bluuebunny/crossref_metadata_2025 huggingface dataset:
Monitoring Antimicrobial Resistance in the Food Supply Chain and Its Implications for FDA Policy Initiatives
Authors: Zawack Kelson , Li Min , Booth James G. , Love Will , Lanzas Cristina , Gröhn Yrjö T.
Published: June 2016

In response to concerning increases in antimicrobial resistance (AMR), the Food and Drug Administration (FDA) has decided to increase veterinary oversight requirements for antimicrobials and restrict their use in growth promotion. Given the high stakes of this policy for the food supply, economy, and human and veterinary health, it is important to rigorously assess the effects of this policy. We have undertaken a detailed analysis of data provided by the National Antimicrobial Resistance Monitoring System (NARMS). We examined the trends in both AMR proportion and MIC between 2004 and 2012 at slaughter and retail stages. We investigated the makeup of variation in these data and estimated the sample and effect size requirements necessary to distinguish an effect of the policy change. Finally, we applied our approach to take a detailed look at the 2005 withdrawal of approval for the fluoroquinolone enrofloxacin in poultry water. Slaughter and retail showed similar trends. Both AMR proportion and MIC were valuable in assessing AMR, capturing different information. Most variation was within years, not between years, and accounting for geographic location explained little additional variation. At current rates of data collection, a 1-fold change in MIC should be detectable in 5 years and a 6% decrease in percent resistance could be detected in 6 years following establishment of a new resistance rate. Analysis of the enrofloxacin policy change showed the complexities of the AMR policy with no statistically significant change in resistance of both
Campylobacter jejuni
and
Campylobacter coli
to ciprofloxacin, another second-generation fluoroquinolone.
Repurposing the Nonsteroidal Anti-inflammatory Drug Diflunisal as an Osteoprotective, Antivirulence Therapy for Staphylococcus aureus Osteomyelitis
Authors: Hendrix Andrew S. , Spoonmore Thomas J. , Wilde Aimee D. , Putnam Nicole E. , Hammer Neal D. , Snyder Daniel J. , Guelcher Scott A. , Skaar Eric P. , Cassat James E.
Published: June 2016

Staphylococcus aureus
osteomyelitis is a common and debilitating invasive infection of bone. Treatment of osteomyelitis is confounded by widespread antimicrobial resistance and the propensity of bacteria to trigger pathological changes in bone remodeling that limit antimicrobial penetration to the infectious focus. Adjunctive therapies that limit pathogen-induced bone destruction could therefore limit morbidity and enhance traditional antimicrobial therapies. In this study, we evaluate the efficacy of the U.S. Food and Drug Administration-approved, nonsteroidal anti-inflammatory (NSAID) compound diflunisal in limiting
S. aureus
cytotoxicity toward skeletal cells and in preventing bone destruction during staphylococcal osteomyelitis. Diflunisal is known to inhibit
S. aureus
virulence factor production by the accessory gene regulator (
agr
) locus, and we have previously demonstrated that the Agr system plays a substantial role in pathological bone remodeling during staphylococcal osteomyelitis. Consistent with these observations, we find that diflunisal potently inhibits osteoblast cytotoxicity caused by
S. aureus
secreted toxins independently of effects on bacterial growth. Compared to commonly used NSAIDs, diflunisal is uniquely potent in the inhibition of skeletal cell death
in vitro
. Moreover, local delivery of diflunisal by means of a drug-eluting, bioresorbable foam significantly limits bone destruction during
S. aureus
osteomyelitis
in vivo
. Collectively, these data demonstrate that diflunisal potently inhibits skeletal cell death and bone destruction associated with
S. aureus
infection and may therefore be a useful adjunctive therapy for osteomyelitis.
Role of Inflammatory and Oxidative Stress, Cytochrome P450 2E1, and Bile Acid Disturbance in Rat Liver Injury Induced by Isoniazid and Lipopolysaccharide Cotreatment
Authors: Hassan Hozeifa Mohamed , Guo Hongli , Yousef Bashir Alsiddig , Guerram Mounia , Hamdi Aida Mejda , Zhang Luyong , Jiang Zhenzhou
Published: June 2016

Isoniazid (INH) remains the core drug in tuberculosis management, but serious hepatotoxicity and potentially fatal liver injury continue to accompany INH consumption. Among numerous theories that have been established to explain INH-induced liver injury, an inflammatory stress theory has recently been widely used to explain the idiosyncrasy. Inflammatory stress usually sensitizes tissues to a drug's toxic consequences. Therefore, the present study was conducted to verify whether bacterial lipopolysaccharide (LPS)-induced inflammation may have a role in enhancing INH hepatotoxicity. While single INH or LPS administration showed no major toxicity signs, INH-LPS cotreatment intensified liver toxicity. Both blood biomarkers and histological evaluations clearly showed positive signs of severe liver damage accompanied by massive necrosis, inflammatory infiltration, and hepatic steatosis. Furthermore, elevated serum levels of bile acid associated with the repression of bile acid synthesis and transport regulatory parameters were observed. Moreover, the principal impact of cytochrome P450 2E1 (CYP2E1) on INH toxicity could be anticipated, as its protein expression showed enormous increases in INH-LPS-cotreated animals. Furthermore, the crucial role of CYP2E1 in the production of reactive oxygen species (ROS) was clearly obvious in the repression of hepatic antioxidant parameters. In summary, these results confirmed that this LPS-induced inflammation model might prove valuable in revealing the hepatotoxic mechanisms of INH and the crucial role played by CYP2E1 in the initiation and propagation of INH-induced liver damage, information which could be very useful to clinicians in understanding the pathogenesis of drug-induced liver injury.
Full-Length Nucleotide Sequences of
mcr-1
-Harboring Plasmids Isolated from Extended-Spectrum-β-Lactamase-Producing Escherichia coli Isolates of Different Origins
Authors: Zurfluh Katrin , Klumpp Jochen , Nüesch-Inderbinen Magdalena , Stephan Roger
Published: June 2016

