bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving admission medication reconciliation with pharmacists or pharmacy technicians in the emergency department: a randomised controlled trial
Authors: Pevnick Joshua M , Nguyen Caroline , Jackevicius Cynthia A , Palmer Katherine A , Shane Rita , Cook-Wiens Galen , Rogatko Andre , Bear Mackenzie , Rosen Olga , Seki David , Doyle Brian , Desai Anish , Bell Douglas S
Published: October 2017

Background

Admission medication history (AMH) errors frequently cause medication order errors and patient harm.

Objective

To quantify AMH error reduction achieved when pharmacy staff obtain AMHs before admission medication orders (AMO) are placed.

Methods

This was a three-arm randomised controlled trial of 306 inpatients. In one intervention arm, pharmacists, and in the second intervention arm, pharmacy technicians, obtained initial AMHs prior to admission. They obtained and reconciled medication information from multiple sources. All arms, including the control arm, received usual AMH care, which included variation in several common processes. The primary outcome was severity-weighted mean AMH error score. To detect AMH errors, all patients received reference standard AMHs, which were compared with intervention and control group AMHs. AMH errors and resultant AMO errors were independently identified and rated by ≥2 investigators as significant, serious or life threatening. Each error was assigned 1, 4 or 9 points, respectively, to calculate severity-weighted AMH and AMO error scores for each patient.

Results

Patient characteristics were similar across arms (mean±SD age 72±16 years, number of medications 15±7). Analysis was limited to 278 patients (91%) with reference standard AMHs. Mean±SD AMH errors per patient in the usual care, pharmacist and technician arms were 8.0±5.6, 1.4±1.9 and 1.5±2.1, respectively (p<0.0001). Mean±SD severity-weighted AMH error scores were 23.0±16.1, 4.1±6.8 and 4.1±7.0 per patient, respectively (p<0.0001). These AMH errors led to a mean±SD of 3.2±2.9, 0.6±1.1 and 0.6±1.1 AMO errors per patient, and mean severity-weighted AMO error scores of 6.9±7.2, 1.5±2.9 and 1.2±2.5 per patient, respectively (both p<0.0001).

Conclusions

Pharmacists and technicians reduced AMH errors and resultant AMO errors by over 80%. Future research should examine other sites and patient-centred outcomes.

Trial registration number

NCT02026453.
Mortality, readmission and length of stay have different relationships using hospital-level versus patient-level data: an example of the ecological fallacy affecting hospital performance indicators
Authors: Hofstede Stefanie N , van Bodegom-Vos Leti , Kringos Dionne S , Steyerberg Ewout , Marang-van de Mheen Perla J
Published: October 2017

Background

Ecological fallacy refers to an erroneous inference about individuals on the basis of findings for the group to which those individuals belong. Suppose analysis of a large database shows that hospitals with a high proportion of long length of stay (LOS) patients also have higher than average in-hospital mortality. This may prompt efforts to reduce mortality among patients with long LOS. But patients with long LOS may not be the ones at higher risk of death. It may be that hospitals with higher mortality (regardless of LOS) also have more long LOS patients—either because of quality problems on both counts or because of unaccounted differences in case mix. To provide more insight how the ecological fallacy influences the evaluation of hospital performance indicators, we assessed whether hospital-level associations between in-hospital mortality, readmission and long LOS reflect patient-level associations.

Methods

Patient admissions from the Dutch National Medical Registration (2007–2012) for specific diseases (stroke, colorectal carcinoma, heart failure, acute myocardial infarction and hip/knee replacements in patients with osteoarthritis) were analysed, as well as all admissions. Logistic regression analysis was used to assess patient-level associations. Pearson correlation coefficients were used to quantify hospital-level associations.

Results

Overall, we observed 2.2% in-hospital mortality, 8.1% readmissions and a mean LOS of 5.9 days among 8 478 884 admissions in 95 hospitals. Of the 10 disease-specific associations tested, 2 were reversed at hospital-level, 3 were consistent and 5 were only significant at either hospital-level or patient-level. A reversed association was found for stroke: patients with long LOS had 58% lower in-hospital mortality (OR 0.42 (95% CI 0.40 to 0.44)), whereas the hospital-level association was reversed (r=0.30, p<0.01). Similar negative patient-level associations were found for each hospital, but LOS varied across hospitals, thereby resulting in a positive hospital-level association. A similar effect was found for long LOS and readmission in patients with heart failure.

Conclusions

Hospital-level associations did not reflect the same patient-level associations in 7 of 10 associations, and were even reversed in 2 associations. Ecological fallacy thus potentially influences interpretation of hospital performance when patient-level associations are not taken into account.
Non-ischaemic cardiomyopathy, sudden death and implantable defibrillators: a review and meta-analysis
Authors: Beggs Simon A S , Jhund Pardeep S , Jackson Colette E , McMurray John J V , Gardner Roy S
Published: October 2017

Objective

The recent Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) trial suggested that implantable cardioverter defibrillators (ICDs) do not reduce overall mortality in patients with non-ischaemic cardiomyopathy (NICM), despite reducing sudden cardiac death. We performed an updated meta-analysis to examine the impact of ICD therapy on mortality in NICM patients.

Methods

A systematic search for studies that examined the effect of ICDs on outcomes in NICM was performed. Our analysis compared patients randomised to an ICD with those randomised to no ICD, and examined the endpoint of overall mortality.

