bluuebunny/crossref_metadata_2025 huggingface dataset:
A research agenda for moving early medical pregnancy termination over the counter
Authors: Kapp N , Grossman D , Jackson E , Castleman L , Brahmi D
Published: March 2017

Given the overall safety profile and increasing availability of medical pregnancy termination drugs, we asked: would the mifepristone–misoprostol regimen for medical termination at ≤10 weeks of gestation meet US Food and Drug Administration regulatory criteria for over‐the‐counter (OTC) approval, and if not, what are the present research gaps? We conducted a literature review of consumer behaviours necessary for a successful OTC application for medical termination at ≤10 weeks of gestation and identified crucial research gaps. If we were to embark on a development programme for OTC or more generally, self‐use of medical termination, the critical elements missing are the label comprehension, self‐selection and actual use studies.

Tweetable abstract

Considering medical pregnancy termination through the over‐the‐counter regulatory lens clarifies critical evidence gaps.
Ketamine reduces the need for intubation in patients with acute severe mental illness and agitation requiring transport to definitive care: An observational study
Authors: Parsch Cathrin S , Boonstra Adrianne , Teubner David , Emmerton Wade , McKenny Brian , Ellis Daniel Y
Published: March 2017

Objectives

The aim of this study was to review mental health patients transported by a dedicated statewide critical care retrieval team before and after the implementation of a ketamine sedation guideline.

Methods

This is a a retrospective cohort study of mental health patients with acute behavioural disturbance, transported between January 2010 and December 2015.

Results

A total of 78 patients were transported in the study period, 50 before and 28 after implementation of the ketamine guideline in June 2013. The introduction of the ketamine guideline was associated with a significant reduction in intubation for transport (36.00 vs 7.14%) (odds ratio 0.14, 95% confidence interval 0.02–0.71, P < 0.01). The likelihood of utilising ketamine for non‐intubated patients (n = 58) was higher in the period after implementation (37.50 vs 84.62%, odds ratio 9.17, 95% confidence interval 2.54–33.08, P < 0.005). The incidence of complications in our series was low.

Conclusions

The implementation of a ketamine clinical practice guideline for agitated mental health patients was associated with an increase in the number of patients receiving ketamine as part of their sedation regime and a reduction in the number of patients requiring intubation for transport. Appropriately trained critical care retrieval teams should consider ketamine as part of the sedation regime for agitated mental health patients.
Adherence to national exercise guidelines by patients attending emergency departments: A multi‐site survey
Authors: Berlingeri Paul , Cunningham Neil , Taylor David McD , Knott Jonathan , McLean Daniel , Gavan Rex , Plant Luke , Chen Hayley , Weiland Tracey
Published: March 2017

Objective

The proportion of adults in Australia meeting or exceeding the national guidelines for physical activity has remained relatively static over the past 10 years. The research objective was to measure self‐reported physical activity and sedentary behaviour among ED patients in accordance with Australia's current physical activity and sedentary behaviour guidelines, revised in 2014.

Methods

A convenience sample of participants was recruited from three EDs in Melbourne between February and May 2016. Eligible participants were administered the International Physical Activity Questionnaire – Short Form plus researcher‐derived questions. Participants were assessed as whether meeting the physical activity guidelines or not, using pre‐defined criteria.

Results

The proportion of 18–64 year olds meeting all of the physical activity guidelines was 19.0% (95% confidence interval [CI] 15.2–22.8). A majority of participants (63.1%, 95% CI 58.5–67.7) met the aerobic component of the guidelines although only 28.9% (95% CI 24.5–33.3) of participants reported undertaking strength building exercises two or more times per week. Adults in the oldest age group were found to be less likely to engage in muscle strengthening exercises (23.3%, n = 30) than those in the youngest age group (40.0%, n = 60, P = 0.005). Average daily sitting time (minutes) did not differ between men (median = 300) and women (median = 360, P = 0.118).

Conclusions

Overall adherence with physical activity guidelines is low among adults attending the ED. All adults need to be encouraged to undertake muscle strengthening activities, especially adults in older age groups.
Thoracic electrical bioimpedance versus suprasternal Doppler in emergency care
Authors: Elwan Mohammed H , Hue Jeremy , Green Samira J , Eltahan Salah M , Sims Mark R , Coats Timothy J
Published: March 2017

Objective

There are a number of cardiac output (CO) monitors that could potentially be used in the ED. Two of the most promising methods, thoracic electrical bioimpedance and suprasternal Doppler, have not been directly compared. The aim of this study was to investigate the feasibility of CO monitoring using suprasternal Doppler and bioimpedance in emergency care and compare haemodynamic data obtained from both monitors.

Methods

Haemodynamic measurements were made on the same group of patients using bioimpedance (Niccomo, Medis, Germany) and suprasternal Doppler (USCOM, Sydney, Australia).

Results

Usable CO data were obtained in 97% of patients by suprasternal Doppler and 87% by bioimpedance. The median CO obtained by Doppler was 3.4 L/min lower than bioimpedance. The stroke volume median was lower by 51 mL in Doppler.

Conclusions

These two methods of non‐invasive cardiac monitoring are not interchangeable. The results suggest that the choice of non‐invasive cardiac monitor is important, but the grounds on which to make this choice are not currently clear.
Usefulness of laboratory and radiological investigations in the management of supraventricular tachycardia
Authors: Ashok Aadith , Cabalag Miguel , Taylor David McD
Published: March 2017

Objective

AlthoughEDpatients presenting with supraventricular tachycardia (SVT) are commonly investigated, the value of these investigations has been questioned. We aimed to determine the frequency and utility of investigations in patients withSVT.

