyse the issue of conscientious objection in relation to cosmetic surgery. I consider cases of doctors who might refuse to perform a cosmetic treatment because: (1) the treatment aims at achieving a goal which is not in the traditional scope of cosmetic surgery; (2) the motivation of the patient to undergo the surgery is considered trivial; (3) the patient wants to use the surgery to promote moral or political values that conflict with the doctor's ones; (4) the patient requires an intervention that would benefit himself/herself, but could damage society at large.
Conscientious objection in healthcare and the duty to refer
Authors: Cowley Christopher
Published: March 2017

Although some healthcare professionals have the legal right to conscientiously object to authorise or perform certain lawful medical services, they have an associated duty to provide the patient with enough information to seek out another professional willing to authorise or provide the service (the ‘duty to refer’). Does the duty to refer morally undermine the professional's conscientious objection (CO)? I narrow my discussion to the National Health Service in Britain, and the case of a general practitioner (GP) being asked by a pregnant woman to authorise an abortion. I will be careful not to enter the debate about whether abortion should be legalised, or the debate about whether CO should be permitted—I will take both as given. I defend the objecting GP's duty to refer against those I call the ‘conscience absolutists’, who would claim that if a state is serious enough in permitting the GP's objection in the first place (as is the UK), then it has to recognise the right to withhold any information about abortion.
Two-year outcome after early or late Intervention in non-ST elevation acute coronary syndrome
Authors: Badings Erik A , Remkes Wouter S , The Salem H K , Dambrink Jan-Henk E , Tjeerdsma Geert , Rasoul Saman , Timmer Jorik R , van der Wielen Marloes L J , Lok Dirk J A , Hermanides Renicus S , Van Wijngaarden Jan , Suryapranata Harry , van ’t Hof Arnoud W J
Published: March 2017

Objective

To compare long-term outcome of an early to a delayed invasive strategy in high-risk patients with non-ST elevation acute coronary syndrome (NSTE-ACS).

Methods

This prospective, multicentre trial included patients with NSTE-ACS and at least two out of three of the following high-risk criteria: (1) evidence of extensive myocardial ischaemia on ECG, (2) elevated biomarkers for myocardial necrosis and (3) age above 65 years. Patients were randomised to either an early (angiography and revascularisation if appropriate <12 hours) or a delayed invasive strategy (>48 hours after randomisation). Endpoint for this prespecified long-term follow-up was the composite incidence of death or reinfarction after 2 years. Data collection was performed by telephone contact with the patients, their relatives or general practitioner and by review of hospital records.

Results

Endpoint status after 2-year follow-up was collected in 521 of 542 initially enrolled patients. Incidence of death or reinfarction was 11.8% in the early and 13.1% in the delayed treatment group (relative risk (RR)=0.90, 95% CI 0.57 to 1.42). No significant differences were found in occurrence of the individual components of the primary endpoint: death 6.1% vs 8.9%, RR 0.69 (95% CI 0.37 to 1.27), reinfarction 6.5% vs 5.4%, RR 1.20 (95% CI 0.60 to 2.38). Post-hoc subgroup analysis showed statistical significant interaction between age and treatment strategy on outcome (p=0.02).

Conclusions

After 2 years follow-up, no difference in incidence of death or reinfarction was seen between early to late invasive strategy. These findings are in line with results of other studies with longer follow-up. Older patients seem to benefit more from early invasive treatment.
Insights into the challenges of risk characterization using drinking water safety plans
Authors: Post Yvonne , Thompson Emma , McBean Edward
Published: March 2017

Risk assessment methodologies, specifically water safety plans (WSPs), provide a water operator with a greater awareness of the drinking water system and the hazards that may occur. This brings key issues to the forefront and promotes a proactive approach to drinking water safety. This paper identifies the challenges in completing a WSP and evaluates the robustness of procedures. Experts knowledgeable in drinking water treatment were asked to complete Alberta’s Drinking Water Safety Plan template for a hypothetical community. Findings from use of a condensed version of the WSP are also described, and the resulting risk scores obtained from both methodologies are compared. A high degree of variability between experts’ responses was observed from both; however, trends between responses show that the condensed WSP makes it easier to compare hazards relative to each other, to determine key risk areas that warrant more attention.
Modeling the drift of European (Anguilla anguilla) and American (Anguilla rostrata) eel larvae during the year of spawning
Authors: Westerberg Håkan , Pacariz Selma , Marohn Lasse , Fagerström Vilhelm , Wysujack Klaus , Miller Michael J. , Freese Marko , Pohlmann Jan-Dag , Hanel Reinhold
Published: March 2017

The distribution of the leptocephalus larvae of European (Anguilla anguilla) and American (Anguilla rostrata) eels collected during recent Sargasso Sea surveys was used to model larval drift. The drift trajectories of individual larva were back-calculated to the estimated time of spawning, using current data from two global oceanographic assimilation models. The results of both models give the same overall result; widespread spawning extended in time from December to March. The drift was also calculated forwards for approximately 1 year. The forward drift modelling showed that most leptocephali remained in the area south of the Subtropical Frontal Zone. One conclusion is that the majority of leptocephali remain trapped and possibly die in the retention area. A small proportion of leptocephali are entrained into the Gulf Stream system. An implication is that the spawning success may be highly sensitive to oceanographic and climatic factors that alter the dispersion of leptocephali out from the retention area. An alternative interpretation is that the surveys were made too late after the peak spawning period and that the core spawning area was missed.
First-principles identification of charge-transition levels of native defects in BaF2
Authors: Ibraheem A. M. , Eisa M. H. , Adlan W. , Amolo George O. , Khalafalla M. A. H.
Published: March 2017

This paper reports on semilocal and hybrid density functional analysis of charge-transition levels of native defects in BaF2 structure. The transition level is defined as the Fermi level where two defect charge states have the same formation energy. The errors arising from the small supercell size effects have been relieved through extrapolating the formation energies to the limit of infinite supercell size. The level placement in the corrected band gap is achieved using a correction factor obtained from the difference between the valence band maxima in semilocal and hybrid calculations. The band gap size from hybrid calculation is validated using the full-potential, linearized augmented planewave method with the modified Becke–Johnson exchange potential. Our results are sufficiently accurate and, thus, significant for direct comparison with experiments.
A (gravitational) toy story
Authors: Barreto W. , de Oliveira H. P. , Rodriguez-Mueller B.
Published: March 2017

Frequently in Physics, insights and conclusions can be drawn from simple, idealized models. The discovery of critical behavior in the gravitational collapse of a massless scalar field leads to the simulation of binary black holes, from its coalescence to merging and ringdown. We refined a toy model to explore black hole formation as these events unfold to revisit the instability of a gravitational kink. We confirmed a conjecture related to a mass gap for critical behavior at the threshold of black hole formation. We find a critical exponent twice the standard value. Surprisingly, this larger critical exponent is also present in the multiple critical behavior for the black hole formation from a massless scalar field in asymptotically anti-de Sitter spacetimes. What is the meaning of this mass gap? Does it have physical relevance?