bluuebunny/crossref_metadata_2025 huggingface dataset:
Discrepancies between self-reported hearing difficulty and hearing loss diagnosed by audiometry: prevalence and associated factors in a national survey
Authors: Choi Ji Eun , Moon Il Joon , Baek Sun-Young , Kim Seon Woo , Cho Yang-Sun
Published: May 2019

Objective

To evaluate discrepancies prevalent between self-reported hearing difficulty (SHD) and audiometrically measured hearing loss (AHL) and factors associated with such discrepancies.

Design

Nationwide cross-sectional survey.

Setting

Data from 2010 to 2012 Korea National Health and Nutrition Examination Survey conducted by the Korea Centers for Disease Control and Prevention.

Participants

We included 14 345 participants aged ≥19 years who had normal tympanic membranes (mean age of 49 years).

Measures

Self-reported hearing was assessed by asking participants whether they had difficulty in hearing. AHL was defined as >25 dB of mean hearing thresholds measured at 0.5, 1, 2 and 4 kHz in better ear. Underestimated hearing impairment (HI) was defined as having AHL without SHD. Likewise, overestimated HI was defined as having SHD without AHL. Prevalence of underestimated and overestimated HIs was determined. Univariable and multivariable analyses were performed to examine factors associated with such discrepancies compared with concordant HL.

Results

Among 14 345 participants, 1876 (13.1%) had underestimated HI while 733 (5.1%) had overestimated HI. Multivariable models revealed that participants who had discrepancies between SHD and AHL were less likely to have older age (OR: 0.979, 95% CI: 0.967 to 0.991 for the underestimated HI, OR: 0.905, 95% CI: 0.890 to 0.921 for the overestimated HI) and tinnitus (OR: 0.425, 95% CI: 0.344 to 0.525 for the underestimated HI and OR 0.523, 95% CI: 0.391 to 0.699 for the overestimated HI) compared with those who had concordant HI. Exposure to occupational noise (OR: 0.566, 95% CI: 0.423 to 0.758) was associated with underestimated HI, and medical history of hypertension (OR: 1.501, 95% CI: 1.061 to 2.123) and depression (OR: 1.771, 95% CI: 1.041 to 3.016) was associated with overestimated HI.

Conclusion

Age, tinnitus, occupational noise exposure, hypertension and depression should be incorporated into evaluation of hearing loss in clinical practice.
Socioeconomic inequalities in the delivery of brief interventions for smoking and excessive drinking: findings from a cross-sectional household survey in England
Authors: Angus Colin , Brown Jamie , Beard Emma , Gillespie Duncan , Buykx Penelope , Kaner Eileen F S , Michie Susan , Meier Petra
Published: May 2019

Objectives

Brief interventions (BI) for smoking and risky drinking are effective and cost-effective policy approaches to reducing alcohol harm currently used in primary care in England; however, little is known about their contribution to health inequalities. This paper aims to investigate whether self-reported receipt of BI is associated with socioeconomic position (SEP) and whether this differs for smoking or alcohol.

Design

Population survey of 8978 smokers or risky drinkers in England aged 16+ taking part in the Alcohol and Smoking Toolkit Studies.

Measures

Survey participants answered questions regarding whether they had received advice and support to cut down their drinking or smoking from a primary healthcare professional in the past 12 months as well as their SEP, demographic details, whether they smoke and their motivation to cut down their smoking and/or drinking. Respondents also completed the Alcohol Use Disorders Identification Test (AUDIT). Smokers were defined as those reporting any smoking in the past year. Risky drinkers were defined as those scoring eight or more on the AUDIT.

Results

After adjusting for demographic factors and patterns in smoking and drinking, BI delivery was highest in lower socioeconomic groups. Smokers in the lowest social grade had 30% (95% CI 5% to 61%) greater odds of reporting receipt of a BI than those in the highest grade. The relationship for risky drinking appeared stronger, with those in the lowest social grade having 111% (95% CI 27% to 252%) greater odds of reporting BI receipt than the highest grade. Rates of BI delivery were eight times greater among smokers than risky drinkers (48.3% vs 6.1%).

Conclusions

Current delivery of BI for smoking and drinking in primary care in England may be contributing to a reduction in socioeconomic inequalities in health. This effect could be increased if intervention rates, particularly for drinking, were raised.
What explains wage differences between male and female Brazilian physicians? A cross-sectional nationwide study
Authors: Mainardi Giulia Marcelino , Cassenote Alex J Flores , Guilloux Aline G Alves , Miotto Bruno A , Scheffer Mario Cesar
Published: May 2019

Objective

In many countries an increase in the number of women in medicine is accompanied by gender inequality in various aspects of professional practice. Women in medical workforce usually earn less than their male counterparts. The aim of this study was to describe the gender wage difference and analyse the associated factors in relation to Brazil’s physicians.

Participants

2400 physicians.

Setting

Nationwide, cross-sectional study conducted in 2014.

Methods

Data were collected via a telephone enquiry. Sociodemographic and work characteristics were considered factors, and monthly wages (only the monthly earnings based on a medical profession) were considered as the primary outcome. A hierarchical multiple regression model was used to study the factors related to wage differences between male and female physicians. The adjustment of different models was verified by indicators of residual deviance and the Akaike information criterion. Analysis of variance was used to verify the equality hypothesis subsequently among the different models.

