bluuebunny/crossref_metadata_2025 huggingface dataset:
Human middle-ear model with compound eardrum and airway branching in mastoid air cells
Authors: Keefe Douglas H.
Published: May 2015

An acoustical/mechanical model of normal adult human middle-ear function is described for forward and reverse transmission. The eardrum model included one component bound along the manubrium and another bound by the tympanic cleft. Eardrum components were coupled by a time-delayed impedance. The acoustics of the middle-ear cleft was represented by an acoustical transmission-line model for the tympanic cavity, aditus, antrum, and mastoid air cell system with variable amounts of excess viscothermal loss. Model parameters were fitted to published measurements of energy reflectance (0.25–13 kHz), equivalent input impedance at the eardrum (0.25–11 kHz), temporal-bone pressure in scala vestibuli and scala tympani (0.1–11 kHz), and reverse middle-ear impedance (0.25–8 kHz). Inner-ear fluid motion included cochlear and physiological third-window pathways. The two-component eardrum with time delay helped fit intracochlear pressure responses. A multi-modal representation of the eardrum and high-frequency modeling of the middle-ear cleft helped fit ear-canal responses. Input reactance at the eardrum was small at high frequencies due to multiple modal resonances. The model predicted the middle-ear efficiency between ear canal and cochlea, and the cochlear pressures at threshold.
The role of spectral cues in timbre discrimination by ferrets and humans
Authors: Town Stephen M. , Atilgan Huriye , Wood Katherine C. , Bizley Jennifer K.
Published: May 2015

Timbre distinguishes sounds of equal loudness, pitch, and duration; however, little is known about the neural mechanisms underlying timbre perception. Such understanding requires animal models such as the ferret in which neuronal and behavioral observation can be combined. The current study asked what spectral cues ferrets use to discriminate between synthetic vowels. Ferrets were trained to discriminate vowels differing in the position of the first (F1) and second formants (F2), inter-formant distance, and spectral centroid. In experiment 1, ferrets responded to probe trials containing novel vowels in which the spectral cues of trained vowels were mismatched. Regression models fitted to behavioral responses determined that F2 and spectral centroid were stronger predictors of ferrets' behavior than either F1 or inter-formant distance. Experiment 2 examined responses to single formant vowels and found that individual spectral peaks failed to account for multi-formant vowel perception. Experiment 3 measured responses to unvoiced vowels and showed that ferrets could generalize vowel identity across voicing conditions. Experiment 4 employed the same design as experiment 1 but with human participants. Their responses were also predicted by F2 and spectral centroid. Together these findings further support the ferret as a model for studying the neural processes underlying timbre perception.
Comment on “Attenuation and dispersion of sound in dilute suspensions of spherical particles” [J. Acoust. Soc. Am. 108(1), 126–146 (2000)]
Authors: Shukla Shiva Kant , Elvira Luis
Published: May 2015

Comment is made on an article by Temkin [J. Acoust. Soc. Am. 108(1), 126–146 (2000)]. This work illustrates the impact of particle size distribution on the dispersion and attenuation of sound waves propagating through particle suspensions. Temkin's propagation theory is extended for poly-disperse distributions of spherical particles, applicable to real suspensions. Significant changes in dispersion and attenuation appear near the particle resonance for both bubble and solid particle suspensions. Existing experimental data for bubble distributions also shows a good agreement with the poly-disperse modifications proposed.
Acoustic detection of biosonar activity of deep diving odontocetes at Josephine Seamount High Seas Marine Protected Area
Authors: Giorli Giacomo , Au Whitlow W. L. , Ou Hui , Jarvis Susan , Morrissey Ronald , Moretti David
Published: May 2015

The temporal occurrence of deep diving cetaceans in the Josephine Seamount High Seas Marine Protected Area (JSHSMPA), south-west Portugal, was monitored using a passive acoustic recorder. The recorder was deployed on 13 May 2010 at a depth of 814 m during the North Atlantic Treaty Organization Centre for Maritime Research and Experimentation cruise “Sirena10” and recovered on 6 June 2010. The recorder was programmed to record 40 s of data every 2 min. Acoustic data analysis, for the detection and classification of echolocation clicks, was performed using automatic detector/classification systems: M3R (Marine Mammal Monitoring on Navy Ranges), a custom matlab program, and an operator-supervised custom matlab program to assess the classification performance of the detector/classification systems. M3R CS-SVM algorithm contains templates to detect beaked whales, sperm whales, blackfish (pilot and false killer whales), and Risso's dolphins. The detections of each group of odontocetes was monitored as a function of time. Blackfish and Risso's dolphins were detected every day, while beaked whales and sperm whales were detected almost every day. The hourly distribution of detections reveals that blackfish and Risso's dolphins were more active at night, while beaked whales and sperm whales were more active during daylight hours.
Comment on “Transient response of an acoustic medium by an excited submerged spherical shell” [J. Acoust. Soc. Am. 109(6), 2789–2796 (2001)]
Authors: Bahari Ako , Popplewell Neil
Published: May 2015

