bluuebunny/crossref_metadata_2025 huggingface dataset:
Lunacy in a tertiary emergency department: A 3‐year cohort study of the association between moon cycles and occupational violence and aggression
Authors: Yeung Timothy , O'Reilly Gerard , Mitra Biswadev , Olaussen Alexander
Published: August 2020

Objective

Occupational violence and aggression (OVA) in the ED is an issue of global concern and increasing incidence. The empirical evidence for the relationship between the lunar cycle and ‘lunatics’ remains equivocal. The present study aims to examine the association between OVA in ED and the full moon (FM).

Methods

Data on all presentations were extracted from The Alfred Hospital ED records for consecutive patients over a 3‐year period (January 2013–December 2015). The primary outcome of the present study is OVA among patients in the ED. Univariable and multivariable logistic regression were used to determine the association between aspects of the lunar cycle and OVA.

Results

There were 184 059 ED presentations during the 3 years, 6234 (3.4%) of which occurred on a FM. There were 1853 episodes of OVA, 57 (3.1%) of which occurred on a FM. OVA among patients presenting to ED was not associated with the FM (adjusted odds ratio [OR] 0.92 [95% confidence interval 0.70–1.20]; P = 0.53). However, the first quarter (FQ) (adjusted OR 1.38 [1.11–1.72]; P < 0.01) and third quarter (TQ) (adjusted OR 1.29 [95% confidence interval 1.03–1.62]; P = 0.03) moons of the lunar cycle were independently associated with OVA.

Conclusions

Contrary to traditional beliefs, the FQ and TQ of the lunar cycle but not the FM were associated with OVA. This highlights a relatively unexplored relationship that has previously been overshadowed by the FM in the literature. Prediction models of violence in the ED could consider incorporating the FQ and TQ of the lunar cycle in their models.
Development of a reduced‐calorie high pressure processed sapodilla (Manilkara zapota L.) jam based on rheological, textural, and sensory properties
Authors: Shinwari Kaunsar Jabeen , Rao Pavuluri Srinivasa
Published: August 2020

High pressure technology (400 MPa at 27 ± 1.5 °C for 10 min) was applied for the processing of jam, and target was the reduction (∼47%) of sugar requirement by using a fiber‐rich fruit, that is, sapodilla. Different formulations of jam containing various combinations of pectin (0.5 to 5.0%), sugar (45 to 65%), and acid (0.5 to 1) were investigated for textural, rheological, and sensory properties of the pressure‐processed jam. The textural parameters mainly hardness (varied 16 to 594 g force) of the jam samples were significantly (P < 0.01) affected by the formulation ingredients viz. sugar and pectin content. Also, an interaction effect (P < 0.01) of sugar and pectin was observed on the jam hardness. The rheological parameters (gel strength, K′) also varied (1036 to 2852 Pa) with the change in total soluble solids (TSS) and pectin content. However, the samples having lower TSS content (e.g. 45%) and appropriate pectin content (4.0, 4.5, or 5.0%) were similar (P > 0.05) to the samples having higher TSS content (65%) and corresponding pectin level (0.5, 1.0, or 1.5%) based on the rheological properties. On the other hand, the samples with middle levels of pectin at the corresponding TSS level (45 to 65%) were highest (score of >6 on seven‐point hedonic scale) and equally preferred (P > 0.05) by the sensory panelist based on overall acceptability calculated from the scores obtained for sensory attributes viz. color, aroma, sweetness, sourness, texture, and spreadability. Therefore, the jam formulation containing sapodilla pulp as a base material, TSS 45%, pectin 4.5%, and citric acid 0.5% was determined to be the preferred formulation for the production of reduced‐calorie, pressure‐processed jam based on its gel strength, overall acceptability, and storage stability.

Practical Application

High‐fiber fruit was used for the development of a reduced‐calorie high pressure processed jam in this study. The inherited or externally added fiber can favor the reduction in sugar requirement of a food product particularly those processed by high pressure, leading to reduction in calories. The findings of this study can be used for the development of novel HPP products with functional properties.
Exploration of natural phosphatidylcholine sources from six beans by UHPLC‐Q‐HRMS
Authors: Yang Fu , Zhou Li , Zhang Minghao , Liu Jikai , Marchioni Eric
Published: August 2020

Beans are a rich source of phosphatidylcholine (PC). This study aims to explore natural PC sources rich in polyunsaturated fatty acid (PUFA) with nutritional interest. PCs from six beans were purified (purity > 98.2%) by thin layer chromatography (TLC), and subsequently identified by ultra‐high performance liquid chromatography–Quadrupole (Q)–high‐resolution mass spectrometry (UHPLC‐Q‐HRMS). Results showed that the PC content of chickpea (Cicer arietinum) and soybean (Glycine max) was 50.0 and 34.0 mg/g, respectively, which was significantly higher than that of other beans (P < 0.05). Gas chromatographic analysis showed that soybean contained high proportion of PUFA (58.78%), and chickpea contained high proportion of docosahexaenoic acid (DHA) (2.73%). A total of 49 molecular species were identified by UHPLC‐Q‐HRMS. (18:2‐18:2)PC was predominant in soybean, adzuki bean, runner bean, and common bean. (16:0‐18:1)PC was the major species of chickpea PC, and many ether PC species and DHA‐PC were identified. Discriminatory analysis by principal component analysis (PCA) indicated that the molecular profiles of chickpea PC were significantly different from other beans studied. The findings suggest that chickpea appears to be an interesting plant source of DHA and ether lipids for dietary supplement.

