bluuebunny/crossref_metadata_2025 huggingface dataset:
A transgenic strategy for controlling plant bugs (Adelphocoris suturalis) through expression of double‐stranded RNA homologous to fatty acyl‐coenzyme A reductase in cotton
Authors: Luo Jing , Liang Sijia , Li Jianying , Xu Zhongping , Li Lun , Zhu Bangqin , Li Zhe , Lei Chaoliang , Lindsey Keith , Chen Lizhen , Jin Shuangxia , Zhang Xianlong
Published: June 2017

Plant bugs (Miridae species), which are sap‐sucking insects, have emerged as major pests of cotton in China. Most Miridae species are not sensitive to commercial Bacillus thuringiensis (Bt) cotton, resulting in significant economic losses and an increased application of insecticide, which eventually may compromise the future of Bt cotton.

We demonstrate that FATTY ACYL‐COA REDUCTASE (AsFAR) plays an essential role in the reproduction of the bug Adelphocoris suturalis. Down‐regulation of AsFAR expression by injection of double‐stranded RNA suppresses ovarian development and female fertility, resulting in females producing few viable offspring.

To determine the viability of an RNA interference approach to limit FAR expression and reproductive ability in A. suturalis, a dsRNA targeting the AsFAR gene (dsAsFAR) of A. suturalis was expressed in transgenic cotton plants. AsFAR transcription levels were significantly downregulated in A. suturalis feeding on the transgenic plants. In contained field trials, the transgenic cotton lines significantly suppressed the development of A. suturalis populations and were resistant to damage caused by plant bug infestation.

These results suggest a new strategy for the management of plant bug pests of cotton.
Comparative evaluation of efficacy and safety of calcipotriol versus tacalcitol ointment, both in combination with NBUVB phototherapy in the treatment of stable plaque psoriasis
Authors: Dua Ishita , Aggarwal Kamal , Jain Vijay K.
Published: June 2017

Background

Vitamin D analogues and NBUVB phototherapy are both well‐established modalities of treatment in psoriasis. The objective of this open label, intraindividual, left right study was to compare two different vitamin D analogues, calcipotriol and tacalcitol, in combination with NBUVB phototherapy in chronic stable plaque psoriasis.

Methods

Thirty patients with stable plaque psoriasis were enrolled for a 12‐week clinical trial. The target lesion on left side was treated topically with tacalcitol ointment once daily, while that on the right side was treated with calcipotriol ointment twice daily. NBUVB phototherapy was given thrice weekly. Efficacy was assessed by target plaque scoring.

Results

Both therapies resulted in statistically significant reduction in erythema, scaling, thickness and target plaque score, seen as early as 2 weeks into therapy. However, calcipotriol combination led to an earlier clearance of plaques and a lesser relapse rate than tacalcitol combination. The number of treatment sessions and cumulative NBUVB doses were significantly lower in the calcipotriol‐treated group.

Conclusion

Both vitamin D analogues appear to be safe, effective and cosmetically acceptable, calcipotriol being more efficacious, well tolerated with a rapid onset of action and a better maintenance of response.
Network Structure, Strength of Relationships, and Communities’ Success in Project Implementation
Authors: Shrestha Manoj K.
Published: June 2017

Studies of network effectiveness in the collaborative public program setting commonly have found that actors with more organizational partners, more indirect (bridging) ties to other partners, and more cohesive relationships among partners have greater success in implementing projects. This article contributes to this literature by developing and testing hypotheses about how strength of relationships, measured by frequency of contacts, moderates these results. In the context of community water supply projects in Nepal, the article shows that greater frequency of contacts between communities and organizational partners enhances the impact of having more partners and more cohesive relationships among partners but decreases the impact of having more indirect connections. For practitioners and network theorists, these findings highlight the importance of strength of relationships in the link between networks and performance.
Ultrapure versus standard dialysate: A cost‐benefit analysis
Authors: Upadhyay Ashish , Susantitaphong Paweena , Jaber Bertrand L.
Published: June 2017

Low‐level bacterial and endotoxin contamination of water used to generate dialysate propagates chronic inflammation in patients with a wide‐range of potential adverse consequences, including erythropoietin hyporesponsiveness. Advancements in hemodialysis systems now allow for the generation of ultrapure dialysate that has lower bacterial and endotoxin levels than the standard dialysate. The cost associated with ultrapure dialysate is thought to be a major barrier to its widespread adoption. In this report, we conduct a cost‐benefit analysis examining the excess cost of generating ultrapure dialysate and the potential cost saving from a lower erythropoietin dose requirement. Our analysis suggests a potential cost saving of approximately $371 to $425 million per year with full adoption of ultrapure dialysate in the United States.
Spatial and temporal variations in thunderstorm casualties over India
Authors: Bhardwaj Pankaj , Singh Omvir , Kumar Dinesh
Published: June 2017