Here, we present the full sequences of three
mcr-1
-carrying plasmids isolated from extended-spectrum-β-lactamase (ESBL)-producing
Escherichia coli
. The plasmids belong to three different replicon types and are 34,640 bp, 209,401 bp, and 247,885 bp in size. We describe for the first time a composite transposon containing
mcr-1
localized on a multidrug-resistant (MDR) IncHI2 plasmid harboring additional determinants of resistance to six different classes of antibiotics, including the ESBL gene
bla
CTX-M-1
, and heavy metal resistance.
Meningococcal Two-Partner Secretion Systems and Their Association with Outcome in Patients with Meningitis
Authors: Piet Jurgen R. , van Ulsen Peter , ur Rahman Sadeeq , Bovenkerk Sandra , Bentley Stephen D. , van de Beek Diederik , van der Ende Arie
Published: June 2016

Two-partner secretion (TPS) systems export large TpsA proteins to the surface and extracellular milieu. In meningococci, three different TPS systems exist, and of these, TPS system 2 (TPS2) and TPS3 can be detected by the host's immune system. We evaluated the distribution of TPS systems among clinical isolates from two prospective cohort studies comprising 373 patients with meningococcal meningitis. TPS system 1 was present in 91% of isolates, and system 2 and/or 3 was present in 67%. The TPS system distribution was related to clonal complexes. Infection with strains with TPS2 and/or TPS3 resulted in less severe disease and better outcomes than infection with strains without these systems. Using whole-blood stimulation experiments, we found no differences in the host cytokine response between patients infected with TPS system 2 and 3 knockout strains and patients infected with a wild-type strain. In conclusion, meningococcal TPS system 2 and/or 3 is associated with disease severity and outcome in patients with meningitis.
Bacteroides fragilis Enterotoxin Upregulates Heme Oxygenase-1 in Intestinal Epithelial Cells via a Mitogen-Activated Protein Kinase- and NF-κB-Dependent Pathway, Leading to Modulation of Apoptosis
Authors: Ko Su Hyuk , Rho Da Jeong , Jeon Jong Ik , Kim Young-Jeon , Woo Hyun Ae , Lee Yun Kyung , Kim Jung Mogg
Published: June 2016

The
Bacteroides fragilis
enterotoxin (BFT), a virulence factor of enterotoxigenic
B. fragilis
(ETBF), interacts with intestinal epithelial cells and can provoke signals that induce mucosal inflammation. Although expression of heme oxygenase-1 (HO-1) is associated with regulation of inflammatory responses, little is known about HO-1 induction in ETBF infection. This study was conducted to investigate the effect of BFT on HO-1 expression in intestinal epithelial cells. Stimulation of intestinal epithelial cells with BFT resulted in upregulated expression of HO-1. BFT activated transcription factors such as NF-κB, AP-1, and Nrf2 in intestinal epithelial cells. Upregulation of HO-1 in intestinal epithelial cells was dependent on activated IκB kinase (IKK)–NF-κB signals. However, suppression of Nrf2 or AP-1 signals in intestinal epithelial cells did not result in significant attenuation of BFT-induced HO-1 expression. HO-1 induction via IKK–NF-κB in intestinal epithelial cells was regulated by p38 mitogen-activated protein kinases (MAPKs). Furthermore, suppression of HO-1 activity led to increased apoptosis in BFT-stimulated epithelial cells. These results suggest that a signaling pathway involving p38 MAPK–IKK–NF-κB in intestinal epithelial cells is required for HO-1 induction during exposure to BFT. Following this induction, increased HO-1 expression may regulate the apoptotic process in responses to BFT stimulation.
The Type IV Secretion System Effector Protein CirA Stimulates the GTPase Activity of RhoA and Is Required for Virulence in a Mouse Model of Coxiella burnetii Infection
Authors: Weber Mary M. , Faris Robert , van Schaik Erin J. , McLachlan Juanita Thrasher , Wright William U. , Tellez Andres , Roman Victor A. , Rowin Kristina , Case Elizabeth Di Russo , Luo Zhao-Qing , Samuel James E.
Published: June 2016

