bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability of Hip Rotation Range of Motion in Supine and Seated Positions
Authors: Gradoz Marissa C. , Bauer Lauren E. , Grindstaff Terry L. , Bagwell Jennifer J.
Published: January 2018

Context: Hip rotation range of motion (ROM) is commonly assessed in individuals with lower extremity or spine pathology. It remains unknown which hip rotation ROM testing position is most reliable. Objective: To compare interrater and intrarater reliabilities between hip internal rotation (IR) and external rotation (ER) ROM in supine and seated positions. Study Design: Controlled laboratory study. Setting: University research laboratory. Participants: A total of 19 participants (11 females and 8 males; age = 23.5 [1.2] y; height = 173.2 [8.6] cm; and mass = 69.2 [13.4] kg) without hip, knee, low back, or sacroiliac pain within the preceding 3 months or history of hip or low back surgery were recruited. Interventions: Three testers obtained measures during 2 testing sessions. Passive supine and seated hip IR and ER ROM were performed with the hip and knee flexed to 90°. Main Outcome Measures: The primary outcome measures were hip IR and ER ROM in supine and seated positions (in degrees). Interrater and intrarater reliabilities were calculated using intraclass correlation coefficients (ICCs). Minimal detectable change was calculated. Differences between supine and seated hip IR and ER ROM values were assessed using paired t tests (significance level was .05). Results: Supine hip IR and ER ROM interrater and intrarater reliabilities were excellent (ICC = .75–.91). Seated hip IR ROM interrater and intrarater reliabilities were good (ICC = .64–.71). Seated hip ER ROM interrater reliability was good (ICC = .65), and intrarater reliabilities were good to excellent (ICC = .65–.82). Minimal detectable change values for supine and seated hip IR and ER ROM ranged from 6.1° to 8.6°. There were significant differences between supine and seated positions for hip IR and ER ROM (41.6° vs 44.5°; P < .01 and 53.0° vs 44.2°; P < .01, respectively). Conclusion: Supine hip rotation had higher interrater and intrarater reliabilities. Hip IR and ER ROM values differed significantly between supine and seated positions and should not be used interchangeably.
Intracellular cavity of sensor domain controls allosteric gating of TRPA1 channel
Authors: Zimova Lucie , Sinica Viktor , Kadkova Anna , Vyklicka Lenka , Zima Vlastimil , Barvik Ivan , Vlachova Viktorie
Published: January 2018

A cavity in the ion channel TRPA1 coordinates electrophilic, voltage, and calcium sensitivity and might be targeted to treat pain and other disorders.
Neuronal suppression causing depression?
Authors: Dzirasa Kafui
Published: January 2018

Suppressed dopaminergic activity in a specific brain area may play a causal role in depression.
Risk Factors and Outcomes of Endocarditis Due to Non-HACEK Gram-Negative Bacilli: Data from the Prospective Multicenter Italian Endocarditis Study Cohort
Authors: Falcone Marco , Tiseo Giusy , Durante-Mangoni Emanuele , Ravasio Veronica , Barbaro Francesco , Ursi Maria Paola , Pasticci Maria Bruna , Bassetti Matteo , Grossi Paolo , Venditti Mario , Rizzi Marco
Published: January 2018

