bluuebunny/crossref_metadata_2025 huggingface dataset:
What Is a Geriatrician? American Geriatrics Society and Association of Directors of Geriatric Academic Programs End‐of‐Training Entrustable Professional Activities for Geriatric Medicine
Authors: Leipzig Rosanne M. , Sauvigné Karen , Granville Lisa J. , Harper G. Michael , Kirk Lynne M. , Levine Sharon A. , Mosqueda Laura , Parks Susan Mockus , Fernandez Helen M.
Published: April 2014

Entrustable professional activities (EPAs) describe the core work that constitutes a discipline's specific expertise and provide the framework for faculty to perform meaningful assessment of geriatric fellows. This article describes the collaborative process of developing the end‐of‐training American Geriatrics Society (AGS) and Association of Directors of Geriatric Academic Programs (ADGAP) EPAs for Geriatric Medicine (AGS/ADGAP EPAs). The geriatrics EPAs describes a geriatrician's fundamental expertise and how geriatricians differ from general internists and family practitioners who care for older adults.
Workplace Violence and Occupational Stress in Healthcare Workers: A Chicken‐and‐Egg Situation—Results of a 6‐Year Follow‐up Study
Authors: Magnavita Nicola
Published: April 2014

Objectives

Violence at work (WV) is an important occupational hazard for health care workers (HCWs). A number of surveys addressing the causes and effects of WV have shown that it is associated with work‐related stress. However, it is not clear what direction this relationship takes, that is, whether job strain facilitates aggression against HCWs or WV is the cause of job strain.

Methods

From 2003 to 2009, HCWs from a public health care unit were asked to self‐assess their level of work‐related stress and to report aggression that occurred in the 12‐month period preceding their routine medical examination. In 2009, physical and mental health and job satisfaction were also assessed. A total of 698 out of 723 HCWs (96.5%) completed the study.

Findings

Job strain and lack of social support were predictors of the occurrence of nonphysical aggression during the ensuing year. HCWs who experienced WV reported high strain and low support at work in the following year. The experience of nonphysical violence and a prolonged state of strain and social isolation were significant predictors of psychological problems and bad health at follow‐up.

Conclusions and Implications

The relationship between work‐related distress and WV is bidirectional. The monitoring of workers through questionnaires distributed before their periodic examination is a simple and effective way of studying WV and monitoring distress.

Clinical Relevance

The findings of the present study may facilitate the subsequent design of participatory intervention for the prevention of violence in healthcare facilities. This should always be accompanied by measures designed to reduce strain and improve social support.
Parental reflective functioning: analysis and promotion of the concept for paediatric nursing
Authors: Ordway Monica R , Sadler Lois S , Dixon Jane , Slade Arietta
Published: April 2014

Aims and objectives

To identify the definitional elements of parental reflective functioning and develop a framework for nurses to apply this concept in their clinical work with families.

Background

In recent years, researchers have concluded that parental reflective functioning is a key mechanism in the development of child attachment security leading to lifelong mental and physical health benefits. Despite its clinical relevance, little has been published in the nursing literature on this concept.

Design

Concept analysis.

Methods

The Walker and Avant (2011, Strategies for theory construction in nursing. Prentice Hall, Upper Saddle River, NJ) method of concept analysis and the Whittemore and Knafl (Journal of Advanced Nursing, 52, 2005, 546) method of integrative review were used. A search of the literature published from 1989–2013 was conducted using edited texts and online databases – Scopus, CINAHL, PubMed and PsychInfo. Among the 85 sources, 31 empirical studies, 17 book chapters, 32 review papers and five case studies were identified concerning parental reflective functioning.

Results

The concept of reflective functioning, defined as the capacity to envision the mental states of self and other, was first described in 1989 by Fonagy. Slade (Attachment and Human Development, 7, 2005, 269) expanded the concept specifically for parents (i.e. parental reflective functioning). Results of this concept analysis describe seven defining attributes and five antecedent conditions. Consequences of parental reflective functioning are related to a child's attachment early in life and behaviour later in life. A model case is provided to contextualise the concept. To date, there are three measures for parental reflective functioning.

Conclusions

While parental reflective functioning has been predominately featured in psychology and parenting interventions, the potential consequences of secure attachment and longer‐term children's behavioural outcomes suggest that the concept has global implications for paediatric nurses and primary healthcare clinicians.

Relevance to clinical practice

Parental reflective functioning offers exciting and promising opportunities for paediatric health and new approaches for those who provide paediatric health care.
Effect of Dietary Nonstructural Carbohydrate Content on Activation of 5′‐Adenosine Monophosphate‐Activated Protein Kinase in Liver, Skeletal Muscle, and Digital Laminae of Lean and Obese Ponies
Authors: Burns T.A. , Watts M.R. , Weber P.S. , McCutcheon L.J. , Geor R.J. , Belknap J.K.
Published: April 2014

Background

In EMS‐associated laminitis, laminar failure may occur in response to energy failure related to insulin resistance (IR) or to the effect of hyperinsulinemia on laminar tissue. 5′‐Adenosine‐monophosphate‐activated protein kinase (AMPK) is a marker of tissue energy deprivation, which may occur in IR.