Results

Six primary prevention trials and two secondary prevention trials were identified that met the pre-specified search criteria. Using a fixed-effects model, analysis of primary prevention trials revealed a reduction in overall mortality with ICD therapy (RR 0.76, 95% CI 0.65 to 0.91).

Conclusions

Although our updated meta-analysis demonstrates a survival benefit of ICD therapy, the effect is substantively weakened by the inclusion of the DANISH trial—which is both the largest and most recent of the analysed trials—indicating that the residual pooled benefit of ICDs may reflect the risk of sudden death in older trials which included patients treated sub-optimally by contemporary standards. As such, these data must be interpreted cautiously. The results of the DANISH trial emphasise that there is no ‘one size fits all’ indication for primary prevention ICDs in NICM patients, and clinicians must consider age and comorbidity on an individual basis when determining whether a defibrillator is appropriate.
Ferumoxytol-enhanced magnetic resonance imaging in acute myocarditis
Authors: Stirrat Colin G , Alam Shirjel R , MacGillivray Thomas J , Gray Calum D , Dweck Marc R , Dibb Kevin , Spath Nick , Payne John R , Prasad Sanjay K , Gardner Roy S , Mirsadraee Saeed , Henriksen Peter A , Semple Scott IK , Newby David E
Published: October 2017

Objectives

Ultrasmall superparamagnetic particles of iron oxide (USPIO)-enhanced MRI can detect tissue-resident macrophage activity and identify cellular inflammation within tissues. We hypothesised that USPIO-enhanced MRI would provide a non-invasive imaging technique that would improve the diagnosis and management of patients with acute myocarditis.

Methods

Ten volunteers and 14 patients with suspected acute myocarditis underwent T2, T2* and late gadolinium enhancement (LGE) 3T MRI, with further T2* imaging at 24 hours after USPIO (ferumoxytol, 4 mg/kg) infusion, at baseline and 3 months. Myocardial oedema and USPIO enhancement were determined within areas of LGE as well as throughout the myocardium.

Results

Myocarditis was confirmed in nine of the 14 suspected cases of myocarditis. There was greater myocardial oedema in regions of LGE in patients with myocarditis when compared with healthy volunteer myocardium (T2 value, 57.1±5.3 vs 46.7±1.6 ms, p<0.0001). There was no demonstrable difference in USPIO enhancement between patients and volunteers even within regions displaying LGE (change in R2*, 35.0±15.0 vs 37.2±9.6 s−1, p>0.05). Imaging after 3 months in patients with myocarditis revealed a reduction in volume of LGE, a reduction in oedema measures within regions displaying LGE and improvement in ejection fraction (mean −19.7 mL, 95% CI (−0.5 to −40.0)), −5.8 ms (−0.9 to −10.7) and +6% (0.5% to 11.5%), respectively, p<0.05 for all).

Conclusion

In patients with acute myocarditis, USPIO-enhanced MRI does not provide additional clinically relevant information to LGE and T2 mapping MRI. This suggests that tissue-resident macrophages do not provide a substantial contribution to the myocardial inflammation in this condition.

Clinical trial registration NCT02319278; Results.
Renin–angiotensin system blockade therapy after transcatheter aortic valve implantation
Authors: Ochiai Tomoki , Saito Shigeru , Yamanaka Futoshi , Shishido Koki , Tanaka Yutaka , Yamabe Tsuyoshi , Shirai Shinichi , Tada Norio , Araki Motoharu , Naganuma Toru , Watanabe Yusuke , Yamamoto Masanori , Hayashida Kentaro
Published: October 2017

Objective

The persistence of left ventricular (LV) hypertrophy is associated with poor clinical outcomes after transcatheter aortic valve implantation (TAVI) for aortic stenosis. However, the optimal medical therapy after TAVI remains unknown. We investigated the effect of renin−angiotensin system (RAS) blockade therapy on LV hypertrophy and mortality in patients undergoing TAVI.

Methods

Between October 2013 and April 2016, 1215 patients undergoing TAVI were prospectively enrolled in the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI registry. This cohort was stratified according to the postoperative usage of RAS blockade therapy with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs). Patients with at least two prescriptions dispensed 180 days apart after TAVI and at least a 6-month follow-up constituted the RAS blockade group (n=371), while those not prescribed any ACE inhibitors or ARBs after TAVI were included in the no RAS blockade group (n=189).

Results

At 6 months postoperatively, the RAS blockade group had significantly greater LV mass index regression than the no RAS blockade group (−9±24% vs −2±25%, p=0.024). Kaplan-Meier analysis revealed a significantly lower cumulative 2-year mortality in the RAS blockade than that in the no RAS blockade group (7.5% vs 12.5%; log-rank test, p=0.031). After adjusting for confounding factors, RAS blockade therapy was associated with significantly lower all-cause mortality (HR, 0.45; 95% CI 0.22 to 0.91; p=0.025).

Conclusions

Postoperative RAS blockade therapy is associated with greater LV mass index regression and reduced all-cause mortality. These data need to be confirmed by a prospective randomised controlled outcome trial.
Predictors of successful chronic total occlusion percutaneous coronary interventions: a systematic review and meta-analysis
Authors: Wang Nelson , Fulcher Jordan , Abeysuriya Nishan , Adams Mark , Lal Sean
Published: October 2017

Objective

The aim of this study was to identify positive and negative predictors of technical and clinical success for percutaneous coronary intervention (PCI) of chronic total occlusions (CTO).