The objective of this study was to investigate predisposing factors and outcomes of infective endocarditis (IE) caused by non-HACEK Gram-negative bacilli (GNB) in a contemporary multicenter cohort. Patients with IE due to GNB, prospectively observed in 26 Italian centers from 2004 to 2011, were analyzed. Using a case-control design, each case was compared to three age- and sex-matched controls with IE due to other etiologies. Logistic regression was performed to identify risk factors for IE due to GNB. Factors associated with early and late mortality were assessed by Cox regression analysis. The study group comprised 58 patients with IE due to GNB. We found that
Escherichia coli
was the most common pathogen, followed by
Pseudomonas aeruginosa
and
Klebsiella pneumoniae
. The genitourinary tract as a source of infection (odds ratio [OR], 13.59; 95% confidence interval [CI], 4.63 to 39.93;
P
< 0.001), immunosuppression (OR, 5.16; 95% CI, 1.60 to 16.24;
P
= 0.006), and the presence of a cardiac implantable electronic device (CIED) (OR, 3.57; 95% CI, 1.55 to 8.20;
P
= 0.003) were factors independently associated with IE due to GNB. In-hospital mortality was 13.8%, and mortality rose to 30.6% at 1 year. A multidrug-resistant (MDR) etiology was associated with in-hospital mortality (hazard ratio [HR], 21.849; 95% CI, 2.672 to 178.683;
P
= 0.004) and 1-year mortality (HR, 4.408; 95% CI, 1.581 to 12.287;
P
= 0.005). We conclude that the presence of a genitourinary focus, immunosuppressive therapy, and an indwelling CIED are factors associated with IE due to GNB. MDR etiology is the major determinant of in-hospital and long-term mortality.
Genome Sequence of
Rhizobium sullae
HCNT1 Isolated from
Hedysarum coronarium
Nodules and Featuring Peculiar Denitrification Phenotypes
Authors: de Diego-Diaz B. , Treu L. , Campanaro S. , da Silva Duarte V. , Basaglia M. , Favaro L. , Casella S. , Squartini A.
Published: January 2018

The genome sequence of
Rhizobium sullae
strain HCNT1, isolated from root nodules of the legume
Hedysarum coronarium
growing in wild stands in Tuscany, Italy, is described here. Unlike other
R. sullae
strains, this isolate features a truncated denitrification pathway lacking NO/N
2
O reductase activity and displaying high sensitivity to nitrite under anaerobic conditions.
Draft Genome Sequence of
Telmatospirillum siberiense
26-4b1, an Acidotolerant Peatland Alphaproteobacterium Potentially Involved in Sulfur Cycling
Authors: Hausmann Bela , Pjevac Petra , Schreck Katharina , Herbold Craig W. , Daims Holger , Wagner Michael , Loy Alexander
Published: January 2018

The facultative anaerobic chemoorganoheterotrophic alphaproteobacterium
Telmatospirillum siberiense
26-4b1 was isolated from a Siberian peatland. We report here a 6.20-Mbp near-complete high-quality draft genome sequence of
T. siberiense
that reveals expected and novel metabolic potential for the genus
Telmatospirillum
, including genes for sulfur oxidation.
Complete Genome Sequences of Four Toxigenic
Clostridium difficile
Clinical Isolates from Patients of the Lower Hudson Valley, New York, USA
Authors: Yin Changhong , Chen Donald S. , Zhuge Jian , McKenna Donna , Sagurton Joan , Wang Guiqing , Huang Weihua , Dimitrova Nevenka , Fallon John T.
Published: January 2018

Complete genome sequences of four toxigenic
Clostridium difficile
isolates from patients in the lower Hudson Valley, New York, USA, were achieved. These isolates represent four common sequence types (ST1, ST2, ST8, and ST42) belonging to two distinct phylogenetic clades. All isolates have a 4.0- to 4.2-Mb circular chromosome, and one carries a phage.
Draft Genome Sequence of
Tetzosporium hominis
VT-49 gen. nov., sp. nov., Isolated from the Dental Decay Plaque of a Patient with Periodontitis
Authors: Tetz George , Tetz Victor
Published: January 2018

Here, we report the draft genome sequence of
Tetzosporium hominis
VT-49 gen. nov., sp. nov., isolated from the dental plaque of a patient with severe periodontal disease. The draft genome sequence was 2,780,751 bp in length with a 43.3% G+C content. We detected 3,001 genes, which are predicted to encode proteins that regulate both virulence and antibiotic resistance.
Draft Genome Sequence of
Pantoea ananatis
Strain 1.38, a Bacterium Isolated from the Rhizosphere of
Oryza sativa
var. Puntal That Shows Biotechnological Potential as an Inoculant
Authors: Megías Esaú , dos Reis Junior Fábio Bueno , Ribeiro Renan Augusto , Ollero Francisco Javier , Megías Manuel , Hungria Mariangela
Published: January 2018