Practical Application

In this study, we reported an UHPLC‐Q‐HRMS technique to identify PC molecular species of six beans. The diversity of PC molecular species in the different beans was classified using chemometrics. This analytical method not only provides comprehensive information to nutritionists about the PC distribution in different beans, but also can identify biomarkers for bean flour fraud identification in food supplementation. Furthermore, the approach gives fragmentation patterns of several PC species and could be further applied to determine the chemical structure of PC molecular species from many natural resources.
Effect of poly‐γ‐glutamic acid on hydration and structure of wheat gluten
Authors: Xie Xinhua , Wu Xiuyuan , Shen Yue , Song Miao , Xu Chao , Zhang Bei , Aziz Usman , Xu Xinjun
Published: August 2020

In recent years, hydrocolloids have been used extensively as enhancers in dough products. However, studies on the effect of hydrophilic polymers on wheat gluten (WG) within the dough are scarce. In the present study, poly‐γ‐glutamic acid (γ‐PGA), a new and healthy food additive, was added to the WG to investigate its effect on hydration, rheological properties, and structures of WG. Results showed that with the addition of γ‐PGA, the water‐holding capacity (WHC) of WG and the content of bound water increased, whereas the content of immobilized water decreased. In addition, γ‐PGA changed the rheological properties of WG. The elastic properties of WG gradually weakened and the viscous properties gradually increased. Furthermore, scanning electron microscopy (SEM) results showed that with the addition of γ‐PGA, the structure of the WG network became more uniform and the pore size was smaller. A change also occurred in the secondary structure of WG, in which the α‐helix content was significantly reduced while the contents of β‐turn angles were significantly increased, thereby suggesting that γ‐PGA not only functions as a filler in the WG system, but also interacts with WG. From the present study, we conclude that γ‐PGA can interact with WG and water to change the WG secondary structure. γ‐PGA can also restrict moisture migration and enhance the WHC of WG, thereby changing the WG microstructure and improving its functional properties. This condition provides the basis for γ‐PGA to be recommended as WG enhancer for addition in WG‐containing products such as bread, seitan (meat replacement), and others.

Practical Application

WG performance plays a key role in the quality of flour products. Thus, many studies have been conducted to improve the WG quality to produce highly popular flour products. The results of this study showed that γ‐PGA can interact with WG and water, and had a good effect on improving the WHC of WG, which means that γ‐PGA has potential usefulness in improving the quality of WG and WG‐containing products such as bread, seitan (meat replacement), and others.
Effect of inspiratory muscle training on respiratory muscle strength and functional capacity in patients with type 2 diabetes mellitus: A randomized clinical trial
Authors: Albarrati Ali , Taher Mohammed , Nazer Rakan
Published: August 2020

Background

Type 2 diabetes mellitus (T2DM) is usually associated with respiratory manifestations including inspiratory muscle weakness which affects exercise capacity. The present study aimed to determine the effect of inspiratory muscle training (IMT) on inspiratory muscle strength and exercise capacity in patients with Type 2 diabetes mellitus (T2DM).

Methods

This was a randomized controlled trial in patients with type 2 diabetes mellitus with no previous cardiopulmonary or neuromuscular diseases. Patients had no back pain. Patients were randomized into interventional or placebo groups. Sniff nasal inspiratory pressure (SNIP), maximum inspiratory pressure (MIP), and six‐minute walking test (6MWT) were measured at baseline and 8 weeks post incremental inspiratory muscle training.

Results

At baseline, interventional and placebo groups were similar in age, body mass index, sex inspiratory muscle strength, and exercise capacity. After 8 weeks of incremental inspiratory muscle training at 40% of MIP, the interventional group had a significant increase in the SNIP (mean difference: 18.5 ± 5.30 cm H2O vs 2.8 ± 4.8 cm H2O) and MIP (mean difference: 19.4 ± 4.3 Vs 5.4 ± 3.6 cm H2O) compared to the placebo group, respectively. The interventional group showed improvement in the 6MWT (mean difference: 70 ± 29 m vs 34 ± 24 m) compared to the placebo group, P < .05.

Conclusion

Incremental inspiratory muscle training increased the diaphragm strength in patients with T2DM and improved exercise capacity.
Interleukin‐1 receptor‐associated kinase gene polymorphisms contribute to rheumatoid arthritis risk: A meta‐analysis
Authors: Zhao Pingli , Li Qihui , Liang Renxian , He Xiong
Published: August 2020

Aim

Rheumatoid arthritis (RA) is a systemic autoimmune disease affecting about 1% of world population. Three polymorphisms of Interleukin‐1 receptor‐associated kinase (IRAK1) gene, rs3027898, rs1059702 and rs1059703, are studied to associate with RA risk. However, the findings are inconclusive. Therefore, we performed a meta‐analysis to derive a more precise estimation of the impact of the 3 polymorphisms on RA risk.

Method

The strength of association between 3 polymorphisms and RA risk was assessed by calculating odds ratios (ORs) with the corresponding 95% confidence intervals (CIs).