Hypothesis/Objectives

To characterize tissue AMPK regulation in ponies subjected to a dietary carbohydrate (CHO) challenge.

Animals

Twenty‐two mixed‐breed ponies.

Methods

Immunohistochemistry and immunoblotting for total AMPK and phospho(P)‐AMPK and RT‐qPCR for AMPK‐responsive genes were performed on laminar, liver, and skeletal muscle samples collected after a 7‐day feeding protocol in which ponies stratified on body condition score (BCS; obese or lean) were fed either a low‐CHO diet (ESC + starch, approximately 7% DM; n = 5 obese, 5 lean) or a high‐CHO diet (ESC + starch, approximately 42% DM; n = 6 obese, 6 lean).

Results

5′‐Adenosine‐monophosphate‐activated protein kinase was immunolocalized to laminar keratinocytes, dermal constituents, and hepatocytes. A high‐CHO diet resulted in significantly decreased laminar [P‐AMPK] in lean ponies (P = .03), but no changes in skeletal muscle (lean, P = .33; obese, P = .43) or liver (lean, P = .84; obese, P = .13) [P‐AMPK]. An inverse correlation existed between [blood glucose] and laminar [P‐AMPK] in obese ponies on a high‐CHO diet.

Conclusions and Clinical Importance

Laminar tissue exhibited a normal response to a high‐CHO diet (decreased [P‐AMPK]), whereas this response was not observed in liver and skeletal muscle in both lean (skeletal muscle, P = .33; liver, P = .84) and obese (skeletal muscle, P = .43; liver, P = .13) ponies.
Can cystatin C in cerebrospinal fluid be a biomarker for amyotrophic lateral sclerosis? A lesson from previous studies
Authors: Sako Wataru , Ishimoto Shinji
Published: April 2014

Background and Aim

Amyotrophic lateral sclerosis (ALS) is an idiopathic and fatal neurodegenerative disease of the motor system that results in loss of upper and lower motor neurons in the brainstem and multiple spinal cord regions. We do not have a useful biomarker for early diagnosis yet. In terms of cerebrospinal fluid (CSF), cystatin C is a candidate, but the results are controversial. In the present study, we synthesized the results of published research on cystatin C in CSF to test whether or not cystatin C level was reduced in ALS relative to other neurological disorders (OND) using a meta‐analysis method.

Methods

Comprehensive literature search yielded four studies that satisfied our inclusion criteria (112 ALS, 72 OND). The outcome of cystatin C concentration was expressed as the standardized mean difference (SMD) between ALS and OND.

Results

The overall effect of ALS on cystatin C level in CSF was not significantly different from OND (SMD = −0.81, 95% CI −1.78 to 0.16, P = 0.10, four studies, n = 184). This result was based on heterogeneous studies (P < 0.0001, I2 = 88%). We carried out sensitivity analysis with the exclusion of each study sequentially. There was no significant summary effect regardless of any exclusion.

Conclusions

The present meta‐analysis could not detect a significant difference of cystatin C in CSF between ALS and OND with heterogeneous studies. Here, we mainly discussed the possible cause of heterogeneity, which provided several suggestions for future research.
Conflict of interest in American neurology and neurological societies
Authors: Mitsumoto Hiroshi
Published: April 2014

As physicians, we are expected to adhere to the highest ethical standards when treating our patients, educating the medical community and society as a whole, and investigating new medical evidence. When we receive anything from, speak for and study in collaboration with the pharmaceutical and device industry, an opportunity for conflicts of interest (COI) develops. As a society, we have witnessed that COI can have highly negative and damaging effects; for example, COI related to leaded gasoline and tobacco use. Egregious COI in several cutting‐edge medical research endeavors have resulted in lethal outcomes, and most unfortunately, examples of similar flagrant COI continue to come to light. In the business of medical care and in research today, with many physicians being closely associated with for‐profit medical companies, the possibility of COI is always present. As an academic neurologist practicing in the USA, I review here the historical background, definition and nature of COI, which is both tangible and intangible. At present, public disclosure is the best practice to reduce COI by a process of checks and balances. The present review provides details of the COI process of the American Academy of Neurology, the largest professional neurological organization in the world. In addition, I discuss my own personal experience with COI. COI will never be resolved or disappear in the foreseen future, and indeed will become even more complicated. I hope this review will illuminate COI, and help neurologists to address COI by openly disclosing their relationships with industry and avoiding potential harm.
The cost‐effectiveness of contemporary home haemodialysis modalities compared with facility haemodialysis: A systematic review of full economic evaluations
Authors: Walker Rachael , Marshall Mark R , Morton Rachael L , McFarlane Philip , Howard Kirsten
Published: April 2014

Aim

The financial burden of the increasing dialysis population challenges healthcare resources internationally. Home haemodialysis offers many benefits over conventional facility dialysis including superior clinical, patient‐centred outcomes and reduced cost. This review updates a previous review, conducted a decade prior, incorporating contemporary home dialysis techniques of frequent and nocturnal dialysis. We sought comparative cost‐effectiveness studies of homeversusfacility haemodialysis (HD) for people with end‐stage kidney failure (ESKF).