Methods

We conducted a systematic review and meta-analysis of studies published between 2000 and 2016 analysing rates of CTO PCI success with respect to demographic and angiographic characteristics. Crude ORs and 95% CIs for each predictor were calculated using a random effects model. Predictors of technical and clinical success were assessed among 28 demographic and 31 angiographic variables. Clinical success was defined as technical success without major adverse cardiac events.

Results

A total of 61 studies, totalling 69 886 patients were included in this analysis. The major demographic characteristics associated with a 20% or greater reduction in the odds of technical and clinical success were a history of myocardial infarction, PCI, coronary artery bypass grafting, stroke/transient ischaemic attack and peripheral vascular disease. Angiographic factors were generally stronger predictors of reduced technical and clinical success. Those associated with >20% odds reduction included non-left anterior descending CTOs, multivessel disease, presence of bridging collaterals, moderate-to-severe calcification, >45 degree vessel bending, tortuous vessel, blunt stump and ostial lesions. Of these, novel predictors included prior PCI, prior stroke, peripheral vascular disease, presence of multivessel disease and bridging collaterals.

Conclusion

The present study has identified strong negative predictors for clinical success for CTO PCI, which will aid in patient selection for this procedure.
Characterising violent deaths of undetermined intent: a population-based study, 1999–2012
Authors: Lachaud James , Donnelly Peter , Henry David , Kornas Kathy , Fitzpatrick Tiffany , Calzavara Andrew , Bornbaum Catherine , Rosella Laura
Published: October 2017

Objectives

Violent deaths classified as undetermined intent (UD) are sometimes included in suicide counts. This study investigated age and sex differences, along with socioeconomic gradients in UD and suicide deaths in the province of Ontario between 1999 and 2012.

Methods

We used data from the Institute for Clinical Evaluative Sciences, which has linked vital statistics from the Office of the Registrar General Deaths register with Census data between 1999 and 2012. Socioeconomic status was operationalised through the four dimensions of the Ontario Marginalization Index. We computed age-specific and annual age-standardised mortality rates, and risk ratios to calculate risk gradients according to each of the four dimensions of marginalization.

Results

Rates of UD-classified deaths were highest for men aged 45–64 years residing in the most materially deprived (7.9 per 100 000 population (95% CI 6.8 to 9.0)) and residentially unstable (8.1 (95% CI 7.1 to 9.1)) neighbourhoods. Similarly, suicide rates were highest among these same groups of men aged 45–64 living in the most materially deprived (28.2 (95% CI 26.1 to 30.3)) and residentially unstable (30.7 (95% CI 28.7 to 32.6)) neighbourhoods. Relative to methods of death, poisoning was the most frequently used method in UD cases (64%), while it represented the second most common method (27%) among suicides after hanging (40%).

Discussion

The similarities observed between both causes of death suggest that at least a proportion of UD deaths may be misclassified suicide cases. However, the discrepancies identified in this analysis seem to indicate that not all UD deaths are misclassified suicides.
Injury upon injury: a prospective cohort study examining subsequent injury claims in the 24 months following a substantial injury
Authors: Harcombe Helen , Davie Gabrielle , Wyeth Emma , Samaranayaka Ari , Derrett Sarah
Published: October 2017

Objectives

This study examines subsequent injuries reported to the Accident Compensation Corporation (ACC), New Zealand’s universal no-fault injury insurer, in the 24 months following an ACC entitlement claim injury event. Specific aims were to determine the: (1) 12 and 24 month cumulative incidence of at least one ACC-reported subsequent injury (ACC-SUBS-Inj), (2) characteristics of participants with and without ACC-SUBS-Inj, (3) frequency of ACC-SUBS-Inj, (4) time periods in which people are at higher risk of ACC-SUBS-Inj and (5) types of ACC-SUBS-Inj.

Methods

Interview data collected directly from participants in the Prospective Outcomes of Injury Study (POIS) were combined with ACC-SUBS-Inj data from ACC and hospital discharge datasets. A subsequent injury was defined as any injury event resulting in an ACC claim within 24 months following the injury event for which participants were recruited to POIS (the sentinel injury). All ACC-SUBS-Inj were included irrespective of whether they were the same as the sentinel injury or not.

Results

Of 2856 participants, 58% (n=1653) experienced at least one ACC-SUBS-Inj in 24 months; 31% (n=888) had more than one ACC-SUBS-Inj. The time period of lowest risk of ACC-SUBS-Inj was the first 3 months following the sentinel injury event. Spine sprain/strain was the type of injury with the greatest number of ACC-SUBS-Inj claims per person.

Conclusions

More than half of those with an ACC entitlement claim injury incurred further injury events that resulted in a claim in the following 24 months. Greater understanding of these subsequent injury events provides an avenue for injury prevention.
Comprehensive background check policy and firearm background checks in three US states
Authors: Castillo-Carniglia Alvaro , Kagawa Rose M C , Webster Daniel W , Vernick Jon S , Cerdá Magdalena , Wintemute Garen J
Published: October 2017

Background

Comprehensive background check (CBC) policies are hypothesised to reduce firearm-related violence because they extend background checks to private party firearm sales, but no study has determined whether these policies actually increase background checks, an expected intermediary outcome. We evaluate the association between CBC policies and the rates of firearm background checks in three states that recently implemented these policies: Delaware (July 2013), Colorado (July 2013) and Washington (December 2014).