Results

The probability of men receiving the highest monthly wage range is higher than women for all factors. Almost 80% of women are concentrated in the three lowest wage categories, while 51% of men are in the three highest categories. Among physicians working between 20 and 40 hours a week, only 2.7% of women reported receiving >US$10 762 per month, compared with 13% of men. After adjustment for work characteristics in the hierarchical multiple regression model, the gender variable estimations (ß) remained, with no significant modifications. The final effect of this full model suggests that the probability of men receiving the highest salary level (≥US$10 762) is 17.1%, and for women it is 4.1%. Results indicate that a significant gender wage difference exists in Brazil.

Conclusion

The inequality between sexes persisted even after adjusting for working factors such as weekly workload, number of weekly on-call shifts, physician office work, length of practice and specialisation.
Protocol for the development of a core outcome set for cauda equina syndrome: systematic literature review, qualitative interviews, Delphi survey and consensus meeting
Authors: Srikandarajah Nisaharan , Noble Adam J , Wilby Martin , Clark Simon , Williamson Paula R , Marson Anthony Guy
Published: May 2019

Introduction

Cauda equina syndrome (CES) is a serious neurological condition most commonly due to compression of the lumbosacral nerve roots, which can result in significant disability. The evidence for acute intervention in CES is mainly from retrospective studies. There is heterogeneity in the outcomes chosen for analysis in these studies, which makes it difficult to synthesise the data across studies. This study will develop a core outcome set for use in future studies of CES, engaging with key stakeholders and using transparent methodology. This will help ensure that relevant outcomes are used in future and will facilitate attempts to summarise data across studies in systematic reviews.

Methods and analysis

A systematic literature review will document all the outcomes for CES after surgery mentioned in the literature. The qualitative interviews with patients with CES will be semistructured, audio recorded, transcribed and thematically analysed with the use of NVivo V.10 to identify outcomes and determine the themes described. The outcomes from the literature review and patient interviews will be combined and prioritised to determine what the most important outcomes are in CES research studies to patients and healthcare professionals. The prioritisation will be done through a two-round iterative Delphi survey and a consensus meeting. This process will decide the core outcome set for patients with CES.

Ethics and dissemination

REC and HRA approval was obtained on the 6/12/16 for the qualitative interviews from South Central—Hampshire A REC. REC reference 16/SC/0587. REC and HRA approval was obtained on 26/3/18 for the Delphi process and consensus meeting from North West—Greater Manchester Central REC. REC reference was 18/NW/0022. The final core outcome set will be published and freely available.

Trial registration number

This study is registered with the Core Outcome Measures in Effectiveness Trials database as study 824.
Is neutrophil CD11b a special marker for the early diagnosis of sepsis in neonates? A systematic review and meta-analysis
Authors: Qiu Xia , Li Jinhui , Yang Xiaoyan , Tang Jun , Shi Jing , Tong Yu , Qu Yi , Mu Dezhi
Published: May 2019

Objectives

Our study aimed to synthesise and analyse the early diagnostic value of neutrophil CD11b (nCD11b) for neonatal sepsis.

Design

Systematic review and meta-analysis.

Methods

Pubmed, Embase, the Cochrane Library and Web of Science Databases were searched up to June 2018. We used Stata software (V.14.0) to conduct the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic OR (DOR), pretest probability, post-test probability and summary receiver operating characteristic (SROC) curve for diagnostic efficiency of n CD11b.

Results

Nine studies, accounting for 843 neonates, were included. The overall pooled sensitivity, specificity, PLR, NLR, DOR, post-test positive probability and post-test negative probability and the area under the SROC curve were 0.82 (95% CI 0.71 to 0.90), 0.93 (95% CI 0.62 to 0.99), 11.51 (95% CI 1.55 to 85.62), 0.19 (95% CI 0.10 to 0.36), 59.50 (95% CI 4.65 to 761.58), 74%, 5% and 0.90, which had accuracy in diagnosing neonatal sepsis.

Conclusion

The present evidence indicated that nCD11b is a promising biomarker for the early diagnosis of neonatal sepsis.
Gestational route to healthy birth (GaRBH): protocol for an Indian prospective cohort study
Authors: Gupta Vipin , Saxena Ruchi , Walia Gagandeep Kaur , Agarwal Tripti , Vats Harsh , Dunn Warwick , Relton Caroline , Sovio Ulla , Papageorghiou Aris , Davey Smith George , Khadgawat Rajesh , Sachdeva Mohinder Pal
Published: May 2019

Introduction

Pregnancy is characterised by a high rate of metabolic shifts from early to late phases of gestation in order to meet the raised physiological and metabolic needs. This change in levels of metabolites is influenced by gestational weight gain (GWG), which is an important characteristic of healthy pregnancy. Inadequate/excessive GWG has short-term and long-term implications on maternal and child health. Exploration of gestational metabolism is required for understanding the quantitative changes in metabolite levels during the course of pregnancy. Therefore, our aim is to study trimester-specific variation in levels of metabolites in relation to GWG and its influence on fetal growth and newborn anthropometric traits at birth.

