bluuebunny/crossref_metadata_2025 huggingface dataset:
The agreement between oscillometric and intra‐arterial technique for blood pressure monitoring in the lower extremities for infants and toddlers undergoing aortic coarctation repair
Authors: Peng Zhe‐Zhe , Zhang Ma‐Zhong , Sun Ying , Bai Jie , Gu Hong‐Bin , Liu Pei‐Pei , Li Min , Cai Mei‐Hua
Published: August 2016

Objective

Anesthetic management for patients undergoing surgical repair of aortic coarctation (CoA) should include constant blood pressure monitoring of the right upper extremity and a lower extremity. The delayed or absent pulse in the lower limbs often leads to unsuccessful arterial cannulation in infants and the oscillometric technique used for blood pressure measurement. The aim of this study was to evaluate the agreement between the oscillometric method and intra‐arterial technique for blood pressure monitoring in the lower limbs of infants undergoing CoA.

Methods

A total of 45 infants diagnosed with isolated CoA were initially enrolled in this study and five were excluded because of cannulation failure. Thus, 40 patients had their blood pressure measured simultaneously by both oscillometric technique on the thigh and femoral artery catheterization. After induction and intubation, five pairs of blood pressure readings from each patient were collected in an interval of 3 min. Statistical analysis was accomplished by revised Bland–Altman analysis.

Results

There was a strong correlation between oscillometric and invasive blood pressure measurements [systolic blood pressure (SBP) r = 0.771, diastolic blood pressure (DBP) r = 0.704 and mean artery pressure (MAP) r = 0.850]. The mean difference and 95% limits of agreement (95% LOA) between oscillometric and femoral artery blood pressure readings was 3.830 mmHg (−19.297, 26.957) for SBP, −8.725 mmHg (−26.236, 8.786) for DBP, and −3.235 mmHg (−18.842, 12.372) for MAP. There were only one pair of MAP (1/40) and two pairs of SBP readings (2/40) out of range (95% LOA), and all of paired DBP readings were within 95% LOA.

Conclusion

There was a good agreement between oscillometric and invasive blood pressure measurements of lower extremities in infants with isolated CoA statistically. However, the oscillometry‐measured SBP showed a tendency to overestimate the intra‐arterial blood pressure reference, while oscillometry‐measured DBP underestimated its reference. MAP measurement provided the most accurate and reliable results in this study.
Gastric ultrasound as a preoperative bedside test for residual gastric contents volume in children
Authors: Schmitz Achim , Schmidt Alexander R. , Buehler Philipp K. , Schraner Thomas , Frühauf Melanie , Weiss Markus , Klaghofer Richard , Kellenberger Christian J.
Published: August 2016

Background

Emergency situations and conditions with impaired gastric emptying enhance the risk of perioperative pulmonary aspiration due to increased residual gastric contents volume (GCV). Gastric ultrasonographic (US) measurement of the gastric antral cross‐sectional area (CSA) has been proposed to estimate preanesthetic GCV. However, only few healthy children and fasted pediatric patients have been investigated so far, predicting GCV with considerable imprecision. This study aimed to compare GCV assessed by US in different patient positions for measuring CSA, using magnetic resonance imaging (MRI) as reference, and to evaluate its potential as diagnostic test.

Methods

Healthy volunteer children were examined in a crossover design on 2 days. After baseline examination, they received a light breakfast, followed by 7 ml·kg−1 clear fluid after 2 or 4 h. Gastric emptying was examined with MRI over 4 or 6 h, respectively. US was performed immediately after MRI in right lateral decubital (RLD) and supine with upper body elevated (SUBE) positions. Correlation coefficients (Pearson R; 95%CI) between CSA and body weight corrected GCV (GCVw) as determined by MRI volumetry were calculated. Data are presented as median (range).

Results

Eighteen children aged 9.8 (6.8–12.2) years had 72 US examinations completed. CSA was 401 (101–1311) mm2 and 271 (118–582) mm2, and R between CSA and GCVw was 0.76 (0.76–1) and 0.57 (0.41–0.88) for the RLD and SUBE positions, respectively. The corresponding GCVw was 2.1 (0.1–13.8) ml·kg−1. A linear regression model from RLD was similar to one previously derived. Bland–Altman analysis and ROC plots are presented.

Conclusion

CSA correlated with GCVw in healthy children over a wide range of gastric filling, with the RLD position clearly superior to the SUBE position, confirming a previously derived formula. Although direct calculation of GCVw is imprecise, this technique has the potential to become a diagnostic risk assessment test.
Balance in children with acute lymphoblastic leukemia
Authors: Varedi Mitra , McKenna Raymond , Lamberg Eric M
Published: August 2016

Background

Treatment for acute lymphoblastic leukemia (ALL) can affect balance via different mechanisms, including sensory and motor peripheral neuropathy, cognitive impairment, and reduced muscle strength and flexibility. To provide an overview of what is currently known about the effects of cancer treatment on balance in pediatric ALL patients and survivors, and of the predictors of poor balance, a review of the literature was conducted.

Methods

Five databases were searched for English‐language original research articles on balance during or after treatment for pediatric ALL.