Thunderstorms are one of the most dangerous convective weather events. Despite the recent advances in prediction of convective storms worldwide, thousands of casualties occur annually. In the present study, the authors highlight specifically, thunderstorm‐related casualties reported in India from 1978–2012. Analysis of long‐term data have revealed about 16 308 casualties resulting from 1381 thunderstorm events with an average of 465 casualties occurring annually. The maximum number of casualties were concentrated in north‐eastern and central north‐eastern states. About 80 per cent of total casualties were recorded in West Bengal (23 per cent), Assam (20 per cent), Orissa (14 per cent), Bihar (13 per cent) and Jharkhand (8 per cent) states. The national casualties rate per million population per year and casualties density standardized by area has been found to be 0.50 and 5.07, respectively. Male casualties were found to be more prominent than female and children casualties, probably due to the larger proportion of males performing their work outdoors. The number of thunderstorm events and casualties was observed to be highest during pre‐monsoon season and lowest during winter. It is believed that the findings from this study will help policy makers to draw strategies to cope with the perils of thunderstorms.
A descriptive single‐centre experience of the management and outcome of maternal alloantibodies in pregnancy
Authors: Chatziantoniou V. , Heeney N. , Maggs T. , Rozette C. , Fountain C. , Watts T. , Harrison C. , Pasupathy D. , Sankaran S. , Kyle P. , Robinson S.
Published: June 2017

Background

Haemolytic disease of the fetus and newborn (HDFN) occurs when maternal IgG alloantibodies to fetal red blood cell antigens cross the placenta, causing haemolysis in the fetus and/or neonate. After delivery, the main concern is hyperbilirubinaemia, which can cause neurological damage.

Objectives

To summarise our current management and outcome data to inform health‐care professionals counselling women whose pregnancies are at risk of HDFN and to compare these data with relevant studies.

Methods

This is a retrospective descriptive study of all high‐risk pregnancies at risk of HDFN at Guy's and St. Thomas' NHS Foundation Trust (GSTFT) Maternity Unit over a 7‐year period. We defined high‐risk pregnancies as those in whom anti‐D, anti‐c, anti‐K or high (>32 or doubling strength) titres of all other antibodies were identified.

Results

A total of 130 pregnancies in 112 women were followed up. A single alloantibody was found in 93 pregnancies (71.5%) and multiple alloantibodies in 37 pregnancies (28.5%). Anti‐D was most commonly encountered (n = 48, 36.9%), followed by anti‐c (n = 31, 23.8%) and anti‐E (n = 15, 11.5%).

In 65 of 130 pregnancies (50%), antibody concentrations triggered scans to screen for fetal anaemia. Of 130 pregnancies, 6 (4.6%) required intrauterine transfusions, and 31 of 130 (26%) neonates required post‐natal intervention. Overall, morbidity was 0.1% and mortality 0.002%.

Conclusions

This study demonstrates that morbidity and mortality caused by HDFN is minimal. These results are reassuring for women at risk of HDFN as even severely affected cases are successfully managed in most instances. Further studies are needed to identify predictors of disease severity.
A photo‐responsive F‐box protein FOF2 regulates floral initiation by promoting FLC expression in Arabidopsis
Authors: He Reqing , Li Xinmei , Zhong Ming , Yan Jindong , Ji Ronghuan , Li Xu , Wang Qin , Wu Dan , Sun Mengsi , Tang Dongying , Lin Jianzhong , Li Hongyu , Liu Bin , Liu Hongtao , Liu Xuanming , Zhao Xiaoying , Lin Chentao
Published: June 2017

Floral initiation is regulated by various genetic pathways in response to light, temperature, hormones and developmental status; however, the molecular mechanisms underlying the interactions between different genetic pathways are not fully understood. Here, we show that the photoresponsive gene FOF2 (F‐box of flowering 2) negatively regulates flowering. FOF2 encodes a putative F‐box protein that interacts specifically with ASK14, and its overexpression results in later flowering under both long‐day and short‐day photoperiods. Conversely, transgenic plants expressing the F‐box domain deletion mutant of FOF2 (FOF2ΔF), or double loss of function mutant of FOF2 and FOL1 (FOF2‐LIKE 1) present early flowering phenotypes. The late flowering phenotype of the FOF2 overexpression lines is suppressed by the flc‐3 loss‐of‐function mutation. Furthermore, FOF2 mRNA expression is regulated by autonomous pathway gene FCA, and the repressive effect of FOF2 in flowering can be overcome by vernalization. Interestingly, FOF2 expression is regulated by light. The protein level of FOF2 accumulates in response to light, whereas it is degraded under dark conditions via the 26S proteasome pathway. Our findings suggest a possible mechanistic link between light conditions and the autonomous floral promotion pathway in Arabidopsis.
Implications of the corrosion index for the quality of flowing tap water and the effects of added alkalinity on corrosion control
Authors: Kim Yeong‐Kwan
Published: June 2017

Three corrosion indices, Langelier saturation index (LSI), Ryznar index (RI) and calcium carbonate precipitation potential (CCPP), were determined to find whether the corrosive index of flowing tap water could indicate the quality of the water that corresponded to the calculated index value. Water samples were collected from tap water distribution pipe in buildings of Kangwon National University, Korea. Correlations among the LSI, RI and CCPP were also investigated. The effects of alkalinity addition using lime and carbon dioxide on the progress of corrosion were examined in a laboratory‐scale simulated water distribution system (SWDS) for 5 months. In the SWDS study, corrosion rate in flowing tap waters was retarded by 12% with the alkalinity addition. The results of the current study confirmed that the corrosion indices are not always the best indicators to predict the quality of the flowing tap water.
Statistical modelling anaerobic digestion for process optimisation and bench‐marking: a case study of E. coli inactivation across all Thames Water conventional sewage sludge treatment sites
Authors: Liu Jin , Gao Yun , Pearce Peter , Shana Achame , Smith Stephen R.
Published: June 2017