Pantoea ananatis
1.38 is a strain isolated from the rhizosphere of irrigated rice in southern Spain. Its genome was estimated at 4,869,281 bp, with 4,644 coding sequences (CDSs). The genome encompasses several CDSs related to plant growth promotion, such as that for siderophore metabolism, and virulence genes characteristic of pathogenic
Pantoea
spp. are absent.
Brucella abortus Senses the Intracellular Environment through the BvrR/BvrS Two-Component System, Which Allows B. abortus To Adapt to Its Replicative Niche
Authors: Altamirano-Silva Pamela , Meza-Torres Jazmín , Castillo-Zeledón Amanda , Ruiz-Villalobos Nazareth , Zuñiga-Pereira Ana Mariel , Chacón-Díaz Carlos , Moreno Edgardo , Guzmán-Verri Caterina , Chaves-Olarte Esteban
Published: January 2018

Brucella abortus
is a facultative extracellular-intracellular pathogen belonging to a group of
Alphaproteobacteria
that establishes close interactions with animal cells. This bacterium enters host cells in a membrane-bound compartment, avoiding the lysosomal route and reaching the endoplasmic reticulum through the action of the type IV secretion system, VirB. In this work, we demonstrate that the BvrR/BvrS two-component system senses the intracellular environment to mount the transcriptional response required for intracellular life adaptation. By combining a method to purify intracellularly extracted bacteria with a strategy that allows direct determination of BvrR phosphorylation, we showed that upon entrance to host cells, the regulatory protein BvrR was activated (BvrR-P) by phosphorylation at aspartate 58. This activation takes place in response to intracellular cues found in early compartments, such as low pH and nutrient deprivation. Furthermore, BvrR activation was followed by an increase in the expression of VjbR and VirB. The
in vitro
activation of this BvrR-P/VjbR/VirB virulence circuit rescued
B. abortus
from the inhibition of intracellular replication induced by bafilomycin treatment of cells, demonstrating the relevance of this mechanism for intracellular bacterial survival and replication. All together, our results indicate that
B. abortus
senses the transition from the extracellular to the intracellular milieu through BvrR/BvrS, allowing the bacterium to transit safely to its replicative niche. These results serve as a working model for understanding the role of this family of two-component systems in the adaptation to intracellular life of
Alphaproteobacteria
.
Hydrothermal formation of heavy rare earth element (HREE)–xenotime deposits at 100 °C in a sedimentary basin
Authors: Richter Lisa , Diamond Larryn W. , Atanasova Petya , Banks David A. , Gutzmer Jens
Published: January 2018

Most rare earth element deposits form from magmatic fluids, but there have also been discoveries of heavy rare earth element (HREE)–enriched hydrothermal xenotime deposits within sedimentary basins. As xenotime is notoriously insoluble, the question arises as to whether these lesser-known deposits form at typical basin temperatures or by influx of much hotter magmatic-hydrothermal fluids. The Browns Range District in northern Western Australia hosts deposits of xenotime that are enriched in HREEs and also uranium. The ore bodies consist of fault-controlled hydrothermal quartz-xenotime breccias that crosscut Archean basement rocks and overlying Paleoproterozoic sandstones. Analyses of fluid inclusions show that the xenotime precipitated at remarkably low temperatures, between 100 and 120 °C, in response to decompression boiling. The inclusions contain high excess concentrations of yttrium (10−3 mol/kg), REEs (1–7 × 10−5 mol/kg), and uranium (4 × 10−5 mol/kg) in equilibrium with xenotime at these low temperatures, showing that availability of phosphate limited the amount of xenotime precipitated. The analyses further identify SO42– and Cl– as the ligands that facilitated the elevated REE and uranium solubilities. These findings establish that significant REE transport and deposition is feasible at basin temperatures, and hence they raise the potential of unconformity settings for REE exploration. Moreover, the aqueous metal contents support a genetic link between this type of ore fluid and world-class Proterozoic unconformity-related uranium deposits elsewhere.
U-Pb dating of calcite cement and diagenetic history in microporous carbonate reservoirs: Case of the Urgonian Limestone, France
Authors: Godeau Nicolas , Deschamps Pierre , Guihou Abel , Leonide Philippe , Tendil Anthony , Gerdes Axel , Hamelin Bruno , Girard Jean-Pierre
Published: January 2018