Methods

We conducted a systematic review of literature fromJanuary 2000–March 2014. Studies were included if they provided comparative information on the costs, health outcomes and cost‐effectiveness ratios of homeHDand facilityHD. We searched medical and health economic databases usingMeSHheadings and text words for economic evaluation and haemodialysis.

Results

Six studies of economic evaluations that compared home to facilityHDwere identified. Two studies compared home nocturnalHD, one home nocturnal and daily homeHD, and three compared contemporary homeHDto facilityHD. Overall these studies suggest that contemporary homeHDmodalities are less costly and more effective than facilityHD. HomeHDstart‐up costs tend to be higher in the short term, but these are offset by cost savings over the longer term.

Conclusions

Contemporaneous dialysis modalities including nocturnal and daily home haemodialysis are cost‐effective or cost‐saving compared with facility‐based haemodialysis. This result is largely driven by lower staff costs, and better health outcomes for survival and quality of life. Expanding the proportion of haemodialysis patients managed at home is likely to produce cost savings.
Xenospecific regulatory T cells generated on porcine B cells are capable in controlling xenogeneic immune responses in humanized mice
Authors: Lee Yun‐Shien , Noyan Fatih , Hardtke‐Wolenski Mathias , Knoefel Ann‐Kathrin , Taubert Richard , Baron Udo , Manns Michael P. , Jaeckel Elmar
Published: April 2014

There is a constant shortage of human organs suitable for transplantation which has led the focus of research to the possibility of transplanting porcine organs into human. In order to overcome the immunological barriers in xenotransplantion major progresses have been made in the last decades regarding antibody‐mediated and complement mediated hyperacute rejection, yet coagulation incompatibilities as well as innate and adaptive xenogeneic immune responses still remain problematic. Regarding the latter, regulatory T cells have been of special interest because of their immunosuppressive capacities. Polyspecific regulatory T cells have been shown to be able to prevent xenogeneic graft versus host disease but only under lymphopenic conditions, which is not the case after transplantion. Donor‐specific regulatory T cells may therefore offer another more promising approach in cellular therapy in immunocompetent specimens. Recently, we developed a protocol for the ex vivo generation of alloantigen‐specific human regulatory T cells by activation with donor‐derived activated B cell blasts. These alloantigen‐specific regulatory T cells were far more potent in controlling T cell mediated immune responses. Transferring this protocol into a xenogeneic setting, we succeeded in expanding porcine B cells by activation with the human CD40‐ligand. Activation of polyspecific human regulatory T cells led to the generation of xenospecific regulatory T cells, which show promising immunosuppressive properties when compared to polyspecific regulatory T cells in preliminary experiments.
Pressure Gradient Effects on Smooth- and Rough-Surface Turbulent Boundary Layers—Part II: Adverse Pressure Gradient
Authors: Shin Ju Hyun , Jin Song Seung
Published: April 2014

An experimental investigation has been conducted to identify the effects of pressure gradient and surface roughness on turbulent boundary layers. In Part II, smooth- and rough-surface turbulent boundary layers with and without adverse pressure gradient (APG) are presented at a fixed Reynolds number (based on the length of flat plate) of 900,000. Flat-plate boundary layer measurements have been conducted using a single-sensor, hot-wire probe. For smooth surfaces, compared to the zero pressure gradient (ZPG) boundary layer, the APG boundary layer has a higher mean velocity defect throughout the boundary layer and lower friction coefficient. APG decreases the streamwise normal Reynolds stress for y less than 0.4 times the boundary layer thickness and increases it slightly in the outer region. For rough surfaces, APG reduces the roughness effects of increasing the mean velocity defect and normal Reynolds stress for y less than 23 and 28 times the average roughness height, respectively. Consistently, for the same roughness, APG decreases the integrated streamwise turbulent kinetic energy. APG also decreases the roughness effect on the friction coefficient, roughness Reynolds number, and roughness shift. Compared to the ZPG boundary layers, the roughness effects on integral boundary layer parameters—boundary layer thickness and momentum thickness—are weaker under APG. Thus, contrary to the favorable pressure gradient (FPG) in part I, APG reduces the roughness effects on turbulent boundary layers.
Plasto-Elastohydrodynamic Lubrication in Point Contacts for Surfaces With Three-Dimensional Sinusoidal Waviness and Real Machined Roughness
Authors: He Tao , Ren Ning , Zhu Dong , Wang Jiaxu
Published: April 2014

Efficiency and durability are among the top concerns in mechanical design to minimize environmental impact and conserve natural resources while fulfilling performance requirements. Today mechanical systems are more compact, lightweight, and transmit more power than ever before, which imposes great challenges to designers. Under the circumstances, some simplified analyses may no longer be satisfactory, and in-depth studies on mixed lubrication characteristics, taking into account the effects of 3D surface roughness and possible plastic deformation, are certainly needed. In this paper, the recently developed plasto-elastohydrodynamic lubrication (PEHL) model is employed, and numerous cases with both sinusoidal waviness and real machined roughness are analyzed. It is observed that plastic deformation may occur due to localized high pressure peaks caused by the rough surface asperity contacts, even though the external load is still considerably below the critical load determined at the onset of plastic deformation in the corresponding smooth surface contact. It is also found, based on a series of cases analyzed, that the roughness height, wavelength, material hardening property, and operating conditions may all have significant influences on the PEHL performance, subsurface von Mises stress field, residual stresses, and plastic strains. Generally, the presence of plastic deformation may significantly reduce some of the pressure spikes and peak values of subsurface stresses and make the load support more evenly distributed among all the rough surface asperities in contact.
On the long term antibacterial features of silver-doped diamondlike carbon coatings deposited via a hybrid plasma process
Authors: Cloutier Maxime , Tolouei Ranna , Lesage Olivier , Lévesque Lucie , Turgeon Stéphane , Tatoulian Michael , Mantovani Diego
Published: April 2014