Coxiella burnetii
, the etiological agent of Q fever in humans, is an intracellular pathogen that replicates in an acidified parasitophorous vacuole derived from host lysosomes. Generation of this replicative compartment requires effectors delivered into the host cell by the Dot/Icm type IVb secretion system. Several effectors crucial for
C. burnetii
intracellular replication have been identified, but the host pathways coopted by these essential effectors are poorly defined, and very little is known about how spacious vacuoles are formed and maintained. Here we demonstrate that the essential type IVb effector, CirA, stimulates GTPase activity of RhoA. Overexpression of CirA in mammalian cells results in cell rounding and stress fiber disruption, a phenotype that is rescued by overexpression of wild-type or constitutively active RhoA. Unlike other effector proteins that subvert Rho GTPases to modulate uptake, CirA is the first effector identified that is dispensable for uptake and instead recruits Rho GTPase to promote biogenesis of the bacterial vacuole. Collectively our results highlight the importance of CirA in coopting host Rho GTPases for establishment of
Coxiella burnetii
infection and virulence in mammalian cell culture and mouse models of infection.
A Suppressor Mutation That Creates a Faster and More Robust σE Envelope Stress Response
Authors: Konovalova Anna , Schwalm Jaclyn A. , Silhavy Thomas J.
Published: June 2016

The σE envelope stress response is an essential signal transduction pathway which detects and removes mistargeted outer membrane (OM) β-barrel proteins (OMPs) in the periplasm of
Escherichia coli
. It relies on σE, an alternative sigma factor encoded by the
rpoE
gene. Here we report a novel mutation, a nucleotide change of C to A in the third base of the second codon, which increases levels of σE (
rpoE_S2R
). The
rpoE_S2R
mutation does not lead to the induction of the stress response during normal growth but instead changes the dynamics of induction upon periplasmic stress, resulting in a faster and more robust response. This allows cells to adapt faster to the periplasmic stress, avoiding lethal accumulation of unfolded OMPs in the periplasm caused by severe defects in the OMP assembly pathway.

IMPORTANCE
Survival of bacteria under conditions of external or internal stresses depends on timely induction of stress response signaling pathways to regulate expression of appropriate genes that function to maintain cellular homeostasis. Previous studies have shown that strong preinduction of envelope stress responses can allow bacteria to survive a number of lethal genetic perturbations. In our paper, we describe a unique mutation that enhances kinetics of the σE envelope stress response pathway rather than preinducing the response. This allows bacteria to quickly adapt to sudden and severe periplasmic stress.
Ethanolamine Catabolism in Pseudomonas aeruginosa PAO1 Is Regulated by the Enhancer-Binding Protein EatR (PA4021) and the Alternative Sigma Factor RpoN
Authors: Lundgren Benjamin R. , Sarwar Zaara , Pinto Atahualpa , Ganley Jack G. , Nomura Christopher T.
Published: June 2016

Although genes encoding enzymes and proteins related to ethanolamine catabolism are widely distributed in the genomes of
Pseudomonas
spp., ethanolamine catabolism has received little attention among this metabolically versatile group of bacteria. In an attempt to shed light on this subject, this study focused on defining the key regulatory factors that govern the expression of the central ethanolamine catabolic pathway in
Pseudomonas aeruginosa
PAO1. This pathway is encoded by the
PA4022-eat-eutBC
operon and consists of a transport protein (Eat), an ethanolamine-ammonia lyase (EutBC), and an acetaldehyde dehydrogenase (PA4022). EutBC is an essential enzyme in ethanolamine catabolism because it hydrolyzes this amino alcohol into ammonia and acetaldehyde. The acetaldehyde intermediate is then converted into acetate in a reaction catalyzed by acetaldehyde dehydrogenase. Using a combination of growth analyses and β-galactosidase fusions, the enhancer-binding protein PA4021 and the sigma factor RpoN were shown to be positive regulators of the
PA4022-eat-eutBC
operon in
P. aeruginosa
PAO1. PA4021 and RpoN were required for growth on ethanolamine, and both of these regulatory proteins were essential for induction of the
PA4022-eat-eutBC
operon. Unexpectedly, the results indicate that acetaldehyde (and not ethanolamine) serves as the inducer molecule that is sensed by PA4021 and leads to the transcriptional activation of the
PA4022-eat-eutBC
operon. Due to its regulatory role in ethanolamine catabolism, PA4021 was given the name EatR. Both EatR and its target genes are conserved in several other
Pseudomonas
spp., suggesting that these bacteria share a mechanism for regulating ethanolamine catabolism.

IMPORTANCE
The results of this study provide a basis for understanding ethanolamine catabolism and its regulation in
Pseudomonas aeruginosa
PAO1. Interestingly, expression of the ethanolamine-catabolic genes in this bacterium was found to be under the control of a positive-feedback regulatory loop in a manner dependent on the transcriptional regulator PA4021, the sigma factor RpoN, and the metabolite acetaldehyde. Previously characterized regulators of ethanolamine catabolism are known to sense and respond directly to ethanolamine. In contrast, PA4021 (EatR) appears to monitor the intracellular levels of free acetaldehyde and responds through transcriptional activation of the ethanolamine-catabolic genes. This regulatory mechanism is unique and represents an alternative strategy used by bacteria to govern the acquisition of ethanolamine from their surroundings.
Is the Evolution of Salmonella enterica subsp.entericaLinked to Restriction-Modification Systems?
Authors: Roer Louise , Hendriksen Rene S. , Leekitcharoenphon Pimlapas , Lukjancenko Oksana , Kaas Rolf Sommer , Hasman Henrik , Aarestrup Frank M.
Published: June 2016