Results

Overall, for rs3027898 polymorphism, no association was observed in pooled analysis, but the stratified analysis suggested that rs3027898 CA genotype was associated with a reduced risk of RA in an Asian population (heterozygous model: OR = 0.79, 95% CI = 0.66‐0.96, P = .018). Rs1059702 polymorphism was related with an increased RA risk (homozygous model: OR = 1.59, 95% CI = 1.19‐2.13, P = .002, heterozygous model: OR = 1.49, 95% CI = 1.17‐1.88, P = .001, and allele comparison model: OR = 1.35, 95% CI = 1.20‐1.53, P < .001). Moreover, rs1059703 was also associated with an increased RA risk (dominant model: OR = 1.26, 95% CI = 1.07‐1.49, P = .006), especially in Caucasian populations.

Conclusion

These results indicated that all 3 Interleukin‐1 receptor‐associated kinase (IRAK1) gene polymorphisms, rs3027898, rs1059702 and rs1059703 were related to RA risk.
Agricultural Households: An Exploratory Analysis Revisiting Financial Position and Well‐being in Australia*
Authors: Chancellor Will , Zhao Shiji
Published: August 2020

As the issue of agricultural household economic well‐being begins to resurface, we use custom data sets to compare the financial position of agricultural households to the general Australian population. We find that agricultural households tend to have higher levels of wealth compared to households in the average Australian population, yet experience more income volatility on average. Our study brings attention to the important well‐being issue while also highlighting the need to collect robust farm household data in order to better understand the complex dynamics of household well‐being in the Australian agricultural sector.
A field and video annotation guide for baited remote underwater stereo‐video surveys of demersal fish assemblages
Authors: Langlois Tim , Goetze Jordan , Bond Todd , Monk Jacquomo , Abesamis Rene A. , Asher Jacob , Barrett Neville , Bernard Anthony T. F. , Bouchet Phil J. , Birt Matthew J. , Cappo Mike , Currey‐Randall Leanne M. , Driessen Damon , Fairclough David V. , Fullwood Laura A. F. , Gibbons Brooke A. , Harasti David , Heupel Michelle R. , Hicks Jamie , Holmes Thomas H. , Huveneers Charlie , Ierodiaconou Daniel , Jordan Alan , Knott Nathan A. , Lindfield Steve , Malcolm Hamish A. , McLean Dianne , Meekan Mark , Miller David , Mitchell Peter J. , Newman Stephen J. , Radford Ben , Rolim Fernanda A. , Saunders Benjamin J. , Stowar Marcus , Smith Adam N. H. , Travers Michael J. , Wakefield Corey B. , Whitmarsh Sasha K. , Williams Joel , Harvey Euan S.
Published: August 2020

Baited remote underwater stereo‐video systems (stereo‐BRUVs) are a popular tool to sample demersal fish assemblages and gather data on their relative abundance and body size structure in a robust, cost‐effective and non‐invasive manner. Given the rapid uptake of the method, subtle differences have emerged in the way stereo‐BRUVs are deployed and how the resulting imagery is annotated. These disparities limit the interoperability of datasets obtained across studies, preventing broadscale insights into the dynamics of ecological systems.

We provide the first globally accepted guide for using stereo‐BRUVs to survey demersal fish assemblages and associated benthic habitats.

Information on stereo‐BRUVs design, camera settings, field operations and image annotation are outlined. Additionally, we provide links to protocols for data validation, archiving and sharing.

Globally, the use of stereo‐BRUVs is spreading rapidly. We provide a standardized protocol that will reduce methodological variation among researchers and encourage the use of Findable, Accessible, Interoperable and Reusable workflows to increase the ability to synthesize global datasets and answer a broad suite of ecological questions.
Serum‐neuroproteins, near‐infrared spectroscopy, and cognitive outcome after beach‐chair shoulder surgery: Observational cohort study analyses
Authors: Larsen Jens Rolighed , Kobborg Tina , Shahim Pashtun , Blennow Kaj , Rasmussen Lars S. , Zetterberg Henrik
Published: August 2020

Background

Cerebral hypoxia may occur during surgery but currently used cerebral oxygenation saturation (rSO2) monitors remain controversial with respect to improving clinical outcome. Novel neuroprotein biomarkers are potentially released into systemic circulation and combined with near‐infrared spectroscopy (NIRS) could clarify the presence of per‐operative cerebral hypoxia. We investigated changes to serum‐neuroprotein concentrations post‐surgically, paired with NIRS and cognitive outcome, in patients operated in the beach chair position (BCP).

Methods

A prospective cohort in 28 shoulder surgery patients placed in the BCP. Blood samples were collected before induction of anaesthesia, and 2 hours and 3‐5 days post‐operatively. We analysed blood levels of biomarkers including tau and neurofilament light (NFL). We post hoc assessed the cross‐wise relationship between biomarker levels and post‐surgical changes in cognitive function and intraoperatively monitored rSO2 from NIRS.

Results

Serum‐NFL decreased from 24.2 pg/mL to 21.5 (P = .02) 2 hours post‐operatively, then increased to 27.7 pg/mL on day 3‐5 (P = .03). Conversely, s‐tau increased from 0.77 pg/mL to 0.98 (2 h), then decreased to 0.81 on day 3‐5 (P = .08). In 14/28 patients, episodic rSO2 below 55% occurred, and the duration < 55% was correlated to change in s‐tau (P < .05). The cognitive function z‐score at 1 week and 3 mo. correlated to the change in tau (P = .01), but not to NFL.