Environmental surfaces are increasingly recognized as important sources of transmission of hospital-acquired infections. The use of antibacterial surface coatings may constitute an effective solution to reduce the spread of contamination in healthcare settings, provided that they exhibit sufficient stability and a long-term antibacterial effect. In this study, silver-incorporated diamondlike carbon films (Ag-DLC) were prepared in a continuous, single-step plasma process using a hybrid, inductively coupled plasma reactor combined with a very-low-frequency sputtering setup. The average Ag concentration in the films, ranging from 0 to 2.4 at. %, was controlled by varying the sputtering bias on the silver target. The authors found that the activity of Escherichia coli was reduced by 2.5 orders of magnitude, compared with the control surface, after a 4-h contact with a 2.4 at. % Ag-DLC coating. The coatings displayed slow release kinetics, with a total silver ion release in the sub-ppb range after 4 h in solution, as measured by graphite furnace-atomic absorption spectroscopy. This was confirmed by Kirby–Bauer diffusion tests, which showed limited diffusion of biocidal silver with a localized antibacterial effect. As a slow and continuous release is mandatory to ensure a lasting antibacterial effect, the newly developed Ag-DLC coatings appears as promising materials for environmental hospital surfaces.
Effect of water uptake on the fracture behavior of low-k organosilicate glass
Authors: Guo Xiangyu , Jakes Joseph E. , Banna Samer , Nishi Yoshio , Leon Shohet J.
Published: April 2014

Water uptake in porous low-k dielectrics has become a significant challenge for both back-end-of-the-line integration and circuit reliability. This work examines the effects of water uptake on the fracture behavior of nanoporous low-k organosilicate glass. By using annealing dehydration and humidity conditioning, the roles of different water types and their concentrations are analyzed in detail. For as-deposited SiCOH films, annealing dehydration can enhance the resistance to crack occurrence, and these enhancements can be offset by higher humidity conditioning. It was found that the film-cracking threshold can be lowered by in-diffused water in the film as well as by water at the SiCOH/subtract interface. This occurs because the water decreases the film fracture energy and adhesion energy, respectively. By conditioning at high humidity, the variation of the film cracking threshold agrees well with the behavior of the film hardness and modulus of elasticity as a function of relative humidity. The crack morphologies of low-k porous films are also implicitly related to water uptake in the materials. Film cracking thresholds and crack morphologies of UV-cured low-k materials exhibit a weaker dependence on the water uptake, indicating a low degree of hydrophilicity of the SiCOH film after UV curing, which corroborates the previous results. Furthermore, by measuring the surface crack length, the material–fracture toughness can be found. The results demonstrate that neither annealing dehydration nor water uptake have significant effects on fracture toughness of as-deposited SiCOH, while for UV-cured SiCOH, annealing enhances the film-fracture toughness.
Revealing optically induced magnetization in SrTiO3 using optically coupled SQUID magnetometry and magnetic circular dichroism
Authors: Rice William D. , Ambwani Palak , Thompson Joe D. , Leighton Christopher , Crooker Scott A.
Published: April 2014

In this work, the authors study the time- and temperature-dependence of optically induced magnetization in bulk crystals of slightly oxygen-deficient SrTiO3–δ using an optically coupled superconducting quantum interference device magnetometer. Circularly-polarized sub-bandgap light is found to induce a weak (∼5 × 10−7 emu) but extremely long-lived (hours) magnetic moment in SrTiO3–δ at zero magnetic field. The authors utilize this effect to demonstrate that SrTiO3–δ crystals can be used as an optically addressable magnetic memory by writing and subsequently reading magnetic patterns with light. The induced magnetization is consistent with that of a polarized ensemble of independent oxygen-vacancy-related complexes, rather than from collective or long-range magnetic order.
Antifungal Susceptibilities of Candida Isolates Causing Bloodstream Infections at a Medical Center in Taiwan, 2009-2010
Authors: Huang Yu-Tsung , Liu Chia-Ying , Liao Chun-Hsing , Chung Kuei-Pin , Sheng Wang-Huei , Hsueh Po-Ren
Published: April 2014