Methods

We undertook an explicit retrospective medical record audit of patients withSVTwho presented to a singleED(January 2004 to June 2014). Data on demographics, presenting complaints, investigations and outcomes were extracted. The outcomes were nature and utility of investigations.

Results

A total of 633 patients were enrolled (mean [SD] age 55.4 [17.7] years, 62% female). Laboratory investigations were common: electrolytes (83.7% of patients), full blood count (81.2%), magnesium (57.5%), calcium (39.3%) and thyroid function (30.3%). These investigations revealed many mildly abnormal results but resulted in electrolyte supplementation in only 19 patients: eight with mild hypokalaemia (potassium 3.0–3.5 mmol/L) and 11 with mild hypomagnesia (magnesium 0.49–1.1 mmol/L). Troponin was ordered for 302 (47.7%) patients, many of whom had no history or risk factors for cardiac disease, or ischaemic symptoms associated with theirSVT. The troponin was normal, mildly and moderately elevated in 65.2, 24.5 and 10.2% of cases, respectively. Only seven (1.1%) patients were diagnosed with acute myocardial ischemia. Although 190 (30.0%) patients had a chest X‐ray (CXR), it was normal in 78.4% of cases. All CXR abnormalities were incidental and not relevant to the immediateEDmanagement.

Conclusion

Patients with uncomplicatedSVTare over‐investigated. Guidelines forED SVTinvestigation are recommended. Further research is recommended to determine the indications for each investigation in the setting ofSVT.
Transitions to and from long‐term care facilities and length of completed stay: Reuse of population‐based survey data
Authors: Broad Joanna B , Lumley Thomas , Ashton Toni , Davis Peter B , Boyd Michal , Connolly Martin J
Published: March 2017

Objective

This article estimates length of completed stay and resident transitions for RAC residents over 12 months in Auckland.

Methods

Data from a census‐type survey of nursing home residents (n = 6816) were linked with national mortality data. Transitions described include entry to residential aged care (RAC), movement between RAC facilities and deaths.

Results

When reweighted for missing data and adjusted for length bias, an estimated 9676 residents (95% CI 8368–10 985) used care over a 12‐month period. Half of new residents entered RAC via an acute hospital. Median survival was 2.0 years; 17% died within 3 months, and 23% survived over 5 years.

Conclusion

Cross‐sectional survey data, when appropriately adjusted for length‐biased sampling, enable estimates of period prevalence and transition probabilities that are useful for simulation studies. Given population ageing and the costs of ongoing care, these results can inform policy and planning for long‐term care needs of older people.
Association between religious practice and risk of depression in older people in the subacute setting
Authors: Lac Alice , Austin Nicole , Lemke Renata , Poojary Suma , Hunter Peter
Published: March 2017

Objective

To identify the association between religious practice and risk of depression in older people admitted to a subacute hospital.

Methods

A cross‐sectional survey was conducted with 100 patients aged ≥65 years with Mini‐Mental State Examination (MMSE) scores ≥24 consecutively admitted to a subacute hospital. Religious practice was measured using the Duke University Religion Index and risk of depression using the 15‐item Geriatric Depression Scale (GDS).

Results

Geriatric Depression Scale was significantly correlated with intrinsic religiosity (r = −0.21, P = 0.04) and cognition (r = −0.22, P = 0.03).

Conclusion

This cross‐sectional study of older people in a subacute setting found depression scores were negatively and independently associated with both intrinsic religiosity and cognition. In conjunction with cognitive assessment, health professionals working with older people may consider taking a spiritual history as part of holistic care.
Long‐term outcomes and cost effectiveness of high‐dose dexamethasone for cardiac surgery: a randomised trial
Authors: Dieleman J. M. , de Wit G. A. , Nierich A. P. , Rosseel P. M. , van der Maaten J. M. , Hofland J. , Diephuis J. C. , de Lange F. , Boer C. , Neslo R. E. , Moons K. G. , van Herwerden L. A. , Tijssen J. G. , Kalkman C. J. , van Dijk D. ,   the DExamethasone for Cardiac Surgery (DECS) Study Group
Published: March 2017

Prophylactic intra‐operative administration of dexamethasone may improve short‐term clinical outcomes in cardiac surgical patients. The purpose of this study was to evaluate long‐term clinical outcomes and cost effectiveness of dexamethasone versus placebo. Patients included in the multicentre, randomised, double‐blind, placebo‐controlledDExamethasone for Cardiac Surgery (DECS) trial were followed up for 12 months after their cardiac surgical procedure. In theDECStrial, patients received a single intra‐operative dose of dexamethasone 1 mg.kg−1(n = 2239) or placebo (n = 2255). The effects on the incidence of major postoperative events were evaluated. Also, overall costs for the 12‐month postoperative period, and cost effectiveness, were compared between groups. Of 4494 randomised patients, 4457 patients (99%) were followed up until 12 months after surgery. There was no difference in the incidence of major postoperative events, the relative risk (95%CI) being 0.86 (0.72‐1.03); p = 0.1. Treatment with dexamethasone reduced costs per patient by £921 [€1084] (95%CI£−1672 to −137; p = 0.02), mainly through reduction of postoperative respiratory failure and duration of postoperative hospital stay. The probability of dexamethasone being cost effective compared with placebo was 97% at a threshold value of £17,000 [€20,000] per quality‐adjusted life year. We conclude that intra‐operative high‐dose dexamethasone did not have an effect on major adverse events at 12 months after cardiac surgery, but was associated with a reduction in costs. Routine dexamethasone administration is expected to be cost effective at commonly accepted threshold levels for cost effectiveness.
Trends in the surgical treatment of benign prostatic hyperplasia in a tertiary hospital
Authors: Ow Darren , Papa Nathan , Perera Marlon , Liodakis Peter , Sengupta Shomik , Clarke Stephen , Bolton Damien M. , Lawrentschuk Nathan
Published: March 2017

Background

To assess current treatment trends and perioperative outcomes of transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate (PVP) in a tertiary institution.

