bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathophysiology of dyspnoea in acute pulmonary embolism: A cross‐sectional evaluation
Authors: Sanchez Olivier , Caumont‐Prim Aurore , Riant Elisabeth , Plantier Laurent , Dres Martin , Louis Bruno , Collignon Marie‐Anne , Diebold Benoit , Meyer Guy , Peiffer Claudine , Delclaux Christophe
Published: November 2016

ABSTRACT

Background and objective

Dyspnoea in pulmonary embolism (PE) remains poorly characterized. Little is known about how to measure intensity or about the underlying mechanisms that may be related to ventilatory abnormalities, alveolar dead space ventilation or modulating factors such as psychological modulate. We hypothesized that dyspnoea would mainly be associated with pulmonary vascular obstruction and its pathophysiological consequences, while the sensory‐affective domain of dyspnoea would be influenced by other factors.

Methods

We undertook a prospective study of 90 consecutive non‐obese patients (mean ± SD age: 49 ± 16 years, 41 women) without cardiorespiratory disease. All patients were hospitalized with symptoms for <15 days and a confirmed PE (multi‐detector computed tomography (MDCT) scan, n = 87 and high‐probability ventilation/perfusion scan, n = 3). Patients underwent assessment of dyspnoea using the Borg score, modified Medical Research Council (mMRC) scale, assessment of psychological trait, state of anxiety and depression and chest pain via the Visual Analogical Scale at the time of maximum dyspnoea. Functional evaluations such as the quantitative ventilation–perfusion lung scan, echocardiography, alveolar dead space fraction and tidal ventilation measurements were completed within 48 h of admission.

Results

Multivariate analyses demonstrated that dyspnoea was mainly linked to pulmonary vascular obstruction and/or its consequences such as raised pulmonary arterial pressure and chest pain. The sensory‐affective domain of dyspnoea showed additional determinants such as age, depression and breathing variability.

Conclusion

Dyspnoea is mainly related to vascular consequences of PE such as increased pulmonary arterial pressure or chest pain. The sensory‐affective domain of dyspnoea also correlates with age, depression and breathing variability.
A new tool to quantify the geometrical characteristics of facial skin pores. Changes with age and a making‐up procedure in Caucasian women
Authors: Shaiek A. , Flament F. , François G. , Lefebvre‐Descamps V. , Barla C. , Vicic M. , Giron F. , Bazin R.
Published: November 2016

Background

Facial skin pores (FSP) are common and benign signs that generate frequent esthetic concerns or complaints. Despite their worldwide prevalence, related literature remains scarce. Hence, a new device has been developed and applied to validating studies, aiming at best describing FSP as they are self‐perceived, i.e. their anatomic features, their possible alterations with age and their appearance after application of a make‐up product.

Methods

Dermascore+® is an imaging device dedicated to a direct observation and acquisition of various characteristics of the skin surface. Images are captured under a high magnification and under different lighting configurations, to highlight the skin relief, based upon parallel polarized images. Dedicated software allows FSP to being detected and their morphological parameters to being extracted and computed. By measuring each detected FSP in a given region of interest, a statistically significant impact of both age and an applied cosmetic product upon their morphological features can be observed and quantified.

Results

Although the size and density of FSP are not affected by aging, their shape becomes elongated. A few tested make up products show variable effects that closely correlate with visual assessments made by trained estheticians.

Conclusion

The shape of FSP present on cheeks shows age‐related changes, toward a more elongated aspect, likely linked to a progressively altered (more isotropic) skin surface micro‐relief. The new tool Dermascore+® allows foundations to being rapidly differentiated and screened according to their variable effects upon the visual appearance through instrumental, objective depiction of FSP.
Enhancing pedotransfer functions with environmental data for estimating bulk density and effective cation exchange capacity in a data‐sparse situation
Authors: Akpa S. I. C. , Ugbaje S. U. , Bishop T. F. A. , Odeh I. O. A.
Published: November 2016

Soil bulk density (BD) and effective cation exchange capacity (ECEC) are among the most important soil properties required for crop growth and environmental management. This study aimed to explore the combination of soil and environmental data in developing pedotransfer functions (PTFs) for BD and ECEC. Multiple linear regression (MLR) and random forest model (RFM) were employed in developing PTFs using three different data sets: soil data (PTF‐1), environmental data (PTF‐2) and the combination of soil and environmental data (PTF‐3). In developing the PTFs, three depth increments were also considered: all depth, topsoil (<0.40 m) and subsoil (>0.40 m). Results showed that PTF‐3 (R2; 0.29–0.69) outperformed both PTF‐1 (R2; 0.11–0.18) and PTF‐2 (R2; 0.22–0.59) in BD estimation. However, for ECEC estimation, PTF‐3 (R2; 0.61–0.86) performed comparably as PTF‐1 (R2; 0.58–0.76) with both PTFs out‐performing PTF‐2 (R2; 0.30–0.71). Also, grouping of data into different soil depth increments improves the estimation of BD with PTFs (especially PTF‐2 and PTF‐3) performing better at subsoils than topsoils. Generally, the most important predictors of BD are sand, silt, elevation, rainfall, temperature for estimation at topsoil while EVI, elevation, temperature and clay are the most important BD predictors in the subsoil. Also, clay, sand, pH, rainfall and SOC are the most important predictors of ECEC in the topsoil while pH, sand, clay, temperature and rainfall are the most important predictors of ECEC in the subsoil. Findings are important for overcoming the challenges of building national soil databases for large‐scale modelling in most data‐sparse countries, especially in the sub‐Saharan Africa (SSA).
Comprehending 3D Diagrams: Sketching to Support Spatial Reasoning
Authors: Gagnier Kristin M. , Atit Kinnari , Ormand Carol J. , Shipley Thomas F.
Published: November 2016