Methods and analysis

A prospective longitudinal study is planned (start date: February 2018; end date: March 2023) on pregnant women that are being recruited in the first trimester and followed in subsequent trimesters and at the time of delivery (total 3 follow-ups). The study is being conducted in a hospital located in Bikaner district (66% rural population), Rajasthan, India. The estimated sample size is of 1000 mother-offspring pairs. Information on gynaecological and obstetric history, socioeconomic position, diet, physical activity, tobacco and alcohol consumption, depression, anthropometric measurements and blood samples is being collected for metabolic assays in each trimester using standardised methods. Mixed effects regression models will be used to assess the role of gestational weight in influencing metabolite levels in each trimester. The association of maternal levels of metabolites with fetal growth, offspring’s weight and body composition at birth will be investigated using regression modelling.

Ethics and dissemination

The study has been approved by the ethics committees of the Department of Anthropology, University of Delhi and Sardar Patel Medical College, Rajasthan. We are taking written informed consent after discussing the various aspects of the study with the participants in the local language.
Influenza-like illness and antimicrobial prescribing in Australian general practice from 2015 to 2017: a national longitudinal study using the MedicineInsight dataset
Authors: Bernardo Carla De Oliveira , Gonzalez-Chica David , Stocks Nigel
Published: May 2019

Objectives

To investigate the epidemiology of influenza-like illness (ILI) by general practice and patient characteristics, and explore whether sociodemographic variables or comorbidities affect antiviral or antibiotic prescribing.

Design

Open cohort study.

Setting

A representative sample of 550 Australian general practices contributing data to the MedicineInsight programme.

Participants

4 228 149 patients of all age groups who had at least one consultation between 2015 and 2017. Median age was 37 years (Interquartile range: 21–57), 54.4% women, 16.4% aged ≥65 years, 2.2% Aboriginal or Torres Strait Islander, 17.6% had a chronic disease and 18.1% a mental health condition.

Primary and secondary outcome measures

ILI consultation rates (per 1000 consultations) were calculated using all ILI diagnoses for all clinical encounters with a general practitioner between 2015 and 2017. Antiviral and antibiotic prescribing for ILI cases were investigated and logistic regression models adjusted for practice and patient characteristics used to analyse associations.

Results

ILI consultation rates in 2017 were higher than in previous years. Antiviral prescribing increased from 20.6% in 2015, to 23.7 in 2016 and 29.7% in 2017, while antibiotic prescribing decreased from 30.3% to 28.0% and 26.7%, respectively (p<0.05 in both cases). Practices located in high socioeconomic areas had higher ILI consultation rates (4.3 vs 2.5 per 1000 consultations, p<0.05), antibiotic (30.7% vs 23.4%, p<0.05) and antiviral (34.2% vs 13.5%, p<0.05) prescribing than those in lower socioeconomic areas. The coexistence of chronic or mental health conditions was associated with lower ILI consultation rates, higher antibiotic use, but not with antiviral prescribing. However, those with chronic respiratory conditions had a higher frequency of antibiotic and antiviral prescribing in 2017 than individuals with other comorbidities.

Conclusions

Although the apparent decline in antibiotic prescribing for ILI is welcome, the increase in antiviral use may not be targeting those at high risk of complications from infection.
Racial differences of heart failure with midrange ejection fraction (HFmrEF): a large urban centre-based retrospective cohort study in the USA
Authors: Li Dan Leslie , Quispe Renato , Onyekwelu Chioma , Faillace Robert T , Taub Cynthia C
Published: May 2019

Objectives

We aimed to study the racial differences in clinical presentations, survival outcomes and outcome predictors among patients with heart failure (HF) with midrange ejection fraction (HFmrEF, EF 40%–49%).

Design

This is a retrospective study.

Setting

Adults with HF diagnosis at Montefiore Medical Center, Bronx, New York between 2008 and 2012, with an inpatient echocardiogram showing left ventricular ejection fraction of 40%–49% were included as HFmrEF population.

Participants

1,852 HFmrEF patients are included in the study (56% male, mean age 67 years). There were 493 (26.5%) non-Hispanic whites, 541 (29.2%) non-Hispanic black, 489 (26.4%) Hispanics and 329 (17.8%) other racial populations.

Outcome measures

Cumulative probabilities of all-cause mortality among different racial groups were estimated and multivariable adjusted Cox proportional regressions were performed to assess predictors of mortality.

Results

Among the HFmrEF patients, white patients were older and were less likely to be on guideline-directed medications. Blacks had a lower prevalence of prior myocardial infarction comparing to other groups. Hispanics had more chronic diseases and yet better survival comparing to whites and blacks after adjustment for age, sex and comorbidities. Distinct sets of survival predictors were revealed in individual racial groups. Baseline use of mineralocorticoid receptor antagonist (MRA) was associated with lower mortality among HFmrEF patients in general (HR 0.61, 95% CI 0.37 to 0.99).