A closed form solution was derived previously for the response of a submerged spherical shell when the shell was excited by a spatially distributed, transient load at its inner surface [Zakout (2001). J. Acoust. Soc. Am. 109(6), 2789–2796]. Numerical results were presented for the modal and total acoustic pressures outside the empty sphere when the load's temporal history corresponded to the Heaviside step function. However, the result presented for the shell's “breathing” mode was inconsistent with these data as it corresponded to the delta Dirac (impulse) function. Furthermore, numerical results, which were given later for the total acoustic pressure responses, did not involve either of these excitations. Consequently the present objective is to rectify these anomalies.
Information-theoretic analysis of iterated Bayesian acoustic source localization in a static ocean waveguide
Authors: Hayward Thomas J.
Published: May 2015

Fundamental constructs of information theory are applied to quantify the performance of iterated (sequential) Bayesian localization of a time-harmonic source in a range- and time-invariant acoustic waveguide using the segmented Fourier transforms of the received pressure time series. The nonlinear relation, defined by acoustic propagation, between the source location and the received narrowband spectral components is treated as a nonlinear communication channel. The performance analysis includes mismatch between the acoustic channel and the model channel on which the Bayesian inference is based. Source location uncertainty is quantified by the posterior probability density of source location, by the posterior entropy and associated uncertainty area, by the information gain (relative entropy) at each iteration, and by large-ensemble limits of these quantities. A computational example for a vertical receiver array in a shallow-water waveguide is presented with acoustic propagation represented by normal modes and ambient noise represented by a Kuperman–Ingenito model. Performance degradation due to noise-model mismatch is quantified in an example. Potential extensions to uncertain and stochastic environments are discussed.
Time domain compressive beam forming of ultrasound signals
Authors: David Guillaume , Robert Jean-luc , Zhang Bo , Laine Andrew F.
Published: May 2015

Ultrasound imaging is a wide spread technique used in medical imaging as well as in non-destructive testing. The technique offers many advantages such as real-time imaging, good resolution, prompt acquisition, ease of use, and low cost compared to other techniques such as x-ray imaging. However, the maximum frame rate achievable is limited as several beams must be emitted to compute a single image. For each emitted beam, one must wait for the wave to propagate back and forth, thus imposing a limit to the frame rate. Several attempts have been made to use less beams while maintaining image quality. Although efficiently increasing the frame rate, these techniques still use several transmit beams. Compressive Sensing (CS), a universal data completion scheme based on convex optimization, has been successfully applied to a number of imaging modalities over the past few years. Using a priori knowledge of the signal, it can compute an image using less data allowing for shorter acquisition times. In this paper, it is shown that a valid CS framework can be derived from ultrasound propagation theory, and that this framework can be used to compute images of scatterers using only one plane wave as a transmit beam.
Dynamics of soundscape in a shallow water marine environment: A study of the habitat of the Indo-Pacific humpback dolphin
Authors: Guan Shane , Lin Tzu-Hao , Chou Lien-Siang , Vignola Joseph , Judge John , Turo Diego
Published: May 2015

The underwater acoustic field is an important ecological element for many aquatic animals. This research examines the soundscape of a critically endangered Indo-Pacific humpback dolphin population in the shallow water environment off the west coast of Taiwan. Underwater acoustic recordings were conducted between late spring and late fall in 2012 at Yunlin (YL), which is close to a shipping lane, and Waisanding (WS), which is relatively pristine. Site-specific analyses were performed on the dynamics of the temporal and spectral acoustic characteristics for both locations. The results highlight the dynamics of the soundscape in two major octave bands: 150–300 Hz and 1.2–2.4 kHz. The acoustic energy in the former frequency band is mainly associated with passing container vessels near YL, while the latter frequency band is from sonic fish chorus at nighttime in both recording sites. In addition, large variation of low frequency acoustic energy throughout the study period was noticed at WS, where the water depths ranged between 1.5 and 4.5 m depending on tidal cycle. This phenomenon suggests that besides certain sound sources in the environment, the coastal soundscape may also be influenced by its local bathymetry and the dynamics of the physical environment.
Experimental evidence of modal wavenumber relation to zeros in the wavenumber spectrum of a simply supported plate
Authors: Robin Olivier , Berry Alain , Atalla Noureddine , Hambric Stephen A. , Shepherd Micah R.
Published: May 2015

The modal wavenumber of rectangular, simply supported, isotropic thin plates was theoretically shown to be related to the zeros in the wavenumber spectrum and not to the peaks, resulting in an error between the actual modal wavenumber and location of the wavenumber spectrum peak for low mode orders. This theoretical proof is confirmed by experimental results reported in this letter.
Effects of contextual cues on speech recognition in simulated electric-acoustic stimulation
Authors: Kong Ying-Yee , Donaldson Gail , Somarowthu Ala
Published: May 2015

Low-frequency acoustic cues have shown to improve speech perception in cochlear-implant listeners. However, the mechanisms underlying this benefit are still not well understood. This study investigated the extent to which low-frequency cues can facilitate listeners' use of linguistic knowledge in simulated electric-acoustic stimulation (EAS). Experiment 1 examined differences in the magnitude of EAS benefit at the phoneme, word, and sentence levels. Speech materials were processed via noise-channel vocoding and lowpass (LP) filtering. The amount of spectral degradation in the vocoder speech was varied by applying different numbers of vocoder channels. Normal-hearing listeners were tested on vocoder-alone, LP-alone, and vocoder + LP conditions. Experiment 2 further examined factors that underlie the context effect on EAS benefit at the sentence level by limiting the low-frequency cues to temporal envelope and periodicity (AM + FM). Results showed that EAS benefit was greater for higher-context than for lower-context speech materials even when the LP ear received only low-frequency AM + FM cues. Possible explanations for the greater EAS benefit observed with higher-context materials may lie in the interplay between perceptual and expectation-driven processes for EAS speech recognition, and/or the band-importance functions for different types of speech materials.
Infrasonic wind noise under a deciduous tree canopy
Authors: Webster Jeremy , Raspet Richard
Published: May 2015