Untreated sewage sludge potentially contains a wide range of enteric pathogens that present a risk to human health. Mesophilic anaerobic digestion (MAD) is the most‐favoured process for sewage sludge treatment in the United Kingdom. It is a well‐established approach to sludge stabilisation, but the mechanisms responsible for pathogen removal are poorly understood. Operational data collected by Thames Water from conventional MAD sites were statistically scrutinised to examine the effects of primary and secondary digestion on the removal of the enteric indicator bacteria, Escherichia coli, by using the IBM SPSS statistical software package for ANOVA, post‐hoc and multiple regression analysis. The results showed that the process temperature conditions at the MAD plants were equivalent to or exceeded the minimum estimated by the analysis necessary to comply with the 2 log10 removal standard for E. coli. The results also showed that primary digestion conditions (specifically temperature) sublethally damaged E. coli and increased decay in secondary digestion and therefore over the whole digestion process.
A large‐scale experimentation of the smart sewage system
Authors: Abbas O. , Abou Rjeily Y. , Sadek M. , Shahrour I.
Published: June 2017

This paper presents a large‐scale experimentation of the smart sewage system, which is conducted at the Campus of Lille University. The campus stands for a town of about 25 000 users with 150 buildings and 100 km urban networks. The experimentation is carried out within a large‐scale demonstrator of the Smart City, which includes a smart monitoring of the drinking water, sewage, electrical and district heating networks. The originality of this paper lies in the integrated approach, which includes smart monitoring as well as data collection and analysis. The monitoring of the drinking water and sewage networks allows the use of numerical modelling of and the detection of eventual connection between the sewage and storm water systems. The paper shows how the smart technology could be implemented and used to enhance our understanding of the sewage system and to improve its management.
A Study of Students’ Loneliness Levels and Their Attachment Styles
Authors: Kıralp F. Sülen Şahin , Serin Nergüz B.
Published: June 2017

The purpose of this study was to examine the relationship between loneliness levels and attachment styles of university students. In this research, it was investigated whether the attachment styles differed in terms of variables such as gender, class, place of stay, socio-economic level of their family, parental education levels, counterpart friendship relations, number of siblings, whether to receive psychological help or not. This research was conducted as a relational search. A total of 247 university students selected randomly formed the sample of the research. The results of the research can be summarized as follows; Loneliness levels of those who perceive the socioeconomic status as low and those who didn't get psychological help are found to be higher. Male students and students who get psychological help have higher scores on secure attachment. According to the results of the research there’s a low negative correlation between the loneliness levels of students and dismissing attachment style, a low positive correlation between the loneliness level and preoccupied attachment style, and a low negative correlation between the loneliness level and secure attachment style.
Professional Identities of Vocational High School Students and Extracurricular Activities
Authors: Altan Bilge Aslan , Altıntas Havva Ozge
Published: June 2017

Vocational high schools are one of the controversial topics, and also the hardly touched fields in educational field. Students’ profiles of vocational schools, their visions, and professional identity developments are not frequently reflected in the literature. Therefore, the main aim of the study is to research whether vocational high school students’ professional identities are supported with extracurricular activities. Followingly, it was also researched whether vocational high school students’ future professional identities complied with their selected school and/or specialized fields. The research was conducted on qualitative research approach through semi-structured question form and analyzed via descriptive and content analysis of qualitative research methods. Results revealed that vocational high school students did not take part in extracurricular activities regarding their professional identities since the schools did not organize these activities. The responses also emphasized that existing extracurricular activities organized outside of the school were insufficient and there was an immediate need for such activities. Additionally, most of the participants highlighted that they selected their schools/department as an obligation. Based on the results, it was revealed that vocational and technical high schools should not focus on extracurricular activities to improve students’ basic and further skills. It is suggested that extracurricular activities should be cared more for students’ academic and practice skills. Moreover, the students and their parents should understand and be introduced to the profession before they come to a future decision.
Ultrasonic attenuation of polycrystalline materials with a distribution of grain sizes
Authors: Arguelles Andrea P. , Turner Joseph A.
Published: June 2017

Elastic wave scattering at grain boundaries in polycrystalline media can be quantified to determine microstructural properties. The amplitude drop observed for coherent wave propagation (attenuation) as well as diffuse-field scattering events have been extensively studied. In all cases, the scattering shows a clear dependence on grain size, grain shape, and microstructural texture. Models used to quantify scattering experiments are often developed assuming dependence on a single spatial length scale, usually, mean grain diameter. However, several microscopy studies suggest that most metals have a log normal distribution of grain sizes. In this study, grain size distribution is discussed within the context of previous attenuation models valid for arbitrary crystallite symmetries. Results are presented for titanium using a range of distribution means and widths assuming equiaxed grains and no preferred crystallographic orientation. The longitudinal and shear attenuations are shown to vary with respect to the frequency dependence for varying distribution widths even when the volumetric mean grain size is held constant. Furthermore, the results suggest that grain size estimates based on attenuation can have large errors if the distribution is neglected. This work is anticipated to play an important role in microstructural characterization research associated with ultrasonic scattering.
Sound trapping and dredging barriers
Authors: Wang Xu , Wang Xiaonan , Yu Wuzhou , Jiang Zaixiu , Mao Dongxing
Published: June 2017