Conclusions

There are significant racial/ethnic differences in clinical phenotypes, survival outcomes and mortality predictors of HFmrEF. Furthermore, the use of MRA predicted a reduced mortality in HFmrEF patients.
Protocol for a controlled human infection with genetically modifiedNeisseria lactamicaexpressing the meningococcal vaccine antigen NadA: a potent new technique for experimental medicine
Authors: Gbesemete Diane , Laver Jay Robert , de Graaf Hans , Ibrahim Muktar , Vaughan Andrew , Faust Saul , Gorringe Andrew , Read Robert Charles
Published: May 2019

Introduction

Neisseria lactamicais a commensal organism found in the human nasopharynx and is closely related to the pathogenN. meningitidis(meningococcus). Carriage ofN. lactamicais associated with reduced meningococcal carriage and disease. We summarise an ethically approved protocol for an experimental human challenge study using a genetically modified strain ofN. lactamicathat expresses the meningococcal antigen NadA. We aim to develop a model to study the role of specific bacterial antigens in nasopharyngeal carriage and immunity, to evaluate vaccines for their efficacy in preventing colonisation and to provide a proof of principle for the development of bacterial medicines.

Methods and analysis

Healthy adult volunteers aged 18–45 years will receive an intranasal inoculation of either the NadA containing strain ofN. lactamicaor a genetically modified, but wild-type equivalent control strain. These challenge volunteers will be admitted for 4.5 days observation following inoculation and will then be discharged with strict infection control rules. Bedroom contacts of the challenge volunteers will also be enrolled as contact volunteers. Safety, colonisation, shedding, transmission and immunogenicity will be assessed over 90 days after which carriage will be terminated with antibiotic eradication therapy.

Ethics and dissemination

This study has been approved by the Department for Environment, Food and Rural Affairs and South Central Oxford A Research Ethics Committee (reference: 18/SC/0133). Findings will be published in peer-reviewed open-access journals as soon as possible.

Trial registration number

NCT03630250; Pre-results.
Genetic associations between genes in the renin-angiotensin-aldosterone system and renal disease: a systematic review and meta-analysis
Authors: Smyth Laura Jane , Cañadas-Garre Marisa , Cappa Ruaidhri C , Maxwell Alexander P , McKnight Amy Jayne
Published: May 2019

Background

Chronic kidney disease (CKD) is defined by abnormalities in kidney structure and/or function present for more than 3 months. Worldwide, both the incidence and prevalence rates of CKD are increasing. The renin-angiotensin-aldosterone system (RAAS) regulates fluid and electrolyte balance through the kidney. RAAS activation is associated with hypertension, which is directly implicated in causation and progression of CKD. RAAS blockade, using drugs targeting individual RAAS mediators and receptors, has proven to be renoprotective.

Objectives

To assess genomic variants present within RAAS genes,ACE,ACE2,AGT,AGTR1,AGTR2andREN, for association with CKD.

Design and data sources

A systematic review and meta-analysis of observational research was performed to evaluate the RAAS gene polymorphisms in CKD using both PubMed and Web of Science databases with publication date between the inception of each database and 31 December 2018. Eligible articles included case–control studies of a defined kidney disease and included genotype counts.

Eligibility criteria

Any paper was removed from the analysis if it was not written in English or Spanish, was a non-human study, was a paediatric study, was not a case–control study, did not have a renal disease phenotype, did not include data for the genes, was a gene expression-based study or had a pharmaceutical drug focus.

Results

A total of 3531 studies were identified, 114 of which met the inclusion criteria. Genetic variants reported in at least three independent publications for populations with the same ethnicity were determined and quantitative analyses performed. Three variants returned significant results in populations with different ethnicities at p<0.05:ACEinsertion,AGTrs699-T allele andAGTR1rs5186-A allele; each variant was associated with a reduced risk of CKD development.

Conclusions

Further biological pathway and functional analyses of the RAAS gene polymorphisms will help define how variation in components of the RAAS pathway contributes to CKD.
Impact of persistent anaemia on mortality in patients hospitalised with acute pulmonary embolism: an Australian retrospective observational study
Authors: Chow Wallace , Wong Christopher , Lau Jerrett K , Chow Vincent , Kritharides Leonard , Ng Austin C C
Published: May 2019

Objectives

Anaemia is associated with increased mortality in acute pulmonary embolism (PE) patients. However, prior studies have not examined the prognostic impact of trends in plasma haemoglobin during admission. This study investigates the impact of changes in haemoglobin level on mortality during hospital stay in acute PE.

Study design

A retrospective observational study.

Setting

Tertiary-referral centre in Australia.

Participants

Consecutive patients from 2000 to 2012 admitted with confirmed acute PE were identified from a dedicated PE database. Haemoglobin levels on days 1, 3–4, 5–6 and 7 of admission were retrieved. Patients without both baseline haemoglobin and subsequent haemoglobin levels were excluded (n=327), leaving 1099 patients as the study cohort. Anaemia was defined as haemoglobin <130 g/L for men and <120 g/L for women. There were 576 patients without anaemia throughout admission, 65 with transient anaemia (anaemic on day 1, but subsequently normalised during admission), 122 with acquired anaemia (normal on day 1 but developed anaemia during admission) and 336 with persistent anaemia. A total of 71 patients received blood transfusion during admission.

Main outcome measure

6-month mortality was tracked from a state-wide death database and analysed using multivariable modelling.