The evolution of bacterial pathogens, their plasticity and ability to rapidly change and adapt to new surroundings are crucial for understanding the epidemiology and public health. With the application of genomics, it became clear that horizontal gene transfer played a key role in evolution. To understand the evolution and diversification of pathogens, we need to understand the processes that drive the horizontal gene transfer. Restriction-modification systems are thought to cause rearrangements within the chromosome, as well as act as a barrier to horizontal gene transfer. However, here we show that the correlation between restriction-modification systems and evolution in other bacterial species does not apply toSalmonella entericasubsp.enterica. In summary, from this work, we conclude that other mechanisms might be involved in controlling and shaping the evolution ofSalmonella entericasubsp.enterica.
Goldenhar syndrome: a rare diagnosis with possible prenatal findings
Authors: Ribeiro Bárbara , Igreja Joana , Gonçalves-Rocha Miguel , Cadilhe Alexandra
Published: June 2016

Goldenhar syndrome is a rare congenital disease associated with hemifacial hypoplasia as well as ear and ocular defects. Sometimes it is also associated with vertebral and other bone defects, cardiac malformations and central nervous system anomalies. Its aetiology is not yet clarified in the literature. We present a case of multiple malformations detected in the morphology ultrasound (at 22 weeks of gestation), namely absent nasal bones, micrognathia and absent left radius, among other defects. Genetic counselling, fetal brain MRI and cardiac sonography, which showed ventricular septal defect, were performed. 11 syndromes with poor fetal or neonatal prognosis were identified as possible diagnosis, using a genetic database and the couple asked for a medical termination of pregnancy. Postmortem examination has shown features consistent with Goldenhar syndrome.
Changes in echocardiography and blood variables during and after development of Ballantyne syndrome
Authors: Umazume Takeshi , Morikawa Mamoru , Yamada Takahiro , Minakami Hisanori
Published: June 2016

We report a pregnant woman who was monitored by echocardiography and determination of blood variables, including components of the renin–angiotensin–aldosterone system (RAAS), cardiac biomarkers and soluble fms-like tyrosine kinase-1 (sFlt-1), during and after the development of Ballantyne syndrome. Generalised maternal oedema with dyspnoea following fetal and placental hydrops necessitated a caesarean section at 33 weeks of gestation. Changes in blood variables and simultaneous echocardiography changes indicated acutely enhanced RAAS and hyperdynamic left ventricular function in response to excessive volume overload (as evidenced by brain-type natriuretic peptide level of 523 pg/mL) in the absence of increased systemic vascular resistance. Elevated sFlt-1 (15 600 pg/mL) and human chorionic gonadotrophin (404 000 IU/L) levels were also noted. The increased plasma aldosterone concentration (2070 pg/mL) may have been responsible for the increase in circulating plasma volume, and the increased sFlt-1 level was responsible for generalised maternal oedema. It remains unclear which factor(s) triggered RAAS activation.
Systematic review of patients' participation in and experiences of technology-based monitoring of mental health symptoms in the community
Authors: Walsh Sophie , Golden Eoin , Priebe Stefan
Published: June 2016

Objectives

To review systematically the literature on patients’ experiences of, and participation in, technology-based monitoring of mental health symptoms. This practice was defined as patients monitoring their mental health symptoms, emotions or behaviours outside of routine clinical appointments by submitting symptom data using technology, with feedback arising from the data (for example, supportive messages or symptom summaries, being sent to the patient, clinician or carer).

Design

Systematic review following PRISMA guidelines of studies evaluating technology-based symptom monitoring. Tools from narrative synthesis were used to analyse quantitative findings on participation rates and qualitative findings on patient views.

Data sources

PubMed, EMBASE, PsycINFO, BNI, CINAHL, Cochrane Registers and Web of Science electronic databases were searched using a combination of ‘psychiatry’, ‘symptom monitoring’ and ‘technology’ descriptors. A secondary hand search was performed in grey literature and references.

Results

57 papers representing 42 studies met the inclusion criteria for the review. Technology-based symptom monitoring was used for a range of mental health conditions, either independently of a specific therapeutic intervention or as an integrated component of therapeutic interventions. The majority of studies reported moderate-to-strong rates of participation, though a third reported lower rates. Qualitative feedback suggests that acceptability of monitoring is related to perceived validity, ease of practice, convenient technology, appropriate frequency and helpfulness of feedback, as well as the impact of monitoring on participants’ ability to manage health and personal relationships.

Conclusions

Such symptom monitoring practices appear to be well accepted and may be a feasible complement to clinical practice. However, there is limited availability of data and heterogeneity of studies. Future research should examine robustly patients’ role in the development and evaluation of technology-based symptom monitoring in order to maximise its clinical utility.
Tranexamic acid in hip fracture patients: a protocol for a randomised, placebo controlled trial on the efficacy of tranexamic acid in reducing blood loss in hip fracture patients
Authors: Gausden Elizabeth Bishop , Garner Matthew R , Warner Stephen J , Levack Ashley , Nellestein Andrew M , Tedore Tiffany , Flores Eva , Lorich Dean G
Published: June 2016

Introduction

There is a high incidence of blood transfusion following hip fractures in elderly patients. Tranexamic acid (TXA) has proven efficacy in decreasing blood loss in general trauma patients as well as patients undergoing elective orthopaedic surgery. A randomised controlled trial will measure the effect of TXA in a population of patients undergoing hip fracture surgery.