Science, technology, engineering, and mathematics (STEM) disciplines commonly illustrate 3D relationships in diagrams, yet these are often challenging for students. Failing to understand diagrams can hinder success in STEM because scientific practice requires understanding and creating diagrammatic representations. We explore a new approach to improving student understanding of diagrams that convey 3D relations that is based on students generating their own predictive diagrams. Participants’ comprehension of 3D spatial diagrams was measured in a pre‐ and post‐design where students selected the correct 2D slice through 3D geologic block diagrams. Generating sketches that predicated the internal structure of a model led to greater improvement in diagram understanding than visualizing the interior of the model without sketching, or sketching the model without attempting to predict unseen spatial relations. In addition, we found a positive correlation between sketched diagram accuracy and improvement on the diagram comprehension measure. Results suggest that generating a predictive diagram facilitates students’ abilities to make inferences about spatial relationships in diagrams. Implications for use of sketching in supporting STEM learning are discussed.
Galilei und Brecht und die Folgen
Authors: Mayer Hans
Published: November 2016

Galilei, Brecht
Grabbe's Last Historical Drama. A Re-examination
Authors: Nieschmidt Hans-Werner
Published: November 2016

Grabbe
Expressionismus - europäische Moderne auf deutsch oder deutsche Seelenkrankheit? Bemerkungen zur Forschung
Authors: Brinkmann Richard
Published: November 2016

Expressionismus,europäische Moderne
Schiller and Baratynsky: Truth and Eternity
Authors: Harvie J. A.
Published: November 2016

Schiller, Baratynsky
Hartmann's Armer Heinrich: The Clasical Mediaeval Dilemma
Authors: Fisher R. W.
Published: November 2016

Ehre
"Die Ehre ist die Ehre". Minna von Barnhelm aus der perspektive des Moralisten La Rochefoucauld
Authors: Delbrück Hansgerd
Published: November 2016

Ehre
Rogue protein's partners offer hope in Parkinson's disease
Authors: Wadman Meredith
Published: November 2016

Two receptor molecules may offer targets for drugs.
Analysis of Germination Capacity and Germinant Receptor (Sub)clusters of Genome-Sequenced Bacillus cereus Environmental Isolates and Model Strains
Authors: Warda Alicja K. , Xiao Yinghua , Boekhorst Jos , Wells-Bennik Marjon H. J. , Nierop Groot Masja N. , Abee Tjakko
Published: November 2016

Spore germination of 17
Bacillus cereus
food isolates and reference strains was evaluated using flow cytometry analysis in combination with fluorescent staining at a single-spore level. This approach allowed for rapid collection of germination data under more than 20 conditions, including heat activation of spores, germination in complex media (brain heart infusion [BHI] and tryptone soy broth [TSB]), and exposure to saturating concentrations of single amino acids and the combination of alanine and inosine. Whole-genome sequence comparison revealed a total of 11 clusters of operons encoding germinant receptors (GRs): GerK, GerI, and GerL were present in all strains, whereas GerR, GerS, GerG, GerQ, GerX, GerF, GerW, and GerZ (sub)clusters showed a more diverse presence/absence in different strains. The spores of tested strains displayed high diversity with regard to their sensitivity and responsiveness to selected germinants and heat activation. The two laboratory strains,
B. cereus
ATCC 14579 and ATCC 10987, and 11 food isolates showed a good germination response under a range of conditions, whereas four other strains (
B. cereus
B4085, B4086, B4116, and B4153) belonging to phylogenetic group IIIA showed a very weak germination response even in BHI and TSB media. Germination responses could not be linked to specific (combinations of) GRs, but it was noted that the four group IIIA strains contained pseudogenes or variants of subunit C in their
gerL
cluster. Additionally, two of those strains (B4086 and B4153) carried pseudogenes in the
gerK
and
gerR
I
(sub)clusters that possibly affected the functionality of these GRs.

IMPORTANCE
Germination of bacterial spores is a critical step before vegetative growth can resume. Food products may contain nutrient germinants that trigger germination and outgrowth of
Bacillus
species spores, possibly leading to food spoilage or foodborne illness. Prediction of spore germination behavior is, however, very challenging, especially for spores of natural isolates that tend to show more diverse germination responses than laboratory strains. The approach used has provided information on the genetic diversity in GRs and corresponding subclusters encoded by
B. cereus
strains, as well as their germination behavior and possible associations with GRs, and it provides a basis for further extension of knowledge on the role of GRs in
B. cereus
(group member) ecology and transmission to the host.
First Report on the Draft Genome Sequences of Corynebacterium diphtheriae Isolates from India
Authors: Veeraraghavan Balaji , Anandan Shalini , Rajamani Sekar Suresh Kumar , Gopi Radha , Devanga Ragupathi Naveen Kumar , Ramesh Srilekha , Verghese Valsan Philip , Korulla Sophy , Mathai Sarah , Sangal Lucky , Joshi Sudhir
Published: November 2016

We report here the draft genome sequences of five
Corynebacterium diphtheriae
isolates of Indian origin. The
C. diphtheriae
isolates TH1141, TH510, TH1526, TH1337, and TH2031 belong to sequence type ST-50, ST-295, ST-377, ST-405, and ST-405, with an average genome size of 2.5 Mbp.
Alternative Polyadenylation of Human Bocavirus at Its 3′ End Is Regulated by Multiple Elements and Affects Capsid Expression
Authors: Hao Sujuan , Zhang Junmei , Chen Zhen , Xu Huanzhou , Wang Hanzhong , Guan Wuxiang
Published: November 2016