Microporous carbonates can constitute excellent hydrocarbon reservoirs if their micropore and/or nanopore structure is sufficiently developed and continuous. In such deposits, assessing the exact timing of reservoir property stabilization is critical to better understand the postdepositional processes favorable to the creation or preservation of porosity. However, placing reliable and accurate chronological constraints on the formation of microporosity in these reservoirs is a major challenge. In this study we performed absolute U-Pb dating of calcite cements occurring in the Urgonian microporous limestone (northern Tethys margin) of southeastern France. U-Pb ages ranging between 96.7 ± 4.9 Ma and 90.5 ± 1.6 Ma were obtained on the major calcitic phase responsible for the cementation, and therefore the stabilization of microporosity, indicating that this diagenetic process occurred synchronously at the regional scale following an extended subaerial exposure. Our results show that (1) the mineralogical stabilization process responsible for the formation of an excellent pervasive microporous network took place relatively early, and (2) the so-acquired reservoir quality was preserved for more than 90 m.y. These observations emphasize the importance of long exposure periods and associated meteoric influx for the formation and preservation of good microporous reservoirs.
Continental growth histories revealed by detrital zircon trace elements: A case study from India
Authors: McKenzie N. Ryan , Smye Andrew J. , Hegde Venkatraman S. , Stockli Daniel F.
Published: January 2018

Simultaneous acquisition of detrital zircon Pb-Pb ages and trace element abundances from grains collected across the Indian craton, spanning ∼3 b.y., reveals prominent shifts in Eu/Eu* and light and middle to heavy rare earth element ratios. These shifts correspond to a ca. 3.0–2.2 Ga interval of crustal thickening during Indian craton formation, followed by a period wherein arc magmatism occurred along thinner craton margins from ca. 1.9 to 1.0 Ga, with arc magmatism concentrated along attenuated continental margins after ca. 1.0 Ga. Similar temporal shifts in trace element concentrations are recognized in global whole-rock compilations. We propose that the post–1.0 Ga increase in juvenile magmatism reflects a switch to lateral arc terrane accretion as the primary style of continental growth over the past billion years.
Deccan volcanism caused coupled pCO2 and terrestrial temperature rises, and pre-impact extinctions in northern China
Authors: Zhang Laiming , Wang Chengshan , Wignall Paul B. , Kluge Tobias , Wan Xiaoqiao , Wang Qian , Gao Yuan
Published: January 2018

Evaluating the terrestrial climate record provides a critical test of the roles of Chicxulub impact and Deccan Traps volcanism during the Cretaceous-Paleogene (K-Pg) mass extinction. Most evidence came from marine records, but our new clumped isotopes data from paleosol carbonates in the Songliao Basin provide a terrestrial climate history from northern China. This reveals there was a pre-impact warming caused by the onset of Deccan Traps volcanism, whereas the following short-term cooling then another warming episode were likely caused by Chicxulub impact and post-boundary volcanism. Our study suggests that the pCO2 levels were probably the main control on the latest Cretaceous cooling and the climatic fluctuations across the K-Pg boundary interval in northern China. In the Songliao Basin, the pre-impact Deccan Traps volcanism links to losses of half of the lacustrine algae species (charophytes) and almost all of the lacustrine ostracodes; this suggests that the Deccan Traps volcanism had already destabilized the ecosystem and caused extinctions prior to the Chicxulub impact.
Report on the incidence of squamous cell carcinomas affecting the eyelids in England over a 15-year period (2000–2014)
Authors: Wawrzynski James , Tudge Isobel , Fitzgerald Eleanor , Collin Richard , Desai Parul , Emeriewen Krisztina , Saleh George M
Published: January 2018