Results

From a total of nine studies, six identified significant balance problems in children with ALL during or after treatment. The percentage of patients or survivors with impaired balance varied between 27% and 69% during treatment, 7% and 65% a few years after completion of treatment, and 14% and 17% many years after the completion of treatment. Factors associated with impaired balance were higher body mass index; higher intrathecal methotrexate dose; cranial radiation; knee extensor weakness; and impaired cognition.

Conclusion

Although heterogeneity between the studies regarding patient age; age at diagnosis; time since completion of treatment; and methods of quantifying balance make it difficult to reach a single conclusion, the evidence suggests that survivors may experience short‐ and/or long‐term balance difficulties. While there is a need for additional studies to better understand the effects of impaired balance in survivors, clinicians treating both child and adult survivors of ALL need to be aware of these potential risks.
Reproductive biology of a hummingbird‐pollinated Billbergia: light influence on pollinator behaviour and specificity in a Brazilian semi‐deciduous forest
Authors: Pansarin E. R. , de Pedro S. R. M.
Published: August 2016

Ornithophily has evolved in parallel several times during evolution of angiosperms. Bird pollination is reported for 65 families, including Bromeliaceae. One of the most diverse bromeliad is Billbergia, which comprises species pollinated mainly by hummingbirds.

Based on investigations on flowering phenology, morpho‐anatomy, volume and concentration of nectar, pollinators and breeding system, this paper explores the reproductive biology and pollinator specificity of B. distachia in a mesophytic semi‐deciduous forest of southeastern Brazil.

The results have show that B. distachia is pollinated by a single species of hermit hummingbird, Phaethornis eurynome, which search for nectar produced by a septal nectary, where the secretory tissue is located above the placenta. The species is self‐incompatible. The combination of pollinator specificity, due to long corolla tubes that exclude visitation of short‐billed hummingbirds, complete self‐incompatibility and non‐territorial behaviour of pollinators, it is very important to reduce pollen loss and increase gene flow within population.

Our results indicate that studies on pollination biology and reproduction are essential to understand the evolutionary history of pollination systems of plants since, at least in Billbergia, variation in the pollinator spectrum has been recorded for different habitats among Brazilian forests. Furthermore, according to our data, foraging of Phaethornis on flowers is independent of air temperature and humidity, while the main factor influencing hummingbird visitation is daylight. Considering current knowledge on climatic parameters influencing hummingbird foraging, pollination and reproductive biology of Neotropical flora and environment of the hermit hummingbird in tropical forests, new insights on plant–pollinator interaction are provided.
Advocacy Group Messaging on Social Media: Using the Narrative Policy Framework to Study Twitter Messages about Nuclear Energy Policy in the United States
Authors: Gupta Kuhika , Ripberger Joseph , Wehde Wesley
Published: August 2016

Increasingly, policy scholars are using the Narrative Policy Framework (NPF) to systematically study the narrative elements and strategies that policy actors and groups use to advance their agendas. The majority of these studies analyze reports, documents, and websites published by the actors and groups that are most active in the policy subsystem. Though useful, these “public consumption documents” can be difficult to find and relatively static. In this article, we suggest that the constant flow of messages and content that competing actors and groups publish on social media may provide a solution to this problem. To test this proposition, we use the NPF to analyze messages published on Twitter by competing advocacy groups in the U.S. nuclear energy policy subsystem from January 2014 to May 2014 (n = 703). We find that both groups use Twitter to disseminate messages that contain the basic elements of policy narratives. Moreover, the narratives they use include strategies that are consistent with their position in the subsystem. These findings demonstrate the utility of the NPF for research on social media and, more importantly, validate the use of Twitter data in future work on the NPF.
Towards a Natural History of Foodgetting
Authors: Friedmann Harriet
Published: August 2016

Like all species, humans change our environments to get food.Foodgetting is the dimension of human history that links us directly and indirectly with all other beings. Inescapably and at once both historical and natural, human foodgetting can be understood both as natural history and as historical nature. It implicates our species being in the evolving web of life. In its complex embodied, encultured and social relations, human nature evolves. To embrace that recognition requires thorough revision of inherited ideas. I draw on specific contributions among many thinkers engaged in this project by following a foodgetting thread through several literatures: (1) approaches to reconnecting natural with social sciences of human nature; (2) a “deep history” (Shryock and Smail 2011) of agriculture, which connects prehistory to written history, by Mazoyer and Roudart (1997, 2006), and its limits; (3) ecological resilience theory, and its model of panarchy, which resonates with emergence, dissolution, and reconstellation of food regimes and food regime transitions. This sets the stage for (4) clarifying different paths taken by food regime analysts, including my differences with co‐founder Philip McMichael. (5) I conclude by suggesting an approach to intentional change of human institutions centred on emergence, and (6) an example of emerging ways of organising territory centred on foodgetting.
The seismogenic thickness in Italy: constraints on potential magnitude and seismic hazard
Authors: Chiarabba Claudio , De Gori Pasquale
Published: August 2016