When sound barriers are installed on both sides of a noise source, degradation in performance is observed. Barriers having negative-phase-gradient surfaces successfully eliminate this drawback by trapping sound energy in between the barriers. In contrast, barriers can also be designed to “dredge” the energy flux out. An extended model considering higher-order diffractions, which resulted from the interplay of the induced surface wave and barrier surface periodicity, is presented. It is found that the sound dredging barriers provide a remarkable enhancement over the trapping ones, and hence have the potential to be widely used in noise control engineering.
Uncharacterized Bacterial Structures Revealed by Electron Cryotomography
Authors: Dobro Megan J. , Oikonomou Catherine M. , Piper Aidan , Cohen John , Guo Kylie , Jensen Taylor , Tadayon Jahan , Donermeyer Joseph , Park Yeram , Solis Benjamin A. , Kjær Andreas , Jewett Andrew I. , McDowall Alasdair W. , Chen Songye , Chang Yi-Wei , Shi Jian , Subramanian Poorna , Iancu Cristina V. , Li Zhuo , Briegel Ariane , Tocheva Elitza I. , Pilhofer Martin , Jensen Grant J.
Published: June 2017

Electron cryotomography (ECT) can reveal the native structure and arrangement of macromolecular complexes inside intact cells. This technique has greatly advanced our understanding of the ultrastructure of bacterial cells. We now view bacteria as structurally complex assemblies of macromolecular machines rather than as undifferentiated bags of enzymes. To date, our group has applied ECT to nearly 90 different bacterial species, collecting more than 15,000 cryotomograms. In addition to known structures, we have observed, to our knowledge, several uncharacterized features in these tomograms. Some are completely novel structures; others expand the features or species range of known structure types. Here, we present a survey of these uncharacterized bacterial structures in the hopes of accelerating their identification and study, and furthering our understanding of the structural complexity of bacterial cells.

IMPORTANCE
Bacteria are more structurally complex than is commonly appreciated. Here we present a survey of previously uncharacterized structures that we observed in bacterial cells by electron cryotomography, structures that will initiate new lines of research investigating their identities and roles.
Anaerobic Cysteine Degradation and Potential Metabolic Coordination in Salmonella enterica and Escherichia coli
Authors: Loddeke Melissa , Schneider Barbara , Oguri Tamiko , Mehta Iti , Xuan Zhenyu , Reitzer Larry
Published: June 2017

Salmonella enterica
has two CyuR-activated enzymes that degrade cysteine, i.e., the aerobic CdsH and an unidentified anaerobic enzyme;
Escherichia coli
has only the latter. To identify the anaerobic enzyme, transcript profiling was performed for
E. coli
without
cyuR
and with overexpressed
cyuR
. Thirty-seven genes showed at least 5-fold changes in expression, and the
cyuPA
(formerly
yhaOM
) operon showed the greatest difference. Homology suggested that CyuP and CyuA represent a cysteine transporter and an iron-sulfur-containing cysteine desulfidase, respectively.
E. coli
and
S. enterica
Δ
cyuA
mutants grown with cysteine generated substantially less sulfide and had lower growth yields. Oxygen affected the CyuR-dependent genes reciprocally;
cyuP-lacZ
expression was greater anaerobically, whereas
cdsH-lacZ
expression was greater aerobically. In
E. coli
and
S. enterica
, anaerobic
cyuP
expression required
cyuR
and cysteine and was induced by
l
-cysteine,
d
-cysteine, and a few sulfur-containing compounds. Loss of either CyuA or RidA, both of which contribute to cysteine degradation to pyruvate, increased
cyuP-lacZ
expression, which suggests that CyuA modulates intracellular cysteine concentrations. Phylogenetic analysis showed that CyuA homologs are present in obligate and facultative anaerobes, confirming an anaerobic function, and in archaeal methanogens and bacterial acetogens, suggesting an ancient origin. Our results show that CyuA is the major anaerobic cysteine-catabolizing enzyme in both
E. coli
and
S. enterica
, and it is proposed that anaerobic cysteine catabolism can contribute to coordination of sulfur assimilation and amino acid synthesis.