Methods

We used the synthetic control group method to estimate the difference from estimated counterfactual postintervention trends in the monthly rate of background checks per 1 00 000 people for handguns, long guns and both types combined, using data for January 1999 through December 2016. Inference was based on results from permutation tests. We conducted multiple sensitivity analyses to assess the robustness of our results.

Results

Background check rates increased in Delaware, by 22%–34% depending on the type of firearm, following enactment of its CBC law. No overall changes were observed in Washington and Colorado. Our results were robust to changes in the comparison group and statistical methods.

Conclusions

The enactment of CBC policies was associated with an overall increase in firearm background checks only in Delaware. Data external to the study suggest that Washington experienced a modest, but consistent, increase in background checks for private party sales, and Colorado experienced a similar increase in checks for sales not at gun shows. Non-compliance may explain the lack of an overall increase in background checks in Washington and Colorado.
Time: would you like more?
Authors: Crowe Carolyne
Published: October 2017

Daily life in practice can sometimes feel like an uphill battle. How many times have you said or heard ‘I ran out of time’ or ‘I don't have time’? If you were given an extra hour each day, what would you do? Would this hour immediately get filled with the tasks you can't currently fit in, or would you fill it with something different, something just for yourself? Like ‘work‐life balance’ the phrase ‘time management’ is overused and under appreciated. You may know someone who seems to fit five times more than the average person into every day ‐ they are not super‐human, they simply plan and manage their time effectively. Here's how you can become one of those people too.
Comments on the dilemma in the September issue: Performance indicators and prescribing antimicrobials
Authors: Aitken Maureen
Published: October 2017

In the dilemma discussed in the September issue of In Practice, a practice has introduced average amount billed per consultation as a key performance indicator for vets and, since then, a vet has been prescribing antimicrobials in situations in which he would not have done so previously or in cases which do not warrant it (IP, September 2017, vol 39, pp 382‐383). Anne Fawcett and Thomas Gottlieb discuss virtue ethics and say that there is an expectation that vets do not pursue personal gain at the expense of their clients. They discuss the Tragedy of the Commons, which hinges on the belief that personal gain should not be sought at the expense of others, pointing out that imprudent use of antimicrobials contributes to antibiotic resistance. Fawcett and Gottlieb conclude that antimicrobials should be excluded from practice profitability calculations.
Maternal health and social outcomes after having a child taken into care: population-based longitudinal cohort study using linkable administrative data
Authors: Wall-Wieler Elizabeth , Roos Leslie L , Bolton James , Brownell Marni , Nickel Nathan C , Chateau Dan
Published: October 2017

Background

We investigated whether mothers experience changes to their health and social situation after having a child taken into care by child protection services, then compared these outcomes with those found in mothers whose children were not taken into care.

Methods

The cohort includes mothers whose first child was born in Manitoba between 1 April 1998 and 31 March 2011. Mothers whose children were taken into care after age 2 (n=1591) were compared with a matched group of women whose children were not taken into care (n=1591).

Results

The rates of mental illness diagnoses, treatment use and social factors were significantly higher for mother whose children were taken into care, both in the 2 years before and in the 2 years after the index date. These adjusted relative rates (ARRs) increased significantly for anxiety (before ARR=2.71, after ARR=3.55), substance use disorder (3.77–5.95), physician visits for mental illness (2.83–3.66), number of prescriptions (psychotropic: 4.35–5.86; overall: 2.34–2.94), number of different prescriptions (psychotropic: 2.70-3.27; overall: 1.62–1.70), residential mobility (1.40–1.63) and welfare use (2.07–2.30).

Conclusion

The health and social situation of mothers involved with child protection services deteriorates after their child is taken into care. Mothers would benefit from supports during this time period to ensure that the outcomes they experience after the loss of their child do not become another barrier to reunification.
Baseline prevalence and longitudinal evolution of non-motor symptoms in early Parkinson’s disease: the PPMI cohort
Authors: Simuni Tanya , Caspell-Garcia Chelsea , Coffey Christopher S , Weintraub Daniel , Mollenhauer Brit , Lasch Shirley , Tanner Caroline M , Jennings Danna , Kieburtz Karl , Chahine Lana M , Marek Kenneth
Published: October 2017

Objective

To examine the baseline prevalence and longitudinal evolution in non-motor symptoms (NMS) in a prospective cohort of, at baseline, patients with de novo Parkinson’s disease (PD) compared with healthy controls (HC).

Methods

Parkinson’s Progression Markers Initiative (PPMI) is a longitudinal, ongoing, controlled study of de novo PD participants and HC. NMS were rated using the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part I score and other validated NMS scales at baseline and after 2 years. Biological variables included cerebrospinal fluid (CSF) markers and dopamine transporter imaging.

Results

423 PD subjects and 196 HC were enrolled and followed for 2 years. MDS-UPDRS Part I total mean (SD) scores increased from baseline 5.6 (4.1) to 7.7 (5.0) at year 2 in PD subjects (p<0.001) versus from 2.9 (3.0) to 3.2 (3.0) in HC (p=0.38), with a significant difference between the groups (p<0.001). In the multivariate analysis, higher baseline NMS score was associated with female sex (p=0.008), higher baseline MDS-UPDRS Part II scores (p<0.001) and more severe motor phenotype (p=0.007). Longitudinal increase in NMS severity was associated with the older age (0.008) and lower CSF Aβ1–42 (0.005) at baseline. There was no association with the dose or class of dopaminergic therapy.