We used the Sensititre YeastOne (SYO) method (Trek Diagnostic Systems) to determine the MICs of nine antifungal agents against 474 nonduplicate blood
Candida
isolates. The MIC results were interpreted according to updated clinical breakpoints (CBPs) recommended by the Clinical and Laboratory Standards Institute (CLSI; document M27-S4) or epidemiology cutoff values (ECVs). The rates of fluconazole susceptibility were 99.2% (234/236) in
Candida albicans
, 86.7% (85/98) in
C. tropicalis
, and 97.7% (42/43) in
C. parapsilosis
. Among the 77 isolates of
C. glabrata
, 90.9% showed dose-dependent susceptibility (S-DD) to fluconazole. Nearly all isolates of
C. albicans
,
C. parapsilosis
, and
C. krusei
were susceptible to voriconazole; however, rates of voriconazole susceptibility were 78.6% in
C. tropicalis
. Few isolates of
C. albicans
(
n
= 5; 2.1%) and
C. glabrata
(
n
= 3; 3.9%), no isolates of
C. parapsilosis
,
C. krusei
, and
C. guilliermondii
, but 62.2% (
n
= 51) of
C. tropicalis
isolates were non-wild type for posaconazole susceptibility. For itraconazole susceptibility, 98.3% of
C. albicans
isolates were wild type, and 3.9% (
n
= 3) of
C. glabrata
isolates were non-wild type. Almost all of the isolates tested (>97% for all species) were susceptible to both micafungin and anidulafungin. All isolates tested were found to be wild type for amphotericin B susceptibility, with MICs of <1μg/ml. Further evaluation is needed to establish CBPs of antifungal agents by the 24-h SYO method for the management of patients with candidemia or other invasive candida infections.
Pharmacokinetics-Pharmacodynamics of the Helicase-Primase Inhibitor Pritelivir following Treatment of Wild-Type or Pritelivir-Resistant Virus Infection in a Murine Herpes Simplex Virus 1 Infection Model
Authors: Biswas Subhajit , Sukla Soumi , Goldner Thomas , Field Hugh J. , Kropeit Dirk , Paulsen Daniela , Welbers André , Ruebsamen-Schaeff Helga , Zimmermann Holger , Birkmann Alexander
Published: April 2014

Herpes simplex virus (HSV) infections can cause considerable morbidity. Transmission of HSV-2 has become a major health concern, since it has been shown to promote transmission of other sexually transmitted diseases. Pritelivir (AIC316, BAY 57-1293) belongs to a new class of HSV antiviral compounds, the helicase-primase inhibitors, which have a mode of action that is distinct from that of antiviral nucleoside analogues currently in clinical use. Analysis of pharmacokinetic-pharmacodynamic parameters is a useful tool for the selection of appropriate doses in clinical trials, especially for compounds belonging to new classes for which no or only limited data on therapeutic profiles are available. For this purpose, the effective dose of pritelivir was determined in a comprehensive mouse model of HSV infection. Corresponding plasma concentrations were measured, and exposures were compared with efficacious concentrations derived from cell cultures. The administration of pritelivir at 10 mg/kg of body weight once daily for 4 days completely suppressed any signs of HSV infection in the animals. Associated plasma concentrations adjusted for protein binding stayed above the cell culture 90% effective concentration (EC
90
) for HSV-1 for almost the entire dosing interval. Interestingly, by increasing the dose 6-fold and prolonging the treatment duration to 8 days, it was possible to treat mice infected with an approximately 30-fold pritelivir-resistant but fully pathogenic HSV-1 virus. Corresponding plasma concentrations exceeded the EC
90
of this mutant for <8 h, indicating that even suboptimal exposure to pritelivir is sufficient to achieve antiviral efficacy, possibly augmented by other factors such as the immune system.
Art-175 Is a Highly Efficient Antibacterial against Multidrug-Resistant Strains and Persisters of Pseudomonas aeruginosa
Authors: Briers Yves , Walmagh Maarten , Grymonprez Barbara , Biebl Manfred , Pirnay Jean-Paul , Defraine Valerie , Michiels Jan , Cenens William , Aertsen Abram , Miller Stefan , Lavigne Rob
Published: April 2014

Artilysins constitute a novel class of efficient enzyme-based antibacterials. Specifically, they covalently combine a bacteriophage-encoded endolysin, which degrades the peptidoglycan, with a targeting peptide that transports the endolysin through the outer membrane of Gram-negative bacteria. Art-085, as well as Art-175, its optimized homolog with increased thermostability, are each composed of the sheep myeloid 29-amino acid (SMAP-29) peptide fused to the KZ144 endolysin. In contrast to KZ144, Art-085 and Art-175 pass the outer membrane and kill
Pseudomonas aeruginosa
, including multidrug-resistant strains, in a rapid and efficient (∼5 log units) manner. Time-lapse microscopy confirms that Art-175 punctures the peptidoglycan layer within 1 min, inducing a bulging membrane and complete lysis. Art-175 is highly refractory to resistance development by naturally occurring mutations. In addition, the resistance mechanisms against 21 therapeutically used antibiotics do not show cross-resistance to Art-175. Since Art-175 does not require an active metabolism for its activity, it has a superior bactericidal effect against
P. aeruginosa
persisters (up to >4 log units compared to that of the untreated controls). In summary, Art-175 is a novel antibacterial that is well suited for a broad range of applications in hygiene and veterinary and human medicine, with a unique potential to target persister-driven chronic infections.
IncH-Type Plasmid Harboring
bla
CTX-M-15
,
bla
DHA-1
, and
qnrB4
Genes Recovered from Animal Isolates
Authors: Schlüter Andreas , Nordmann Patrice , Bonnin Rémy A. , Millemann Yves , Eikmeyer Felix G. , Wibberg Daniel , Pühler Alfred , Poirel Laurent
Published: April 2014