Conclusion

Some biomarkers were significantly changed with surgery in the beach chair position. The change was at some points associated to post‐operative cognitive decline, and to intraoperative low rSO2. (237).
Longitudinal Change in Alcohol Use and Motivations for Drinking Among Asian American College Students
Authors: Greene Kaylin M. , Maggs Jennifer L.
Published: August 2020

Background

Asian Americans are understudied in the literature on alcohol, due to data limitations and the perception that they are at low risk for alcohol misuse. Yet, certain subpopulations—such as college students—may be at higher risk. The current study examined longitudinal change in alcohol use and motivations for drinking among Asian American students. We tested for differences by nativity status, ethnic origin, and gender and examined whether motivations covaried with alcohol use.

Methods

Asian American first‐year college students (N = 199, 45.7% female, 37.7% foreign‐born) attending a US university were identified through stratified random sampling using registrar information. For 7 consecutive semesters, students completed online surveys about their behaviors and beliefs.

Results

Multilevel models demonstrated that alcohol use and alcohol‐related motivations increased over time. US‐born students consistently consumed more alcoholic drinks, reached higher peak drinking levels, and drank more frequently than foreign‐born students; however, motivations did not differ by nativity status. Chinese American students consumed less alcohol, drank less, and were more motivated to avoid alcohol‐related consequences than students of other/multiple heritage ethnic origins. Each motivation subscale was associated with alcohol use at the between‐person level. Likewise, within‐person variability in motivations was linked to variability in drinking across semesters. Controlling for other motivations, drinking for fun emerged as the strongest correlate of alcohol use variability.

Conclusions

Alcohol misuse was highest among US‐born students and those with higher motivations for drinking. Furthermore, alcohol use varied in tandem with motivations, suggesting that motivations may be a useful intervention target among this population.
Glucagon‐Like Peptide‐1 Receptor Signaling in the Ventral Tegmental Area Reduces Alcohol Self‐Administration in Male Rats
Authors: Dixon Tiarani N. , McNally Gavan P. , Ong Zhi Yi
Published: August 2020

Background

The misuse and abuse of alcohol is a major public health issue. However, available treatments are limited with variable efficacy. Recently, preclinical studies show that glucagon‐like‐peptide‐1 (GLP‐1) and its analogue Exendin‐4 (Ex4) potently reduce a range of alcohol intake behaviors, thus highlighting its potential as a treatment for alcohol use disorders. However, the neural mechanisms and sites of action mediating the effects of Ex4 on alcohol intake behaviors remain to be characterized. This study examined the ventral tegmental area (VTA) as a site of action for the effects of GLP‐1 on alcohol intake.

Methods

Male Long‐Evans rats were given intermittent access to 20% alcohol and trained to nose poke for 20% alcohol. Rats received intra‐VTA injections of Ex4 (vehicle, 0.01, 0.05 μg), and the effects of VTA Ex4 on alcohol self‐administration, motivation, and relapse were assessed.

Results

When compared to vehicle treatment, intra‐VTA Ex4 (0.01, 0.05 μg) delivery significantly reduced alcohol self‐administration, an effect that was particularly prominent in high alcohol drinkers. However, VTA Ex4 did not reduce reacquisition of alcohol self‐administration after extinction nor the motivation to obtain alcohol. Importantly, the lower dose of Ex4 (0.01 μg) used had no effect on food intake or locomotor activity, suggesting that the reduction in alcohol self‐administration observed was not secondary to caloric intake or motor deficits.

Conclusions

Together, these findings provide support for the VTA as a key site of action for GLP‐1 on alcohol self‐administration but not the reacquisition of alcohol self‐administration or motivation to work for alcohol.
Proximity to the Southern Border and Sociodemographic Correlates of Drinking and Driving Arrests in California
Authors: Caetano Raul , Vaeth Patrice A. C. , Gruenewald Paul J. , Ponicki William R. , Kaplan Zoe B. , Annechino Rachelle
Published: August 2020

Background

About 30% of all motor vehicle fatalities in the United States are associated with alcohol‐impaired motor vehicle crashes. Arrests for drinking and driving (Driving under the influence [DUI]) are 1 of the most important deterrence actions to minimize DUI. This paper examines trends and population‐level correlates of drinking driving arrests (DUI) from 2005 to 2017 in California.

Methods

Arrest data come from the Monthly Arrest and Citation Register compiled by the California Department of Justice. Sociodemographic and community characteristic data from the U.S. Census, alcohol outlet density, and distance to the U.S.–Mexico border from Law Enforcement Reporting Areas (LERA) centroids were aggregated at the level of 499 LERA contributing to the report. Reported arrest rates were related to area sociodemographic characteristics using hierarchical Bayesian Poisson space–time models.

Results

Both among men and women rates showed an upward trend until 2008, decreasing after that year. DUI arrest rates were greater among Hispanics than Whites for the 2 younger age groups, 18 to 29 (p < 0.001) and 30 to 39 years (p < 0.001). DUI arrest rates in LERA areas are positively related to proximity to the California/Mexico border; a higher percent of bar/pub outlets; a higher percent of Hispanic population; a higher percent of population 18 to 29, 30 to 39, and 40 to 49 years of age; a higher percent of US‐born population; a higher percent of population with annual income of $100,000 or more; a higher percent of population 150% below the federal poverty line; and a higher level of law‐enforcement activities.