IMPORTANCE
Sulfur-containing compounds such as cysteine and sulfide are essential and reactive metabolites. Exogenous sulfur-containing compounds can alter the thiol landscape and intracellular redox reactions and are known to affect several cellular processes, including swarming motility, antibiotic sensitivity, and biofilm formation. Cysteine inhibits several enzymes of amino acid synthesis; therefore, increasing cysteine concentrations could increase the levels of the inhibited enzymes. This inhibition implies that control of intracellular cysteine levels, which is the immediate product of sulfide assimilation, can affect several pathways and coordinate metabolism. For these and other reasons, cysteine and sulfide concentrations must be controlled, and this work shows that cysteine catabolism contributes to this control.
A rare case of late solitary vertebral metastasis from an adenoid cystic carcinoma of the lacrimal gland
Authors: Ahmed Awaiz , Rajankulam Ganesan Satish Kannan , Haleem Shahnawaz , Nicoll James
Published: June 2017

Adenoid cystic carcinoma of the lacrimal gland is one among the common malignancies affecting the lacrimal gland. However, overall, it is a rare condition. It has a rather poor prognosis with local recurrence and distant haematological metastasis which are invariably multiple. We present a rare case of a 51-year-old woman who presented with localised lower thoracic pain with collapse of the T10 vertebral body, which turned out be a solitary late metastasis from her previously treated lacrimal gland tumour.
A large chronic pericardial effusion in an ultramarathon runner with anti-CCP positive rheumatoid arthritis
Authors: McClelland Thomas J , Penfold Rose , Kluzek Stefan , Nagra Navraj S
Published: June 2017

Pericardial effusions arise as an extra-articular manifestation of rheumatoid arthritis (RA). Pericardial effusions are often asymptomatic, particularly in the early phase, but patients are at risk of cardiac tamponade as the effusion progresses. We discuss the case of a 40-year-old male ultramarathon runner with RA who presented with mild pleuritic chest pain and exertional dyspnoea after a recent long-haul flight. Despite a relative tachycardia, his observations were otherwise unremarkable. His blood tests revealed a C-reactive protein (CRP) of 86 mg/L and an anti-cyclic citrullinated peptide (anti-CCP) titre of 360 units/mL. He was initially diagnosed with a pulmonary embolism; however, a large pericardial effusion was found incidentally on CT pulmonary angiogram with over 1500 mL subsequently drained. The patient’s symptoms resolved and CRP normalised 2 weeks later. This unique case illustrates that physically fit patients may physiologically compensate for large pericardial effusions and that arthritic symptoms do not correlate with the severity of extra-articular features in RA.
Angle closure as a cause for intermittent headache in a child
Authors: Pinto Ferreira Nuno , Medeiros Pinto Joana , Pinto Filomena , Abegão Pinto Luis
Published: June 2017

Angle closure is usually associated with older patients, as it typically manifests in middle to later life, being associated with an age-related increased lens volume. However, angle closure can occur in any age group if there is an anatomical predisposition that promotes pupillary block or an anterior pulling of the iris. During an acute angle closure, patients generally experience ocular pain, headache, nausea, vomiting and conjunctival hyperaemia. These attacks can be misinterpreted as migraine, particularly if subacute or chronic and the demographic characteristics of the patient do not suggest a primary angle closure event. Diagnosing a headache as ocular related is of paramount importance, since there is an effective treatment. We report a case of a child with intermittent headache which revealed a subacute angle closure in both eyes.
Fulminant tumefactive multiple sclerosis in pregnancy
Authors: Pakneshan Shabnam , Bernitsas Evanthia
Published: June 2017

A 35-year-old pregnant woman was admitted with acute onset of paresthesias and word finding difficulty. Initial MRI scan of the brain was suggestive of ischaemic event. During hospitalisation, she had a rapid course with worsening of her neurological deficit that prompted additional testing. Further investigations were consistent with tumefactive multiple sclerosis. After a poor initial response to intravenous steroids and plasma exchange, and discussion of all available therapeutic options, the patient decided to proceed with elective termination. Introduction of physical, occupational, speech and disease-modifying therapy resulted in clinical improvement.
Incarcerated inguinal hernia as a complication of new-onset ascites
Authors: Zeitler Matthew R , Wouk Noah
Published: June 2017

This case report presents a patient who developed an acute incarcerated inguinal hernia as a result of newly acquired ascites, a complication of ascites that is not well documented in the medical literature. His story highlights an important and potentially morbid complication of new-onset ascites.
Aberrant course of superficial radial nerve in the forearm: an anatomical variation and its clinical implications
Authors: Kumar Prasoon , John Rakesh , Sharma Gaurav Kumar , Aggarwal Sameer
Published: June 2017

The superficial radial nerve (SRN) is the terminal pure sensory branch of the radial nerve supplying dorsal aspects of the proximal portion of the lateral three and a half digits including the lateral two-thirds of the dorsum of the hand. It transits from its submuscular position to a subcutaneous position by passing between the brachioradialis and extensor carpi radialis longus tendons around 7 to 9 cm proximal to the radial styloid. We present a case where this nerve instead of its normal forearm course, pierced the brachioradialis tendon to become subcutaneous.
Cardiac arrest following arteriovenous fistula manipulation: a cautionary note
Authors: Gandolfi Miles , Fernando Bimbi S
Published: June 2017