The whole sequence of plasmid pENVA carrying the extended-spectrum β-lactamase gene
bla
CTX-M-15
was determined. It was identified from a series of clonally related
Klebsiella pneumoniae
sequence type 274 strains recovered from companion animals. This plasmid was 253,984 bp in size and harbored, in addition to
bla
CTX-M-15
, a large array of genes encoding resistance to many antibiotic molecules, including β-lactams (
bla
TEM-1
,
bla
DHA-1
), aminoglycosides (
aacA2
,
aadA1
), tetracycline (
tetA
), quinolones (
qnrB4
), trimethoprim (
dfrA15
), and sulfonamides (two copies of
sul1
). In addition, genes encoding resistance to mercury, tellurium, nickel, and quaternary compounds were identified. It also carried genes encoding DNA damage protection and mutagenesis repair and a locus for a CRISPR system, which corresponds to an immune system involved in protection against bacteriophages and plasmids. Comparative analysis of the plasmid scaffold showed that it possessed a structure similar to that of only a single plasmid, which was pNDM-MAR encoding the carbapenemase NDM-1 and identified from human
K. pneumoniae
isolates. Both plasmids possessed two replicons, namely, those of IncFIB-like and IncHIB-like plasmids, which were significantly different from those previously characterized. The
bla
CTX-M-15
gene, together with the other antibiotic resistance genes, was part of a large module likely acquired through a transposition process. We characterized here a new plasmid type carrying the
bla
CTX-M-15
gene identified in a
K. pneumoniae
isolate of animal origin. The extent to which this plasmid type may spread efficiently and possibly further enhance the dissemination of
bla
CTX-M-15
among animal and human isolates remains to be determined.
Precooling and percooling (cooling during exercise) both improve performance in the heat: a meta-analytical review
Authors: Bongers Coen C W G , Thijssen Dick H J , Veltmeijer Matthijs T W , Hopman Maria T E , Eijsvogels Thijs M H
Published: April 2014

Background

Exercise increases core body temperature (Tc), which is necessary to optimise physiological processes. However, excessive increase in Tc may impair performance and places participants at risk for the development of heat-related illnesses. Cooling is an effective strategy to attenuate the increase in Tc. This meta-analysis compares the effects of coolingbefore(precooling) andduringexercise (percooling) on performance and physiological outcomes.

Methods

A computerised literature search, citation tracking and hand search were performed up to May 2013. 28 studies met the inclusion criteria, which were trials that examined the effects of cooling strategies on exercise performance in men, while exercise was performed in the heat (>30°C). 20 studies used precooling, while 8 studies used percooling.

Results

The overall effect of precooling and percooling interventions on exercise performance was +6.7±0.9% (effect size (ES)=0.43). We found a comparable effect (p=0.82) of precooling (+5.7±1.0% (ES=0.44)) and percooling (+9.9±1.9% (ES=0.40)) to improve exercise performance. A lower finishing Tc was found in precooling (38.9°C) compared with control condition (39.1°C, p=0.03), while Tc was comparable between conditions in percooling studies. No correlation between Tc and performance was found. We found significant differences between cooling strategies, with a combination of multiple techniques being most effective for precooling (p<0.01) and ice vest for percooling (p=0.02).

Conclusions

Cooling can significantly improve exercise performance in the heat. We found a comparable ES for precooling and percooling on exercise performance, while the type of cooling technique importantly impacts the effects. Precooling lowered the finishing core temperature, while there was no correlation between Tc and performance.
Evolution of the hip fracture population: time to consider the future? A retrospective observational analysis
Authors: Baker Paul N , Salar Omer , Ollivere Benjamin J , Forward Daren P , Weerasuriya Namal , Moppett Iain K , Moran Chris G
Published: April 2014

Objective

To examine how the population with fractured neck of femur has changed over the last decade and determine whether they have evolved to become a more physically and socially dependent cohort.

Design

Retrospective cohort study of prospectively collected Standardised Audit of Hip Fractures of Europe data entered on to an institutional hip fracture registry.

Participants

10 044 consecutive hip fracture admissions (2000–2012).

Setting

A major trauma centre in the UK.

Results

There was a generalised increase in the number of admissions between 2000 (n=740) and 2012 (n=810). This increase was non-linear and best described by a quadratic curve. Assuming no change in the prevalence of hip fracture over the next 20 years, our hospital is projected to treat 871 cases in 2020 and 925 in 2030. This represents an approximate year-on-year increase of just over 1%. There was an increase in the proportion of male admissions over the study period (2000: 174 of 740 admissions (23.5%); 2012: 249 of 810 admissions (30.7%)). This mirrored national census changes within the geographical area during the same period. During the study period there were significant increases in the numbers of patients admitted from their own home, the proportion of patients requiring assistance to mobilise, and the proportion of patients requiring help with basic activities of daily living (all p<0.001). There was also a twofold to fourfold increase in the proportion of patients admitted with a diagnosis of cardiovascular disease, renal disease, diabetes and polypharmacy (use of >4 prescribed medications; all p<0.001).