In a recent paper, the infrasonic wind noise measured at the floor of a pine forest was predicted from the measured wind velocity spectrum and profile within and above the trees [Raspet and Webster, J. Acoust. Soc. Am. 137, 651–659 (2015)]. This research studies the measured and predicted wind noise under a deciduous forest with and without leaves. A calculation of the turbulence–shear interaction pressures above the canopy predicts the low frequency peak in the wind noise spectrum. The calculated turbulence–turbulence interaction pressure due to the turbulence field near the ground predicts the measured wind noise spectrum in the higher frequency region. The low frequency peak displays little dependence on whether the trees have leaves or not. The high frequency contribution with leaves is approximately an order of magnitude smaller than the contribution without leaves. Wind noise levels with leaves are very similar to the wind noise levels in the pine forest. The calculated turbulence–shear contribution from the wind within the canopy is shown to be negligible in comparison to the turbulence–turbulence contribution in both cases. In addition, the effect of taller forests and smaller roughness lengths than those of the test forest on the turbulence–shear interaction is simulated based on measured meteorological parameters.
Informational masking of monaural target speech by a single contralateral formant
Authors: Roberts Brian , Summers Robert J.
Published: May 2015

Recent research suggests that the ability of an extraneous formant to impair intelligibility depends on the variation of its frequency contour. This idea was explored using a method that ensures interference cannot occur through energetic masking. Three-formant (F1 + F2 + F3) analogues of natural sentences were synthesized using a monotonous periodic source. Target formants were presented monaurally, with the target ear assigned randomly on each trial. A competitor for F2 (F2C) was presented contralaterally; listeners must reject F2C to optimize recognition. In experiment 1, F2Cs with various frequency and amplitude contours were used. F2Cs with time-varying frequency contours were effective competitors; constant-frequency F2Cs had far less impact. To a lesser extent, amplitude contour also influenced competitor impact; this effect was additive. In experiment 2, F2Cs were created by inverting the F2 frequency contour about its geometric mean and varying its depth of variation over a range from constant to twice the original (0%−200%). The impact on intelligibility was least for constant F2Cs and increased up to ∼100% depth, but little thereafter. The effect of an extraneous formant depends primarily on its frequency contour; interference increases as the depth of variation is increased until the range exceeds that typical for F2 in natural speech.
High-frequency normal-mode statistics in shallow water: The combined effect of random surface and internal waves
Authors: Raghukumar Kaustubha , Colosi John A.
Published: May 2015

In an earlier article, the statistical properties of mode propagation were studied at a frequency of 1 kHz in a shallow water environment with random sound-speed perturbations from linear internal waves, using a hybrid transport theory and Monte Carlo numerical simulations. Here, the analysis is extended to include the effects of random linear surface waves, in isolation and in combination with internal waves. Mode coupling rates for both surface and internal waves are found to be significant, but strongly dependent on mode number. Mode phase randomization by surface waves is found to be dominated by coupling effects, and therefore a full transport theory treatment of the range evolution of the cross mode coherence matrix is needed. The second-moment of mode amplitudes is calculated using transport theory, thereby providing the mean intensity while the fourth-moment is calculated using Monte Carlo simulations, which provides the scintillation index. The transport theory results for second-moment statistics are shown to closely reproduce Monte Carlo simulations. Both surface waves and internal waves strongly influence the acoustic field fluctuations.
Invariance in vowel systems
Authors: Funabashi Masatoshi
Published: May 2015

This study applies information geometry of normal distribution to model Japanese vowels on the basis of the first and second formants. The distribution of Kullback-Leibler (KL) divergence and its decomposed components were investigated to reveal the statistical invariance in the vowel system. The results suggest that although significant variability exists in individual KL divergence distributions, the population distribution tends to converge into a specific log-normal distribution. This distribution can be considered as an invariant distribution for the standard-Japanese speaking population. Furthermore, it was revealed that the mean and variance components of KL divergence are linearly related in the population distribution. The significance of these invariant features is discussed.
Extreme Variation of Nutritional Composition and Osmolality of Commercially Available Carbohydrate Energy Gels
Authors: Zhang Xuguang , O’Kennedy Niamh , Morton James P.
Published: May 2015