Conclusions

Results of this analysis of spatial correlates of DUI arrests overlap well with the literature on individual‐level data and arrest rates. The decrease in arrest rates as distance to the California/Mexico border increases is potentially associated with the greater availability of alcohol in the border area.
The age of insects and the revival of the minimum age tree
Authors: Klopfstein Seraina
Published: August 2020

Deriving node calibrations from fossils remains by far the most common method for attaching an absolute timescale to a molecular tree. But this 'node dating' approach has a credibility problem: different studies using the same molecular data and even the same sets of fossils regularly arrive at drastically different age estimates. A major reason for these differences is well known: even well‐dated and firmly placed fossils can only provide a minimum age for a particular node. The time lag between that node and the fossil (or in other words: between the origin of a clade and its first appearance in the fossil record) is on the other hand notoriously difficult to quantify. Using recent studies on the age of the insect tree of life as an example, I discuss different rationales for choosing calibration priors based on fossils and argue that none of them is entirely convincing. I thus suggest shifting the objective of node dating analyses back to what can be achieved in a scientifically justifiable way: a dated tree that reflects the minimum ages of its constituent taxa. While this interpretation of time trees was followed widely in the early years of molecular dating, its conceptual advantages seem to have been suppressed over the promises of methods that allow integrating more complex node‐age constraints, even when those are difficult to justify. I argue that ‘minimum age trees’ should be revived for groups for which more sophisticated approaches, such as total‐evidence dating, are currently infeasible. Although minimum age trees do not provide mean estimates for the age of a group, they hold a lot of information in their own right and allow the testing of various hypotheses from the areas of biogeography and co‐evolution, while avoiding reliance on ad hoc assumptions about calibration densities.
The infestation and habitat of the ambrosia beetle Euwallacea interjectus (Coleoptera: Curculionidae: Scolytinae) in the riparian zone of Shanghai, China
Authors: Wang Zhangxun , Li You , Ernstsons A. Simon , Sun Ronghua , Hulcr Jiri , Gao Lei
Published: August 2020

Extensive boring damage into trunks of living poplar trees in the urban forest of Shanghai, eastern China, was investigated in 2017.

In order to determine the taxonomic identity of the pest, we used morphological identification and sequenced mitochondrial COI gene. Based on both morphology and molecular data, it was concluded that the pest boring into the poplars was the ambrosia beetle Euwallacea interjectus (Blandford).

Its occurrence and damage on poplar across Shanghai were also investigated. In the Pudong District, a total of 104.52 ha of urban forest were investigated thoroughly, and 16.22% of surveyed forests were found to be infested. This insect species is an important native pest capable of causing damage across the Shanghai area.

Observations in the field suggested that the damage may be related to distance to water sources. Our statistical analysis confirmed this hypothesis, as the close distance to water bodies correlated with higher levels of damage. We conclude that E. interjectus prefers host trees stressed by an occasional excessive abundance of water, and acts as a parasite on living trees without killing them.
The biology and control of an emerging shield bug pest, Pentatoma rufipes (L.) (Hemiptera: Pentatomidae)
Authors: Powell Glen
Published: August 2020

Pentatoma rufipes (L.) is common and widespread across much of the Palaearctic. The insect is particularly associated with deciduous trees and may remain in woodlands throughout the year, feeding on species such as oak, beech, and hazel.

Pentatoma rufipes is emerging as an important pest of tree fruit in northern Europe. In recent years, agronomists have been finding increasing numbers of P. rufipes in and around orchards. Feeding activity on developing fruits is being linked with pitting and distortion damage to crops including apples and pears.

There has been limited research into the ecology of this pest. Crops are particularly susceptible shortly after flowering, when over‐wintered P. rufipes nymphs feed on developing fruit.

Limited information is available linking local population levels and activity with damage. There has been some research on the impact of control strategies, but the most effective product tested was a broad‐spectrum pyrethroid insecticide. Assessments of more selective plant protection products and the availability of alternative control strategies would help develop more integrated and effective control programmes for this pest. This review highlights several key findings concerning the biology and control of the pest and makes specific recommendations for further research.
Computed tomographic and radiographic morphology of the pastern and coffin joints of One‐Humped Camel (Camelus dromedarius)
Authors: Alsafy Mohamed A. M. , El‐Gendy Samir A. , Kamal Basma
Published: August 2020

The objective of the current study was to describe the structures of the pastern and coffin joints in dromedary camel using x‐ray, bone and soft tissue windows computed tomography (CT) and three‐dimensional volume rendering (3DVR) of CT imaging. 3DVR of CT was obtained at the slight flexed dorsal view, plantar view, dorsolateral view and lateral view which explained all the surfaces and structures of the digit bony parts even the parts of the articular surface. The processed images of 3DVR of CT showed different patterns of the cortical, cancellous, subchondral bones and medullary cavity of the bones of the digits. The present study showed clearly all the hard and soft tissues in the pastern and coffin joints of the camel in CT images; however, the plantar ligaments of the pastern joint and ligaments of the navicular cartilage identified on CT images. The CT soft tissue window visualized the joint cavity and their pouches and tendon sheath of the flexor tendons better than the bone window CT. The radiographic, CT and 3D images could be used as a normal reference for the interpretation of some clinical diseases in the pastern and coffin joints of the camel.
Mortality in the first year of aged care services in Australia
Authors: Inacio Maria C. , Lang Catherine E. , Khadka Jyoti , Watt Amber M. , Crotty Maria , Wesselingh Steve , Whitehead Craig
Published: August 2020

Objective

To examine the one‐year mortality of Australians entering aged care services compared with the general population.