The thickness of the seismogenic layer is a key parameter for seismic hazard, since it can be used to constrain the maximum depth of faulting and the potential magnitude. In this study, we compute the seismogenic thickness in the Italian region by defining the lower seismicity cut‐off, using high‐quality hypocentral locations of earthquakes that occurred in the past decade. Along the eastern Alps, the seismogenic thickness is about 12–14 km, laterally homogeneous along the entire south‐verging thrust front. In the Apennines extensional belt, lateral changes in seismogenic thickness are evident, and correlate with changes in the seismic energy released by past earthquakes. The potential magnitude is larger in the southern Apennines where the seismogenic thickness is greater (16–18 km) than in the northern Apennines where it is less (6–10 km) and seismic energy is partially released by the creeping of faults.
Using Spatial Analysis to Understand the Spatial Heterogeneity of Disability Employment in China
Authors: Liao Yilan , Wang Jinfeng , Du Wei , Gao Bingbo , Liu Xin , Chen Gong , Song Xinming , Zheng Xiaoying
Published: August 2016

During the formulation of employment disability policy, policymakers are often interested in regional variations of disability employment. Decision‐makers are required to distinguish between various geographical factors. However, few previous studies take spatial heterogeneity into account and most of them conducted only a qualitative analysis. Geographical detectors based on spatial variation analyses of identified factors were applied in the study to establish connections between regional features and the disability employment rate, and to identify the city groups with significantly higher and lower percentage rates of disability employment. It is the first application of spatial statistics in studying the employment problem of the disabled. The findings can help the government formulate reasonable adjustments to both job opportunities for, and work roles of, disabled people.
A sum-over-paths approach to one-dimensional time-independent quantum systems
Authors: Malgieri Massimiliano , Onorato Pasquale , De Ambrosis Anna
Published: August 2016

We present an alternative treatment for simple time-independent quantum systems in one dimension, which can be used in the context of an elementary introduction to quantum physics using the Feynman approach. The method is based on representation of the energy-dependent propagator (or Green function) as a sum of complex amplitudes over all possible paths, classical and non-classical, at fixed energy. We treat both confined and open systems with piecewise-constant potentials, obtaining exact results. We introduce an approximation scheme to extend the method to smooth potentials, recovering the Van Vleck-Gutzwiller propagator. Finally, we discuss the educational application of the method.
Predicting the influence of plate geometry on the eddy-current pendulum
Authors: Weigel Catherine , Wachter Jeremy M. , Wagoner Paul , Atherton Timothy J.
Published: August 2016

We quantitatively analyze a familiar classroom demonstration, Van Waltenhofen's eddy current pendulum, to predict the damping effect for a variety of plate geometries from first principles. Results from conformal mapping, finite element simulations, and a simplified model suitable for introductory classes are compared with experiments.
An adjustable parallel-plate capacitor instrument—Test of the theoretical capacitance formula
Authors: Wells Beau , Baker Emily , Farwell Austin , Foster Harrison , Gao Xiaohan , Gruber Benjamin , Jones Erica , Vu Dennis , Xu Sonya , Ye Jingbo
Published: August 2016

We describe an adjustable parallel-plate capacitor apparatus designed for use in an undergraduate laboratory that permits precise variation of plate separation distances and overlap area. Two experiments are performed with the device to test the ideal capacitor formula derived from Gauss's Law. After correcting for edge effects and minor plate tilt, the device yields capacitance values within 3% of theoretical values.
Action physics
Authors: McGinness Lachlan P. , Savage C. M.
Published: August 2016

More than a decade ago, Edwin Taylor issued a “call to action” that presented the case for basing introductory university mechanics teaching around the principle of stationary action [E. F. Taylor, Am. J. Phys. 71, 423–425 (2003)]. We report on our response to that call in the form of an investigation of the teaching and learning of the stationary action formulation of physics in a first-year university course. Our action physics instruction proceeded from the many-paths approach to quantum physics to ray optics, classical mechanics, and relativity. Despite the challenges presented by action physics, students reported it to be accessible, interesting, motivational, and valuable.
Attending to experimental physics practices and lifelong learning skills in an introductory laboratory course
Authors: Gandhi Punit R. , Livezey Jesse A. , Zaniewski Anna M. , Reinholz Daniel L. , Dounas-Frazer Dimitri R.
Published: August 2016

We have designed an introductory laboratory course that engaged first-year undergraduate students in two complementary types of iteration: (1) iterative improvement of experiments through cycles of modeling systems, designing experiments, analyzing data, and refining models and designs; and (2) iterative improvement of self through cycles of reflecting on progress, soliciting feedback, and implementing changes to study habits and habits of mind. The course consisted of three major activities: a thermal expansion activity, which spanned the first half of the semester; final research projects, which spanned the second half of the semester; and guided student reflections, which took place throughout the duration of the course. We describe our curricular designs and report examples of student work that demonstrate students' iterative improvements in multiple contexts.
The least uncomfortable journey from A to B
Authors: Anderson D. , Desaix M. , Nyqvist R.
Published: August 2016