The provision of exogenous carbohydrate (CHO) in the form of energy gels is regularly practiced among endurance and team sport athletes. However, in those instances where athletes ingest suboptimal fluid intake, consuming gels during exercise may lead to gastrointestinal (GI) problems when the nutritional composition of the gel is not aligned with promoting gastric emptying. Accordingly, the aim of the current study was to quantify the degree of diversity in nutritional composition of commercially available CHO gels intended for use in the global sports nutrition market. We surveyed 31 product ranges (incorporating 51 flavor variants) from 23 brands (Accelerade, CNP, High5, GU, Hammer, Maxim, Clif, USN, Mule, Multipower, Nectar, Carb-Boom, Power Bar, Lucozade, Shotz, TORQ, Dextro, Kinetica, SiS, Zipvit, Maxifuel, Gatorade and Squeezy). Gels differed markedly in serving size (50 ± 22 g: 29–120), energy density (2.34 ± 0.7 kcal/g: 0.83–3.40), energy content (105 ± 24 kcal: 78–204), CHO content (26 ± 6 g: 18–51) and free sugar content (9.3 ± 7.0 g: 0.6–26.8). Most notably, gels displayed extreme variation in osmolality (4424 ± 2883 mmol/kg: 303–10,135) thereby having obvious implications for both GI discomfort and the total fluid intake likely required to optimize CHO delivery and oxidation. The large diversity of nutritional composition of commercially available CHO gels illustrate that not all gels should be considered the same. Sports nutrition practitioners should therefore consider the aforementioned variables to make better-informed decisions regarding which gel product best suits the athlete’s specific fueling and hydration requirements.
Aminomethyl spectinomycins as therapeutics for drug-resistant respiratory tract and sexually transmitted bacterial infections
Authors: Bruhn David F. , Waidyarachchi Samanthi L. , Madhura Dora B. , Shcherbakov Dimitri , Zheng Zhong , Liu Jiuyu , Abdelrahman Yasser M. , Singh Aman P. , Duscha Stefan , Rathi Chetan , Lee Robin B. , Belland Robert J. , Meibohm Bernd , Rosch Jason W. , Böttger Erik C. , Lee Richard E.
Published: May 2015

A new series of spectinomycin analogs with potency against drug-resistant bacterial pathogens was designed and developed with a structure-based approach and validated in vitro and in vivo.
The cytoplasmic prolyl-tRNA synthetase of the malaria parasite is a dual-stage target of febrifugine and its analogs
Authors: Herman Jonathan D. , Pepper Lauren R. , Cortese Joseph F. , Estiu Guillermina , Galinsky Kevin , Zuzarte-Luis Vanessa , Derbyshire Emily R. , Ribacke Ulf , Lukens Amanda K. , Santos Sofia A. , Patel Vishal , Clish Clary B. , Sullivan William J. , Zhou Huihao , Bopp Selina E. , Schimmel Paul , Lindquist Susan , Clardy Jon , Mota Maria M. , Keller Tracy L. , Whitman Malcolm , Wiest Olaf , Wirth Dyann F. , Mazitschek Ralph
Published: May 2015

The cytoplasmic prolyl-tRNA synthetase of
Plasmodium falciparum
is a dual-stage therapeutic target for drug development.
Prolonged exposure to acetaminophen reduces testosterone production by the human fetal testis in a xenograft model
Authors: van den Driesche Sander , Macdonald Joni , Anderson Richard A. , Johnston Zoe C. , Chetty Tarini , Smith Lee B. , McKinnell Chris , Dean Afshan , Homer Natalie Z. , Jorgensen Anne , Camacho-Moll Maria E. , Sharpe Richard M. , Mitchell Rod T.
Published: May 2015

Prolonged exposure to therapeutic doses of acetaminophen reduces testosterone production by human fetal testis xenografts in mice.
The α
v
β
1
integrin plays a critical in vivo role in tissue fibrosis
Authors: Reed Nilgun I. , Jo Hyunil , Chen Chun , Tsujino Kazuyuki , Arnold Thomas D. , DeGrado William F. , Sheppard Dean
Published: May 2015

An α
v
β
1
inhibitor attenuated pulmonary and liver fibrosis in mouse models.
Adoptive transfer of activated marrow-infiltrating lymphocytes induces measurable antitumor immunity in the bone marrow in multiple myeloma
Authors: Noonan Kimberly A. , Huff Carol A. , Davis Janice , Lemas M. Victor , Fiorino Susan , Bitzan Jeffrey , Ferguson Anna , Emerling Amy , Luznik Leo , Matsui William , Powell Jonathan , Fuchs Ephraim , Rosner Gary L. , Epstein Caroline , Rudraraju Lakshmi , Ambinder Richard F. , Jones Richard J. , Pardoll Drew , Borrello Ivan
Published: May 2015

Marrow-infiltrating lymphocytes (MILs) may be used as adoptive cell therapy for multiple myeloma.
One integrin to rule them all?
Authors: Dietz Harry C.
Published: May 2015

Myofibroblast-derived αvβ1 integrin has emerged as a critical mediator of transforming growth factor–β activation in experimental fibrosis models.
Management of pregnancy after augmentation cystoplasty
Authors: Correia Catia , Pardal Catarina , Igreja Joana
Published: May 2015

We report a case of successful pregnancy following augmentation ileocystoplasty in a patient with a neurogenic bladder dysfunction. A review of the literature reveals incidences of premature delivery and renal dysfunction. Careful urological monitoring of such patients should result in a successful pregnancy. Nevertheless, the unique clinical challenges and management options published to date are limited.
Unilateral testicular metastasis of low PSA level prostatic adenocarcinoma
Authors: Shinn Brianna Jeanette , Greenwald David W , Ahmad Navid
Published: May 2015