Alternative processing of human bocavirus (HBoV) P5 promoter-transcribed RNA is critical for generating the structural and nonstructural protein-encoding mRNA transcripts. The regulatory mechanism by which HBoV RNA transcripts are polyadenylated at proximal [(pA)p] or distal [(pA)d] polyadenylation sites is still unclear. We constructed a recombinant HBoV infectious clone to study the alternative polyadenylation regulation of HBoV. Surprisingly, in addition to the reported distal polyadenylation site, (pA)d, a novel distal polyadenylation site, (pA)d2, which is located in the right-end hairpin (REH), was identified during infectious clone transfection or recombinant virus infection. (pA)d2 does not contain typical hexanucleotide polyadenylation signal, upstream elements (USE), or downstream elements (DSE) according to sequence analysis. Further study showed that HBoV nonstructural protein NS1, REH, and
cis
elements of (pA)d were necessary and sufficient for efficient polyadenylation at (pA)d2. The distance and sequences between (pA)d and (pA)d2 also played a key role in the regulation of polyadenylation at (pA)d2. Finally, we demonstrated that efficient polyadenylation at (pA)d2 resulted in increased HBoV capsid mRNA transcripts and protein translation. Thus, our study revealed that all the bocaviruses have distal poly(A) signals on the right-end palindromic terminus, and alternative polyadenylation at the HBoV 3′ end regulates its capsid expression.

IMPORTANCE
The distal polyadenylation site, (pA)d, of HBoV is located about 400 nucleotides (nt) from the right-end palindromic terminus, which is different from those of bovine parvovirus (BPV) and canine minute virus (MVC) in the same genus whose distal polyadenylation is located in the right-end stem-loop structure. A novel polyadenylation site, (pA)d2, was identified in the right-end hairpin of HBoV during infectious clone transfection or recombinant virus infection. Sequence analysis showed that (pA)d2 does not contain typical polyadenylation signals, and the last 42 nt form a stem-loop structure which is almost identical to that of MVC. Further study showed that NS1, REH, and
cis
elements of (pA)d are required for efficient polyadenylation at (pA)d2. Polyadenylation at (pA)d2 enhances capsid expression. Our study demonstrates alternative polyadenylation at the 3′ end of HBoV and suggests an additional mechanism by which capsid expression is regulated.
Castleman's disease in carcinoma gall bladder
Authors: Dhakre Vijay Waman , Nagral Sanjay , Jayesh Nanavati Aditya
Published: November 2016

Castleman's disease (CD) also known as angiofollicular lymph node hyperplasia represents a group of uncommon non-clonal lymphoproliferation. We herein report a case of CD associated with carcinoma of the gall bladder. To the best of our knowledge, it is the first of its kind and has not been reported in the past. The hypothesis regarding the aetiopathogenesis of CD is that it is associated with interleukin-6 surges. This may be explained by the overproduction of IL-6 by tumour cells or IL-6 production due to a long-standing/smouldering localised inflammatory response. An important question raised by this observation is whether the finding of CD has any effect on the outcome of this patient of carcinoma of the gall bladder. Further research is required in this matter.
Massive haemolysis, gas-forming liver abscess and sepsis due toClostridium perfringensbacteraemia
Authors: García Carretero Rafael , Romero Brugera Marta , Vazquez-Gomez Oscar , Rebollo-Aparicio Noelia
Published: November 2016

Clostridial soft tissue infections are infrequent, but can be life-threatening when associated with certain underlying conditions, such as immunosuppression or malignancy. When bacteraemia occurs, it can be accompanied by haemolysis. Only surgical removal of the focus of infection and early onset of antibiotic therapy can prevent a very poor outcome. We describe the case of a man aged 65 years who presented with sepsis, haemolysis and rapid worsening. The identification of a gas-forming liver abscess, the early percutaneous drainage and the prompt initiation of antibiotic treatment were the key factors in the outcome of this patient.
Associations of occupational standing with musculoskeletal symptoms: a systematic review with meta-analysis
Authors: Coenen Pieter , Willenberg Lisa , Parry Sharon , Shi Joyce W , Romero Lorena , Blackwood Diana M , Maher Christopher G , Healy Genevieve N , Dunstan David W , Straker Leon M
Published: November 2016

Objective

Given the high exposure to occupational standing in specific occupations, and recent initiatives to encourage intermittent standing among white-collar workers, a better understanding of the potential health consequences of occupational standing is required. We aimed to review and quantify the epidemiological evidence on associations of occupational standing with musculoskeletal symptoms.

Design

A systematic review was performed. Data from included articles were extracted and described, and meta-analyses conducted when data were sufficiently homogeneous.

Data sources

Electronic databases were systematically searched.

Eligibility criteria

Peer-reviewed articles on occupational standing and musculoskeletal symptoms from epidemiological studies were identified.

Results

Of the 11 750 articles screened, 50 articles reporting 49 studies were included (45 cross-sectional and 5 longitudinal; n=88 158 participants) describing the associations of occupational standing with musculoskeletal symptoms, including low-back (39 articles), lower extremity (14 articles) and upper extremity (18 articles) symptoms. In the meta-analysis, ‘substantial’ (>4 hours/workday) occupational standing was associated with the occurrence of low-back symptoms (pooled OR (95% CI) 1.31 (1.10 to 1.56)). Evidence on lower and upper extremity symptoms was too heterogeneous for meta-analyses. The majority of included studies reported statistically significant detrimental associations of occupational standing with lower extremity, but not with upper extremity symptoms.