Conclusions

This study of NMS in early PD identified clinical and biological variables associated with both baseline burden and predictors of progression. The association of a greater longitudinal increase in NMS with lower baseline Aβ1–42 level is an important finding that will have to be replicated in other cohorts.

Trial registration

ClinicalTrials.gov identifier: NCT01141023.
Staging of cortical and deep grey matter functional connectivity changes in multiple sclerosis
Authors: Meijer Kim A , Eijlers Anand J C , Geurts Jeroen J G , Schoonheim Menno M
Published: October 2017

Objective

Functional connectivity is known to increase as well as decrease throughout the brain in multiple sclerosis (MS), which could represent different stages of the disease. In addition, functional connectivity changes could follow the atrophy pattern observed with disease progression, that is, moving from the deep grey matter towards the cortex. This study investigated when and where connectivity changes develop and explored their clinical and cognitive relevance across different MS stages.

Methods

A cohort of 121 patients with early relapsing–remitting MS (RRMS), 122 with late RRMS and 53 with secondary progressive MS (SPMS) as well as 96 healthy controls underwent MRI and neuropsychological testing. Functional connectivity changes were investigated for (1) within deep grey matter connectivity, (2) connectivity between the deep grey matter and cortex and (3) within-cortex connectivity. A post hoc regional analysis was performed to identify which regions were driving the connectivity changes.

Results

Patients with late RRMS and SPMS showed increased connectivity of the deep grey matter, especially of the putamen and palladium, with other deep grey matter structures and with the cortex. Within-cortex connectivity was decreased, especially for temporal, occipital and frontal regions, but only in SPMS relative to early RRMS. Deep grey matter connectivity alterations were related to cognition and disability, whereas within-cortex connectivity was only related to disability.

Conclusion

Increased connectivity of the deep grey matter became apparent in late RRMS and further increased in SPMS. The additive effect of cortical network degeneration, which was only seen in SPMS, may explain the sudden clinical deterioration characteristic to this phase of the disease.
Flortaucipir tau PET imaging in semantic variant primary progressive aphasia
Authors: Makaretz Sara J , Quimby Megan , Collins Jessica , Makris Nikos , McGinnis Scott , Schultz Aaron , Vasdev Neil , Johnson Keith A , Dickerson Bradford C
Published: October 2017

Objective

The semantic variant of primary progressive aphasia (svPPA) is typically associated with frontotemporal lobar degeneration (FTLD) with longTAR DNA-binding protein (TDP)-43-positive neuropil threads and dystrophic neurites (type C), and is only rarely due to a primary tauopathy or Alzheimer’s disease. We undertook this study to investigate the localisation and magnitude of the presumed tau Positron Emission Tomography (PET) tracer [18F]Flortaucipir (FTP; also known as T807 or AV1451) in patients with svPPA, hypothesising that most patients would not show tracer uptake different from controls.

Methods

FTP and [11C]Pittsburgh compound B PET imaging as well as MRI were performed in seven patients with svPPA and in 20 controls. FTP signal was analysed by visual inspection and by quantitative comparison to controls, with and without partial volume correction.

Results

All seven patients showed elevated FTP uptake in the anterior temporal lobe with a leftward asymmetry that was not observed in healthy controls. This elevated FTP signal, largely co-localised with atrophy, was evident on both visual inspection and quantitative cortical surface-based analysis. Five patients were amyloid negative, one was amyloid positive and one has an unknown amyloid status.

Conclusions

In this series of patients with clinical profiles, structural MRI and amyloid PET imaging typical for svPPA, FTP signal was unexpectedly elevated with a spatial pattern localised to areas of atrophy. This raises questions about the possible off-target binding of this tracer to non-tau molecules associated with neurodegeneration. Further investigation with autopsy analysis will help illuminate the binding target(s) of FTP in cases of suspected FTLD-TDP neuropathology.
Quality of life in inflammatory neuropathies: the IN-QoL
Authors: Draak Thomas H P , Faber Catharina G , Merkies Ingemar S J
Published: October 2017

Background

No consensus exists which quality of life (QoL) measure should be used in patients with inflammatory neuropathies. Moreover, most QoL measures are ordinal-based scales with their known deficiencies.

Objectives

To establish a new disease-specific interval-based QoL questionnaire in inflammatory neuropathies (IN-QoL) using the Rasch model and evaluate its scientific properties (validity, reliability and responsiveness).

Methods

264 patients with inflammatory neuropathies completed six commonly used QoL questionnaires. The obtained data were stacked and subjected to Rasch analysis. Responsiveness was determined by using the concept of minimum clinically important differences related to varying individually obtained SEs (responsiveness definition: MCID-SE≥1.96 after 1-year follow-up compared with baseline).

Results

The IN-QoL fulfilled all Rasch’s model requirements with high internal reliability values (patient separation index of 0.94), except being multidimensional. Additional factor analysis resulted in two (functional and mental) subsets that were unidimensional on their own. The IN-QoL showed good correlation with the EuroQol-health quality visual analogue scale (EQ-VAS) (Spearman’s rho 0.72). It demonstrated acceptable responsiveness in patients with Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), as did the EQ-VAS. In patients with monoclonal gammopathy-related neuropathy and multifocal motor neuropathy, hardly any changes were seen over time.