Methods

This is a double-blinded, randomised placebo-controlled trial. Patients admitted through the emergency room that are diagnosed with an intertrochanteric or femoral neck fracture will be eligible for enrolment and randomised to either treatment with 1 g of intravenous TXA or intravenous saline at the time of skin incision. Patients undergoing percutaneous intervention for non-displaced or minimally displaced femoral neck fractures will not be eligible for enrolment. Postoperative transfusion rates will be recorded and blood loss will be calculated from serial haematocrits.

Ethics and dissemination

This protocol was approved by the Institutional Review Board (IRB) and is registered with clinicaltrials.gov. The findings of the trial will be disseminated through peer-reviewed journals and conference presentations.

Trial registration number

NCT01940536.
The use of the reverse shock index to identify high-risk trauma patients in addition to the criteria for trauma team activation: a cross-sectional study based on a trauma registry system
Authors: Kuo Spencer C H , Kuo Pao-Jen , Hsu Shiun-Yuan , Rau Cheng-Shyuan , Chen Yi-Chun , Hsieh Hsiao-Yun , Hsieh Ching-Hua
Published: June 2016

Objectives

The presentation of decrease blood pressure with tachycardia is usually an indicator of significant blood loss. In this study, we used the reverse shock index (RSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), to evaluate the haemodynamic status of trauma patients. As an SBP lower than the HR (RSI<1) may indicate haemodynamic instability, the objective of this study was to assess whether RSI<1 can help to identify high-risk patients with potential shock and poor outcome, even though these patients do not yet meet the criteria for multidisciplinary trauma team activation (TTA).

Design

Cross-sectional study.

Setting

Taiwan.

Participants

We retrospectively reviewed the data of 20 106 patients obtained from the trauma registry system of a level I trauma centre for trauma admissions from January 2009 through December 2014. Patients for whom a trauma team was not activated (regular patients) and who had RSI<1 were compared with regular patients with RSI≥1. The ORs of the associated conditions and injuries were calculated with 95% CIs.

Main outcome measures

In-hospital mortality.

Results

Among regular patients with RSI<1, significantly more patients had an Injury Severity Score (ISS) ≥25 (OR 2.4, 95% CI 1.58 to 3.62; p<0.001) and the mortality rate was also higher (2.1% vs 0.5%; OR 3.9, 95% CI 2.10 to 7.08; p<0.001) than in regular patients with RSI≥1. The intensive care unit length of stay was longer in regular patients with RSI<1 than in regular patients with RSI≥1.

Conclusions

Among patients who did not reach the criteria for TTA, RSI<1 indicates a potentially worse outcome and a requirement for more attention and aggressive care in the emergency department.
Predictors of seeking emergency medical help during overdose events in a provincial naloxone distribution programme: a retrospective analysis
Authors: Ambrose Graham , Amlani Ashraf , Buxton Jane A
Published: June 2016

Objectives

This study sought to identify factors that may be associated with help-seeking by witnesses during overdoses where naloxone is administered.

Setting

Overdose events occurred in and were reported from the five regional health authorities across British Columbia, Canada. Naloxone administration forms completed following overdose events were submitted to the British Columbia Take Home Naloxone programme.

Participants

All 182 reported naloxone administration events, reported by adult men and women and occurring between 31 August 2012 and 31 March 2015, were considered for inclusion in the analysis. Of these, 18 were excluded: 10 events which were reported by the person who overdosed, and 8 events for which completed forms did not indicate whether or not emergency medical help was sought.

Primary and secondary outcome measures

Seeking emergency medical help (calling 911), as reported by participants, was the sole outcome measure of this analysis.

Results

Medical help was sought (emergency services—911 called) in 89 (54.3%) of 164 overdoses where naloxone was administered. The majority of administration events occurred in private residences (50.6%) and on the street (23.4%), where reported rates of calling 911 were 27.5% and 81.1%, respectively. Overdoses occurring on the street (compared to private residence) were significantly associated with higher odds of calling 911 in multivariate analysis (OR=10.68; 95% CI 2.83 to 51.87; p<0.01), after adjusting for other variables.

Conclusions

Overdoses occurring on the street were associated with higher odds of seeking emergency medical help by responders. Further research is needed to determine if sex and stimulant use by the person who overdosed are associated with seeking emergency medical help. The results of this study will inform interventions within the British Columbia Take Home Naloxone programme and other jurisdictions to encourage seeking emergency medical help.
Unit-based incident reporting and root cause analysis: variation at three hospital unit types
Authors: Wagner Cordula , Merten Hanneke , Zwaan Laura , Lubberding Sanne , Timmermans Danielle , Smits Marleen
Published: June 2016

Objectives

To minimise adverse events in healthcare, various large-scale incident reporting and learning systems have been developed worldwide. Nevertheless, learning from patient safety incidents is going slowly. Local, unit-based reporting systems can help to get faster and more detailed insight into unit-specific safety issues. The aim of our study was to gain insight into types and causes of patient safety incidents in hospital units and to explore differences between unit types.