Aims

The authors report on trends in the incidence of squamous cell carcinoma (SCC) affecting the eyelids in England over a 15-year period and identify associations between demographic factors and SCC risk.

Methods

The National Cancer Registration and Analysis Service identified all cases of eyelid SCC in England between 2000 and 2014. The crude and age-standardised rates of eyelid SCCs in England were calculated. The association of SCC with several known demographic risk factors was then examined to assess their importance in periocular cases.

Results

Over the 15 years studied, there were 4022 patients in England diagnosed with a first episode of SCC affecting the eyelids. The age-standardised number of reported cases rose between 2000 and 2014 by a mean of 0.0137 cases per 100 000 population per year (equivalent to a rise in SCC incidence of approximately 2% per year). The mean age-standardised incidence rate of SCC during the study period was 0.63 cases per 100 000 population per year.

Age was exponentially correlated with incidence, with an approximate doubling of the risk for every decade over the age of 60. The relative risk of eyelid SCC in men compared with women was 1.9. Social deprivation quintile by income was not found to be associated with risk of SCC.

Conclusion

The incidence of eyelid SCC in England is rising. In addition, the age-standardised and population-standardised rate of SCC is also rising. A higher risk of SCC is strongly correlated with age and male sex but not with deprivation.
Statin wars: have we been misled about the evidence? A narrative review
Authors: Demasi Maryanne
Published: January 2018

Statins are the most widely prescribed, cholesterol-lowering drugs in the world. Despite the expiration of their patents, revenue for statins is expected to rise, with total sales on track to reach an estimated US$1 trillion by 2020. A bitter dispute has erupted among doctors over suggestions that statins should be prescribed to millions of healthy people at low risk of heart disease. There are concerns that the benefits have been exaggerated and the risks have been underplayed. Also, the raw data on the efficacy and safety of statins are being kept secret and have not been subjected to scrutiny by other scientists. This lack of transparency has led to an erosion of public confidence. Doctors and patients are being misled about the true benefits and harms of statins, and it is now a matter of urgency that the raw data from the clinical trials are released.
Pioglitazone and cause-specific risk of mortality in patients with type 2 diabetes: extended analysis from a European multidatabase cohort study
Authors: Strongman Helen , Christopher Solomon , Majak Maila , Williams Rachael , Bahmanyar Shahram , Linder Marie , Heintjes Edith M , Bennett Dimitri , Korhonen Pasi , Hoti Fabian
Published: January 2018

Objectives

Describe and compare the risk of cardiovascular and non-cardiovascular mortality in patients whose antidiabetic therapy is modified to include pioglitazone compared with an alternative antidiabetic medication at the same stage of disease progression.

Research design and methods

This exploratory linked database cohort analysis used pooled health and mortality data from three European countries: Finland, Sweden and the UK. Propensity score together with exact matching was used to match 31 133 patients with type 2 diabetes first prescribed pioglitazone from 2000 to 2011, to 31 133 patients never prescribed pioglitazone. Exact matching variables were treatment stage, history of diabetes, diabetes complications and cardiovascular disease, and year of cohort entry. Mean follow-up time was 2.60 (SD 2.00) and 2.69 (SD 2.31) years in the pioglitazone and non-pioglitazone-exposed groups, respectively. Crude cause-specific mortality rates were ascertained. Association with pioglitazone use was estimated using Cox proportional hazards models adjusted a priori for country, age, sex, the propensity score quintile and time-dependent variables representing use of antidiabetic drugs. Stepwise testing identified no additional confounders to include in adjusted models.