Arteriovenous fistulas can lead to a number of different chronic complications. We describe a case where a patient developed a thrombosis within her brachiobasilic arteriovenous fistula, which was manually manipulated in order to restore fistula flow. This resulted in a pulseless electrical activity cardiac arrest within a few minutes. After ten minutes of chest compressions and intubation, there was return of spontaneous circulation. No epinephrine was given nor shocks administered. Patient was extubated within minutes and was alert, orientated and haemodynamically stable. CT pulmonary angiogram showed extensive bilateral pulmonary emboli. Manual manipulation of the arteriovenous fistula lead to significant amounts of thrombus embolising to the pulmonary arteries, and resultant cardiac arrest due to circulatory compromise. Chest compressions likely dislodged these emboli, allowing circulation to recommence. We publish this as a cautionary note of a rare but potentially fatal complication.
Burden of vision loss associated with eye disease in China 1990–2020: findings from the Global Burden of Disease Study 2015
Authors: Wang Bingsong , Congdon Nathan , Bourne Rupert , Li Yichong , Cao Kai , Zhao Aiping , Yusufu Mayinuer , Dong Wenlan , Zhou Maigeng , Wang Ningli
Published: June 2017

Aims

To assess the burden of vision loss due to eye disease in China between 1990 and 2015, and to predict the burden in 2020.

Methods

Data from the GBD 2015 (Global Burden of Diseases, Injuries, and Risk Factors Study 2015) were used. The main outcome measures were prevalence and years lived with disability (YLDs) for vision loss due to cataract, glaucoma, macular degeneration, other vision loss, refraction and accommodation disorders and trachoma.

Results

Prevalence for eye diseases increased steadily from 1990 to 2015, and will increase until 2020. From 1990 to 2015, the most common eye disorder was refraction and accommodation disorders. From 1990 to 2015, the vision loss burden due to eye disease decreased for those aged 0–14 years, and increased for those aged 15 years and above, with the most notable increases occurring among those aged 50 years and above. China ranked 10th when comparing YLDs for vision loss due to eye disease with the other members of the G20 (Group of Twenty, an international forum for the governments from 20 major economies) . Age-standardised YLD rates for vision loss due to eye disease declined in all 19 countries, except for China. The burden from vision loss due to eye disease ranked 12th and 11th among all causes of health loss in China in 1990 and 2015, respectively.

Conclusion

Alone among major economies, China has experienced an increase in the burden of age-standardised vision loss from eye disease over the last two decades. In the future, China may expect a growing burden of vision loss due to population growth and ageing.
Health policy and systems research: towards a better understanding and review of ethical issues
Authors: Luyckx Valerie Ann , Biller-Andorno Nikola , Saxena Abha , Tran Nhan T
Published: June 2017

Given the focus on health systems in the post-millennium development goal era and moving towards the sustainable development goals, there is a compelling need for a common framework for health policy and systems research ethics to guide researchers and facilitate review by research ethics committees. A consultation of global health policy and systems research and ethics experts was convened to identify ethical considerations relevant to health policy and systems research based on existing knowledge and to identify knowledge gaps through a scoping review and further expert deliberation. Health policy and systems research is highly complex and, in the absence of guidance documents, there is significant variability in ethics review. Although fundamental ethical principles pertain to both traditional clinical research and health policy and systems research, the application of these principles requires a comprehensive understanding of the nature of health policy and systems research with its distinct challenges. Such awareness must be raised among researchers and research ethics committees. Current research ethics committees lack familiarity with health policy and systems research and because health policy and systems research is conducted in real-world contexts, committees often have difficulties in determining whether a project is indeed research and/or requires ethical review. Given the strong current focus on health policy and systems research to rapidly improve health and health systems functioning globally, greater engagement and dialogue around the ethical concerns is required to optimise research review and research conduct in this rapidly evolving field.
Use of standardised patients to assess quality of healthcare in Nairobi, Kenya: a pilot, cross-sectional study with international comparisons
Authors: Daniels Benjamin , Dolinger Amy , Bedoya Guadalupe , Rogo Khama , Goicoechea Ana , Coarasa Jorge , Wafula Francis , Mwaura Njeri , Kimeu Redemptar , Das Jishnu
Published: June 2017

Introduction

The quality of clinical care can be reliably measured in multiple settings using standardised patients (SPs), but this methodology has not been extensively used in Sub-Saharan Africa. This study validates the use of SPs for a variety of tracer conditions in Nairobi, Kenya, and provides new results on the quality of care in sampled primary care clinics.

Methods

We deployed 14 SPs in private and public clinics presenting either asthma, child diarrhoea, tuberculosis or unstable angina. Case management guidelines and checklists were jointly developed with the Ministry of Health. We validated the SP method based on the ability of SPs to avoid detection or dangerous situations, without imposing a substantial time burden on providers. We also evaluated the sensitivity of quality measures to SP characteristics. We assessed quality of practice through adherence to guidelines and checklists for the entire sample, stratified by case and stratified by sector, and in comparison with previously published results from urban India, rural India and rural China.

Results

Across 166 interactions in 42 facilities, detection rates and exposure to unsafe conditions were both zero. There were no detected outcome correlations with SP characteristics that would bias the results. Across all four conditions, 53% of SPs were correctly managed with wide variation across tracer conditions. SPs paid 76% less in public clinics, but proportions of correct management were similar to private clinics for three conditions and higher for the fourth. Kenyan outcomes compared favourably with India and China in all but the angina case.