A 71-year-old man presented with a firm left testicle 15 years after being diagnosed with prostatic adenocarcinoma. After the initial diagnosis, the patient underwent a radical prostatectomy. He received radiation therapy 5 years after surgery for a slightly elevated prostate-specific antigen (PSA) level and a negative metastatic workup. Eight years later, the patient's PSA rose to 3.38 ng/mL and he was started on intermittent Lupron therapy. It was then 3 years later when the patient discovered the testicular mass. At that time, his PSA level was 2.98 ng/mL. He underwent a left orchiectomy which demonstrated metastatic prostatic adenocarcinoma. Currently, the patient is doing well 3 months postorchiectomy and is now receiving continuous testosterone suppression therapy. This case report discusses the unique modes of spread from the prostate to the testicle as well as the importance of follow-up care in patients with prostate cancer, especially in the setting of low PSA levels.
Fresh arterial homograft for bypass in critical limb ischaemia with infection
Authors: Wayne Stephanie , Milne Charles , Cox Geoffrey
Published: May 2015

We present what we believe is Australia's first fresh peripheral arterial transplant for revascularisation of an ischaemic limb. Although cryopreserved homografts are accepted as a management option for revascularisation of critical limb ischaemia in infected fields, cryopreserved peripheral vascular tissue is not currently available in Australia. We describe a 72-year-old man without autologous conduit in whom infected prosthetic grafts were explanted, causing critical limb ischaemia of a below knee stump. Fresh peripheral arterial tissue was procured via the Australian organ donation authority, DonateLife, and was used to revascularise the stump with an axillofemoral bypass. This permitted successful healing of the stump within 6 weeks and mobilisation with a prosthesis. This case illustrates that fresh arterial homografts are a viable bridging solution for revascularisation of limb ischaemia with infection. However, it also highlights the need to establish a peripheral homograft bank so that cryopreserved conduits are readily available for similar scenarios.
A search strategy to identify studies on the prognosis of work disability: a diagnostic test framework
Authors: Kok Rob , Verbeek Jos A H M , Faber Babs , van Dijk Frank J H , Hoving Jan L
Published: May 2015

Objective

Searching the medical literature for evidence on prognosis is an important aspect of evidence-based disability evaluation. To facilitate this, we aimed to develop and evaluate a comprehensive and efficient search strategy in PubMed, to be used by either researchers or practitioners and that will identify articles on the prognosis of work disability.

Methods

We used a diagnostic test analytic framework. First, we created a reference set of 225 articles on the prognosis of work disability by screening a total of 65 692 titles and abstracts from10 journals in the period 2000–2009. Included studies had a minimum follow-up of 6 months, participants in the age of 18–64 with a minimum sick leave of 4 weeks or longer or having serious activity limitations in 50% of the cases and outcome measures that reflect impairments, activity limitations or participation restrictions. Using text mining methods, we extracted search terms from the reference set and, according to sensitivity and relative frequency, we combined these into search strings.

Results

Both the research and the practice search filter outperformed existing filters in occupational health, all combined with the Yale-prognostic filter. The Work Disability Prognosis filter for Research showed a comprehensiveness of 90% (95% CI 86 to 94) and efficiency expressed more user-friendly as Number Needed to Read=20 (95% CI 17 to 34).

Conclusions

The Work Disability Prognosis filter will help practitioners and researchers who want to find prognostic evidence in the area of work disability evaluation. However, further refining of this filter is possible and needed, especially for the practitioner for whom efficiency is especially important.
Assessment of the feasibility of an ultra-low power, wireless digital patch for the continuous ambulatory monitoring of vital signs
Authors: Hernandez-Silveira Miguel , Ahmed Kamran , Ang Su-Shin , Zandari Fahriya , Mehta Tinaz , Weir Rebecca , Burdett Alison , Toumazou Chris , Brett Stephen J
Published: May 2015

Background and objectives

Vital signs are usually recorded at 4–8 h intervals in hospital patients, and deterioration between measurements can have serious consequences. The primary study objective was to assess agreement between a new ultra-low power, wireless and wearable surveillance system for continuous ambulatory monitoring of vital signs and a widely used clinical vital signs monitor. The secondary objective was to examine the system's ability to automatically identify and reject invalid physiological data.

Setting

Single hospital centre.

Participants

Heart and respiratory rate were recorded over 2 h in 20 patients undergoing elective surgery and a second group of 41 patients with comorbid conditions, in the general ward.

Outcome measures

Primary outcome measures were limits of agreement and bias. The secondary outcome measure was proportion of data rejected.

Results

The digital patch provided reliable heart rate values in the majority of patients (about 80%) with normal sinus rhythm, and in the presence of abnormal ECG recordings (excluding aperiodic arrhythmias such as atrial fibrillation). The mean difference between systems was less than ±1 bpm in all patient groups studied. Although respiratory data were more frequently rejected as invalid because of the high sensitivity of impedance pneumography to motion artefacts, valid rates were reported for 50% of recordings with a mean difference of less than ±1 brpm compared with the bedside monitor. Correlation between systems was statistically significant (p<0.0001) for heart and respiratory rate, apart from respiratory rate in patients with atrial fibrillation (p=0.02).