Results

The crude mortality rate was lower in the pioglitazone-exposed group than the non-exposed group for both cardiovascular and non-cardiovascular mortality. Adjusted HRs comparing pioglitazone to alternative antidiabetic exposure were 0.58 (95% CI 0.52 to 0.63) and 0.63 (95% CI 0.58 to 0.68) for cardiovascular and non-cardiovascular mortality, respectively. A protective effect associated with pioglitazone was also found for all specific cardiovascular causes.

Conclusions

This analysis suggests that pioglitazone is associated with a decrease in both cardiovascular and non-cardiovascular mortality. Results should be interpreted with caution due to the potential for residual confounding in this exploratory analysis. Further studies, specifically designed to test the association between pioglitazone use and patient-focused outcomes, are suggested.

Study registration number

European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP; EUPAS3626).
Strengthening global health security by embedding the International Health Regulations requirements into national health systems
Authors: Kluge Hans , Martín-Moreno Jose Maria , Emiroglu Nedret , Rodier Guenael , Kelley Edward , Vujnovic Melitta , Permanand Govin
Published: January 2018

The International Health Regulations (IHR) 2005, as the overarching instrument for global health security, are designed to prevent and cope with major international public health threats. But poor implementation in countries hampers their effectiveness. In the wake of a number of major international health crises, such as the 2014 Ebola and 2016 Zika outbreaks, and the findings of a number of high-level assessments of the global response to these crises, it has become clear that there is a need for more joined-up thinking between health system strengthening activities and health security efforts for prevention, alert and response. WHO is working directly with its Member States to promote this approach, more specifically around how to better embed the IHR (2005) core capacities into the main health system functions. This paper looks at how and where the intersections between the IHR and the health system can be best leveraged towards developing greater health system resilience. This merging of approaches is a key component in pursuit of Universal Health Coverage and strengthened global health security as two mutually reinforcing agendas.
Expanded cardiac rehabilitation in socially vulnerable patients with myocardial infarction: a 10-year follow-up study focusing on mortality and non-fatal events
Authors: Hald Kathrine , Nielsen Kirsten Melgaard , Nielsen Claus Vinther , Meillier Lucette Kirsten , Larsen Finn Breinholt , Christensen Bo , Larsen Mogens Lytken
Published: January 2018

Objective

Cardiac rehabilitation (CR) has been shown to reduce cardiovascular risk. A research project performed at a university hospital in Denmark offered an expanded CR intervention to socially vulnerable patients. One-year follow-up showed significant improvements concerning medicine compliance, lipid profile, blood pressure and body mass index when compared with socially vulnerable patients receiving standard CR. The aim of the study was to perform a long-term follow-up on the socially differentiated CR intervention and examine the impact of the intervention on all-cause mortality, cardiovascular mortality, non-fatal recurrent events and major cardiac events (MACE) 10 years after.

Design

Prospective cohort study.

Setting

The cardiac ward at a university hospital in Denmark from 2000 to 2004.

Participants

379 patients aged <70 years admitted with first episode myocardial infarction (MI). The patients were defined as socially vulnerable or non-socially vulnerable according to their educational level and their social network. A complete follow-up was achieved.

Intervention

A socially differentiated CR intervention. The intervention consisted of standard CR and additionally a longer phase II course, more consultations, telephone follow-up and a better handover to phase III CR in the municipal sector, in general practice and in the patient association.

Main outcome measures

All-cause mortality, cardiovascular mortality, non-fatal recurrent events and MACE.

Results

There was no significant difference in all-cause mortality (OR: 1.29, 95% CI 0.58 to 2,89), cardiovascular mortality (OR: 0.80, 95% CI 0.31 to 2.09), non-fatal recurrent events (OR:1.62, 95% CI 0.67 to 3.92) or MACE (OR: 1.31, 95% CI 0.53 to 2.42) measured at 10-year follow-up when comparing the expanded CR intervention to standard CR.