Conclusions

The evidence suggests that substantial occupational standing is associated with the occurrence of low-back and (inconclusively) lower extremity symptoms, but there may not be such an association with upper extremity symptoms. However, these conclusions are tentative as only limited evidence was found from high-quality, longitudinal studies with fully adjusted models using objective measures of standing.
Diagnostic accuracy of the Ottawa Ankle and Midfoot Rules: a systematic review with meta-analysis
Authors: Beckenkamp Paula R , Lin Chung-Wei Christine , Macaskill Petra , Michaleff Zoe A , Maher Chris G , Moseley Anne M
Published: November 2016

Objective

To review the diagnostic accuracy of the Ottawa Ankle and Midfoot Rules and explore if clinical features and/or methodological quality of the study influence diagnostic accuracy estimates.

Design

Systematic review with meta-analysis.

Data sources

MEDLINE, EMBASE, CINAHL, SPORTDiscus and Cochrane Library.

Eligibility criteria for selecting studies

Primary diagnostic studies reporting the accuracy of the Rules in people with ankle and/or midfoot injury were retrieved. Diagnostic accuracy estimates, overall and for subgroups (patient’s age, profession of the assessor and setting of application), were made. Sensitivity analyses included studies with a low risk of bias and studies where all patients received radiographs.

Results

66 studies were included. Ankle and Midfoot Rules presented similar accuracies, which were homogeneous and high for sensitivity and negative likelihood ratios and poor and heterogeneous for specificity and positive likelihood ratios (mean, 95% CI pooled sensitivity of Ankle Rules: 99.4%, 97.9% to 99.8%; specificity: 35.3%, 28.8% to 42.3%). Sensitivity of the Ankle Rules was higher in adults than in children, but the profession of the assessor did not appear to influence accuracy. Specificity was higher for Midfoot than for Ankle Rules. There were not enough studies to allow comparison according to setting of application. Studies with a low risk of bias and where all patients received radiographs provided lower accuracy estimates. Specificity heterogeneity was not explained by assessor training, use of imaging in all patients and low risk of bias.

Conclusions

Study features and the methodological quality influence estimates of the diagnostic accuracy of the Ottawa Ankle and Midfoot Rules.
Circulating SerpinB1 levels and clinical features in patients with type 2 diabetes
Authors: Takebayashi Kohzo , Hara Kenji , Terasawa Tomoko , Naruse Rika , Suetsugu Mariko , Tsuchiya Takafumi , Inukai Toshihiko
Published: November 2016

Objective

The main purpose of this study was to investigate the association of serum SerpinB1 levels and various parameters in patients with type 2 diabetes. The effect of canagliflozin (a sodium glucose cotransporter 2 (SGLT2) inhibitor), which can decrease circulating insulin levels, on serum SerpinB1 levels was also investigated. A recent study suggests that the serum levels of SerpinB1, also known as monocyte neutrophil elastase inhibitor, increase with insulin resistance, may have a protective effect for pancreatic β cells, and may decrease insulin resistance.

Research design and methods

The study included 30 patients with type 2 diabetes hospitalized for glycemic control and 10 control subjects.

Results

SerpinB1 levels were significantly higher in patients with type 2 diabetes, compared with that in heathy control subjects (10.01±3.59 vs 5.69±1.64 ng/mL, p<0.0001). Serum SerpinB1 levels had a significant negative correlation with low-density lipoprotein cholesterol (LDL-C) (p=0.0123). Serum SerpinB1 levels had a significant positive association or trend toward a positive association with age and with hemoglobin A1c (HbA1c), and significant negative association with LDL-C levels in some multiple regression analysis models. Patients treated with statins had a tendency toward higher serum SerpinB1 levels, compared with those patients not treated with statins. During a 3-day observation period both with and without canagliflozin treatment, the serum SerpinB1 levels did not change.

Conclusions

Serum SerpinB1 levels are elevated in patients with type 2 diabetes compared with that in healthy subjects and are negatively correlated with serum LDL-C.
Quality of care in rural youth with type 1 diabetes: a cross-sectional pilot assessment
Authors: Stumetz Kyle S , Yi-Frazier Joyce P , Mitrovich Connor , Briggs Early Kathaleen
Published: November 2016

Background

Type 1 diabetes mellitus (T1DM) presents a significant health burden for patients and families. The quality of care (QOC) among those living in rural communities is thought to be subpar compared with those in urban communities; however, little data exist to reflect this, especially in pediatric diabetes.

Objective

The purpose of this pilot study was to investigate diabetes QOC among families living in rural versus urban areas. 6 QOC markers were used to compare youth with T1DM: appointment adherence, patient–provider communication, diabetes education during clinic visit, congruency with diabetes standards of care, diabetes self-management behaviors, and diabetes-related hospitalizations.

Research design and methods

Participants were rural or urban adult caregivers of youth ages 2–18 with ≥10-month history of T1DM receiving treatment at Seattle Children's Hospital, USA. Participants were from rural areas of central Washington, or urban areas of western Washington. Caregivers completed a 26-item survey pertaining to the 6 QOC markers. The 6 QOC markers were compared across 61 participants (34 rural, 27 urban), to determine how diabetes care quality and experiences differed. Data were collected over 12 months. Groups were compared using t-tests and χ2tests, as appropriate.