Methods

We prospectively collected a database of all patients undergoing TURP and PVP for benign prostatic hyperplasia (BPH) at a tertiary hospital between January 2011 and December 2013. Patient characteristics such as length of stay, readmission, anticoagulation status, American Society of Anesthesiologists (ASA) score and need for blood transfusion were recorded and analysed.

Results

In total, 560 cases were included: 204 (36.4%) underwent TURP and 356 (63.6%) PVP. Patients undergoing PVP had higher ASA scores (P < 0.001) and were more frequently on continuing anticoagulant therapy (P < 0.001). With regards to non‐aspirin/asasantin coagulation therapy, 61 (17.1%) patients underwent PVP with their anticoagulants continued while no patients who received TURP continued anticoagulation. Blood transfusion percentages were similar at 1.0% for TURP and 1.7% for PVP but readmission proportions were higher after PVP (32 patients, 9.0%) compared to TURP (10 patients, 4.9%). These differences were attenuated when excluding patients continuing anticoagulation during the procedure.

Conclusion

At our institution, the use of PVP has been increasing on a year‐by‐year basis. The results of the current study demonstrated that PVP is safe in patients with increased anaesthetic risk or on active anticoagulation when compared to traditional TURP. While this makes PVP an attractive alternative to TURP in high‐risk anticoagulated patients, these patients may have complex post‐discharge issues that should be addressed during the informed consent process.
Blue nevus‐like and blue nevus‐associated melanoma: a comprehensive review of the literature
Authors: Borgenvik Thore L. , Karlsvik Tina M. , Ray Saikat , Fawzy Monica , James Nick
Published: March 2017

Background

Malignant blue nevus, blue nevus‐associated melanoma and blue nevus‐like melanoma are all terms used to describe malignant melanomas arising from, in association with, or resembling blue nevi. This review is aimed at summarizing the available literature to reduce the confusion surrounding this rare malignancy, and aid the surgeon in choosing further diagnostic or therapeutic measures.

Methods

We conducted a search of Medline, Embase, Science Direct, Scopus and the Cochrane Library for all full text articles published in English that reported on a malignant melanoma arising from, in association with, or resembling a blue nevus.

Results

We identified 91 cases that fit the criteria above. The mean age at diagnosis was 45 years, with a slight male predominance (males: 48; females: 43). Metastatic cases were reported in 55% (n = 50), of which 16 were metastatic at the time of diagnosis, 16 developed metastases within the first year and 18 within 5 years of initial diagnosis. The mean Breslow thickness was 6.8 mm at the time of diagnosis (n = 39).

Conclusions

The histological criteria for diagnosing this malignancy are very poorly defined, and may contribute to the substantial confusion surrounding the terminology. There is no consensus on which prognostic indicators predictive of outcome in ‘conventional’ malignant melanoma are applicable to blue nevus‐like melanoma/blue nevus‐associated melanoma. However, two larger case series have demonstrated a significant association between Breslow thickness (or largest tumour dimension when non‐epidermal) and recurrence‐free survival, as well as rate of local recurrence, but larger studies are needed to confirm this.
The effects of pregnancy on the pharmacokinetics of infliximab and adalimumab in inflammatory bowel disease
Authors: Seow C. H. , Leung Y. , Vande Casteele N. , Ehteshami Afshar E. , Tanyingoh D. , Bindra G. , Stewart M. J. , Beck P. L. , Kaplan G. G. , Ghosh S. , Panaccione R.
Published: March 2017

Background

Transplacental transfer of infliximab and adalimumab results in detectable drug levels in the cord blood and infant.

Aim

To determine if pregnancy influenced the pharmacokinetics of anti‐TNF agents in women with inflammatory bowel disease.

Methods

Twenty‐five women from the University of Calgary inflammatory bowel disease(IBD) pregnancy clinic on maintenance infliximab or adalimumab were recruited prospectively with serum bio‐banking performed each trimester. Infliximab trough and adalimumab steady‐state levels were the outcomes of interest and were analysed using the ANSER infliximab and adalimumab assays. Multivariate linear mixed‐effects models were constructed to assess infliximab and adalimumab drug levels during pregnancy adjusting for the clinical covariates of albumin, BMI and CRP.

Results

Fifteen women (eight Crohn's disease, seven ulcerative colitis) received infliximab and 10 women with 11 pregnancies were treated with adalimumab. Median age was 29.6 years (IQR: 27.6–31.2 years). Median disease duration was 9.2 years (IQR: 3.16–15.0 years). Median trough infliximab concentrations were 8.50 μg/mL (IQR: 7.23–10.07 μg/mL), 10.31 μg/mL (IQR: 7.66–15.63 μg/mL) and 21.02 μg/mL (IQR: 16.01–26.70 μg/mL) at trimesters 1, 2 and 3 respectively. Significant changes in albumin and BMI (P < 0.05) but not CRP (P > 0.05) were documented throughout pregnancy. After adjusting for albumin, BMI and CRP, infliximab trough levels increased during pregnancy, by 4.2 μg/mL per trimester (P = 0.02), while adalimumab drug levels remained stable (P > 0.05).