Results

After adjusting for transfusion, patietns with persistent anaemia had a significantly increased 6-month mortality risk (adjusted HR 1.97, 95% CI 1.26 to 3.09, p=0.003) compared with patients without anaemia. There was no difference in mortality between patients with transient or acquired anaemia and patients without anaemia.

Conclusion

Among patients who had anaemia during their admission for acute PE, only the subgroup with persistent anaemia demonstrated worse outcomes.
Rationale and design of the HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) Trial: a protocol for an international randomised controlled trial evaluating early surgery for hip fracture patients
Authors: Borges Flavia K , Bhandari Mohit , Patel Ameen , Avram Victoria , Guerra-Farfán Ernesto , Sigamani Alben , Umer Masood , Tiboni Maria , Adili Anthony , Neary John , Tandon Vikas , Sancheti Parag K , Lawendy AbdelRahman , Jenkinson Richard , Ramokgopa Mmampapatla , Biccard Bruce M , Szczeklik Wojciech , Wang Chew Yin , Landoni Giovanni , Forget Patrice , Popova Ekaterine , Wood Gavin , Nabi Nur Aamer , John Bobby , Ślęczka Paweł , Feibel Robert J , Balaguer-Castro Mariano , Deheshi Benjamin , Winemaker Mitchell , de Beer Justin , Kolesar Richard , Teixidor-Serra Jordi , Tomas-Hernandez Jordi , McGillion Michael , Shanthanna Harsha , Moppett Iain , Vincent Jessica , Pettit Shirley , Harvey Valerie , Gauthier Leslie , Alvarado Kim , Devereaux P J
Published: May 2019

Introduction

Annually, millions of adults suffer hip fractures. The mortality rate post a hip fracture is 7%–10% at 30 days and 10%–20% at 90 days. Observational data suggest that early surgery can improve these outcomes in hip fracture patients. We designed a clinical trial—HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) to determine the effect of accelerated surgery compared with standard care on the 90-day risk of all-cause mortality and major perioperative complications.

Methods and analysis

HIP ATTACK is a multicentre, international, parallel group randomised controlled trial (RCT) that will include patients ≥45 years of age and diagnosed with a hip fracture from a low-energy mechanism requiring surgery. Patients are randomised to accelerated medical assessment and surgical repair (goal within 6 h) or standard care. The co-primary outcomes are (1) all-cause mortality and (2) a composite of major perioperative complications (ie, mortality and non-fatal myocardial infarction, pulmonary embolism, pneumonia, sepsis, stroke, and life-threatening and major bleeding) at 90 days after randomisation. All patients will be followed up for a period of 1 year. We will enrol 3000 patients.

Ethics and dissemination

All centres had ethics approval before randomising patients. Written informed consent is required for all patients before randomisation. HIP ATTACK is the first large international trial designed to examine whether accelerated surgery can improve outcomes in patients with a hip fracture. The dissemination plan includes publishing the results in a policy-influencing journal, conference presentations, engagement of influential medical organisations, and providing public awareness through multimedia resources.

Trial registration number

NCT02027896; Pre-results.
Dermatophytosis in cats and dogs: a practical guide to diagnosis and treatment
Authors: Moriello Karen
Published: May 2019

Dermatophytosis is an infectious and contagious superficial fungal skin disease of dogs and cats. The disease is not life threatening and will resolve without intervention; however, treatment is recommended to shorten the course of infection and limit transmission. This article summarises the major learning points identified in a recent evidence‐based review on this disease (Moriello and others 2017).
Local analgesia techniques for dental and head procedures in horses
Authors: Tremaine Henry
Published: May 2019

In equine first‐opinion and referral practice, diagnostic and treatment procedures involving the head and dentition are often performed with the animal conscious and sedated in a standing position. To enable such tasks to be performed safely, humanely and effectively, regional analgesia can be helpful, if not essential, in many cases. With the risk of injury to equine clinicians being of concern, a more scientific and rational approach than has been practised historically is now required. Over the past 20 years there have been a number of scientific articles in the literature describing and validating the use of different sedative–analgesic combinations that enable surgical and dental procedures of an advanced nature to be performed safely and effectively in conscious horses in the standing position. Allied to these, there have been descriptions of effective regional analgesia in the head and the development of some new techniques for its application. This article describes these approaches for those intending to perform painful procedures, such as dental, ophthalmic and paranasal sinus treatments, on a conscious horse.
Three handy tips and a practical guide to improve your propensity score models
Authors: Bergstra Sytske Anne , Sepriano Alexandre , Ramiro Sofia , Landewé Robert
Published: May 2019

Real-world data are increasingly available to investigate ‘real-world’ safety and efficacy. However, since treatment in observational studies is not randomly allocated, confounding by indication may occur, in which differences in patient characteristics may influence both treatment choices and treatment responses. A popular method to adjust for this type of bias is the use of propensity scores (PS). The PS is a score between 0 and 1 that reflects the likelihood per patient of receiving one of the treatment categories of interest conditional on a set of variables. At least in theory, in patients with similar PS, the treatment prescribed will be independent of these variables (pseudorandomisation). But researchers using PS sometimes fail to recognise important methodological flaws which can lead to spurious conclusions. These include perfect prediction of treatment allocation, untied observations and lack of generalisability due to oversimplification of complex clinical scenarios. In this viewpoint we will discuss the most commonly encountered flaws and provide a stepwise description on the estimation and use of PS, such that in future publications these flaws can be avoided.
The TEAM (Trauma Evaluation and Management) course: medical student knowledge gains and retention in the USA versus Ghana
Authors: Berndtson Allison E , Morna Martin , Debrah Samuel , Coimbra Raul
Published: May 2019