A short introduction is given about direct variational methods and their relation to Galerkin and moment methods, all flexible and powerful approaches for finding approximate solutions to difficult physical equations. An application of these methods is given in the form of the variational problem of minimizing the discomfort experienced during different journeys, between two fixed horizontal points while keeping the travel time constant. The analysis is shown to provide simple, yet accurate, approximate solutions of the problem and illustrates the usefulness and the power of direct variational and moment methods. It also demonstrates the problem of a priori assessing the accuracy of the approximate solutions and illustrates that the variational solution does not necessarily provide a more accurate solution than that obtained by moment methods.
An exciton-polariton laser based on biologically produced fluorescent protein
Authors: Dietrich Christof P. , Steude Anja , Tropf Laura , Schubert Marcel , Kronenberg Nils M. , Ostermann Kai , Höfling Sven , Gather Malte C.
Published: August 2016

Microcavities filled with biologically produced green fluorescent protein show polariton condensation at room temperature.
Self-organization in precipitation reactions far from the equilibrium
Authors: Nakouzi Elias , Steinbock Oliver
Published: August 2016

Self-organized precipitation structures might hold the key to a new microengineering paradigm that grows materials biomimetically.
Can mantle convection be self-regulated?
Authors: Korenaga Jun
Published: August 2016

Contrary to a popular belief, the thermal evolution of terrestrial planets can be highly sensitive to initial conditions.
High Prevalence of Diverse Insertion Sequences within the rRNA Operons of Mycoplasma bovis
Authors: Amram Eytan , Borovok Ilya , Nachum-Biala Yaarit , Ayling Roger , Lerner Uri , Harrus Shimon , Lysnyansky Inna
Published: August 2016

Insertion sequences (ISs) are widespread in the genome of
Mycoplasma bovis
strain PG45, but no ISs were identified within its two tandemly positioned rRNA operons (
rrn1
and
rrn2
). However, characterization of the
rrn
locus in 70
M. bovis
isolates revealed the presence of ISs related to the IS
Mbov1
(IS
30
family) and IS
Mbov4
(IS
4
family) isomers in 35 isolates. ISs were inserted into intergenic region 1 (IGR-1) or IGR-3, which are the putative promoter regions of
rrn1
and
rrn2
, respectively, and into IGR-5, located downstream of the
rrl2
gene. Seven different configurations (A to G) of the
rrn
locus with respect to ISs were identified, including those in five annotated genomes. The transcriptional start site for the single
rrn
operon in
M. bovis
strain 88127 was mapped within IGR-1, 60 bp upstream of the
rrs
gene. Notably, only 1 nucleotide separated the direct repeat (DR) for IS
Mbov1
and the promoter –35 element in configuration D, while in configuration F, the −35 motif was a part of the IS
Mbov1
DR. Relative quantitative real-time (qRT) PCR analysis and growth rate comparisons detected a significant increase (
P
< 0.05) in the expression of the
rrs
genes and in the number of viable cells during log phase growth (8, 12, and 16 h) in the strains with configuration F in comparison to strains with one or two
rrn
operons that did not have ISs. A high prevalence of IS elements within or close to the
M. bovis
rrn
operon-promoter region may reflect their important role in regulation of both ribosome synthesis and function.

IMPORTANCE
Data presented in this study show a high prevalence of diverse ISs within the
M. bovis rrn
locus resulting in intraspecies variability and diversity. Such abundance of IS elements near or within the
rrn
locus may offer a selective advantage to
M. bovis
. Moreover, the fact that expression of the
rrs
genes as well as the number of viable cells increased in the group of strains with IS element insertion within a putative promoter −35 sequence (configuration F) in comparison to that in strains with one or two
rrn
operons that do not have ISs may serve as a basis for understanding the possible role of
M. bovis
IS elements in fundamental biological processes such as regulation of ribosome synthesis and function.
Comparison of Microbial and Chemical Source Tracking Markers To Identify Fecal Contamination Sources in the Humber River (Toronto, Ontario, Canada) and Associated Storm Water Outfalls
Authors: Staley Zachery R. , Grabuski Josey , Sverko Ed , Edge Thomas A.
Published: August 2016

Storm water runoff is a major source of pollution, and understanding the components of storm water discharge is essential to remediation efforts and proper assessment of risks to human and ecosystem health. In this study, culturable
Escherichia coli
and ampicillin-resistant
E. coli
levels were quantified and microbial source tracking (MST) markers (including markers for general
Bacteroidales
spp., human, ruminant/cow, gull, and dog) were detected in storm water outfalls and sites along the Humber River in Toronto, Ontario, Canada, and enumerated via endpoint PCR and quantitative PCR (qPCR). Additionally, chemical source tracking (CST) markers specific for human wastewater (caffeine, carbamazepine, codeine, cotinine, acetaminophen, and acesulfame) were quantified. Human and gull fecal sources were detected at all sites, although concentrations of the human fecal marker were higher, particularly in outfalls (mean outfall concentrations of 4.22 log
10
copies, expressed as copy numbers [CN]/100 milliliters for human and 0.46 log
10
CN/100 milliliters for gull). Higher concentrations of caffeine, acetaminophen, acesulfame,
E. coli
, and the human fecal marker were indicative of greater raw sewage contamination at several sites (maximum concentrations of 34,800 ng/liter, 5,120 ng/liter, 9,720 ng/liter, 5.26 log
10
CFU/100 ml, and 7.65 log
10
CN/100 ml, respectively). These results indicate pervasive sewage contamination at storm water outfalls and throughout the Humber River, with multiple lines of evidence identifying Black Creek and two storm water outfalls with prominent sewage cross-connection problems requiring remediation. Limited data are available on specific sources of pollution in storm water, though our results indicate the value of using both MST and CST methodologies to more reliably assess sewage contamination in impacted watersheds.