Conclusions

Overall agreement between digital patch and clinical monitor was satisfactory, as was the efficacy of the system for automatic rejection of invalid data. Wireless monitoring technologies, such as the one tested, may offer clinical value when implemented as part of wider hospital systems that integrate and support existing clinical protocols and workflows.
Cost-effectiveness and public health benefit of secondary cardiovascular disease prevention from improved adherence using a polypill in the UK
Authors: Becerra Virginia , Gracia Alfredo , Desai Kamal , Abogunrin Seye , Brand Sarah , Chapman Ruth , García Alonso Fernando , Fuster Valentín , Sanz Ginés
Published: May 2015

Objective

To evaluate the public health and economic benefits of adherence to a fixed-dose combination polypill for the secondary prevention of cardiovascular (CV) events in adults with a history of myocardial infarction (MI) in the UK.

Design

Markov-model-based cost-effectiveness analysis, informed by systematic reviews, which identified efficacy, utilities and adherence data inputs.

Setting

General practice in the UK.

Participants

Patients with a mean age of 64.7 years, most of whom are men with a recent or non-recent diagnosis of MI and for whom secondary preventive medication is indicated and well tolerated.

Intervention

Fixed-dose combination polypill (100 mg aspirin, 20 mg atorvastatin and 2.5, 5, or 10 mg ramipril) compared with multiple monotherapy.

Primary and secondary outcome measures

CV events prevented per 1000 patients; cost per life-year gained; and cost per quality-adjusted life-year (QALY) gained.

Results

The model estimates that for each 10% increase in adherence, an additional 6.7% fatal and non-fatal CV events can be prevented. In the base case, over 10 years, the polypill would improve adherence by ∼20% and thereby prevent 47 of 323 (15%) fatal and non-fatal CV events per 1000 patients compared with multiple monotherapy, with an incremental cost-effectiveness ratio (ICER) of £8200 per QALY gained. Probabilistic sensitivity analyses for the base-case assumptions showed an 81.5% chance of the polypill being cost-effective at a willingness-to-pay threshold of £20 000 per QALY gained compared with multiple monotherapy. In scenario analyses that varied structural assumptions, ICERs ranged between cost saving and £21 430 per QALY gained.

Conclusions

Assuming that some 450 000 adults are at risk of MI, a 10 percentage point uptake of the polypill could prevent 3260 CV events and 590 CV deaths over a decade.The polypill appears to be a cost-effective strategy to prevent fatal and non-fatal CV events in the UK.
Validation of the Framingham general cardiovascular risk score in a multiethnic Asian population: a retrospective cohort study
Authors: Chia Yook Chin , Gray Sarah Yu Weng , Ching Siew Mooi , Lim Hooi Min , Chinna Karuthan
Published: May 2015

Objective

This study aims to examine the validity of the Framingham general cardiovascular disease (CVD) risk chart in a primary care setting.

Design

This is a 10-year retrospective cohort study.

Setting

A primary care clinic in a teaching hospital in Malaysia.

Participants

967 patients’ records were randomly selected from patients who were attending follow-up in the clinic.

Main outcome measures

Baseline demographic data, history of diabetes and smoking, blood pressure (BP), and serum lipids were captured from patient records in 1998. Each patient's Framingham CVD score was computed from these parameters. All atherosclerotic CVD events occurring between 1998 and 2007 were counted.

Results

In 1998, mean age was 57 years with 33.8% men, 6.1% smokers, 43.3% diabetics and 59.7% hypertensive. Median BP was 140/80 mm Hg and total cholesterol 6.0 mmol/L (1.3). The predicted median Framingham general CVD risk score for the study population was 21.5% (IQR 1.2–30.0) while the actual CVD events that occurred in the 10 years was 13.1% (127/967). The median CVD points for men was 30.0, giving them a CVD risk of more than 30%; for women it is 18.5, a CVD risk of 21.5%. Our study found that the Framingham general CVD risk score to have moderate discrimination with an area under the receiver operating characteristic curve (AUC) of 0.63. It also discriminates well for Malay (AUC 0.65, p=0.01), Chinese (AUC 0.60, p=0.03), and Indians (AUC 0.65, p=0.001). There was good calibration with Hosmer-Lemeshow test χ2=3.25, p=0.78.

Conclusions

Taking into account that this cohort of patients were already on treatment, the Framingham General CVD Risk Prediction Score predicts fairly accurately for men and overestimates somewhat for women. In the absence of local risk prediction charts, the Framingham general CVD risk prediction chart is a reasonable alternative for use in a multiethnic group in a primary care setting.
What do you think overdiagnosis means? A qualitative analysis of responses from a national community survey of Australians
Authors: Moynihan Ray , Nickel Brooke , Hersch Jolyn , Doust Jenny , Barratt Alexandra , Beller Elaine , McCaffery Kirsten
Published: May 2015

Objective

Overdiagnosis occurs when someone is diagnosed with a disease that will not harm them. Against a backdrop of growing evidence and concern about the risk of overdiagnosis associated with certain screening activities, and recognition of the need to better inform the public about it, we aimed to ask what the Australian community understood overdiagnosis to mean.

Design, setting and participants

Content analysis of verbatim responses from a randomly sampled community telephone survey of 500 Australian adults, between January and February 2014. Data were analysed independently by two researchers.

Main outcome measures

Analysis of themes arising from community responses to open-ended questions about the meaning of overdiagnosis.

Results

The sample was broadly representative of the Australian population. Forty per cent of respondents thought overdiagnosis meant exaggerating a condition that was there, diagnosing something that was not there or too much diagnosis. Twenty-four per cent described overdiagnosis as overprescribing, overtesting or overtreatment. Only 3% considered overdiagnosis meant doctors gained financially. No respondents mentioned screening in conjunction with overdiagnosis, and over 10% of participants were unable to give an answer.