Conclusion

The IN-QoL questionnaire fulfils modern clinimetric requirements and correlates strongly with a patient’s self-assessment of their own quality of health, while also showing responsiveness in patients with GBS and CIDP. We propose using the IN-QoL and the EQ-VAS for assessing the QoL of patients with inflammatory neuropathies in future studies.
Shocking the system: AEDs in military resuscitation
Authors: Buckley Andrew M , Cox A T , Rees P
Published: October 2017

Automated external defibrillator (AED) devices have been in routine clinical use since the early 1990s to deliver life-saving shocks to appropriate patients in non-clinical environments. As expectations of survival from out-of-hospital cardiac arrest increase, and evidence incontrovertibly points to reduced timelines as the most crucial factor in achieving return of spontaneous circulation, questions regarding the availability and location of AEDs in the UK military need to be readdressed. This article explores the background of AEDs and reviews their history, life-saving potential and defines current and best practice. It goes on to review the evidence surrounding training and looks to identify knowledge gaps that might be addressed effectively by future research. Finally, it makes recommendations regarding training, availability of AEDs on military bases and locations most likely to deliver good outcomes for military personnel in the future.
Autoadjusted versus fixed CPAP for obstructive sleep apnoea: a multicentre, randomised equivalence trial
Authors: Bloch Konrad E , Huber Fabienne , Furian Michael , Latshang Tsogyal D , Lo Cascio Christian M , Nussbaumer-Ochsner Yvonne , Senn Oliver , Russi Erich W , Kohler Malcolm , Schoch Otto D , Turk Alexander , Imhof Edelbert , Laube Irène , Matthews Felix , Thurnheer Robert
Published: October 2017

Background

The obstructive sleep apnoea syndrome (OSAS) is conventionally treated by continuous positive airway pressure set at a fixed level (fCPAP). Automatic mask pressure adjustment (autoCPAP) is increasingly used during home therapy. We investigated whether autoCPAP is equivalent to fCPAP in improving sleepiness in patients with OSAS in the long-term.

Methods

In this multicentre equivalence trial, 208 patients with OSAS, with median Epworth sleepiness score (ESS) 13, apnoea/hypopnoea index 48.4/hour, were randomised to treatment with autoCPAP (5–15 mbar) or fCPAP (pressure set at the 90th percentile applied by autoCPAP during 2–4 weeks adaptation). Coprimary outcomes were changes in subjective and objective sleepiness from baseline to 2 years after treatment. Equivalence ranges were ±2 points in ESS and ±3 min sleep resistance time evaluated by recording responses to light signals.

Results

At 2 years, in the intention to treat analysis, the reduction in sleepiness versus pretreatment baseline was similar in patients using autoCPAP (n=113, mean ESS-change −6.3, 95% CI −7.1 to −5.5; sleep resistance time +8.3 min, +6.9 to +9.7) and fCPAP (n=95, mean ESS-change −6.2, 95% CI −7.0 to −5.3; sleep resistance time +6.3 min, +4.7 to +7.8). The 95% CI of difference in ESS-reduction between autoCPAP and fCPAP was −0.9 to +1.4 and the 95% CI of difference in increase in sleep resistance time was −2.6 to +1.0 min. Blood pressure reduction and OSAS-related costs were similar between groups.

Conclusions

AutoCPAP and fCPAP are equivalent within prespecified ranges in improving subjective and objective sleepiness in patients with OSAS over the course of 2 years. Costs of these treatments are similar.

Trial registration number

ClinicalTrials.gov NCT00280800.
Relationship between smoking and health and education spending in Chile
Authors: Paraje Guillermo , Araya Daniel
Published: October 2017

Objective

To estimate the degree to which tobacco consumption is associated with spending on a set of goods and services in Chile, especially health and education, for the total population as well as for specific subgroups.

Methods

A seemingly unrelated regression equation system was used to estimate the statistical relationship between having tobacco expenditures and the budget share allocated to other items for the total population and for specific subgroups in Chile (eg, households within the bottom/top 33% by total expenditures). The use of household-level data allows for the control of a number of sociodemographic characteristics. The nationally representative 2012 Chilean Household Expenditure Survey was used for the analysis.

Results

Tobacco consumption is associated with lower budget shares allocated to healthcare, education and housing expenses, especially for poorer households. In the case of health, not consuming tobacco is related to higher health expenditures: up to 32% for the total population. Similarly, in the case of education, not consuming tobacco is statistically related to higher education expenditures: up to 16% for the total population. For all groups, tobacco consumption is also related to a significantly higher budget share allocated to alcoholic beverages.