Conclusions

Infliximab levels rise during pregnancy, whereas adalimumab levels remain stable after accounting for changes in albumin, BMI and CRP. Therapeutic drug monitoring in the second trimester may be useful in guiding dosing in the third trimester.
Retracted: Systematic review: benefits and harms of transarterial embolisation for treating hepatocellular adenoma
Authors: Zhao C. , Pei S. ‐L. , Cucchetti A. , Tong T. ‐J. , Ma Y. ‐L. , Zhong J. ‐H. , Li L. ‐Q.
Published: March 2017

The above article1 from Alimentary Pharmacology & Therapeutics, published online on 20 March 2017 in Wiley OnlineLibrary (www.onlinelibrary.wiley.com) has been retracted by agreement between the Authors, the Editor‐in‐Chief, R.E. Pounder, and John Wiley & Sons Ltd. The retraction has been agreed due to the inclusion of data accessible only during peer review for another journal.

REFERENCE

1. Zhao C, Pei S‐L, Cucchetti A, et al. Systematic review: benefits and harms of transarterial embolisation for treating hepatocellular adenoma. Aliment Pharmacol Ther. 2017. https://doi.org/10.1111/apt.14044
Integrated Reporting in an Internet and Social Media Communication Environment: Conceptual Insights
Authors: Lodhia Sumit , Stone Gerard
Published: March 2017

This paper discusses the potential role of Internet communication technologies, including social media, in the integrated reporting process. A media richness framework provides a conceptual basis to examine the features of Internet technologies, which can facilitate the important external communication aspect of integrated reporting. We find that Internet technologies possess rich features and capabilities that have potentially significant application in enhancing external communications with integrated reporting stakeholders. We also identify risks and challenges associated with utilising Internet technologies to enable the external communication aspect of integrated reporting. Through its focus on the potential role of Internet communication technologies in integrated reporting, the paper extends the nascent integrated reporting literature and accounting communications research. The paper also offers practical guidance and insights for business and accounting's integrated reporting communication practices. To our knowledge, this is the first conceptual paper to comprehensively examine the role of Internet communication technologies in integrated reporting.
Baclofen and Alcohol‐Dependent Patients: A Real Risk of Severe Self‐Poisoning
Authors: Boels David , Victorri‐Vigneau Caroline , Grall‐Bronnec Marie , Touré Ali , Garnier Anais , Turcant Alain , Le Roux Gaël
Published: March 2017

Baclofen is often prescribed in high doses to fight cravings experienced by alcohol‐dependent patients. Such an increase in the availability of baclofen is concerning. This study aimed to determine the change in number and profile of self‐poisoning with baclofen over time, as baclofen has become increasingly popular, in order to describe the severity of self‐poisoning with baclofen and to focus on co‐existing alcohol use disorders, and psychiatric illnesses determine predictors of severity. This was a retrospective study of self‐poisoning with baclofen as reported by the western France Poison Control Center (PCC), which represents a population of more than 12 million people from January 2008 to March 2014. One hundred and eleven cases of self‐poisoning with baclofen were reported to the western France PCC (62 males and 49 females; average age 39 ± 12). Poisoning severities were as follows: ‘null’ (nine cases), ‘minor’ (37 cases), ‘moderate’ (19 cases) and ‘high’ (46 cases, including four deaths). The most frequently reported symptoms were neurological (45%) and cardiovascular (27%). The severity was significantly associated with psychiatric disorders (OR = 2.9; p = 0.03). Baclofen, prescribed in high doses, may lead to severe poisoning, particularly in patients with psychiatric illnesses. Authorities should put forward a new policy for prescribing the drug as a treatment for alcohol dependence.
Monoclonal antibodies in the treatment of multiple sclerosis: emergence of B‐cell‐targeted therapies
Authors: Nguyen Ai‐Lan , Gresle Melissa , Marshall Tessa , Butzkueven Helmut , Field Judith
Published: March 2017

Multiple sclerosis (MS) is a chronic inflammatory disease of the CNS, and one of the most common causes of disability in young adults. Over the last decade, new disease‐modifying therapies have emerged, including monoclonal antibodies (mAbs) that provide highly targeted therapies with greater efficacy than platform therapies. In particular, monoclonal antibodies directed against CD20‐positive B cells have shown remarkable results in recent clinical trials and renewed interest in the mechanism of B cell‐depleting therapies to ameliorate relapse activity and progression in MS. Here, we review the mechanisms of action and clinical evidence of approved and emerging mAbs, with a focus on B cell‐targeted therapies.
Immunization of looked‐after children and young people: a review of the literature
Authors: Walton S. , Bedford H.
Published: March 2017

Background

Numbers of looked‐after children and young people (LACYP) in the UK have risen over the last seven years. Looked‐after children and young people should receive regular health assessments, including establishing immunization status and, if needed, developing a health plan to achieve full immunization. The Department for Education publish data on immunizations among LACYP to monitor both how well they are immunized and service performance.