Conclusions

Around half the community surveyed had an approximate understanding of overdiagnosis, although no one identified it as a screening risk and a quarter equated it with overuse. Strategies to inform people about the risk of overdiagnosis associated with screening and diagnostic tests, in clinical and public health settings, could build on a nascent understanding of the nature of the problem.
Work-related allergies to storage mites in Parma (Italy) ham workers
Authors: Tafuro Federica , Ridolo Erminia , Goldoni Matteo , Montagni Marcello , Mutti Antonio , Corradi Massimo
Published: May 2015

Objectives

To investigate the role of storage mites in the development of allergic diseases among ham production workers, and to search for early alterations in lung function tests and early inflammation markers in exhaled air. Respiratory allergies due to storage mites have been reported in people with various occupations but, although such mites are unavoidable when curing ham, there are no published data concerning ham production workers.

Setting

Secondary care.

Design

Experimental cross-sectional study.

Participants

220 participants (110 ham production workers and 110 controls) were recruited.

Primary and secondary outcome measures

Workersanswered a medical questionnaire, and underwent spirometry and fraction of exhaled nitric oxide at 50 mL/s (FeNO50) measurements. Those with allergic symptoms also underwent skin prick tests to determine their sensitisation to airborne allergens. A methacholine test was performed in symptomatic participants when spirometry was normal to assess airways hyper-responsiveness.

Results

Symptomatic storage mite sensitisation was observed in 16 workers (14.5%) (rhinoconjunctivitis in 15 (63%) and asthma in (4%)) and 2 controls (1.8%; p=0.001). Higher FeNO50values in exposed symptomatic workers compared with healthy control participants (34.65±7.49 vs 13.29±4.29 ppb; p<0.001) suggested bronchial and nasal involvement, although their lung function parameters were normal. Regardless of exposure, a FeNO50value of 22.5 ppb seems to be 100% sensitive and 99.4% specific in distinguishing allergic and non-allergic participants. Multivariate analysis of FeNO50values in the symptomatic participants showed that they were positively influenced by IgE-mediated allergy (p=0.001) and reported symptom severity (p=0.041), and negatively by smoking status (p=0.049).

Conclusions

Ham processing workers, as well as workers involved in any meat processing work that includes curing, should be informed about the occupational risk of sensitisation to mites.
Professionalism dilemmas, moral distress and the healthcare student: insights from two online UK-wide questionnaire studies
Authors: Monrouxe Lynn V , Rees Charlotte E , Dennis Ian , Wells Stephanie E
Published: May 2015

Objective

To understand the prevalence of healthcare students’ witnessing or participating in something that they think unethical (professionalism dilemmas) during workplace learning and examine whether differences exist in moral distress intensity resulting from these experiences according to gender and the frequency of occurrence.

Design

Two cross-sectional online questionnaires of UK medical (study 1) and nursing, dentistry, physiotherapy and pharmacy students (study 2) concerning professionalism dilemmas and subsequent distress for (1) Patient dignity and safety breaches; (2) Valid consent for students’ learning on patients; and (3) Negative workplace behaviours (eg, student abuse).

Participants and setting

2397 medical (67.4% female) and 1399 other healthcare students (81.1% female) responded.

Main results

The most commonly encountered professionalism dilemmas were: student abuse and patient dignity and safety dilemmas. Multinomial and logistic regression identified significant effects for gender and frequency of occurrence. In both studies, men were more likely to classify themselves as experiencing no distress; women were more likely to classify themselves as distressed. Two distinct patterns concerning frequency were apparent: (1)Habituation(study 1): less distress with increased exposure to dilemmas ‘justified’ for learning; (2)Disturbance(studies 1 and 2): more distress with increased exposure to dilemmas that could not be justified.

Conclusions

Tomorrow's healthcare practitioners learn within a workplace in which they frequently encounter dilemmas resulting in distress. Gender differences could be respondents acting according to gendered expectations (eg, males downplaying distress because they are expected to appear tough).Habituationto dilemmas suggests students might balance patient autonomy and right to dignity with their own needs to learn for future patient benefit.Disturbancecontests the ‘accepted’ notion that students become less empathic over time. Future research might examine the strategies that students use to manage their distress, to understand how this impacts of issues such as burnout and/or leaving the profession.
Predictors of skilled attendance at delivery among antenatal clinic attendants in Ghana: a cross-sectional study of population data
Authors: Amoakoh-Coleman Mary , Ansah Evelyn K , Agyepong Irene Akua , Grobbee Diederick E , Kayode Gbenga A , Klipstein-Grobusch Kerstin
Published: May 2015

Objective

To identify demographic, maternal and community predictors of skilled attendance at delivery among women who attend antenatal clinic at least once during their pregnancy in Ghana.

Design

A cross-sectional study using the 2008 Ghana Demographic and Health Survey (DHS) data. We used frequencies for descriptive analysis, χ2test for associations and logistic regression to identify significant predictors. Predictive models were built with estimation of area under the receiver operating characteristic curves (AUC).

Setting

Ghana.

Participants

A total of 2041 women who had a live birth in the 5 years preceding the survey, and attended an antenatal clinic having a skilled provider, at least once, during the pregnancy.