Conclusions

The strong significant statistical relationship found between tobacco consumption and resources allocated to healthcare and education consumption may be indicative of the existence of a crowding out effect of tobacco. This effect, in turn, may increase the burden that the rest of society must bear for the increased healthcare that they require because of tobacco consumption.
Bacterial isolates and antimicrobial susceptibilities from odontogenic abscesses in rabbits: 48 cases
Authors: Gardhouse Sara , Sanchez‐Migallon Guzman David , Paul‐Murphy Joanne , Byrne Barbara A , Hawkins Michelle G
Published: October 2017

The medical record database of a veterinary teaching hospital was searched from 2000 through 2014 for records of client‐owned rabbits with positive cultures from odontogenic abscesses. Data reviewed included sex, age, abscess location, sampling technique, previous antimicrobial treatments, microorganisms identified and antibiotic susceptibility of aerobic bacteria. Forty‐eight client owned rabbits with one or more odontogenic abscesses and culture results were evaluated. One hundred and eighty‐five isolates (52 aerobic, 133 anaerobic) were identified from 61 positive cultures from odontogenic abscesses. The most common aerobic bacterial isolates were Pseudomonas aeruginosa (14/52), Pasteurella species (10/52), Streptococcus species (8/52) and Staphylococcus species (7/52). The most common anaerobic bacterial isolates were Fusobacterium species (36/133), Peptostreptococcus species (27/133) and Bacteroides species (27/133). Mixed aerobic and anaerobic isolates were detected in 73.3 per cent of cultures and 50.8 per cent of the samples had greater than three isolates. P aeruginosa was susceptible to amikacin and gentamicin, had variable resistance to enrofloxacin, and resistance to chloramphenicol. Pasteurella species, Streptococcus species and Staphylococcus species isolates were susceptible to most antibiotics tested. The bacterial isolates from rabbit odontogenic abscesses are a mixture of aerobic and anaerobic Gram‐positive and Gram‐negative organisms and without culture and susceptibility testing, it is difficult to predict appropriate antimicrobial treatment.
Determination of reference values for intraocular pressure and Schirmer tear test results in clinically normal domestic donkeys (Equus asinus)
Authors: Selk Ghaffari Masoud , Sabzevari Amin , Ghamsari SeyedMehdi , Shad Hussein
Published: October 2017

This study was conducted to establish normal reference range for the Schirmer tear test (STT) and intraocular pressure (IOP) in clinically normal donkeys for use in clinical practice. Sixteen adult Ethiopian domestic donkeys were used in this study. Complete ophthalmic examinations were performed without chemical restraint. STT values were evaluated in both eyes of all donkeys using a commercial STT strip. IOP was measured in both eyes with a Tono‐Pen Vet (Reichert. USA) without using regional nerve blocks. STT values for all eyes (n=32) were 22.1±6.9 mm/minute with a range of 13–35 mm/minute. Comparison of mean STT values between right (n=16) and left eyes (n=16) showed no differences (P=0.6). Mean ±sd IOP values by applanation tonometry were 17.8±3.7 mmHg (range 13.5–24.5 mmHg). Comparison of mean IOP values between right (n=16) and left eyes (n=16) showed no differences (P=0.7). This initial survey provides means and ranges for IOP and STT values in donkeys. These data will assist veterinary ophthalmologists in more accurate diagnosis and management of ophthalmic diseases in donkeys, including keratoconjunctivitis sicca and glaucoma
BVA Policy Committee welcomes a new member
Authors: Findon Amelia
Published: October 2017

Amelia Findon, BVA head of policy, introduces Sally Everitt, the newest member of the BVA Policy Committee.
Effects of slaughter weight and growth rate on the longissimus muscle metabolic characteristics, and pork sensory quality in pigs of two sexes
Authors: Duan Yan , Faucitano Luigi , Rivest Joël , Graveline Nancy , Cliche Simon , Gariépy Claude
Published: October 2017

A total of 119 pigs were used to investigate the effect of slaughter weight (107, 115, and 125 kg), growth rate (fast vs. slow), and sex (barrows vs. gilts) on the longissimus muscle biochemical and sensory traits. Increasing slaughter weight to 125 kg resulted in greater postmortem activity of calpastatin (P = 0.01), lactate dehydrogenase (P = 0.01), and citrate synthase (P = 0.02). Pork toughness and juiciness at 6 d were affected by the interaction slaughter weight × growth rate × sex, with pork being tougher (P = 0.04) and juicer (P = 0.03) in slow-growing gilts slaughtered at 125 and 115 kg, respectively. Flavour was scored higher (P = 0.03) in pork from gilts than from barrows. Overall, based on the slight and likely undetectable differences by the average consumer in the meat sensory traits, it can be concluded that slaughter weight can be increased to 125 kg without appreciable effect on the sensory properties.
Pollen morphology in selected species of Caricaceae with special reference to novel palynological characters
Authors: Zini Lucía Melisa , Carrera Constanza Soledad , Lattar Elsa Clorinda , Ferrucci María Silvia
Published: October 2017

The pollen grain morphology of Jacaratia corumbensis Kuntze, J. spinosa (Aubl.) A.DC., Vasconcellea quercifolia A. St.-Hil., and Carica papaya L. from Argentine samples were examined for the first time, using light and scanning electron microscopes. Observations and measurements were performed on acetolyzed pollen grains. Principal-components analysis was performed for quantitative morphological variables. Pollen grains were tri-colporate with lalongate endoaperture, oblate spheroidal to prolate, medium, exine bireticulate or reticulate, with a granulate lumina. A fastigium was present. Novel palynological data in this study for species identification revealed the presence of margo in C. papaya and variations in endoaperture shapes in all the species. The endoaperture ends often were H-shaped or horn-shaped. A biplot showed clear separation of the four taxa based on the palynological traits. Vasconcellea quercifolia was strongly correlated with equatorial diameter, equatorial diameter in polar view, exine thickness, and polar diameter, whereas J. corumbensis and J. spinosa were positively correlated with polar index and polar area index, respectively. The distance between two colpi allowed the discrimination of C. papaya. We confirmed the homogenous nature for most of the qualitative palynological characters in Caricaceae, and demonstrated that pollen morphology in combination with statistical analyses is a reliable tool for delimiting taxonomic groups.
Modeling oxythermal stress for cool-water fishes in lakes using a cumulative dosage approach
Authors: Magee Madeline R. , McIntyre Peter B. , Wu Chin H.
Published: October 2017