Results

Compared with urban families, rural families reported significantly lower income and a 4-fold greater usage of public insurance. Among the QOC measures, rural participants were significantly worse off in the appointment adherence, patient–provider communication, and hospitalizations categories. Congruence with diabetes standards of care (foot care only) was also significantly poorer in rural participants.

Conclusions

The burden of travel in conjunction with the lack of resources in this rural population of families with T1DM youth is cause for concern and warrants further research.
Trends and level of control of hypertension among adults attending an ambulatory HIV clinic in Kampala, Uganda: a retrospective study
Authors: Kalyesubula Robert , Kayongo Alex , Semitala Fred Collins , Muhanguzi Asaph , Katantazi Nehemiah , Ayers Dieter , Forrest Jamie I , Mills Edward J
Published: November 2016

Background

With an ageing HIV-positive population, sub-Saharan Africa is now facing a dual epidemic of communicable and non-communicable diseases (NCDs). This study aimed to assess trends in the prevalence of hypertension and factors associated with hypertension, among adults attending an ambulatory HIV clinic in Kampala, Uganda.

Methods

We conducted a retrospective chart review to identify patients with hypertension. We used a random number generator to select 400 patient charts from each year from 2009 to 2014. Blood pressure, age, body mass index (BMI), WHO disease stage and Karnofsky scores were extracted. Logistic regression was used to estimate the strength of the association between each of these factors and the presence of hypertension.

Results

In total, 1996 charts were included in this analysis. The mean age of participants was 31 years and 1311/1996 (65.7%) were female. The overall prevalence of hypertension was 418/1996 (20.9%). This rose from 16.9% in 2009 to 32.3% in 2013. Of the patients with hypertension, 96/418 (23.0%) were receiving adequate treatment. Patients >50 years of age had 3.12 times the odds of hypertension compared with patients aged 20–29 years (95% CI 2.00 to 4.85). Men had 1.65 times the odds of hypertension compared with women (95% CI 1.34 to 2.03) and patients with a BMI of 35–39 kg/m2had 3.93 times the odds of hypertension compared with patients with a BMI <25 kg/m2.

Conclusions

The prevalence of hypertension is rising in the Ugandan HIV-positive population. There remains inadequate management and control of hypertension in this group highlighting the need to better integrate NCD care within the HIV clinical settings.
Towards the genetic basis of cerebral venous thrombosis—the BEAST Consortium: a study protocol
Authors: Cotlarciuc Ioana , Marjot Thomas , Khan Muhammad S , Hiltunen Sini , Haapaniemi Elena , Metso Tiina M , Putaala Jukka , Zuurbier Susanna M , Brouwer Matthijs C , Passamonti Serena M , Bucciarelli Paolo , Pappalardo Emanuela , Patel Tasmin , Costa Paolo , Colombi Marina , Canhão Patrícia , Tkach Aleksander , Santacroce Rosa , Margaglione Maurizio , Favuzzi Giovanni , Grandone Elvira , Colaizzo Donatella , Spengos Kostas , Arauz Antonio , Hodge Amanda , Ditta Reina , Debette Stephanie , Zedde Marialuisa , Pare Guillaume , Ferro José M , Thijs Vincent , Pezzini Alessandro , Majersik Jennifer J , Martinelli Ida , Coutinho Jonathan M , Tatlisumak Turgut , Sharma Pankaj
Published: November 2016

Introduction

Cerebral venous thrombosis (CVT) is a rare cerebrovascular condition accounting for <1% of all stroke cases and mainly affects young adults. Its genetic aetiology is not clearly elucidated.

Methods and analysis

To better understand the genetic basis of CVT, we have established an international biobank of CVT cases, Biorepository to Establish the Aetiology of Sinovenous Thrombosis (BEAST) which aims to recruit highly phenotyped cases initially of European descent and later from other populations. To date we have recruited 745 CVT cases from 12 research centres. As an initial step, the consortium plans to undertake a genome-wide association analysis of CVT using the Illumina Infinium HumanCoreExome BeadChip to assess the association and impact of common and low-frequency genetic variants on CVT risk by using a case–control study design. Replication will be performed to confirm putative findings. Furthermore, we aim to identify interactions of genetic variants with several environmental and comorbidity factors which will likely contribute to improve the understanding of the biological mechanisms underlying this complex disease.

Ethics and dissemination

BEAST meets all ethical standards set by local institutional review boards for each of the participating sites. The research outcomes will be published in international peer-reviewed open-access journals with high impact and visibility. The results will be presented at national and international meetings to highlight the contributions into improving the understanding of the mechanisms underlying this uncommon but important disease. This international DNA repository will become an important resource for investigators in the field of haematological and vascular disorders.
Real-world evidence studies into treatment adherence, thresholds for intervention and disparities in treatment in people with type 2 diabetes in the UK
Authors: McGovern Andrew , Hinton William , Correa Ana , Munro Neil , Whyte Martin , de Lusignan Simon
Published: November 2016

Purpose

The University of Surrey-Lilly Real World Evidence (RWE) diabetes cohort has been established to provide insights into the management of type 2 diabetes mellitus (T2DM). There are 3 areas of study due to be conducted to provide insights into T2DM management: exploration of medication adherence, thresholds for changing diabetes therapies, and ethnicity-related or socioeconomic-related disparities in management. This paper describes the identification of a cohort of people with T2DM which will be used for these analyses, through a case finding algorithm, and describes the characteristics of the identified cohort.