Introduction

Trauma and injury are significant contributors to the global burden of disease, with 5 million deaths and 250 million disability-adjusted life years lost in 2015. This burden is disproportionally borne by low- and middle-income countries (LMICs). Solutions are complex, but one area for improvement is basic trauma education. The American College of Surgeons has developed the Trauma Evaluation and Management (TEAM) course as an introduction to trauma care for medical students. We hypothesized that the TEAM course would be an effective educational program in LMICs and result in increased knowledge gains and retention similar to students in high-income countries (HICs).

Methods

The TEAM course was taught and students evaluated at two sites, one LMIC (Ghana) and one HIC (USA), after obtaining approval from the HIC Institutional Review Board and medical schools at both sites. Participation was optional for all students and results were de-identified. The course was administered by a single educator for all sessions. Multiple-choice exams were given before and after the course, and again 6 months later.

Results

A total of 62 LMIC and 64 HIC students participated in the course and completed initial testing. Demographics for the two groups were similar, as was participant attrition over time. LMIC students started with a relative knowledge deficit, scoring lower on both pre-course and post-course tests than HIC students, but gained more knowledge during the initial teaching session. After 6 months, the LMIC students continued to improve, whereas the HIC students’ knowledge had regressed. Most students recommended course expansion.

Conclusion

The TEAM course is a useful tool to provide the basic principles of trauma care to students in LMICs, and should be expanded. Further study is needed to determine the impact of TEAM education on patient care in LMICs.

Level of evidence

Level III; Care Management
Randomised controlled trial of fractionated and unfractionated prednisolone regimens for dogs with immune‐mediated haemolytic anaemia
Authors: Swann James W , Szladovits Balazs , Threlfall Anna J , Garden Oliver A , Chang Yu‐Mei , Church David B , Glanemann Barbara
Published: May 2019

Methods

A randomised non‐blinded non‐inferiority trial was conducted to determine whether treatment with an unfractionated regimen of oral prednisolone was inferior to a fractionated regimen for dogs with primary immune‐mediated haemolytic anaemia. Dogs received the same total daily dose of prednisolone as unfractionated (group 1, starting at 4 mg/kg orally once daily) or fractionated (group 2, starting at 2 mg/kg orally twice daily) doses. Questionnaires were administered to owners to assess adverse effects and quality of life (QoL). End points included survival to eight weeks, and changes in QoL and clinicopathological parameters over time.

Results

Thirty‐nine dogs were enrolled in the study, of which 5 were withdrawn and 17 were assigned to each group. The number of cases recruited was insufficient to determine whether unfractionated treatment was inferior to fractionated. Total serum bilirubin decreased more rapidly in dogs in group 2, whereas polydipsia improved more rapidly in group 1. Blood pressure and score for polyuria were higher in dogs in group 2 over time, whereas lymphocyte concentration was lower.

Conclusion

Administration of the same total daily dose of prednisolone as an unfractionated dose resulted in fewer adverse effects but the effect on survival could not be assessed in this study.
Synthesis, characterization, and photocatalytic activity of silver and zinc co-doped TiO2 nanoparticle for photodegradation of methyl orange dye in aqueous solution
Authors: Oladipo Gabriel O. , Akinlabi Akinola K. , Alayande Samson O. , Msagati Titus A.M. , Nyoni Hlengilizwe H. , Ogunyinka Opeyemi O.
Published: May 2019

In this study, TiO2 nanocrystals, 1 mol% Ag-doped TiO2, and 1 mol% Ag and 0.6 mol% Zn co-doped TiO2 powders were synthesized by the sol–gel route. Their photocatalytic activities on methyl orange dye under visible irradiation were investigated. The powders were characterized by X-ray diffraction (XRD), UV–visible spectroscopy (UV–vis), Brunauer–Emmett–Teller (BET), and Fourier transform infrared spectroscopy (FTIR). The XRD results revealed the presence of a rutile phase with an average crystallite size of 9 and 11 nm. The UV–vis spectra showed a red-shift towards a longer wavelength with the corresponding decrease in band gap from 2.9 to 2.5 eV. The BET surface areas of the nanoparticles ranged from 4.7 to 11.8 m2 g−1 with an average pore size between 18.9 and 56.6 nm. The Ag-doped TiO2 has the largest surface area of 11.8 m2 g−1, whereas the Ag–Zn co-doped TiO2 was found to have the highest pore size and volume. The absorption bands at 750–500 cm−1 were attributed to the –O–Ti–O– bond in the TiO2 lattice. The photocatalytic efficiency was highest at an optimum pH of 4.1 for Ag–Zn co-doped TiO2. The results confirmed that Ag-doped and Ag–Zn co-doped TiO2 were more effective than pure TiO2. The kinetic data were fitted into a pseudo first-order equation using a Langmuir–Hinshelwood kinetic model.
BIM-based building design coordination: processes, bottlenecks, and considerations
Authors: Mehrbod Sarmad , Staub-French Sheryl , Tory Melanie
Published: May 2019