Methods

A population‐based analysis evaluating one‐year mortality among people who received first ever aged care services in 2013 compared with the general population was conducted.

Results

In 2013, 3.3 million Australians were ≥ 65 years and 34 919 (1%) entered permanent residential care, 23 288 (0.7%) respite care, 20 265 (0.6%) commenced home care packages, and 15 387 (0.5%) transition care. Individuals receiving aged care services had higher mortality than the general population, with those entering permanent residential care (age and sex direct standardised mortality rate ratio = 10.1, 95% CI: 9.8‐10.5) having the greatest difference, followed by people accessing respite (7.2, 95% CI: 6.9‐7.6), transition (4.6, 95% CI: 4.4‐4.9) and home care (4.1, 95% CI: 3.9‐4.4). Significant variation by sex and age was observed.

Conclusion

Our study has identified significant variations in mortality rates that highlight which cohorts entering aged care are the most vulnerable.
Histopathological discrepancy between biopsy and Mohs micrographic surgery in keratinocyte carcinoma: A 464 case series in an Australian population
Authors: Stewart Nicholas , Rodríguez Bandera Ana Isabel , Lee Simon
Published: August 2020

Background/objectives

Therapeutic approaches to keratinocyte carcinoma rely on the accuracy of the biopsy to correctly identify, grade or subtype the tumour. Several studies have investigated the frequency and nature of histopathological discordance between the biopsy and final excision specimen. We analysed information extracted from an Australian Mohs micrographic surgery (MMS) database and compared similar studies.

Methods

An Australian MMS database was retrospectively reviewed for a period of one year. Correlation was made between the preoperative lesion diagnosis based on the formal pathology report and the histopathological results reported at the time of MMS. A systematic PubMed review of similar articles was also performed.

Results

A total of 464 cancers (406 BCC and 58 SCC) in 399 patients were included. The overall discrepancy rate in the histopathological classification of keratinocyte carcinoma in our study (42.2%) and the proportion of cases in which the biopsy underestimated the aggressiveness of the tumour (12.9%) were consistent with those found in similar studies. The percentage of biopsies that failed to identify an aggressive BCC subtype (31.6%), and that of biopsy‐proven superficial BCC that demonstrated an invasive component in MMS (79.3%), were higher in our study than in comparable studies. The high prevalence of mixed histopathological subtypes, especially amongst BCC with discordant histopathological results, appeared as an important contributing factor.

Conclusions

Despite subtle differences, the results from this Australian study support the results from similar studies and highlight that the biopsy report should be carefully interpreted in combination with the clinical findings.
Lichen sclerosus and hidradenitis suppurativa: Two case reports of a new possible association
Authors: Moliterni Elisa , Miraglia Emanuele , Iacovino Chiara , Bianchini Daniela , Giustini Sandra
Published: August 2020

We report the cases of two women affected by lichen sclerosus also having clinical signs of hidradenitis suppurativa. Lichen sclerosus is a chronic autoimmune disease, in which activated fibroblasts produce significantly altered collagen leading to fibrosis Hidradenitis suppurativa is a chronic relapsing inflammatory disease affecting folliculopilosebaceous unit and apocrine gland, which lesions are nodules and abscesses. The association between lichen sclerosus and autoimmune disorders is well known, but not the one with hidradenitis suppurativa. We present two case reports of these unusual comorbidities.
Effects of Dark Tetrad traits on utilitarian moral judgement: The role of personal involvement and familiarity with the victim
Authors: Dinić Bojana M. , Milosavljević Miroslav , Mandarić Jovana
Published: August 2020

The aim of this study was to re‐examine relations between dark traits and utilitarian moral judgement in sacrificial moral dilemmas by taking into account two contextual characteristics of dilemmas: the actor’s role in sacrificing (personal or impersonal involvement in inflicting harm) and the actor’s familiarity with the victim (a known or an unknown person). Results showed that all dark traits, except for psychopathy, obtained significant main and positive effects on utilitarian moral judgement. However, psychopathy and sadism obtained interaction effects with dilemma type, indicating the importance of the specific context of moral judgement in individuals with these traits. Furthermore, among all dark traits, only sadism showed an incremental contribution to utilitarian judgement over empathy and HEXACO traits, with the highest contribution to dilemmas that include personal harm. Results highlighted the role of enjoyment of cruelty in utilitarian moral judgement.
Is short‐term exposure to grass pollen adversely associated with lung function and airway inflammation in the community?
Authors: Idrose Nur Sabrina , Tham Rachel C. A. , Lodge Caroline J. , Lowe Adrian J. , Bui Dinh , Perret Jennifer L. , Vicendese Don , Newbigin Edward J. , Tang Mimi L. K. , Aldakheel Fahad M. , Waidyatillake Nilakshi T. , Douglass Jo A. , Abramson Michael J. , Walters Eugene Haydn , Erbas Bircan , Dharmage Shyamali C.
Published: August 2020

Background

The association between grass pollen exposure and early markers of asthma exacerbations such as lung function changes and increase in airway inflammation is limited. We investigated the associations between short‐term grass pollen exposure and lung function and airway inflammation in a community‐based sample, and whether any such associations were modified by current asthma, current hay fever, pollen sensitization, age, and other environmental factors.