Design

Prospective observational study.

Setting

10 emergency medicine units, 10 internal medicine units and 10 general surgery units in 20 hospitals in the Netherlands participated. Patient safety incidents were reported by healthcare providers. Reports were analysed with root cause analysis. The results were compared between the 3 unit types.

Results

A total of 2028 incidents were reported in an average reporting period of 8 weeks per unit. More than half had some consequences for patients, such as a prolonged hospital stay or longer waiting time, and a small number resulted in patient harm. Significant differences in incident types and causes were found between unit types. Emergency units reported more incidents related to collaboration, whereas surgical and internal medicine units reported more incidents related to medication use. The distribution of root causes of surgical and emergency medicine units showed more mutual similarities than those of internal medicine units.

Conclusions

Comparable incidents and causes have been found in all units, but there were also differences between units and unit types. Unit-based incident reporting gives specific information and therefore makes improvements easier. We conclude that unit-based incident reporting has an added value besides hospital-wide or national reporting systems that already exist in various countries.
‘We have beaten HIV a bit’: a qualitative study of experiences of peer support during pregnancy with an HIV Mentor Mother project in England
Authors: McLeish Jenny , Redshaw Maggie
Published: June 2016

Objectives

To explore the experiences of women living with HIV in England who received or gave Mentor Mother (trained mother-to-mother) volunteer peer support during pregnancy and early motherhood.

Design

Qualitative descriptive study, using semistructured, in-depth interviews and inductive thematic analysis, theoretically informed by phenomenological social psychology.

Setting

A London-based third sector peer support organisation for people living with HIV.

Participants

12 women living with HIV who had given or received Mentor Mother volunteer peer support (6 had given support and 6 had received support). 11 were black African.

Results

The key themes in participants' descriptions of their lives as pregnant women and mothers living with HIV were ‘fear and distress’, ‘stigma and isolation’ and ‘the gap in maternity care’. The key themes related to Mentor Mother peer support during and after pregnancy were ‘support to avoid mother-to-child transmission’ (with subthemes ‘reinforcing medical advice’, ‘reframing faith issues’, ‘prioritisation and problem-solving’ and ‘practical strategies for managing HIV and motherhood’), and ‘emotional support’ (with subthemes ‘role modelling and inspiring hope’, ‘openness and non-judgemental acceptance’, ‘a caring relationship’, ‘recreating the lost family network’, ‘being understood from the inside’ and ‘self-confidence’). The Mentor Mothers' support appeared to be a successful hybrid between the peer education Mentor Mothers programmes in southern Africa and the more general pregnancy volunteer peer support models operating in England.

Conclusions

A Mentor Mother peer support programme is acceptable to, and valued by, black African mothers with HIV in England. Peer support from trained volunteers during and after pregnancy can complement and reinforce medical advice on avoiding mother-to-child transmission of HIV, and can have a multidimensional positive impact on vulnerable mothers' emotional well-being. Mentor Mother peer support should be considered by those designing programmes for the support of pregnant women with HIV and the prevention of mother-to-child transmission of HIV.
Development and validation of a web-based questionnaire for surveying the health and working conditions of high-performance marine craft populations
Authors: de Alwis Manudul Pahansen , Lo Martire Riccardo , Äng Björn O , Garme Karl
Published: June 2016

Background

High-performance marine craft crews are susceptible to various adverse health conditions caused by multiple interactive factors. However, there are limited epidemiological data available for assessment of working conditions at sea. Although questionnaire surveys are widely used for identifying exposures, outcomes and associated risks with high accuracy levels, until now, no validated epidemiological tool exists for surveying occupational health and performance in these populations.

Aim

To develop and validate a web-based questionnaire for epidemiological assessment of occupational and individual risk exposure pertinent to the musculoskeletal health conditions and performance in high-performance marine craft populations.

Method

A questionnaire for investigating the association between work-related exposure, performance and health was initially developed by a consensus panel under four subdomains, viz. demography, lifestyle, work exposure and health and systematically validated by expert raters for content relevance and simplicity in three consecutive stages, each iteratively followed by a consensus panel revision. The item content validity index (I-CVI) was determined as the proportion of experts giving a rating of 3 or 4. The scale content validity index (S-CVI/Ave) was computed by averaging the I-CVIs for the assessment of the questionnaire as a tool. Finally, the questionnaire was pilot tested.

Results

The S-CVI/Ave increased from 0.89 to 0.96 for relevance and from 0.76 to 0.94 for simplicity, resulting in 36 items in the final questionnaire. The pilot test confirmed the feasibility of the questionnaire.

Conclusions

The present study shows that the web-based questionnaire fulfils previously published validity acceptance criteria and is therefore considered valid and feasible for the empirical surveying of epidemiological aspects among high-performance marine craft crews and similar populations.
Pulmonary embolism and mortality following total ankle replacement: a data linkage study using the NJR data set
Authors: Zaidi Razi , MacGregor Alexander , Cro Suzie , Goldberg Andy
Published: June 2016

Objective

To determine the mortality rate following total ankle replacement (TAR) and incidence of 90 day pulmonary embolism (PE) along with the associated risk factors.