Successful management of the building design coordination process is critical to the efficient delivery of cost-effective and quality projects. The traditional setting of design coordination, however, is inefficient and error-prone. Building information modelling (BIM) has proven valuable for increasing satisfaction with the meeting process and decreasing arguments over issues. Despite the many advantages of BIM tools, however, many design coordination issues remain undetected, design issues are poorly documented, and coordination strategies are inefficient. The objective of this study was to develop a characterization of the BIM building design coordination process, identify the bottlenecks in the current process, and provide design considerations to alleviate the bottlenecks. The bottlenecks include: outdated BIM, disconnected trades, lack of terminology, insufficient documentation, inefficient transitions across views and artifacts, unavailability of design information, information discrepancy, unfit navigation tools, and office–site disconnect. The outcomes of this research is useful for future construction projects and the software development community.
Addressing the unique challenges of community-based capture–hold–release aquariums through a facility health program
Authors: Stephen Craig , Griffith-Cochrane Laura , Wade Joy
Published: May 2019

Community-based capture–hold–release (CHR) aquariums were developed to (i) increase community connection to local marine environments by displaying local animals, (ii) avoid negative perceptions about holding animals by minimizing the time any individual is held captive, and (iii) operate with a low ecological footprint. CHR aquariums in British Columbia, Canada, require government-issued licences and permits to capture, hold, and release animals, a condition of which is that neither capture nor release can result in negative ecological, genetic, or disease impacts on wild populations in the collecting or receiving waters. Growth in the popularity of CHR aquariums is placing them under greater scrutiny from permitting agencies. Because of variability between facilities and a lack of performance standards, CHR aquariums cannot be assured of a consistent assessment. This paper proposes a CHR Aquarium Health Program that transparently and consistently provides assurances that they are socially and ecologically safe and recognizes the unique challenges of small-scaled, often rural aquariums. The value of this approach is discussed with respect to 10 years of implementation at the Ucluelet Aquarium.
Multi-State 2-Bit CMOS Logic Using n- and p- Quantum Well Channel Spatial Wavefunction Switched (SWS) FETs
Authors: Jain Faquir , Saman Bander , Gudlavalleti Raja Hari , Chandy John , Heller Evan
Published: May 2019

Unlike conventional FETs, spatial wavefunction switched (SWS)-FETs are comprised of two or more vertically stacked coupled quantum well or quantum dot channels, and the spatial location of carriers within these channels is used to encode the logic states (00), (01), (10) and (11). The aim of this paper is to present 4-states/2-bit output-input transfer characteristics using two Si/SiGe quantum well channels configured as CMOS using n- and p-channel spatial wavefunction switched field-effect transistors (SWS-FETs). Quantum simulations show switching of wavefunctions as the gate voltage is increased from lower Si quantum well to the upper well in n-channel and from upper SiGe quantum well to lower well in the p-channel. The inverter transfer characteristic and current switching are obtained by integrating BSIM (Berkeley Short-channel IGFET Model) and the Analog Behavioral Model (ABM). The simulation shows current flow only during switching.
A Rapid Method Based on Fluorescence Spectroscopy for Meat Spoilage Detection
Authors: Wu Binlin , Dahlberg Kevin , Gao Xin , Smith Jason , Bailin Jacob
Published: May 2019

Food spoilage is mainly caused by microorganisms, such as bacteria. In this study, we measure the autofluorescence in meat samples longitudinally over a week in an attempt to develop a method to rapidly detect meat spoilage using fluorescence spectroscopy. Meat food is a biological tissue, which contains intrinsic fluorophores, such as tryptophan, collagen, nicotinamide adenine dinucleotide (NADH) and flavin adenine dinucleotide (FAD) etc. As meat spoils, it undergoes various morphological and chemical changes. The concentrations of the native fluorophores present in a sample may change. In particular, the changes in NADH and FAD are associated with microbial metabolism, which is the most important process of the bacteria in food spoilage. Such changes may be revealed by fluorescence spectroscopy and used to indicate the status of meat spoilage. Therefore, such native fluorophores may be unique, reliable and non-subjective indicators for detection of spoiled meat. The results of the study show that the relative concentrations of all above fluorophores change as the meat samples kept in room temperature (~19°C) spoil. The changes become more rapidly after about two days. For the meat samples kept in a freezer (~ -12°C), the changes are much less or even unnoticeable over a-week-long storage.
Fast and Reversible Chemiresistive Sensors for Robust Detection of Organic Vapors Using Oleylamine-Functionalized Palladium Nanoparticles
Authors: Gao Tuo , Wang Yongchen , Luo Yi , Zhang Chengwu , Pittman Zachariah , Oliveira Alexandra , Craig Howard , Zhao Jing , Willis Brian G.
Published: May 2019