Methods

Cross‐sectional and short‐term analyses of data from the Melbourne Atopy Cohort Study (MACS) participants (n = 936). Lung function was assessed using spirometry. Airway inflammation was assessed by fractional exhaled nitric oxide (FeNO) and exhaled breath condensate pH and nitrogen oxides (NOx). Daily pollen counts were collected using a volumetric spore trap. The associations were examined by linear regression.

Results

Higher ambient levels of grass pollen 2 days before (lag 2) were associated with lower mid‐forced expiratory flow (FEF25%‐75%) and FEV1/FVC ratio (Coef. [95% CI] = −119 [−226, −11] mL/s and −1.0 [−3.0, −0.03] %, respectively) and also 3 days before (lag 3). Increased levels of grass pollen a day before (lag 1) were associated with increased FeNO (4.35 [−0.1, 8.7] ppb) and also at lag 2. Adverse associations between pollen and multiple outcomes were greater in adults with current asthma, hay fever, and pollen sensitization.

Conclusion

Grass pollen exposure was associated with eosinophilic airway inflammation 1‐2 days after exposure and airway obstruction 2‐3 days after exposure. Adults and individuals with asthma, hay fever, and pollen sensitization may be at higher risk.
Karma Masters: The Ethical Wound, Hauntological Choreography, and Complex Personhood in Thailand
Authors: Stonington Scott D.
Published: August 2020

In contexts of severe illness in Northern Thailand, many conceive of themselves as combinations of beings assembled through the binding ethical force of karma. Scholars working in many world areas have built frameworks for understanding “complex” (distributed, partible, fluid, transient) personhood. In this article, I bring these frameworks into conversation with ethical theory to ask how one can make sense of ethical action when one is always already partly the other. For many in Northern Thailand, the answer is anethical and hauntological choreography; rather than relying only on rational frameworks for right action or cultivating individual ethical dispositions, people seek to assemble optimal elements—other people, beings that have become components of themselves, material objects infused with ethical force—into scenes where the residual karmic “stickiness” of all can be unmade. This unmaking is achieved through a form of forgiveness and kindness that moves beyond individual agency. [personhood, ethics, ontology, haunting, Buddhism, Thailand]
An observational study of distractions in the operating theatre
Authors: van Harten A. , Gooszen H. G. , Koksma J. J. , Niessen T. J. H. , Abma T. A.
Published: August 2020

Several studies have reported on the negative impact of interruptions and distractions on anaesthetic, surgical and team performance in the operating theatre. This study aimed to gain a deeper understanding of these events and why they remain part of everyday clinical practice. We used a mixed methods observational study design. We scored each distractor and interruption according to an established scheme during induction of anaesthesia and the surgical procedure for 58 general surgical cases requiring general anaesthesia. We made field notes of observations, small conversations and meetings. We observed 64 members of staff for 148 hours and recorded 4594 events, giving a mean (SD) event rate of 32.8 (16.3) h‐1. The most frequent events observed during induction of anaesthesia were door movements, which accounted for 869 (63%) events, giving a mean (SD) event rate of 28.1 (14.5) h‐1. These, however, had little impact. The most common events observed during surgery were case‐irrelevant verbal communication and smartphone usage, which accounted for 1020 (32%) events, giving a mean (SD) event rate of 9.0 (4.2) h‐1. These occurred mostly in periods of low work‐load in a sub‐team. Participants ranged from experiencing these events as severe disruption through to a welcome distraction that served to keep healthcare professionals active during low work‐load, as well as reinforcing the social connections between colleagues. Mostly, team members showed no awareness of the need for silence among other sub‐teams and did not vocalise the need for silence to others. Case‐irrelevant verbal communication and smartphone usage may serve a physical and psychological need. The extent to which healthcare professionals may feel disrupted depends on the situation and context. When a team member was disrupted, a resilient team response often lacked. Reducing disruptive social activity might be a powerful strategy to develop a habit of cross‐monitoring and mutual help across surgical and anaesthetic sub‐teams. Further research is needed on how to bridge cultural borders and develop resilient interprofessional behaviours.
Anatomic accuracy of airway training manikins compared with humans*
Authors: Blackburn M. B. , Wang S. C. , Ross B. E. , Holcombe S. A. , Kempski K. M. , Blackburn A. N. , DeLorenzo R. A. , Ryan K. L.
Published: August 2020

Airway simulators, or training manikins, are frequently used in research studies for device development and training purposes. This study was designed to determine the anatomic accuracy of the most frequently used low‐fidelity airway training manikins. Computerised tomography scans and ruler measurements were taken of the SynDaver®, Laerdal® and AirSim® manikins. These measurements were compared with human computerised tomography (CT) scans (n = 33) from patients at the University of Michigan Medical Center or previously published values. Manikin measurements were scored as a percentile among the distribution of the same measurements in the human population and 10 out of 27 manikin measurements (nine measurements each in three manikins) were outside of two standard deviations from the mean in the participants. All three manikins were visually identifiable as outliers when plotting the first two dimensions from multidimensional scaling. In particular, the airway space between the epiglottis and posterior pharyngeal wall, through which airway devices must pass, was too large in all three manikins. SynDaver, Laerdal and AirSim manikins do not have anatomically correct static dimensions in relation to humans and these inaccuracies may lead to imprecise airway device development, negatively affect training and cause over‐confidence in users.
Re‐admissions after ileostomy formation: a retrospective analysis from a New Zealand tertiary centre
Authors: Liu Chen , Bhat Sameer , O'Grady Gregory , Bissett Ian
Published: August 2020