Methods

A literature review was conducted using four databases (PubMed, Embase, Scopus and Web of Science) on immunization status of LACYP, factors affecting uptake and challenges to immunization, and interventions to improve immunization rates.

Results

Thirty‐two papers were identified, 16 of which were UK based. Looked‐after children and young people are less likely to be ‘up‐to‐date’ with their immunizations than children in the general population. Looked‐after children and young people are less likely to receive timely immunizations, and older LACYP are less likely to be ‘up‐to‐date’ than younger LACYP. Barriers to immunization include failure to attend health checks, absence from school and frequent placement moves. Unknown and discrepant immunization histories, name changes, sharing of information between organizations and obtaining consent for immunizations are also challenges.

Conclusions

In recent years, immunization of LACYP has been given a higher priority. However, the immunization figures produced by the Department for Education are problematic because of challenges in determining whether the child is ‘up‐to‐date’, and data are not comparable with the general population; ideally, this should be changed to correspond to routine immunization data. In the interim, for reporting purposes, the use of a tool to assist with determining a child's immunization status would be beneficial. When a child's immunization status is incomplete or unknown, Public Health England's algorithm for vaccination of individuals with uncertain or incomplete status should be used. Practice to improve immunization uptake amongst LACYP needs to be evaluated to develop evidence‐based recommendations.
Exploring Children's Perceptions of their Local Environment in Relation to Time Spent Outside
Authors: Hayball Felicity , McCrorie Paul , Kirk Alison , Gibson Ann‐Marie , Ellaway Anne
Published: March 2017

This study aims to understand how children perceive their environment, exploring the affordances children perceive to influence their physical activity (PA) behaviour when outside. Participants included boys and girls aged 10–12 years (n = 15) living in Scotland. Children's visual and verbal representations of their perceived environment were analysed to assess environmental determinants of PA. The findings suggested that physical affordances that offer a sense of risk were important to children's play spaces. Social affordances influenced where the children went in their environment and the features they utilised as part of play behaviour; strangers were considered threatening depending on whether the activity was recognised.
Barriers to the management of obstructed defaecation according to colorectal surgeons
Authors: Al‐Mozany N. , Wright C. , O'Grady G. , Young C. J. , Solomon M. J.
Published: March 2017

Aim

Obstructed defaecation (OD) has a high prevalence and high disease impact; however, patients often experience suboptimal management. This problem reflects the complex pathophysiology of OD as well as health service delivery factors. This study aimed to identify the factors that act as a barrier to effective management of OD as perceived by specialist colorectal surgeons treating this disorder.

Method

A postal questionnaire was administered to a bi‐national sampling of colorectal specialists in Australia and New Zealand who were registered with their specialty society. Questions addressed variables relevant in OD management, including clinical access, decision‐making, patient factors and surgeon experience and perceptions, and used Likert scales. Statistical analyses compared surgeon practice variables.

Results

The response rate was 68.5% (n = 113). Most surgeons managed OD (94%), and preferred to treat OD patients themselves (87%); however, 33% of these respondents were dissatisfied with their management, 46% felt they lacked management expertise and 33% stated they had inadequate expertise in OD investigations. Clinical investigation services were more limited in private than public practice, and many surgeons lacked access to biofeedback (31%). Other barriers included heterogeneity in decision‐making by surgeon age and practice location (P < 0.05), dual pathologies (e.g. irritable bowel syndrome) and psychological factors, and limited uptake of multidisciplinary services and standardized (Rome) diagnostic criteria.

Conclusion

Barriers to OD management include surgeon‐specific factors, patient‐specific factors and healthcare access factors. Increased utilization of pelvic floor and multidisciplinary services, increased training and standardization of OD investigations and improved access to specialist investigations and allied‐health management services could improve outcomes for OD.
Characterization of blood flow through intrapulmonary arteriovenous anastomoses and patent foramen ovale at rest and during exercise in stroke and transient ischemic attack patients
Authors: Romac Rinaldo , Barak Otto , Glavas Duska , Susilovic Grabovac Zora , Lozo Petar , Roje Igor , Caljkusic Kresimir , Drmic‐Hofman Irena , Davis James T. , Dujic Zeljko , Lovering Andrew T.
Published: March 2017

Objectives

We determined whether stroke and/or TIA subjects have exercise‐induced blood flow through intrapulmonary arteriovenous anastomoses (QIPAVA) and/or patent foramen ovale (QPFO) and a genetic predisposition for ischemic stroke.

Methods

Twenty‐eight stroke and/or TIA subjects (33–63 years old) underwent transthoracic saline contrast echocardiography concomitant with transcranial Doppler to detect QIPAVA and QPFO at rest and during supine exercise with and without breathing 100% O2. We also examined genetic polymorphisms in FV Leiden (G1691A; rs6025), factor II (FII) prothrombin (G20210A; rs1799963), methylene tetrahydfropholate reductase (C677T, rs1801133), and plasminogen‐activator inhibitor‐1 (PAI‐1) (4G/5G; rs1799889) and angiotensin‐converting enzyme (ACE; I/D, rs4646994) in 24/28 subjects.