Lake warming can negatively impact cool-water fishes through both temperature and oxygen stress. We modeled the joint dynamics of water column temperature and oxygen to quantify oxythermal habitat for yellow perch (Perca flavescens) in Fish Lake, Wisconsin, USA. To estimate annual oxythermal stress, we developed a novel metric (cumulative oxythermal stress dosage; COSD) that integrates both stress duration and stress magnitude. We find that COSD better predicts observed perch declines than the published TDO3 metric (temperature at depth where dissolved oxygen is 3 mg·L−1), which was developed for cold-water fish. Simulations show increases in COSD between 1911 and 2014, punctuated by a sharp rise since 1989. Extreme COSD years result from the intersection of high maximum daily dosage and prolonged duration exceeding the tolerance threshold. Temperature perturbation experiments to explore future climate scenarios reveal that COSD would increase greatly if the atmosphere warms by >3 °C. Applying the COSD metric broadly to temperate lakes could help direct management efforts toward the ecosystems most likely to serve as climate refugia for cold- and cool-water fishes in the future.
CLASSIFICATION OF FOCAL AND NONFOCAL EEG SIGNALS USING FEATURES DERIVED FROM FOURIER-BASED RHYTHMS
Authors: SINGH PUSHPENDRA , PACHORI RAM BILAS
Published: October 2017

We propose a new technique for the automated classification of focal and nonfocal electroencephalogram (EEG) signals using Fourier-based rhythms in this paper. The EEG rhythms, namely, delta, theta, alpha, beta and gamma, are obtained using the discrete Fourier transform (DFT)-based filter bank applied on EEG signals. The mean-frequency (MF) and root-mean-square (RMS) bandwidth features are derived using DFT-based computation on rhythms of EEG signals and their envelopes. These derived features, namely, MF and RMS bandwidths have been provided as an input feature set for the classification of focal and nonfocal EEG signals using a least-squares support vector machine (LS-SVM) classifier. We present experimental results obtained from the publicly available database in order to demonstrate the effectiveness of the proposed feature sets for the automated classification of the focal and nonfocal classes of EEG signals. The obtained classification accuracy in this dataset for the automated classification of focal and nonfocal 50 pairs and 750 pairs of EEG signals are 89.7% and 89.52%, respectively.
Exploiting Chip Idleness for Minimizing Garbage Collection—Induced Chip Access Conflict on SSDs
Authors: Gao Congming , Shi Liang , Di Yejia , Li Qiao , Xue Chun Jason , Wu Kaijie , Sha Edwin
Published: October 2017

Solid state drives (SSDs) are normally constructed with a number of parallel-accessible flash chips, where host I/O requests are processed in parallel. In addition, there are many internal activities in SSDs, such as garbage collection and wear leveling induced read, write, and erase operations, to solve the issues of inability of in-place updates and limited lifetime. When internal activities are triggered on a chip, the chip will be blocked. Our preliminary studies on several workloads show that when internal activities are frequently triggered, the host I/O performance will be significantly impacted because of the
access conflict
between them. In this work, in order to improve the access conflict induced performance degradation, a novel
access conflict
minimization scheme is proposed. The basic idea of the scheme is motivated by an interesting observation in SSDs: several chips are idle when other chips are busy with internal activities and host I/O requests. Based on this observation, we propose to schedule internal activities induced operations for minimized access conflict by exploiting the idleness of the multiple chips of SSDs. This approach is realized by two steps: First, read internal activities accessed data to the controller; second, by exploiting the idle chips during internal activities, write internal activities accessed data back to these idle chips. With this scheme, the internal activities can be processed with minimized access conflict to the host requests. Simulation results show that the proposed approach significantly reduces the access conflict, and in turn leads to a significant performance improvement of SSDs.
Early Evaluation of Implementation Alternatives of Composite Data Structures Toward Maintainability
Authors: Karanikolas Chris , Dimitroulakos Grigoris , Masselos Konstantinos
Published: October 2017

Selecting between different design options is a crucial decision for object-oriented software developers that affects code quality characteristics. Conventionally developers use their experience to make such decisions, which leads to suboptimal results regarding code quality. In this article, a formal model for providing early estimates of quality metrics of object-oriented software implementation alternatives is proposed. The model supports software developers in making fast decisions in a systematic way early during the design phase to achieve improved code characteristics. The approach employs a comparison model related to the application of the Visitor design pattern and inheritance-based implementation on structures following the Composite design pattern. The model captures maintainability as a metric of software quality and provides precise assessments of the quality of each implementation alternative. Furthermore, the model introduces the structural maintenance cost metric based on which the progressive analysis of the maintenance process is introduced. The proposed approach has been applied to several test cases for different relevant quality metrics. The results prove that the proposed model delivers accurate estimations. Thus, the proposed methodology can be used for comparing different implementation alternatives against various measures and quality factors before code development, leading to reduced effort and cost for software maintenance.