IMPORTANCE
Storm water runoff is one of the most prominent non-point sources of biological and chemical contaminants which can potentially degrade water quality and pose risks to human and ecosystem health. Therefore, identifying fecal contamination in storm water runoff and outfalls is essential for remediation efforts to reduce risks to public health. This study employed multiple methods of identifying levels and sources of fecal contamination in both river and storm water outfall sites, evaluating the efficacy of using culture-based enumeration of
E. coli
, molecular methods of determining the source(s) of contamination, and CST markers as indicators of fecal contamination. The results identified pervasive human sewage contamination in storm water outfalls and throughout an urban watershed and highlight the utility of using both MST and CST to identify raw sewage contamination.
Fitness of Enterohemorrhagic Escherichia coli (EHEC)/Enteroaggregative E. coli O104:H4 in Comparison to That of EHEC O157: Survival Studies in Food and
In Vitro
Authors: Böhnlein Christina , Kabisch Jan , Meske Diana , Franz Charles M. A. P. , Pichner Rohtraud
Published: August 2016

In 2011, one of the world's largest outbreaks of hemolytic-uremic syndrome (HUS) occurred, caused by a rare
Escherichia coli
serotype, O104:H4, that shared the virulence profiles of Shiga toxin-producing
E. coli
(STEC)/enterohemorrhagic
E. coli
(EHEC) and enteroaggregative
E. coli
(EAEC). The persistence and fitness factors of the highly virulent EHEC/EAEC O104:H4 strain, grown either in food or
in vitro
, were compared with those of
E. coli
O157 outbreak-associated strains. The log reduction rates of the different EHEC strains during the maturation of fermented sausages were not significantly different. Both the O157:NM and O104:H4 serotypes could be shown by qualitative enrichment to be present after 60 days of sausage storage. Moreover, the EHEC/EAEC O104:H4 strain appeared to be more viable than
E. coli
O157:H7 under conditions of decreased pH and in the presence of sodium nitrite. Analysis of specific EHEC strains in experiments with an EHEC inoculation cocktail showed a dominance of EHEC/EAEC O104:H4, which could be isolated from fermented sausages for 60 days. Inhibitory activities of EHEC/EAEC O104:H4 toward several
E. coli
strains, including serotype O157 strains, could be determined. Our study suggests that EHEC/EAEC O104:H4 is well adapted to the multiple adverse conditions occurring in fermented raw sausages. Therefore, it is strongly recommended that STEC strain cocktails composed of several serotypes, instead of
E. coli
O157:H7 alone, be used in food risk assessments. The enhanced persistence of EHEC/EAEC O104:H4 as a result of its robustness, as well as the production of bacteriocins, may account for its extraordinary virulence potential.

IMPORTANCE
In 2011, a severe outbreak caused by an EHEC/EAEC serovar O104:H4 strain led to many HUS sequelae. In this study, the persistence of the O104:H4 strain was compared with those of other outbreak-relevant STEC strains under conditions of fermented raw sausage production. Both O157:NM and O104:H4 strains could survive longer during the production of fermented sausages than
E. coli
O157:H7 strains.
E. coli
O104:H4 was also shown to be well adapted to the multiple adverse conditions encountered in fermented sausages, and the secretion of a bacteriocin may explain the competitive advantage of this strain in an EHEC strain cocktail. Consequently, this study strongly suggests that enhanced survival and persistence, and the presumptive production of a bacteriocin, may explain the increased virulence of the O104:H4 outbreak strain. Furthermore, this strain appears to be capable of surviving in a meat product, suggesting that meat should not be excluded as a source of potential
E. coli
O104:H4 infection.
Plasmids from Shiga Toxin-Producing Escherichia coli Strains with Rare Enterohemolysin Gene (
ehxA
) Subtypes Reveal Pathogenicity Potential and Display a Novel Evolutionary Path
Authors: Lorenz Sandra C. , Monday Steven R. , Hoffmann Maria , Fischer Markus , Kase Julie A.
Published: August 2016

Most Shiga toxin-producing
Escherichia coli
(STEC) strains associated with severe disease, such as hemolytic-uremic syndrome (HUS), carry large enterohemolysin-encoding (
ehxA
) plasmids, e.g., pO157 and pO103, that contribute to STEC clinical manifestations. Six
ehxA
subtypes (A through F) exist that phylogenetically cluster into
eae
-positive (B, C, F), a mix of
eae
-positive (E) and
eae
-negative (A), and a third, more distantly related, cluster of
eae
-negative (D) STEC strains. While subtype B, C, and F plasmids share a number of virulence traits that are distinct from those of subtype A, sequence data have not been available for subtype D and E plasmids. Here, we determined and compared the genetic composition of four subtype D and two subtype E plasmids to establish their evolutionary relatedness among
ehxA
subtypes and define their potential role in pathogenicity. We found that subtype D strains carry one exceptionally large plasmid (>200 kbp) that carries a variety of virulence genes that are associated with enterotoxigenic and enterohemorrhagic
E. coli
, which, quite possibly, enables these strains to cause disease despite being food isolates. Our data offer further support for the hypothesis that this subtype D plasmid represents a novel virulence plasmid, sharing very few genetic features with other plasmids; we conclude that these plasmids have evolved from a different evolutionary lineage than the plasmids carrying the other
ehxA
subtypes. In contrast, the 50-kbp plasmids of subtype E (pO145), although isolated from HUS outbreak strains, carried only few virulence-associated determinants, suggesting that the clinical presentation of subtype E strains is largely a result of chromosomally encoded virulence factors.