Results

No subject without PFO had QIPAVA at rest (n=17), but 12/17 did with exercise. All PFO subjects had QPFO at rest (n=11) and 7/11 had either QIPAVA or QPFO with exercise. Breathing 100% O2 during exercise reduced or eliminated left heart contrast in all subjects. Gene analyses revealed that 15/24 patients were either heterozygous or homozygous for methylenetetrahydrofolate reductase gene polymorphism; 4G/4G and 4G/5G genotypes of plasminogen‐activator inhibitor‐1 were present in 7/24 and 13/24 patients, respectively; polymorphisms of ACE D/D genotype were present in 6/24 and I/D in 14/24 patients. Having both I/D and 4G/4G genotypes was more prevalent in PFO+ subjects (P=.03), and there was a trend (P=.06) for PFO− subjects to have a greater D/D genotype prevalence.

Conclusions

Novel genetic predispositions reported here in PFO subjects should be investigated further in larger stroke and/or TIA patient datasets.
Added clinical value of applying myocardial deformation imaging to assess right ventricular function
Authors: Sokalskis Vladislavs , Peluso Diletta , Jagodzinski Annika , Sinning Christoph
Published: March 2017

Right heart dysfunction has been found to be a strong prognostic factor predicting adverse outcome in various cardiopulmonary diseases. Conventional echocardiographic measurements can be limited by geometrical assumptions and impaired reproducibility. Speckle tracking–derived strain provides a robust quantification of right ventricular function. It explicitly evaluates myocardial deformation, as opposed to tissue Doppler–derived strain, which is computed from tissue velocity gradients. Right ventricular longitudinal strain provides a sensitive tool for detecting right ventricular dysfunction, even at subclinical levels. Moreover, the longitudinal strain can be applied for prognostic stratification of patients with pulmonary hypertension, pulmonary embolism, and congestive heart failure. Speckle tracking–derived right atrial strain, right ventricular longitudinal strain–derived mechanical dyssynchrony, and three‐dimensional echocardiography–derived strain are emerging imaging parameters and methods. Their application in research is paving the way for their clinical use.
3q26‐29 Amplification in head and neck squamous cell carcinoma: a review of established and prospective oncogenes
Authors: Davidson Matthew A. , Shanks Emma J.
Published: March 2017

Head and neck squamous cell carcinoma (HNSCC) is significantly underrepresented in worldwide cancer research, yet survival rates for the disease have remained static for over 50 years. Distant metastasis is often present at the time of diagnosis, and is the primary cause of death in cancer patients. In the absence of routine effective targeted therapies, the standard of care treatment remains chemoradiation in combination with (often disfiguring) surgery. A defining characteristic of HNSCC is the amplification of a region of chromosome 3 (3q26‐29), which is consistently associated with poorer patient outcome. This review provides an overview of the role the 3q26‐29 region plays in HNSCC, in terms of both known and as yet undiscovered processes, which may have potential clinical relevance.
Energy Boom and Gloom? Local Effects of Oil and Natural Gas Drilling on Subjective Well‐Being
Authors: Maguire Karen , Winters John V.
Published: March 2017

Prior to the precipitous drop in oil prices in 2014, the U.S. had experienced a substantial increase in oil and natural gas extraction due to technological advancements including horizontal drilling and hydraulic fracturing. This increased energy development likely created both benefits and costs, but the net effects for local residents are not well understood. This paper examines the effects of conventional and horizontal oil and natural gas drilling in Texas on subjective assessments of life‐satisfaction and bad mental health days for nearby residents. Horizontal drilling has statistically significant deleterious effects on well‐being, but the effects are driven by the Dallas‐Fort Worth (DFW) metropolitan area, an area with both very high levels of horizontal drilling and a large urban population.
Agreement between factor XIII activity and antigen assays in measurement of factor XIII: A French multicenter study of 147 human plasma samples
Authors: Caron C. , Meley R. , Le Cam Duchez V. , Aillaud M. F. , Lavenu‐Bombled C. , Dutrillaux F. , Flaujac C. , Ryman A. , Ternisien C. , Lasne D. , Galinat H. , Pouplard C.
Published: March 2017

Introduction

Factor XIII (FXIII) deficiency is a rare hemorrhagic disorder whose early diagnosis is crucial for appropriate treatment and prophylactic supplementation in cases of severe deficiency. International guidelines recommend a quantitative FXIII activity assay as first‐line screening test. FXIII antigen measurement may be performed to establish the subtype of FXIII deficiency (FXIIID) when activity is decreased.

Methods

The aim of this multicenter study was to evaluate the analytical and diagnostic levels of performance of a new latex immunoassay, K‐Assay® FXIII reagent from Stago, for first‐line measurement of FXIII antigen. Results were compared to those obtained with the Berichrom® FXIII chromogenic assay for measurement of FXIII activity. Of the 147 patient plasma samples, 138 were selected for analysis.

Results

The accuracy was very good, with intercenter reproducibility close to 7%. Five groups were defined on FXIII activity level (<5% (n = 5), 5%–30% (n = 23), 30%–60% (n = 17), 60%–120% (n = 69), above 120% (n = 24)), without statistical differences between activity and antigen levels (P value >0.05). Correlation of the K‐Assay® with the Berichrom® FXIII activity results was excellent (r = 0.919). Good agreement was established by the Bland and Altman method, with a bias of +9.4% on all samples, and of −1.4% for FXIII levels lower than 30%. One patient with afibrinogenemia showed low levels of Berichrom® FXIII activity but normal antigen level and clot solubility as expected.