Design

Data-linkage study of the UK National Joint Registry (NJR) data and Hospital Episodes Statistics (HES) database. Linkage was performed in a deterministic fashion. HES episodes 90 days after the index procedure were analysed for PE. Mortality data were obtained pertaining to all the index procedures from the NJR for analysis.

Participants

All primary and revision ankle replacement patients captured on the NJR between February 2008 and February 2013.

Results

The 90-day mortality following TAR was 0.13% (95% CI 0.03 to 0.52) and 1-year mortality was 0.72% (95% CI 0.40 to 1.30); no deaths were as a result of PE. The incidence of PE within 90 days following primary TAR was 0.51% (95% CI 0.23 to 1.13). There was only one PE following revision surgery. Patients with an Royal College of Surgeons Charlson score greater than zero were at 13 times greater risk of PE (p=0.003).

Conclusions

There is low incidence of PE following TAR, but multiple comorbidities are a leading risk factor for its occurrence.
Education and training to enhance end-of-life care for nursing home staff: a systematic literature review
Authors: Anstey Sally , Powell Tom , Coles Bernadette , Hale Rachel , Gould Dinah
Published: June 2016

Background

The delivery of end-of-life care in nursing homes is challenging. This situation is of concern as 20% of the population die in this setting. Commonly reported reasons include limited access to medical care, inadequate clinical leadership and poor communication between nursing home and medical staff. Education for nursing home staff is suggested as the most important way of overcoming these obstacles.

Objectives

To identify educational interventions to enhance end-of-life care for nursing home staff and to identify types of study designs and outcomes to indicate success and benchmark interventions against recent international guidelines for education for palliative and end-of-life care.

Design

Thirteen databases and reference lists of key journals were searched from the inception of each up to September 2014. Included studies were appraised for quality and data were synthesised thematically.

Results

Twenty-one studies were reviewed. Methodological quality was poor. Education was not of a standard that could be expected to alter clinical behaviour and was evaluated mainly from the perspectives of staff: self-reported increase in knowledge, skills and confidence delivering care rather than direct evidence of impact on clinical practice and patient outcomes. Follow-up was often short term, and despite sound economic arguments for delivering effective end-of-life care to reduce burden on the health service, no economic analyses were reported.

Conclusions

There is a clear and urgent need to design educational interventions that have the potential to improve end-of-life care in nursing homes. Robust evaluation of these interventions should include impact on residents, families and staff and include economic analysis.
Top 10 (+1) tips to get started with in situ simulation in emergency and critical care departments
Authors: Spurr Jesse , Gatward Jonathan , Joshi Nikita , Carley Simon D
Published: June 2016

Simulation is increasingly valued as a teaching and learning tool in emergency medicine. Bringing simulation into the workplace to train in situ offers a unique and effective training opportunity for the emergency department (ED) multiprofessional workforce. Integrating simulation in a busy department is difficult but can be done. In this article, we outline 10 tips to help make it happen.
Endovascular treatment of posterior inferior cerebellar artery aneurysms: a 7-year single-center experience
Authors: Xu Feng , Hong Yong , Zheng Yongtao , Xu Qiang , Leng Bing
Published: June 2016

Aim

To report our experience with endovascular treatment of posterior inferior cerebellar artery (PICA) aneurysms.

Methods

Between January 2007 and December 2014, 40 patients with 42 PICA aneurysms were treated with endovascular embolization at our institution. Twenty-eight patients had 29 saccular aneurysms and 12 patients had 13 fusiform/dissecting aneurysms. The endovascular modalities were: (1) selective occlusion of the aneurysm with or without stent assistance (n=19); (2) occlusion of the aneurysm and the parent artery (n=22); and (3) occlusion of the aneurysm including the vertebral artery and PICA origin (n=1). Specifically, selective embolization was performed in 93.3% of aneurysms (14/15) proximal to the telovelotonsillary segment.

Results

Immediate angiographic results included 31 complete occlusions (74%), 3 nearly complete occlusions (7%), and 8 incomplete occlusions (19%). Mean follow-up of 20 months in 31 aneurysms showed 27 stable results, 3 further thromoboses, and 1 recurrence. Final results included 27 complete occlusions (87.1%) and 4 incomplete occlusions (12.9%). There were 5 overall procedural-related complications (12.5%), including 1 infarction (2.5%) and 4 intraprocedural ruptures (10.0%). Procedure-related morbidity and morbidity was 5.0% (2/40) and 2.5% (1/40), respectively. Clinical outcome was excellent (Glasgow Outcome Scale 5 in 31 of 33 patients at long-term follow-up).