Outcome

Skilled attendance at delivery.

Results

Overall, 60.5% (1235/2041) of women in our study sample reported skilled attendance at delivery. Significant positive associations existed between skilled attendance at delivery and the variables such as maternal educational level, wealth status class, ever use of contraception, previous pregnancy complications and health insurance coverage (p<0.001). Significant predictors of skilled attendance were wealth status class, residency, previous delivery complication, health insurance coverage and religion in a model with AUC (95% CI) of 0.85 (0.83 to 0.88).

Conclusions

Women less likely to have skilled attendance at delivery can be identified during antenatal care by using data on wealth status class, health insurance coverage, residence, history of previous birth complications and religion, and targeted with interventions to improve skilled attendance at delivery.
Are we recording postoperative complications correctly? Comparison of NHS Hospital Episode Statistics with the American College of Surgeons National Surgical Quality Improvement Program
Authors: Parthasarathy Muralidharan , Reid Vicki , Pyne Laura , Groot-Wassink Thomas
Published: May 2015

Background

Hospital Episode Statistics (HES) data are used to measure surgical outcomes, but its quality has been considered inferior to that of clinical databases. We compare the recording accuracy of HES, an administrative database used in the National Health Service (NHS), with that of ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Program), a well-established clinical database.

Methods

1323 patient records from our hospital, common to both databases were compared for ten surgical procedures (amputation, appendicectomy, cholecystectomy, femoral hernia repair, Hartmann's procedure, incisional hernia repair, inguinal hernia repair, long saphenous vein surgery, parathyroidectomy and umbilical hernia repair) and nine postoperative complications (acute renal failure, myocardial infarction, pneumonia, pulmonary embolism, urinary tract infection, blood transfusion, septic shock, surgical site infection and wound disruption) using text strings or ICD-10 (International Classification of Diseases) codes. κ coefficient was calculated as a measure of concordance between HES and ACS NSQIP databases.

Results

The databases showed perfect or very good agreement in recording a majority of surgical procedures (κ coefficient range 0.82–1.0), but there was discordance in recording postoperative complications. When HES was investigated using text string or ICD-10 code, the κ coefficient range for nine postoperative complications was 0.00–0.56, indicating poor to moderate inter-rater agreement. Concordance was even less when searched by HES coder's recommended way to record postoperative complications.

Conclusions

HES poorly registers postoperative complications. Suggested improvements include addition of dates when a condition is diagnosed, agreed criteria to identify postoperative complications, specifically trained coding staff for surgery and consistent use of the coding guidance.
How members of the public interpret the wordaccident
Authors: Girasek D C
Published: May 2015

Objective

To explore what the wordaccidentmeans to the lay public. This interpretation is of interest because it has been raised by injury control professionals as one justification for discouraging use of that word.

Methods

A national telephone survey of 943 adults in the United States was conducted. Respondents were selected at random from households whose phone numbers were generated using random digit dialing techniques. Bivariate and multivariate analyses were performed to determine if respondent characteristics predicted their interpretations of the wordaccident.

Results

Eighty three per cent of respondents associated preventability with the wordaccident, and only 26% felt that accidents were controlled by fate. However, 71% thought that accidents could not be predicted, and 4% felt that accidents were done on purpose. Age, education, income, and race emerged as independent predictors of variousaccidentinterpretations.

Conclusions

Only in the case of “unpredictability” does the public's interpretation of the wordaccidentmatch many experts' expectations. The concept of “unintentionality” is what seems to be communicated most strongly by use of the wordaccident. Persistent attempts on the part of injury control professionals to eliminate this word from social discourse may result in unintended consequences, which are discussed.
Calcitriol increases Dicer expression and modifies the microRNAs signature in SiHa cervical cancer cells
Authors: González-Duarte Ramiro José , Cázares-Ordoñez Verna , Romero-Córdoba Sandra , Díaz Lorenza , Ortíz Víctor , Freyre-González Julio Augusto , Hidalgo-Miranda Alfredo , Larrea Fernando , Avila Euclides
Published: May 2015

MicroRNAs play important roles in cancer biology. Calcitriol, the hormonal form of vitamin D3, regulates microRNAs expression in tumor cells. In the present study we asked if calcitriol would modify some of the components of the microRNA processing machinery, namely, Drosha and Dicer, in calcitriol-responsive cervical cancer cells. We found that calcitriol treatment did not affect Drosha mRNA; however, it significantly increased Dicer mRNA and protein expression in VDR-positive SiHa and HeLa cells. In VDR-negative C33-A cells, calcitriol had no effect on Dicer mRNA. We also found a vitamin D response element in Dicer promoter that interacts in vitro to vitamin D and retinoid X receptors. To explore the biological plausibility of these results, we asked if calcitriol alters the microRNA expression profile in SiHa cells. Our results revealed that calcitriol regulates the expression of a subset of microRNAs with potential regulatory functions in cancer pathways, such as miR-22, miR-296-3p, and miR-498, which exert tumor-suppressive effects. In summary, the data indicate that in SiHa cells, calcitriol stimulates the expression of Dicer possibly through the vitamin D response element located in its promoter. This may explain the calcitriol-dependent modulation of microRNAs whose target mRNAs are related to anticancer pathways, further adding to the various anticancer mechanisms of calcitriol.