Background

Ileostomy formation is a commonly performed procedure in colorectal surgery. The morbidity associated with ileostomies is substantial, particularly for unplanned hospital re‐admissions and re‐admissions with dehydration. Studies of post‐ileostomy re‐admissions from an Australasian institution are currently lacking. This retrospective study aimed to quantify the 60‐day re‐admission rate after ileostomy formation in a New Zealand tertiary centre and to determine the predictive factors.

Methods

The surgical database of Auckland City Hospital was searched for all patients aged ≥18 years with a new ileostomy formed between first January 2015 and first January 2019. Patient electronic medical records were reviewed to obtain data regarding the primary outcome of re‐admissions within 60 days of discharge, as well as patient and operative variables. Multivariate regression analysis was performed to identify independent predictors of all‐cause re‐admissions and re‐admissions with dehydration.

Results

A total of 246 patients with 266 ileostomy formations were included. The 60‐day re‐admission rate was 29.3%, with dehydration present in 27.0% of these re‐admissions. Renal impairment at discharge (odds ratio 2.819, 95% confidence interval 1.087–7.310) and the presence of at least one Clavien‐Dindo 1 complication (odds ratio 2.268, 95% confidence interval 1.301–3.954) were independently associated with all‐cause re‐admission. The independent predictors of re‐admission with dehydration were renal impairment at discharge, codeine prescribed on discharge, Charlson Comorbidity Index and body mass index.

Conclusion

Unplanned hospital re‐admission following ileostomy formation is a significant issue in the New Zealand patient population. Some patient groups are at particularly high risk, such as those with renal impairment at discharge.
Acute diverticulitis: an ongoing economic burden on the health system
Authors: O'Grady Michael , Turner Gregory , Currie William , Yi Ma , Frizelle Frank , Purcell Rachel
Published: August 2020

Background

Acute diverticulitis (AD) is an increasingly common cause of acute hospital admissions. An understanding of its economic burden is necessary to plan resource allocation, and for targeting health research funding. The aim of this study is to obtain an accurate estimate of the cost of AD, accounting not only for the initial episode, but all related costs incurred during long‐term follow‐up.

Methods

The study captures a cohort of patients who had an initial admission for AD from 1 January 2012–31 December 2012, and their treatment over a 6‐year period. Cases were identified from a prospectively maintained database, with AD confirmed by computed tomography scan. The primary outcome was total healthcare cost related to AD.

Results

The study included 170 patients. The total cost was NZD1 956 859 with a median cost per patient of NZD4814. A total of 57% of the cost was incurred for the initial inpatient admission, with the remaining 43% incurred through re‐admission, follow‐up appointments, investigations and management. Half of the total cost was incurred by 11.8% of the cohort. In multivariate analysis, high cost of care was significantly associated with complicated and recurrent disease, operative intervention and length of stay.

Conclusion

This study provides an accurate estimate of the overall cost of AD and its sequelae. There are considerable long‐term costs associated with the index episode and a large proportion of the expenditure is incurred by a small group that included those with complicated disease. These findings are important for healthcare resource allocation and for targeting health research funding.
Random colonic biopsies in macroscopically normal colonoscopies: is there any benefit? A two‐centre audit of current practice
Authors: Seenarain Vidya , Idrees Marwan , Mogridge Jessie , Sinha Atul , Thompson Andrew
Published: August 2020

Background

Recent guidelines from the British Society of Gastroenterology published in April 2018, recommended performing random colonic biopsies (RCB) in endoscopically normal colonic mucosa when investigating chronic diarrhoea in adults to rule out microscopic colitis; however, cost effectiveness was not accounted for due to poor evidence base. There is now more evidence that RCBs are of low yield and of significant cost.

Methods

A two‐centre audit of current practice was conducted at Rockingham General Hospital and Fremantle Hospital in Western Australia, aiming to determine the yield of RCB in macroscopically normal mucosa for microscopic colitis, from 1 January 2009 to 30 June 2018, with comparisons of practice and results between gastroenterologists and general surgeons. Variability in the indications (diarrhoea and non‐diarrhoea indications) for RCBs was determined and the cost of consumables, additional endoscopy time and histopathology analysis were calculated.

Results

A total of 872 normal colonoscopies with RCBs were included; 48.7% of colonoscopies with RCB were for diarrhoea. Only 1.5% of RCBs were positive for microscopic colitis; 3.1% of patients with diarrhoea had microscopic colitis. Only one patient received pharmacologial treatment as a result of the test. The calculated cost per positive diagnosis of microscopic colitis was $10 862.42.

Conclusion

RCBs from normal colonic mucosa have poor yield and are costly. Local guidelines should be updated, so RCBs are performed only in patients with a high degree of suspicion of an organic cause of chronic diarrhoea.