Participants

A cohort of people with T2DM was identified from the Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) data set. This data set comprises electronic patient records collected from a nationally distributed sample of 130 primary care practices across England with scope to increase the number of practices to 200.

Findings to date

A cohort (N=58 717) of adults with T2DM was identified from the RCGP RSC population (N=1 260 761), a crude prevalence of diabetes of 5.8% in the adult population. High data quality within the practice network and an ontological approach to classification resulted in a high level of data completeness in the T2DM cohort; ethnicity identification (82.1%), smoking status (99.3%), alcohol use (93.3%), glycated haemoglobin (HbA1c; 97.9%), body mass index (98.0%), blood pressure (99.4%), cholesterol (87.4%) and renal function (97.8%). Data completeness compares favourably to other, similarly large, observational cohorts. The cohort comprises a distribution of ages, socioeconomic and ethnic backgrounds, diabetes complications, and comorbidities, enabling the planned analyses.

Future plans

Regular data uploads from the RCGP RSC practice network will enable this cohort to be followed prospectively. We will investigate medication adherence, explore thresholds and triggers for changing diabetes therapies, and investigate any ethnicity-related or socioeconomic-related disparities in diabetes management.
ACCESS HD pilot: A randomised feasibility trial Comparing Catheters with fistulas in Elderly patientS Starting haemodialysis
Authors: Quinn Robert , Ravani Pietro
Published: November 2016

Introduction

The selection of the type of vascular access for haemodialysis is an important intervention question. However, only observational studies are available to inform decision-making in this area, and they are at high risk of selection bias. While a clinical trial comparing the effects of the 2 most frequently chosen strategies for haemodialysis access (fistulas and catheters) on patient important and ‘hard’ clinical end points is needed, the feasibility of such a trial is uncertain.

Methods and analysis

This open-label pilot randomised controlled trial will test the feasibility and safety of randomising elderly people (≥65 years) who start haemodialysis with a central venous catheter (the most common initial type of haemodialysis access), and are eligible to receive a fistula, to a catheter-based strategy (comparator) or to a fistula-based strategy (intervention). We will enrol 100 patients at 10 centres across Canada. Participants assigned to the catheter-strategy arm will continue to use catheters; participants assigned to the fistula-strategy arm will receive a surgical attempt at fistula creation. The inclusion criteria are designed to minimise the risk of protocol violation and attrition. The primary outcome is feasibility, which we will assess by measuring: (1) the proportion of participants deemed eligible for the trial who consent to randomisation; and (2) the proportion of participants randomised to the intervention who receive the fistula surgery within 90 days of randomisation. Secondary outcomes will include safety outcomes, the reasons people and healthcare providers may not accept randomisation, and the reasons sites may not adhere to the trial protocol.

Ethics and dissemination

The Conjoint Health Research Ethics Board at the University of Calgary approved the study protocol. We will submit the results of this feasibility study in a peer-reviewed journal.

Trial registration number

NCT02675569, Pre-results.
Narrative medicine and death in the ICU: word clouds as a visual legacy
Authors: Vanstone Meredith , Toledo Feli , Clarke France , Boyle Anne , Giacomini Mita , Swinton Marilyn , Saunders Lois , Shears Melissa , Zytaruk Nicole , Woods Anne , Rose Trudy , Hand-Breckenridge Tracey , Heels-Ansdell Diane , Anderson-White Shelley , Sheppard Robert , Cook Deborah
Published: November 2016

Objective

The Word Cloud is a frequent wish in the 3 Wishes Project developed to nurture peace and ease the grieving process for dying critically ill patients. The objective was to examine whether Word Clouds can act as a heuristic approach to encourage a narrative orientation to medicine. Narrative medicine is an approach which can strengthen relationships, compassion and resilience.

Design

Word Clouds were created for 42 dying patients, and we interviewed 37 family members and 73 clinicians about their impact. We conducted a directed qualitative content analysis, using the 3 stages of narrative medicine (attention, representation, affiliation) to examine the narrative medicine potential of Word Clouds.

Results

The elicitation of stories for the Word Cloud promotes narrative attention to the patient as a whole person. The distillation of these stories into a list of words and the prioritisation of those words for arrangement in the collage encourages a representation that did not enforce a beginning, middle or end to the story of the patient's life. Strong affiliative connections were achieved through the honouring of patients, caring for families and sharing of memories encouraged through the creation, sharing and discussion of Word Clouds.

Conclusions

In the 3 Wishes Project, Word Clouds are 1 way that families and clinicians honour a dying patient. Engaging in the process of making a Word Cloud can promote a narrative orientation to medicine, forging connections, making meaning through reminiscence and leaving a legacy of a loved one. Documenting and displaying words to remember someone in death reaffirms their life.
Clinical metrics in emergency medicine: the shock index and the probability of hospital admission and inpatient mortality
Authors: Balhara Kamna S , Hsieh Yu-Hsiang , Hamade Bachar , Circh Ryan , Kelen Gabor D , Bayram Jamil D
Published: November 2016

Study objectives

The shock index (SI), defined as the ratio of HR to systolic BP, has been studied as an alternative prognostic tool to traditional vital signs in specific disease states and subgroups of patients. However, literature regarding its utility in the general ED population is lacking. Our main objective was to determine the probability of admission and inpatient mortality based on the first measured SI at initial presentation in the general adult ED population in our tertiary care centre.

Methods

A retrospective chart review of all adult patients (≥18 years old) presenting to the ED at our tertiary care centre over a 12-month period was conducted. Likelihood ratios (LRs) were calculated in order to determine the optimal SI cut-off for predicting hospital admission and inpatient mortality.