Conclusions

PICA aneurysms may be effectively treated by different endovascular approaches with favorable clinical and radiologic outcomes. Further studies are required to compare the safety and efficacy of endovascular treatment with open surgery.
Quality‐of‐life aspects in idiopathic epilepsy in dogs
Authors: Wessmann A. , Volk H. A. , Packer R. M. A. , Ortega M. , Anderson T. J.
Published: June 2016

Quality of life (QoL) plays a significant role in the treatment of dogs with idiopathic epilepsy (IE), yet is so far understudied. This study describes the outcome evaluation of an online questionnaire based on the carer's perception focusing on 62 QoL questions in 159 dogs with IE. Results showed that seizure frequency, but not seizure severity or presence of cluster seizures, was significantly associated with carer‐perceived dog's QoL. Dogs receiving third‐line antiepileptic drugs had a significantly lower perceived QoL than those that did not. Generalised linear mixed model analysis demonstrated that severity of the side effects sleeping more and ataxia were significantly associated with carer‐perceived dog's QoL, with higher severities predicting lower QoL scores. The degree of carer acceptability of seizure frequency and severity was significantly associated with the dog's reported seizure frequency and severity. Moreover, there was a significant association between IE‐related QoL changes of the dog and the carer, with reductions in perceived canine QoL scores associated with reductions in carer QoL, and vice versa. In conclusion, aspects of canine IE can affect both the carer and their dog's QoL. This has implications for the management and requires consideration when treatment options and outcomes are discussed.
Laboratory assessment of the effects of polymer treatment on geotechnical properties of low-plasticity soil slurry
Authors: Reid David , Fourie Andy
Published: June 2016

A laboratory study was undertaken to assess the effects of polymer treatment (PT) on the geotechnical behaviour of a low-plasticity slurry. PT was undertaken on the material using a high molecular weight polyacrylamide polymer. Slurry consolidometer and triaxial testing were undertaken to compare the geotechnical behaviour of the material following PT, compared to an untreated (UT) condition. The material was prepared from a slurry state in a nonsegregating condition, to enable comparison of uniform samples. Testing indicated that PT resulted in lower final consolidated densities at a given magnitude of effective stress, while increasing the rate of consolidation and hydraulic conductivity. Triaxial testing indicated that PT material, when sheared, appeared to exhibit a different critical state line (CSL) than UT material. The PT CSL was higher in void ratio terms than the UT CSL, and with an increased compressibility. Both PT and UT material exhibited undrained shear strengths consistent with the state of the specimen with respect to that material’s CSL. PT material exhibited higher undrained shear strengths at a given density. All the effects observed following PT appeared to persist across a wide range of effective stresses.
Accounting for climate change in a forest planning stochastic optimization model
Authors: Garcia-Gonzalo Jordi , Pais Cristóbal , Bachmatiuk Joanna , Weintraub Andrés
Published: June 2016

An approach is proposed for incorporating the variations in timber growth and yield due to climate change uncertainty into the forest harvesting decision process. A range of possible climate scenarios are transformed by a forest growth and yield model into tree growth scenarios, which in turn are integrated into a multistage stochastic model that determines the timber cut in each future period so as to maximize net present value over the planning horizon. For comparison purposes, a deterministic model using a single average climate scenario is also developed. The performance of the deterministic and stochastic formulations are tested in a case study of a medium-term forest planning problem for a Eucalyptus forest in Portugal where climate change is expected to severely impact production in the coming years. Experiments conducted using 32 climate scenarios demonstrate the stochastic model’s superior results in terms of present value, particularly in cases of relatively high minimum timber demand. The model should therefore be useful in supporting forest planners’ decisions under climate uncertainty.
TDEM simulation and analysis of thermal conduction through packed granular beds
Authors: Gui Nan , Yang Xingtuan , Tu Jiyuan , Jiang Shengyao
Published: June 2016

The work deals with evaluation and simulation of the thermal discrete element method (TDEM) for particle–particle collision and thermal conduction in a packed bed. The effects of different granular properties, such as particle size, stiffness factor or compression degree, thermal diffusivity, void fraction or concentrations, and packing states, on the thermal conduction and insulation characteristics of granular assembly are discussed. The thermal conductivity and diffusion still play dominant roles in the overall thermal conduction and insulation of the granular bed. However, it is also indicated that increasing compression degree, reducing particle size and void concentration will increase the thermal conduction throughout the granular materials, and vice versa.
Tree Swallow (Tachycineta bicolor) foraging responses to agricultural land use and abundance of insect prey
Authors: Stanton R.L. , Morrissey C.A. , Clark R.G.
Published: June 2016

Throughout North America, many species of aerial insectivorous birds have exhibited steep declines. The timing of these declines coincides with changes in agriculture, perhaps signaling a causal link. Increased agrochemical use, wetland drainage, and cropping intensity may indirectly influence insectivores by reducing the abundance of insect prey. Our objective was to determine whether changes in insect abundance and biomass on agricultural landscapes in the Canadian Prairies influence the foraging behaviour of breeding Tree Swallows (Tachycineta bicolor (Vieillot, 1808)). Swallows were studied at five sites with varying levels of agricultural intensity in Saskatchewan, where insect abundance and biomass were monitored daily with passive aerial samplers. Radio-frequency identification (RFID) technology was employed at Tree Swallow nest boxes to investigate adult foraging behaviour. Foraging rates (number of nest visits/h) were slightly higher on agricultural sites than at grassland sites, and were positively related to daily insect biomass and nestling age. Tree Swallows, especially males, breeding at agricultural sites spent more time away from the nest box, presumably foraging, resulting in reduced nest attentiveness. RFID technology provides an effective technique to measure behaviour in birds and these findings suggest mechanisms by which prey abundance and agricultural land use may affect declining aerial insectivorous bird populations.