Conclusions

The expanding hip fracture population has increasingly complex medical, social and rehabilitation care needs. This needs to be recognised so that appropriate healthcare strategies and service planning can be implemented. This epidemiological analysis allows projections of future service need in terms of patient numbers and dependency.
Dietary fatty acids in the secondary prevention of coronary heart disease: a systematic review, meta-analysis and meta-regression
Authors: Schwingshackl Lukas , Hoffmann Georg
Published: April 2014

Objective

Previous systematic reviews were not restricted to either primary or secondary prevention trials, this study aimed to investigate the effects of reduced and/or modified fat diets and dietary fatty acids on all-cause mortality, cardiovascular mortality and cardiovascular events in participants with established coronary heart disease.

Design

Systematic review, meta-analysis and univariate/multivariate meta-regression.

Eligibility and criteria for selecting studies

Electronic searches for randomised controlled trials comparing reduced/modified fat diets versus control diets were performed in MEDLINE, EMBASE and the Cochrane Library.

Data extraction

Pooled effects were calculated using an inverse-variance random effect meta-analysis. Random effects univariate and multivariate meta-regressions were performed including changes in all types of dietary fatty acids.

Results

Overall, 12 studies enrolling 7150 participants were included in the present systematic review. No significant risk reduction could be observed considering all-cause mortality (relative risk (RR) 0.92, p=0.60; I2=59%) and cardiovascular mortality (RR 0.96, p=0.84; I2=69%), combined cardiovascular events (RR 0.85, p=0.30; I2=75%) and myocardial infarction (RR 0.76, p=0.13; I2=55%) comparing modified fat diets versus control diets. This results could be confirmed for the reduced fat versus control diets (RR 0.79, p=0.47; I2=0%), (RR 0.93, p=0.66; I2=0%), (RR 0.93, p=0.71; I2=57%) and (RR 1.18, p=0.26; I2=18%). The multivariate and univariate model showed no significant associations between the independent variables and the changes from saturated fat, monounsaturated fat, polyunsaturated fat and linoleic acid. Sensitivity analyses did not reveal a significant risk reduction for any outcome parameter when polyunsaturated fat was increased in exchange for saturated fat.

Conclusions

The present systematic review provides no evidence (moderate quality evidence) for the beneficial effects of reduced/modified fat diets in the secondary prevention of coronary heart disease. Recommending higher intakes of polyunsaturated fatty acids in replacement of saturated fatty acids was not associated with risk reduction.
Controlling methicillin-resistantStaphylococcus aureus(MRSA) in a hospital and the role of hydrogen peroxide decontamination: an interrupted time series analysis
Authors: Mitchell Brett G , Digney Wilhelmine , Locket Phil , Dancer Stephanie J
Published: April 2014

Objectives

The impact of surface disinfection versus detergent cleaning on healthcare associated infection rates remains unresolved. We aimed to evaluate the efficacy of hydrogen peroxide (HP) decontamination against methicillin-resistantStaphylococcus aureus(MRSA).

Design

Single centred retrospective before and after study design.

Setting

Launceston General Hospital, Tasmania, Australia.

Participants

Patients with MRSA infection or colonisation.

Interventions

Rooms occupied by patients with MRSA infection or colonisation were cleaned following discharge with either detergent or HP.

Main outcome measures

MRSA room contamination following cleaning; new MRSA acquisition in patients.

Results

Over 3600 discharge cleans were completed, with more than 32 600 environmental swabs processed. MRSA was isolated from 24.7% rooms following detergent cleaning and from 18.8% of rooms after HP (p<0.001). The incidence of MRSA acquisition reduced from 9.0 to 5.3 per 10 000 patient days in detergent and disinfectant arms, respectively (p<0.001).

Conclusions

Use of HP disinfection led to a decrease in residual MRSA contamination in patient rooms compared with detergent. It may also have encouraged the reduction in patient MRSA acquisition despite several confounders including staff feedback on terminal cleaning, additional MRSA screening and quicker laboratory methods. Infection control is best served by concurrent interventions targeting both the patient and healthcare environment.
Key health outcomes for children and young people with neurodisability: qualitative research with young people and parents
Authors: Allard Amanda , Fellowes Andrew , Shilling Valerie , Janssens Astrid , Beresford Bryony , Morris Christopher
Published: April 2014

Objectives

To identify key health outcomes, beyond morbidity and mortality, regarded as important in children and young people with neurodisability, and their parents.

Design

Qualitative research incorporating a thematic analysis of the data supported by the Framework Approach; the International Classification of Functioning, Disability and Health (ICF) provided a theoretical foundation.

Setting

The study was conducted in community settings.

Participants

Participants were 54 children and young people with neurodisability: 50 participated in focus groups, and 4 in interviews; 53 parents participated: 47 in focus groups and 6 in interviews. Children/young people and parents were recruited through different networks, and were not related.

Results

Children/young people and parents viewed health outcomes as inter-related. Achievement in some outcomes appeared valued to the extent that it enabled or supported more valued domains of health. Health outcomes prioritised by both young people and parents were: communication, mobility, pain, self-care, temperament, interpersonal relationships and interactions, community and social life, emotional well-being and gaining independence/future aspirations. Parents also highlighted their child's sleep, behaviour and/or safety.