Conclusions

The SP method is safe and effective in the urban Kenyan setting for the assessment of clinical practice. The pilot results suggest that public providers in this setting provide similar rates of correct management to private providers at significantly lower out-of-pocket costs for patients. However, comparisons across countries are sensitive to the tracer condition considered.
The use of Microsoft Excel as an electronic database for handover and coordination of patients with trauma in a District General Hospital
Authors: Bakti Nik I , Williamson Mark , Sehjal Ranjit , Thilagarajah Michael
Published: June 2017

Communication between healthcare professionals is a key aspect in patient safety especially when dealing with patients with musculoskeletal trauma. The change of junior doctors’ working patterns within the last decade and a multidisciplinary approach has resulted in more healthcare professionals being involved in any one patient’s care. A robust handover and communication tool is essential in ensuring patients’ safety and to allow efficient service coordination. We compared the use of a simple traditional template-based handover system with an electronic interactive database developed using Microsoft Excel specifically designed as a handover tool and to coordinate acute trauma referrals to the orthopaedic department in our hospital. We compared the adequacy and accessibility of patient details and clinical information as well as assessing these systems as tools to facilitate coordination of patients with trauma. Data from both handover systems were collected prospectively over the period of 12 weeks and analysed for the degree of missing information based on the General Medical Council and British Medical Association guidelines for safe handover. A questionnaire was also handed to members of the multidisciplinary team to assess their impression of each handover system on coordination and management of the trauma service. Our study showed a significant reduction in missing information in the electronic database handover system in multiple domains (p<0.001). Our survey of 29 healthcare professionals also showed a significant improvement in their perceived ability to manage acute trauma referrals, coordinate patients awaiting surgery and in accessing previous handover discussions (p<0.001).
Protocol for a qualitative synthesis of barriers and facilitators in implementing guidelines for diagnosis of tuberculosis
Authors: Ochodo Eleanor , Kredo Tamara , Young Taryn , Wiysonge Charles Shey
Published: June 2017

Introduction

Despite the introduction of new tests and guidelines for diagnosis of tuberculosis (TB), worldwide case detection rate of TB is still suboptimal. This could be in part explained by the poor implementation of TB diagnostic guidelines. We aim to identify, appraise and synthesise qualitative evidence exploring the barriers and facilitators to implementing TB diagnostic guidelines.

Methods and analysis

A systematic review of qualitative studies will be conducted. Relevant electronic databases will be searched and studies included based on predefined inclusion criteria. We will also search reference lists, grey literature, conduct forward citation searches and contact relevant content experts. An adaptation of the Critical Appraisal Skills Programme tool will be used to assess the methodological quality of included studies. Two authors will review the search output, extract data and assess methodological quality independently, resolving any disagreements by consensus. We will use the thematic framework analysis approach based on the Supporting the Use of Research Evidence thematic framework to analyse and synthesise our data. We will apply the Confidence in the Evidence from Reviews of Qualitative research approach to transparently assess our confidence in the findings of the systematic review.

Ethics and dissemination

This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42016039790

Trial registration number

PROSPERO 2016: CRD42016039790. Available fromhttp://www.crd.york.ac.uk/PROSPERO/
Defining and measuring suspicion of sepsis: an analysis of routine data
Authors: Inada-Kim Matthew , Page Bethan , Maqsood Imran , Vincent Charles
Published: June 2017

Objectives

To define the target population of patients who have suspicion of sepsis (SOS) and to provide a basis for assessing the burden of SOS, and the evaluation of sepsis guidelines and improvement programmes.

Design

Retrospective analysis of routinely collected hospital administrative data.

Setting

Secondary care, eight National Health Service (NHS) Acute Trusts.

Participants

Hospital Episode Statistics data for 2013–2014 was used to identify all admissions with a primary diagnosis listed in the ‘suspicion of sepsis’ (SOS) coding set. The SOS coding set consists of all bacterial infective diagnoses.

Results

We identified 47 475 admissions with SOS, equivalent to a rate of 17 admissions per 1000 adults in a given year. The mortality for this group was 7.2% during their acute hospital admission. Urinary tract infection was the most common diagnosis and lobar pneumonia was associated with the most deaths. A short list of 10 diagnoses can account for 85% of the deaths.

Conclusions

Patients with SOS can be identified in routine administrative data. It is these patients who should be screened for sepsis and are the target of programmes to improve the detection and treatment of sepsis. The effectiveness of such programmes can be evaluated by examining the outcomes of patients with SOS.
Socioeconomic status and geographical factors associated with active listing in primary care: a cross-sectional population study accounting for multimorbidity, age, sex and primary care
Authors: Ranstad Karin , Midlöv Patrik , Halling Anders
Published: June 2017

Background

Socioeconomic status and geographical factors are associated with health and use of healthcare. Well-performing primary care contributes to better health and more adequate healthcare. In a primary care system based on patient’s choice of practice, this choice (listing) is a key to understand the system.

Objective

To explore the relationship between population and practices in a primary care system based on listing.

Methods

Cross-sectional population-based study. Logistic regressions of the associations between active listing in primary care, income, education, distances to healthcare and geographical location, adjusting for multimorbidity, age, sex and type of primary care practice.