Chemiresistive sensors fabricated by oleylamine-functionalized palladium nanoparticles (OLA-PdNP) have been studied in hydrogen sensing, but not so much in organic vapor sensing. Like the extensively studied gold nanoparticles-based gas sensors, palladium nanoparticles also give the ease of surface modification and large surface-area-to-volume ratio. In this study, we demonstrate an OLA-PdNP chemiresistor array with robust sensor responses (1-15% of ΔR/R0) and accurate discrimination of six organic vapors at a concentration of p/p0 = 0.2, using principal component analysis (PCA). Each microfabricated 36 mm2 chip has 36 individual sensors. By incorporating multiple sensors on one chip, the sensor response gives a distinguishable pattern for each analyte. From this study, an electronic chemical spectrometer can be further developed by incorporating many types of ligands on palladium metal core to enhance sensor accuracy and precision.
Spectra analysis and network coherence for weighted folded hypercube
Authors: Dai Meifeng , He Jiaojiao , Wu Huiling , Wu Xianbin
Published: May 2019

Weighted folded hypercube is an charming variance of the famous hypercube and is superior to the weighted hypercube in many criteria. We mainly study the scaling of network coherence for the weighted folded hypercube that is controlled by a weight factor. Network coherence quantifies the steady-state variance of these fluctuations, and it can be regarded as a measure of robustness of the consensus process to the additive noise. If networks with small steady-state variance have better network coherence, it can be regarded as more robust to noise than networks with low coherence. We firstly calculate the spectra of weighted folded hypercube and obtain the leading terms of network coherence that are quantified as the sum and square sum of reciprocals of all nonzero Laplacian eigenvalues. Finally, the results show that network coherence depends on iterations and weight factor. Meanwhile, with larger order, the scatings of the first- and second-order network coherence of weighted folded hypercube decrease with the increasing of weight factor.
Modified spin-wave theory applied to one-dimensional Heisenberg ferromagnet with the nearest-neighbor and next-nearest-neighbor exchange anisotropies
Authors: Liao Yun , Chen Yuan , Chen Ji Pei , Li Wen An
Published: May 2019

The modified spin-wave theory is used to investigate the one-dimensional Heisenberg ferromagnet with the nearest-neighbor (NN) and next-nearest-neighbor (NNN) exchange anisotropies. The ground-state and low-temperature properties of the system are studied within the self-consistent method. It is found that the effect of the NN anisotropy on the thermodynamic quantities is stronger than that of the NNN anisotropy in the low-temperature region. The anisotropy dependence behaviors (such as the power, exponential and linear laws) are obtained for the position and the height of the maximum of the specific heat and its coefficient, as well as the susceptibility coefficient. The specific heat and its coefficient both display the low-temperature double maxima which are induced by the anisotropies and the NNN interaction. In the very low temperatures the specific heat and the susceptibility behave severally as T[Formula: see text] and T[Formula: see text] at the critical point J2/J1 = −0.25, where J1 and J2 are the NN and NNN interactions, respectively.
Fluctuation in shear rate, with unaltered mean shear rate, improves brachial artery flow-mediated dilation in healthy, young men
Authors: Holder Sophie M. , Dawson Ellen A. , Brislane Áine , Hisdal Jonny , Green Daniel J. , Thijssen Dick H. J.
Published: May 2019

Increase in mean shear stress represents an important and potent hemodynamic stimulus to improve conduit artery endothelial function in humans. No previous study has examined whether fluctuations in shear rate patterns, without altering mean shear stress, impacts conduit artery endothelial function. This study examined the hypothesis that 30-min exposure to fluctuations in shear rate patterns, in the presence of unaltered mean shear rate, improves brachial artery flow-mediated dilation. Fifteen healthy men (27.3 ± 5.0 yr) completed the study. Bilateral brachial artery flow-mediated dilation was assessed before and after unilateral exposure to 30 min of intermittent negative pressure (10 s, −40mmHg; 7 s, 0 mmHg) to induce fluctuation in shear rate, while the contralateral arm was exposed to a resting period. Negative pressure significantly increased shear rate, followed by a decrease in shear rate upon pressure release (both P < 0.001). Across the 30-min intervention, mean shear rate was not different compared with baseline ( P = 0.458). A linear mixed model revealed a significant effect of time observed for flow-mediated dilation ( P = 0.029), with exploratory post hoc analysis showing an increase in the intervention arm (∆FMD +2.0%, P = 0.008), but not in the contralateral control arm (∆FMD +0.5%, P = 0.664). However, there was no effect for arm ( P = 0.619) or interaction effect ( P = 0.096). In conclusion, we found that fluctuations in shear patterns, with unaltered mean shear, improves brachial artery flow-mediated dilation. These novel data suggest that fluctuations in shear pattern, even in the absence of altered mean shear, represent a stimulus to acute change in endothelial function in healthy individuals.

NEW & NOTEWORTHY Intermittent negative pressure applied to the forearm induced significant fluctuations in antegrade and retrograde shear rate, while mean shear was preserved relative to baseline. Our exploratory study revealed that brachial artery flow-mediated dilation was significantly improved following 30-min exposure to intermittent negative pressure. Fluctuations in blood flow or shear rate, with unaltered mean shear, may have important implications for vascular health; however, further research is required to identify the underlying mechanisms and potential long-term health benefits.