Results

We reviewed 58 336 ED patient encounters occurring between 1 October 2012 and 30 September 2013. SI >1.2 was associated with a large increase in the likelihood of hospital admission, with a positive LR (+LR) of 11.69 (95% CI 9.50 to 14.39) and a moderate increase in the likelihood of inpatient mortality with a +LR of 5.82 (95% CI 4.31 to 7.85). SI >0.7 and >0.9, the traditional ‘normal’ cut-offs cited in the literature, were only associated with minimal to small increases in the likelihood of admission and inpatient mortality.

Conclusions

In our single-centre study, the initial SI recorded in the ED shows promise as a clinical metric in the general adult ED population, increasing the probability of both hospital admission and inpatient mortality, specifically at a threshold of SI >1.2.
Cross-sectional and longitudinal associations of neighbourhood social environment and smoking behaviour: the multiethnic study of atherosclerosis
Authors: Mayne Stephanie L , Auchincloss Amy H , Moore Kari A , Michael Yvonne L , Tabb Loni Philip , Echeverria Sandra E , Diez Roux Ana V
Published: November 2016

Background

Social features of neighbourhood environments may influence smoking by creating a stressful environment or by buffering stress through social cohesion. However, the association of the overall neighbourhood social environment (NSE) with smoking, and the association of specific neighbourhood social factors with change in smoking behaviour over time, has rarely been examined.

Methods

This study included 5856 adults aged 45–84 years from the Multi-Ethnic Study of Atherosclerosis (2000–2012, average follow-up: 7.8 years). Outcomes included current smoking status and smoking intensity (average number of cigarettes smoked per day among baseline smokers). NSE was assessed as a composite score composed of aesthetic quality, safety and social cohesion scales (derived from neighbourhood surveys). Generalised linear mixed models evaluated the association of baseline NSE (composite score and individual scales) with current smoking (modified Poisson models) and smoking intensity (negative binomial models) cross-sectionally and longitudinally.

Results

Each SD increase in baseline NSE composite score was associated with 13% lower prevalence of smoking at baseline (adjusted prevalence ratio (aPR) 0.87 (95% CI 0.78 to 0.98). Neighbourhood safety and aesthetic quality were similarly associated with lower smoking prevalence (aPR 0.87 (0.78 to 0.97) and aPR 0.87 (0.77 to 0.99), respectively) but the association with social cohesion was weaker or null. No significant associations were observed for smoking intensity among baseline smokers. Baseline NSE was not associated with changes in smoking risk or intensity over time.

Conclusions

Results suggest that neighbourhood social context influences whether older adults smoke, but does not promote smoking cessation or reduction over time.
Novel approaches to access and treatment of cavernous sinus dural arteriovenous fistula (CS-DAVF): case series and review of the literature
Authors: Wenderoth Jason
Published: November 2016

Caroticocavernous fistula or cavernous sinus dural arteriovenous fistula (CS-DAVF) has presented various treatment challenges over many years. This paper outlines these challenges in a review of the literature, and attempts to address them by analyzing the anatomical and hemodynamic characteristics of 32 consecutive patients with CS-DAVF treated between 2007 and 2016, in doing so proposing novel strategies for safe access and treatment of CS-DAVF.
Educational needs of health professionals working in rheumatology in Europe
Authors: Vliet Vlieland Theodora P M , van den Ende Cornelia H.M , Alliot-Launois Francoise , Beauvais Catherine , Gobbo Milena , Iagnocco Annamaria , Lundberg Ingrid E , Munuera-Martínez Pedro V , Opava Christina H , Prior Yeliz , Redmond Anthony , Smucrova Hana , Wiek Dieter
Published: November 2016

Objective

To explore the availability of postgraduate education for health professionals (HPs) working in rheumatology in Europe, and their perceived educational needs and barriers for participation in current educational offerings.

Methods

Structured interviews were conducted with national representatives of rheumatology HPs' organisations and an online survey among individual HPs was disseminated through existing European League Against Rheumatism (EULAR) networks (10 languages including English). These comprised questions on: availability of postgraduate education, familiarity with EULAR and its educational offerings, unmet needs regarding the contents and mode of delivery and potential barriers to participate in education (0–10 scales).

Results

According to 17 national representatives, postgraduate rheumatology education was most common for nurses, physical and occupational therapists. There were 1041 individuals responding to the survey, of whom 48% completed all questions. More than half (56%) were familiar with EULAR as an organisation, whereas <25% had attended the EULAR congress or were familiar with EULAR online courses. Educational needs regarding contents were highest for ‘inflammatory arthritis’ and ‘connective tissue diseases’ and regarding modes of delivery for ‘courses organised in own country’ and ‘online courses’. Important barriers to participation included lack of ‘resources’, ‘time’ and ‘English language skills’. Overall, there was considerable variation in needs and barriers among countries.

Conclusions

There is a lack of postgraduate rheumatology education for HPs in most countries. There are opportunities to raise awareness regarding EULAR educational offerings and to develop courses provided in HPs' own country, tailored to national needs and barriers and taking language barriers into consideration.
Educational and wealth inequalities in tobacco use among men and women in 54 low-income and middle-income countries
Authors: Sreeramareddy Chandrashekhar T , Harper Sam , Ernstsen Linda
Published: November 2016

Background

Socioeconomic differentials of tobacco smoking in high-income countries are well described. However, studies to support health policies and place monitoring systems to tackle socioeconomic inequalities in smoking and smokeless tobacco use common in low-and-middle-income countries (LMICs) are seldom reported. We aimed to describe, sex-wise, educational and wealth-related inequalities in tobacco use in LMICs.