Conclusions

The measurement of FXIII antigen using the K‐Assay® is a reliable first‐line tool for detection of FXIII deficiency when an activity assay is not available.
Abrogation of red blood cell G6PD enzyme activity through Heat treatment: development of survey material for the UK NEQAS G6PD scheme
Authors: Roper D. R. , De la Salle B. , Soni V. , Fletcher K. , Green J. A.
Published: March 2017

Introduction

Participation in external quality assessment (EQA) is central to the maintenance of high‐quality laboratory results in patient diagnosis and clinical trials. Laboratories in the TAF112582 DETECTIVE study (ClinicalTrials.gov identifier: NCT01376167) are enrolled in the United Kingdom National Quality Assessment Scheme (UK NEQAS) for glucose‐6‐phosphate dehydrogenase (G6PD) quantitative assay, which utilizes ovine (sheep) blood as a readily available source of apparently G6PD‐deficient survey material. A substitute for sheep blood was sought because some non‐UK sites in the study encountered participation difficulties due to the strict regulations on the import of sheep blood into their countries.

Methods

G6PD activity in normal human donor blood was abrogated by the action of heat under controlled conditions. Residual G6PD activity in the heated samples was measured by UK NEQAS using the Trinity Biotech 345 kit (Trinity Biotech) and a Jenway 6715 UV/Vis spectrophotometer with external temperature control to monitor enzyme kinetics and linearity over a set time. Heat‐treated material was also assayed for G6PD activity and assessed for its acceptability as EQA survey material by selected UK laboratories.

Results

Blood heated at 45 °C for 15 h showed a reduction in G6PD activity of 76.3 ± 4.6% (n = 6) and was considered acceptable as EQA material in terms of appearance and behaviour by the majority of UK sites in the trial.

Conclusions

We have developed a simple heat‐treatment procedure to produce EQA survey material with low/intermediate G6PD activity, similar to that found in females heterozygous for G6PD deficiency.
Expression of CD4 is correlated with an unfavorable prognosis in wild‐type NPM1, FLT3‐ITD‐negative cytogenetically normal adult acute myeloid leukemia
Authors: Guo R. J. , Atenafu E. G. , Schimmer A. D. , Minden M. D. , Chang H.
Published: March 2017

Introduction

In the cytogenetically normal population of AML (CN‐AML), FLT3‐ITD‐positive and wild‐type NPM1 is correlated with a worse outcome, and FLT3‐ITD‐negative with NPM1‐mut is correlated with a better outcome. This leaves a large subpopulation of CN‐AML patients without NPM1 or FLT3‐ITD mutations with heterogeneous outcomes with overall survivals (OS) ranging from several weeks to years. Therefore, new prognostic markers are needed to better risk stratify this subset of patients.

Methods

The retrospective study included 60 de novo adult AML patients diagnosed at our institution with normal karyotype, no FLT3‐ITD or NPM1 mutations, and who did not receive allogeneic hematopoietic stem cell transplantations. We investigated the prognostic significance of immunophenotypic markers and clinical laboratory features in this double‐negative population.

Results

Older age (>60) and CD4 expression (14%) were significantly correlated with shorter event‐free survival (EFS) (P < 0.001, P = 0.016, respectively). Expression of CD56 (12%), as well as lack of CD34 expression (19% of the cases), was also associated with a worse EFS (P = 0.048, P = 0.028, respectively). On multivariable analysis, CD4 expression and old age (>60) were identified as independent predictors for worse EFS (P = 0.016; P = 0.001, respectively) and OS (P = 0.048; P = 0.028, respectively).

Conclusions

Our results indicate that CD4 expression and older age are adverse prognostic factors in wild‐type NPM1, FLT3‐ITD‐negative CN‐AML.
Successful third renal transplantation in a child with an occluded inferior vena cava: A novel technique to use the venous interposition between the transplant renal vein and the infrahepatic inferior vena cava
Authors: Muramatsu Masaki , Shishido Seiichiro , Takahashi Yusuke , Hamasaki Yuko , Yoshimura Hiroshi , Nihei Hiroshi , Itabashi Yoshihiro , Kawamura Takeshi , Aikawa Atsushi
Published: March 2017

A girl aged 11 years and 3 months with occlusion of the inferior vena cava had experienced two renal transplant graft failures since birth. The third renal transplant from a live donor was carried out. Preoperative evaluation showed that the arteries from the right common to the right external iliac artery were absent, and the ilio‐caval vein was occluded below the level of the renal vein. The donor's renal artery was anastomosed to the aorta. The donor's ovarian and large saphenous veins were used to extend the transplant renal vein to the recipient's patent inferior vena cava. The present report concludes that the extension of a short donor renal vein using other donor veins is a viable therapeutic option for pediatric patients with vascular occlusions.
Failure mechanisms of calcium magnesium aluminum silicate affected thermal barrier coatings
Authors: Thornton John , Wood Chris , Kimpton Justin A. , Sesso Mitchell , Zonneveldt Matthew , Armstrong Nicholas
Published: March 2017

Depth profiles of the phase composition of two examples of calcium magnesium aluminum silicate (CMAS) affected thermal barrier coatings (TBCs) from an aero gas turbine engine were obtained using a monochromatic and collimated beam of synchrotron radiation. One TBC was deposited by plasma spray and the other by electron beam physical vapor deposition. These examples were complemented with an X‐ray diffraction (XRD) study of mixtures of TBC zirconia powder and sand heated in a furnace. The XRD results were compared with electron backscatter images and energy dispersive spectroscopy studies of the cross sections and mixtures. It was found that when liquid, the CMAS enhances mass transport leading to the densification of the zirconia, which then leads to spalling because of the increased residual stresses generated on cooling. Even without spalling densification will reduce a TBC's ability to thermally insulate. The enhanced mass transport can also lead to destabilization of the zirconia if yttrium ions preferentially transfer to the liquid or greater stabilization if calcium or magnesium ions transfer from the liquid to the zirconia. Zircon also precipitates when the zirconium from the TBC reacts with the silicon in the liquid CMAS.
Determination of oxygen nonstoichiometry in SrFeO3−δ by solid‐state Coulometric titration
Authors: Yoo Jiho , Yoo Chung‐Yul , Yu Ji‐Haeng , Jacobson Allan J.
Published: March 2017