IMPORTANCE
Bacterial plasmids are known to be key agents of change in microbial populations, promoting the dissemination of various traits, such as drug resistance and virulence. This study determined the genetic makeup of virulence plasmids from rare enterohemolysin subtype D and E Shiga toxin-producing
E. coli
strains. We demonstrated that
ehxA
subtype D plasmids represent a novel
E. coli
virulence plasmid, and although subtype D plasmids were derived from nonclinical isolates, they encoded a variety of virulence determinants that are associated with pathogenic
E. coli
. In contrast, subtype E plasmids, isolated from strains recovered from severely ill patients, carry only a few virulence determinants. The results of this study reemphasize the plasticity and vast diversity among
E. coli
plasmids. This work demonstrates that, although
E. coli
strains of certain serogroups may not be frequently associated with disease, they should not be underestimated in protecting human health and food safety.
Outcomes of infants born near term
Authors: Gill Jane V , Boyle Elaine M
Published: August 2016

Most research on outcomes of preterm birth has centred on babies born at <32 weeks gestation and at highest risk of mortality and serious morbidity. Recent years have seen a dramatic increase in studies focusing on late preterm infants (34–36 weeks gestation). Early epidemiological studies demonstrated increased risks of mortality and adverse neonatal outcomes in this group, prompting further investigations. These increased risks have been confirmed and more recent studies have also included babies born at 37–38 weeks, now defined as ‘early-term’ births. It now seems that it is inappropriate to consider term and preterm as a dichotomy; gestational age rather represents a continuum in which risk and severity of adverse outcomes increase with decreasing gestational age, but where measurable effects can be detected even very close to full term. In this review, we summarise current evidence for the outcomes of infants born at late preterm and early-term gestations.
Children and road traffic injuries: can't the world do better?
Authors: Li Qingfeng , Alonge Olakunle , Hyder Adnan A
Published: August 2016

Road traffic injuries (RTI) impose a substantial health burden among children. Globally, 186 300 children (under 18 years) die from RTI each year. It is the fourth leading cause of death among children aged 5–9 years, third among children aged 10–14 years and first among children aged 15–17 years. At the regional level, sub-Saharan Africa accounts for 35.2% of global child deaths caused by RTI; that number is still increasing. Male children are about two times more likely to die due to RTI than female children. RTI are also related to socioeconomic inequalities; low-income and middle-income countries (LMIC) account for 95% of global child RTI deaths, and children from poor households are more likely to fall victims to RTI. Intervention strategies promoted in the five pillars of the Decade of Action for Road Safety 2011–2020 are available to prevent mortality and morbidity caused by RTI, though validation and implementation of such interventions are urgently needed in the LMIC. Through concerted efforts to cultivate strong political will, build action and advocacy capacity, increase global funding and enhance multisectoral collaboration promoted by the Sustainable Development Goals, the world is challenged to do better in saving children from RTI.
Pilot study on identification of incidents in healthcare transitions and concordance between medical records and patient interview data
Authors: van Melle Marije A , Erkelens Daphne C A , van Stel Henk F , de Wit Niek J , Zwart Dorien L M
Published: August 2016

Objective

To investigate whether transitional incidents can be identified from the medical records of the general practitioners and the hospital and to assess the concordance of transitional incidents between medical records and patient interviews.

Design

A pilot study.

Setting

The study was conducted in 2 regions in the Netherlands: a rural and an urban region.

Participants

A purposeful sample of patients who experienced a transitional incident or are at high risk of experiencing transitional incidents.

Main outcome measures

Transitional incidents were identified from both the interviews with patients and medical records and concordance was assessed. We also classified the transitional incidents according to type, severity, estimated cause and preventability.

Results

We identified 28 transitional incidents within 78 transitions of which 3 could not be found in the medical records and another 5 could have been missed without the patient as information source. To summarise, 8 (29%) incidents could have been missed using solely medical records, and 7 (25%) using the patients’ information exclusively. Concordance in transitional incidents between patient interviews and medical records was 64% (18/28). The majority of the transitional incidents were unsafe situations; however, 43% (12/28) of the incidents reached the patient and 18% (5/28) caused temporary patient harm. Over half of the incidents were potentially preventable.

Conclusions

This pilot study suggests that the majority of transitional incidents can be identified from medical records of the general practitioner and hospital. With this information, we aim to develop a measurement tool for transitional incidents in the medical record of general practitioner and hospital.
Parents' and carers' views about emollients for childhood eczema: qualitative interview study
Authors: Santer M , Muller I , Yardley L , Lewis-Jones S , Ersser S , Little P
Published: August 2016

Objective

Leave-on emollients form the mainstay of eczema treatment, but adherence is poor. We aimed to explore parents’/carers' views on effectiveness and acceptability of leave-on emollients for childhood eczema through secondary analysis of data from 2 qualitative data sets.