Setting and subjects

Population over 15 years (n=123 168) in a Swedish county, Blekinge (151 731 inhabitants), in year 2007, actively or passively listed in primary care. The proportion of actively listed was 68%.

Main outcome measure

Actively listed in primary care on 31 December 2007.

Results

Highest ORs for active listing in the model including all factors according to income had quartile two and three with OR 0.70 (95% CI 0.69 to 0.70), and those according to education less than 9 years of education had OR 0.70 (95% CI 0.68 to 0.70). Best odds for geographical factors in the same model had municipality C with OR 0.85 (95% CI 0.85 to 0.86) for active listing. Akaike’s Information Criterion (AIC) was 124 801 for a model including municipality, multimorbidity, age, sex and type of practice and including all factors gave AIC 123 934.

Conclusions

Higher income, shorter education, shorter distance to primary care or longer distance to hospital is associated with active listing in primary care.

Multimorbidity, age, geographical location and type of primary care practice are more important to active listing in primary care than socioeconomic status and distance to healthcare.
Interfacility transfer of pregnant women using publicly funded emergency call centre-based ambulance services: a cross-sectional analysis of service logs from five states in India
Authors: Singh Samiksha , Doyle Pat , Campbell Oona MR , Oakley Laura , Rao GV Ramana , Murthy GVS
Published: June 2017

Objective

To estimate the proportion of interfacility transfers (IFTs) transported by ‘108’ ambulances and to compare the characteristics of the IFTs and non-IFTs to understand the pattern of use of ‘108’ services for pregnant women in India.

Design

A cross-sectional analysis of ‘108’ ambulance records from five states for the period April 2013 to March 2014. Data were obtained from the call centre database for the pregnant women, who called ‘108’.

Main outcomes

Proportion of all pregnancies and institutional deliveries in the population who were transported by ‘108’, both overall and for IFT. Characteristics of the women transported; obstetric emergencies, the distances travelled and the time taken for both IFT and non-IFT.

Results

The ‘108’ ambulances transported 6 08 559 pregnant women, of whom 34 993 were IFTs (5.8%) in the five states. We estimated that ‘108’ transferred 16.5% of all pregnancies and 20.8% of institutional deliveries. Only 1.2% of all institutional deliveries in the population were transported by ‘108’ for IFTs—lowest 0.6% in Gujarat and highest 3.0% in Himachal Pradesh. Of all ‘108’ IFTs, only 8.4% had any pregnancy complication. For all states combined, on adjusted analysis, IFTs were more likely than non-IFTs to be for older and younger women or from urban areas, and less likely to be for women from high-priority districts, from backward or scheduled castes, or women below the poverty line. Obstetric emergencies were more than twice as likely to be IFTs as pregnant women without obstetric emergencies (OR=2.18, 95% CI 2.09 to 2.27). There was considerable variation across states.

Conclusion

Only 6% institutional deliveries made use of the ‘108’ ambulance for IFTs in India. The vast majority did not have any complication or emergency. The ‘108’ service may need to consider strategies to prioritise the transfer of women with obstetric emergency and those requiring IFT, over uncomplicated non-IFT.
Global prevalence of diabetes mellitus in patients with tuberculosis: a systematic review and meta-analysis protocol
Authors: Tankeu Aurel T , Bigna Jean Joël , Nansseu Jobert Richie , Endomba Francky Teddy A , Wafeu Guy Sadeu , Kaze Arnaud D , Noubiap Jean Jacques
Published: June 2017

Introduction

Diabetes mellitus (DM) is an important risk factor for active tuberculosis (TB), which also adversely affect TB treatment outcomes. The escalating global DM epidemic is fuelling the burden of TB and should therefore be a major target in the strategy for ending TB. This review aims to estimate the global prevalence of DM in patients with TB.

Methods and analysis

This systematic review will include cross-sectional, case–control or cohort studies of populations including patients diagnosed with TB that have reported the prevalence of DM using one of the fourth standard recommendations for screening and diagnosis. This protocol is written in accordance with recommendations from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 statement. Relevant abstracts published in English/French from inception to 31 December 2016 will be searched in PubMed, Excerpta Medica Database and online journals. Two investigators will independently screen, select studies, extract data and assess the risk of bias in each study. The study-specific estimates will be pooled through a random-effects meta-analysis model to obtain an overall summary estimate of the prevalence of diabetes across the studies. Heterogeneity will be assessed, and we will pool studies judged to be clinically homogenous. On the other hand, statistical heterogeneity will be evaluated by the χ² test on Cochrane’s Q statistic. Funnel-plots analysis and Egger’s test will be used to investigate publication bias. Results will be presented by continent or geographic regions.

Ethics and dissemination

This study is based on published data. An ethical approval is therefore not required. This systematic review and meta-analysis is expected to inform healthcare providers as well as general population on the co-occurrence of DM and TB. The final report will be published as an original article in a peer-reviewed journal, and will also be presented at conferences and submitted to relevant health authorities. We also plan to update the review every 5 years.

Protocolregistration number

PROSPERO International Prospective Register of Systematic Reviews (CRD42016049901).