Methods

We analysed Demographic and Health Survey data on tobacco use collected from large nationally representative samples of men and women in 54 LMICs. We estimated the weighted prevalence of any current tobacco use (including smokeless tobacco) in each country for 4 educational groups and 4 wealth groups. We calculated absolute and relative measures of inequality, that is, the slope index of inequality (SII) and relative index of inequality (RII), which take into account the distribution of prevalence across all education and wealth groups and account for population size. We also calculated the aggregate SII and RII for low-income (LIC), lower-middle-income (lMIC) and upper-middle-income (uMIC) countries as per World Bank classification.

Findings

Male tobacco use was highest in Bangladesh (70.3%) and lowest in Sao Tome (7.4%), whereas female tobacco use was highest in Madagascar (21%) and lowest in Tajikistan (0.22%). Among men, educational inequalities varied widely between countries, but aggregate RII and SII showed an inverse trend by country wealth groups. RII was 3.61 (95% CI 2.83 to 4.61) in LICs, 1.99 (95% CI 1.66 to 2.38) in lMIC and 1.82 (95% CI 1.24 to 2.67) in uMIC. Wealth inequalities among men varied less between countries, but RII and SII showed an inverse pattern where RII was 2.43 (95% CI 2.05 to 2.88) in LICs, 1.84 (95% CI 1.54 to 2.21) in lMICs and 1.67 (95% CI 1.15 to 2.42) in uMICs. For educational inequalities among women, the RII varied much more than SII varied between the countries, and the aggregate RII was 14.49 (95% CI 8.87 to 23.68) in LICs, 3.05 (95% CI 1.44 to 6.47) in lMIC and 1.58 (95% CI 0.33 to 7.56) in uMIC. Wealth inequalities among women showed a pattern similar to that of men: the RII was 5.88 (95% CI 3.91 to 8.85) in LICs, 1.76 (95% CI 0.80 to 3.85) in lMIC and 0.39 (95% CI 0.09 to 1.64) in uMIC. In contrast to men, among women, the SII was pro-rich (higher smoking among the more advantaged) in 13 of the 52 countries (7 of 23 lMIC and 5 of 7 uMIC).

Interpretation

Our results confirm that socioeconomic inequalities tobacco use exist in LMIC, varied widely between the countries and were much wider in the lowest income countries. These findings are important for better understanding and tackling of socioeconomic inequalities in health in LMIC.
Pathological observations of tick‐borne fever and intercurrent bacterial infections in lambs
Authors: Daniel Roger Graham , Carson Amanda , Evans Carol , Cookson Rachel , Wessels Mark
Published: November 2016

Eighteen lamb deaths were recorded in a group of 250 ewes and lambs, following turnout onto newly rented upland pasture, in the spring of 2016. Three lambs were presented for postmortem examination and found to have heavy tick infestations. Some of the lesions found grossly at postmortem examination were similar to those described in a single lamb investigated by the Wales Veterinary Science Centre at Aberystwyth during the spring of 2015, from a different farm. Gross lesions identified in these three lambs included splenomegaly, lymphadenopathy, pneumonia, fibrinous pericarditis, pleurisy, peritonitis and meningitis. Laboratory findings included positive PCR results for Anaplasma phagocytophilum, the causal organism of tick‐borne fever (TBF), in all three lambs, and secondary bacterial infections. This report describes a range of lesions, some of which are different to those commonly associated with TBF infection. The pathogenesis and means of diagnosis are also discussed.
The K-beta/K-alpha intensity ratios of some elements at different azimuthal scattering angles at 59.54 keV
Authors: Akkuş Tuba , Şahin Yusuf , Yılmaz Demet , Tuzluca Fatma Nur
Published: November 2016

In this study K-beta/K-alpha (Kβ/Kα) intensity ratios of the elements scandium (Sc), vanadium (V), chromium (Cr), nickel (Ni), copper (Cu), zinc (Zn), bromine (Br), yttrium (Y), zirconium (Zr), and niobium (Nb) have been measured at three azimuthal scattering angles (+30°, 0°, and −30°) for two fixed polar scattering angles (85° and 135°). The elements were excited by 59.54 keV gamma photons emitted from 100 mCi Am241 point source. The obtained experimental values were compared with the theoretical values presented in the literature. It is observed that Kβ/Kα intensity ratios of the investigated elements do not depend on azimuthal angles at fixed polar angles.
Caffeine intake increases plasma ketones: an acute metabolic study in humans
Authors: Vandenberghe Camille , St-Pierre Valérie , Courchesne-Loyer Alexandre , Hennebelle Marie , Castellano Christian-Alexandre , Cunnane Stephen C.
Published: November 2016

Brain glucose uptake declines during aging and is significantly impaired in Alzheimer’s disease. Ketones are the main alternative brain fuel to glucose so they represent a potential approach to compensate for the brain glucose reduction. Caffeine is of interest as a potential ketogenic agent owing to its actions on lipolysis and lipid oxidation but whether it is ketogenic in humans is unknown. This study aimed to evaluate the acute ketogenic effect of 2 doses of caffeine (2.5; 5.0 mg/kg) in 10 healthy adults. Caffeine given at breakfast significantly stimulated ketone production in a dose-dependent manner (+88%; +116%) and also raised plasma free fatty acids. Whether caffeine has long-term ketogenic effects or could enhance the ketogenic effect of medium chain triglycerides remains to be determined.