Setting

Study 1 recruited through mail-out from 6 general practices in southern England. Study 2 recruited from a feasibility trial of an intervention to support eczema self-care in 31 practices in the same area.

Participants

Study 1 included 28 interviews with carers of children aged ≤5 years with eczema. Study 2 included 26 interviews with carers of children aged ≤5 years with eczema.

Methods

Interviews followed semistructured guides: study 1 explored carers' understandings around eczema treatments in order to develop a web-based self-care support intervention; study 2 explored carers' understandings of eczema and eczema treatments after using the intervention. Interviews were carried out face to face or by telephone, audio-recorded and transcribed. Secondary analysis of data from both studies focused on views and experiences of emollient use. Data were analysed using an inductive thematic approach facilitated by NVivo V.10 software.

Results

In study 1, most participants felt emollients improved eczema but held mixed views about long-term use to prevent flare-ups. In study 2, where carers had used the web-based intervention, all participants held positive views about long-term emollient use. In both studies, participants expressed a range of preferences about emollient ‘thickness’; some felt that ‘thick’ emollients (ointments) were most effective, while others found these difficult to use. Carers described a process of ‘trial and error’, trying emollients suggested by professionals, friends and family, or bought over-the-counter. Carers expressed a need for understanding differences between products and their effective use.

Conclusions

Providing a rationale for long-term emollient use and choice of emollients could help improve adherence and help families gain more rapid control of eczema.
Epidemiology and temporal trend of suicide mortality in the elderly in Jiading, Shanghai, 2003–2013: a descriptive, observational study
Authors: Shao Yueqin , Zhu Chenghua , Zhang Yiying , Yu Hongjie , Peng Hui , Jin Yaqing , Shi Guozheng , Wang Na , Chen Zheng , Chen Yue , Jiang Qingwu
Published: August 2016

Objectives

To investigate and describe the epidemiological characteristics of suicide in the elderly in Jiading, Shanghai, for the period 2003–2013.

Design

Retrospective, observational, epidemiological study using routinely collected data.

Setting

Jiading District, Shanghai.

Methods

Suicide data were retrieved from the Shanghai Vital Registry database for the period 2003–2013. Crude and age-standardised mortality rates were calculated for various groups according to sex and age. Joinpoint regression was performed to estimate the percentage change (PC) and annual percentage change (APC) for suicide mortality.

Result

A total of 956 deaths due to suicide occurred among people aged ≥65 years during the study period, accounting for 76.7% (956/1247) of all suicide decedents. Among the 956 people with suicide deaths, 88.7% (848/956) had a history of a psychiatric condition. The age-standardised mortality rates for suicide without and with a psychotic history in people aged ≥65 years were much higher than those for people aged <65 years in both genders. Suicide mortality in the elderly showed a declining trend, with a PC of −51.5% for men and −47.5% for women. The APC was −29.1 in 2003–2005, 4.6 in 2005–2008 and −9.7 in 2008–2013 for aged men, and −12.2 in 2003–2006 and −5.2 in 2006–2013 for aged women, respectively. Women living in Jiading had a higher risk of suicide death than men, especially among the elderly. The mortality rate for suicide increased with age in the elderly, and was more marked for those with a psychiatric history than for those without.

Conclusions

Suicide mortality declined in Jiading during the study period 2003–2013 overall, but remained high in the elderly, especially those with a psychiatric history.
Emergency Department care of childhood epistaxis
Authors: Béquignon E , Teissier N , Gauthier A , Brugel L , De Kermadec H , Coste A , Prulière-Escabasse V
Published: August 2016

Objective

The aim of this review is to determine an efficient and safe primary strategy care for paediatric epistaxis.

Data sources

We searched PubMed and Cochrane databases for studies referenced with key words ‘epistaxis AND childhood’. This search yielded 32 research articles about primary care in childhood epistaxis (from 1989 to 2015). Bibliographic references found in these articles were also examined to identify pertinent literature. We compared our results to the specific management of adult epistaxis classically described in the literature.

Results

Epistaxis is one of the most common reasons for referral of children to a hospital ENT outpatient department. The bleeding usually originates from the anterior septum, as opposed to adults. Crusting, digital trauma, foreign bodies and nasal colonisation withStaphylococcus aureushave been suggested as specific nosebleed factors in children. Rare aetiologies as juvenile nasopharyngeal angiofibroma appear later during adolescence. There are different modes of management of mild epistaxis, which begin with clearing out blood clots and bidigital compression. An intranasal topical local anaesthetic and decongestant can be used over 6 years of age. In case ofactive bleeding,chemicalcauterisation is preferred to anterior packing andelectriccauterisation but is only feasible if the bleeding site is clearly visible. In case ofnon-active bleedingin children, and in those with recurrent idiopathic epistaxis, antiseptic cream is easy to apply and can avoid ‘acrobatic’ cauterisation liable to cause further nasal cavity trauma.