Conclusions

Those responsible for health services for children/young people with neurodisability should take account of the aspects of health identified by families. The aspects of health identified in this study provide a basis for selecting appropriate health indicators and outcome measures.
The potential role of NT-proBNP in screening for and predicting prognosis in heart failure: a survival analysis
Authors: Taylor C J , Roalfe A K , Iles R , Hobbs F D R
Published: April 2014

Objective

To determine the potential role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in screening for and predicting prognosis in heart failure by examining diagnosis and survival of patients with a raised NT-proBNP at screening.

Design

Survival analysis.

Setting

Prospective substudy of the Echocardiographic Heart of England Screening study (ECHOES) to investigate 10-year survival in participants with an NT-proBNP level at baseline.

Participants

594 participants took part in the substudy. Records of all participants in the ECHOES cohort were flagged during the screening phase which ended on 25 February 1999. All deaths until 25 February 2009 were coded.

Outcome measures

Logistic regression was used to examine whether NT-proBNP is useful in predicting heart failure at screening after adjustment for age, sex and cohort. Kaplan-Meier curves and log rank tests were used to compare survival times of participants according to NT-proBNP level. Cox regression was carried out to assess the prognostic effect of NT-proBNP after allowing for significant covariates and receiver operator curves were used to determine test reliability.

Results

The risk of heart failure increased almost 18-fold when NT-proBNP was 150 pg/mL or above (adjusted OR=17.7, 95% CI 4.9 to 63.5). 10-year survival in the general population cohort was 61% (95% CI 48% to 71%) for those with NT-proBNP ≥150 pg/mL and 89% (95% CI 84% to 92%) for those below the cut-off at the time of the initial study. After adjustment for age, sex and risk factors for heart failure, NT-proBNP level ≥150 pg/mL was associated with a 58% increase in the risk of death within 10 years (adjusted HR=1.58, 95% CI 1.09 to 2.30).

Conclusions

Raised NT-proBNP levels, when screening the general population, are predictive of a diagnosis of heart failure (at a lower threshold than guidelines for diagnosing symptomatic patients) and also predicted reduced survival at 10 years.
Awareness and enforcement of guidelines for publishing industry-sponsored medical research among publication professionals: the Global Publication Survey
Authors: Wager Elizabeth , Woolley Karen , Adshead Viv , Cairns Angela , Fullam Josh , Gonzalez John , Grant Tom , Tortell Stephanie
Published: April 2014

Objective

To gather information about current practices and implementation of publication guidelines among publication professionals working in or for the pharmaceutical industry.

Design/setting

Web-based survey publicised via email and social media to members of the International Society for Medical Publication Professionals (ISMPP) and other organisations from November 2012 to February 2013.

Participants

469 individuals involved in publishing industry-sponsored research in peer-reviewed journals, mainly working in pharmaceutical or device companies (‘industry’, n=144), communication agencies (‘agency’, n=238), contract research organisations (CRO, n=15) or as freelancers (n=34). Most respondents (78%) had worked on medical publications for ≥5 years and 62% had a PhD/MD.

Results

Over 90% of industry, agency and CRO respondents routinely refer to Good Publication Practice (GPP2) and the International Committee of Medical Journal Editors’ Uniform Requirements. Most respondents (78% industry, 79% agency) received mandatory training on ethical publication practices. Over 90% of respondents’ companies had publication guidelines or policies and required medical writing support to be acknowledged in publications (96% industry, 99% agency). Many industry respondents used publication management tools to monitor compliance with company guidelines and about half (46%) stated that their company had formal publication audits. Fewer agencies audited adherence to guidelines but 20% of agency respondents reported audits of employees and 6% audits of freelancers. Of concern, 37% of agency respondents reported requests from authors or sponsors that they believed were unethical, although 93% of these requests were withdrawn after respondents explained the need for compliance with guidelines. Most respondents’ departments (63% industry, 58% agency, 60% CRO) had been involved in publishing studies with negative or inconclusive results.

Conclusions

Within this sample, most publication professionals working in or for industry were aware of, and applying, major publication guidelines. However, the survey also identified specific areas where education and promotion of guidelines are needed to ensure ethical publication practices.
Simulating the impact of changing trends in smoking and obesity on productivity of an industrial population: an observational study
Authors: Bhojani Faiyaz A , Tsai Shan P , Wendt Judy K , Koller Kim L
Published: April 2014

Objective

To estimate the impact of trends in smoking and obesity prevalence on productivity loss among petrochemical employees from 1980 to 2009.

Methods

Smoking and obesity informations were collected during company physical examinations. Productivity loss was calculated as differential workdays lost between smokers and non-smokers, and obese and normal-weight employees.

Results

During 1980–2009, smoking prevalence decreased from 32% to 17%, while obesity prevalence increased from 14% to 42%. In 1982, lost productivity from obesity was an estimated 43 days/100 employees, and for smoking, 65 days/100 employees, but by 1987, workdays lost due to obesity exceeded that attributable to smoking. In 2007, workdays lost from obesity were 3.7 times higher than for smoking.

Conclusions

Owing to the increasing trend in obesity, the productivity impact on employers from obesity will continue to rise without effective measures supporting employee efforts to achieve healthy weight through sustainable lifestyle changes.