The oxygen nonstoichiometry of SrFeO3−δ was determined by solid‐state Coulometric titration at 750°C‐1040°C and 10−18≤pO2(atm)≤0.5. At T≤850°C, a hysteresis in the oxygen nonstoichiometry (δ) isotherms indicates the presence of a two‐phase region corresponding to a mixture of a perovskite and an oxygen vacancy ordered phase. The variation of δ with temperature at fixed pO2 values and the variation of log(pO2) with reciprocal temperature at fixed δ are reported. The pO2 at the p‐n transition in the electrical conductivity increases as the temperature increases, and the transition in the conductivity isotherm occurs at a composition of SrFeO2.505(1) at 950°C and SrFeO2.508(1) at 900°C. Since strontium exclusively occupies the A‐site, a simple point defect model that assumes noninteracting defects can describe the isotherms but only at 1040°C; nonideal behavior is observed at lower temperatures. The partial molar thermodynamic quantities for oxygen in SrFeO3−δ were determined.
Studies on dielectric relaxation in ceramic multiferroic Gd1−xYxMnO3
Authors: Ramaiyan Mahadevan Sarguna , Varadarajan Sridharan , Awasthi Anand Mohan , Natarajan Subramanian
Published: March 2017

Dielectric study over a broadband was carried out from 10 to 70 K on ceramic Gd1−xYxMnO3 (x=0.2, 0.3 and 0.4). For all the compositions, a prominent sharp peak about ~18 K was observed in the temperature dependence of both ε′(T) and ε″(T) at all frequencies, indicating a long‐range ferroelectric (FE) transition. Using Cole‐Cole fit to the permittivity data, the relaxation time τ and the dielectric strength ∆ε were estimated. Temperature variation of τ(T) in the Arrhenius representation is found to be nonlinear (non‐Debyean relaxation), with increasing barrier‐activation energy over successive temperature‐windows. Interestingly, for all the compositions, we witness a jump in τ(T) about the ferroelectric transition temperature, concurred by a broad‐maximum in ∆ε(T),signifying the critical slow down of relaxations near long‐range FE‐correlations.
The kinetic analysis of irreversible consecutive solid state reactions: The effect of zinc on the formation of cordierite
Authors: Clark Simon M.
Published: March 2017

Many reactions in the solid state occur in multiple reaction steps. Here, I present a method of determining the kinetics of a two‐step consecutive reaction from isothermal, time resolved, powder diffraction data. This method is illustrated with a study of the kinetics of the formation of cordierite from a glass precursor with and without doping with zinc.
Thermal properties of simulated Hanford waste glasses
Authors: Rodriguez Carmen P. , Chun Jaehun , Crum Jarrod V. , Canfield Nathan L. , Rönnebro Ewa C.E. , Vienna John D. , Kruger Albert A.
Published: March 2017

The Hanford Tank Waste Treatment and Immobilization Plant will vitrify the mixed hazardous wastes generated from 45 years of plutonium production at the Hanford Site in Washington State. The molten glasses will be poured into stainless steel containers or canisters and subsequently cooled for storage and disposal. For appropriate facility design and operations to handle such highly energy‐consuming processes, knowledge of the material properties is required. The thermal properties (heat capacity, thermal diffusivity, and thermal conductivity) of representative high‐level and low‐activity waste glasses were studied as functions of temperature in the range of 200°C‐800°C (relevant to the cooling process). Simultaneous differential scanning calorimetry‐thermal gravimetry (DSC‐TGA), Xe‐flash diffusivity, pycnometry, and dilatometry were implemented. The study showed that simultaneous DSC‐TGA would be a reliable method for obtaining the heat capacity of various glasses in the temperature range of interest. Accurate thermal properties from this study were shown to provide a more realistic guideline for capacity and time constraints of the heat removal process when compared to the original conservative design‐basis engineering estimates. The estimates, though useful for design in the absence of measured physical properties, can now be supplanted and the measured thermal properties can be used in design verification activities.
The Devout and the Disabled: Religious and Cultural Accommodation‐as‐Human‐Variation
Authors: Zala Miklos I.
Published: March 2017

This article shows that we can identify a subset of religious and cultural accommodation cases that follow the structure of a particular disability model: the Human Variation Model. According to this model, disadvantageous disability arises because most social arrangements are tailored to the needs of individuals with typical characteristics; people with atypical features are frequently left out from these arrangements. Hence, the latter need personalised resources tailored to them, or their social and/or material environment ought to change according to their atypical characteristics. I argue, however, that not everyone's claim stemming from an atypical characteristic merits accommodation – it would be simply unreasonable to provide personalised resources to everyone or modify the environment to accommodate everyone's needs. In other words, these human variation claimants must be ‘reasonably accommodated’. Nevertheless, members of certain social groups have a justifiable claim to receive such accommodation and those in religious and cultural groups could be among them for two specific sociological reasons.