Conclusions

Aetiologies and treatment vary with patient age and the existence or not of active bleeding at the time of the examination. Local treatments are usually easy to perform, but physicians have to ponder their indications depending on the possible complications in order to inform parents and to know paediatric epistaxis specificities.
Randomised controlled trial of long-term maintenance corticosteroid therapy in patients with autoimmune pancreatitis
Authors: Masamune Atsushi , Nishimori Isao , Kikuta Kazuhiro , Tsuji Ichiro , Mizuno Nobumasa , Iiyama Tatsuo , Kanno Atsushi , Tachibana Yuichi , Ito Tetsuhide , Kamisawa Terumi , Uchida Kazushige , Hamano Hideaki , Yasuda Hiroaki , Sakagami Junichi , Mitoro Akira , Taguchi Masashi , Kihara Yasuyuki , Sugimoto Hiroyuki , Hirooka Yoshiki , Yamamoto Satoshi , Inui Kazuo , Inatomi Osamu , Andoh Akira , Nakahara Kazuyuki , Miyakawa Hiroyuki , Hamada Shin , Kawa Shigeyuki , Okazaki Kazuichi , Shimosegawa Tooru
Published: August 2016

Objective

Corticosteroid has been established as the standard therapy for autoimmune pancreatitis (AIP), but the requirement for maintenance corticosteroid therapy is controversial. We conducted a randomised controlled trial to clarify the efficacy of maintenance corticosteroid therapy in patients with AIP.

Design

We conducted a multicentre, tertiary setting, randomised controlled trial. After the induction of remission with the initial oral prednisolone (PSL) treatment, maintenance therapy with PSL at 5–7.5 mg/day was continued for 3 years or withdrawn at 26 weeks. The primary endpoint was relapse-free survival over 3 years and the secondary endpoint was serious corticosteroid-related complications. All analyses were performed on an intention-to-treat basis.

Results

Between April 2009 and March 2012, 49 patients with AIP were randomly assigned to the maintenance therapy group (n=30) or the cessation group (n=19). Baseline characteristics were not different between the two groups. Relapses occurred within 3 years in 11 out of 19 (57.9%) patients assigned to the cessation group, and in 7 of 30 (23.3%) patients in the maintenance therapy group. The relapse rate over 3 years was significantly lower in the maintenance therapy group than that in the cessation group (p=0.011). The relapse-free survival was significantly longer in the maintenance therapy group than that in the cessation group (p=0.007). No serious corticosteroid-related complications requiring discontinuation of PSL were observed.

Conclusions

Maintenance corticosteroid therapy for 3 years may decrease relapses in patients with AIP compared with those who discontinued the therapy at 26 weeks.

Trial registration number

UMIN000001818; Results.
The usefulness of a novel fully automated PCR-based Idylla test for detection of the BRAF V600E mutation in thyroid tissue: comparison with PNA-clamping PCR, real-time PCR and pyrosequencing
Authors: Yeo Min-Kyung , Jung Min-Kyu , Lee Su-Yel , Lee Yong-Moon , Hur Gang Min , Kim Jin-Man
Published: August 2016

Introduction

The BRAF V600E mutation is the most common genetic event in papillary thyroid carcinoma (PTC). The BRAF V600E mutational status has a significant diagnostic and prognostic role in PTC since it can be detected in 32%–87% of PTC by various molecular methods.

Aim(s)

A novel, fully automated real-time PCR-based Idylla test is assessed to detect the BRAF mutation in formalin-fixed paraffin-embedded (FFPE) thyroid samples.

Methods

99 PTC and 11 nodular hyperplasia FFPE thyroid tissues are evaluated for the BRAF V600E mutation by the Idylla tests and compared with peptide nucleic acid-clamping PCR, real-time PCR and pyrosequencing.

Results

The sensitivity and specificity of the Idylla test to detect BRAF V600E are 98.8% and 100%, which is superior to real-time PCR and pyrosequencing. The concordance between Idylla and true positive is highest at 0.974.

Conclusions

This study validates that the Idylla test is a sensitive and specific method to detect BRAF V600E in FFPE thyroid tissues. A simple, quick and easy to handle Idylla test is a useful and reliable molecular technique to evaluate BRAF mutations.
Interpretation of Pulmonary Function Tests: Beyond the Basics
Authors: Staitieh Bashar S , Ioachimescu Octavian C
Published: August 2016

Although the general framework described in the joint American Thoracic Society/European Respiratory Society guidelines provides a useful and practical method for the interpretation of pulmonary function tests, several other measurements and functional indices, if understood correctly, may help in diagnosis and management of patients with respiratory diseases and in design of research protocols. This review provides information on the underlying physiology, interpretative caveats, and the evidence supporting the use of a number of these indices. Some of these measurements, such as the inspiratory fraction, inspiratory capacity/total lung capacity (IC/TLC), may offer additional prognostic information, while others, such as residual volume (RV)/TLC and forced expiratory volume in 3 s/forced vital capacity (FEV3/FVC), may help fill in the gaps between patient symptoms and more traditional indices of pulmonary function. Although most studies of non-traditional indices focus on airflow-limiting disorders, many can be fruitfully applied in other settings. Understanding the physiology that catalyzed these investigations will undoubtedly enrich the functional assessment armamentarium of the practicing clinician and researcher.