Conclusions

Despite the significant results of the socially differentiated CR intervention at 1-year follow-up, no long-term effects were seen regarding the main outcome measures at 10-year follow-up. Future research should focus on why it is not possible to lower the mortality and morbidity significantly among socially vulnerable patients admitted with first episode MI.
Effect of differentiating exercise guidance based on a patient’s level of low back pain in primary care: a mixed-methods systematic review protocol
Authors: Jorgensen Jens Erik , Afzali Tamana , Riis Allan
Published: January 2018

Introduction

Low back pain (LBP) is one of the health conditions that lead to the most disability worldwide. Guidelines aimed at management of LBP recommend non-invasive and non-pharmacological management, including patient education, advice to stay active and exercise therapy; however, the guidelines offer no recommendation as to the allowable level of pain during exercise or how specific levels of pain should be reflected in the stage and progression of exercises or activities. The purpose of this review is to study the effect of differentiation of exercise guidance based on the level of LBP in patients in primary care.

Methods and analysis

A systematic search will be performed on PubMed, EMBASE, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Physiotherapy Evidence Database (PEDRO), Cochrane and PROSPERO from their inception until September 2017. Published peer-reviewed human experimental and observational studies with quantitative or qualitative designs will be included. Two independent reviewers will identify papers by reviewing titles and abstracts. Papers passing the initial selection will be appraised by two reviewers, based on their full texts. Furthermore, the reference lists of included studies will be snowballed for identification of other relevant studies. Data will be extracted using a standard extraction sheet by two independent reviewers. Disagreements will be resolved by discussion and consensus with a third reviewer. The methodological quality of studies will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation risk of bias tool, or the Critical Appraisal Skills Programme. Results will be reported narratively. Search histories will be documented on EndNote X8 (Clarivate Analytics).

Ethics and dissemination

Ethical approval for this review was not required as primary data will not be collected. The results will be disseminated through a peer-reviewed international journal and conference presentations.

PROSPERO registration number

CRD42017074880.
Improving colorectal cancer referrals
Authors: Gregory Claire
Published: January 2018

The colorectal services at The Royal Bournemouth Hospital needed to adapt to meet the extra demand on fast-track patient referrals to the outpatient department, as a consequence of the changes in the National Institute for Health and Care Excellence (NICE) guidance on cancer referrals in June 2015. Learning from other units, a telephone assessment clinic (TAC) triaging patients straight to colonoscopy was trialled. A Plan–Do–Study–Act (PDSA) methodology was used. A baseline study showed that fast-track colorectal patients referred from their general practitioner (GP) were taking on average 30 days until they received their colonoscopy. This quality improvement project focused on sending fast-track colorectal GP referrals through a straight-to-colonoscopy TAC. The results of this intervention showed an improvement from GP referral to colonoscopy. Both PDSA cycle 1 and PDSA cycle 2 showed an average of 24 days. This reduction of 6 days was a promising improvement in a 62-day patient pathway, so funds were accessed to invest in a temporary full-time TAC nurse appointment to allow more data to be collected. PDSA cycle 3 showed a reduction of the average from referral to colonoscopy to 19 days and a reduction in the variation. This outcome will be sustainable, as the TAC role is now a permanent position.
Bereaved caregivers of patients with high-grade glioma: a systematic review
Authors: Piil Karin , Nordentoft Sara , Larsen Anders , Jarden Mary
Published: January 2018

Objective

Caregivers to patients with primary malignant brain tumours neglect their own physical and emotional needs during the disease trajectory. The aim of the systematic review was to explore how informal caregivers of patients with primary malignant brain tumour (high-grade glioma (HGG)) experience and manage their life situation after the death of the patient.

Methods

A systematic literature search was carried out in December 2016 and revised in September 2017. The following six databases were searched: PubMed, Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database, Scopus, PsycINFO and The Social Sciences Citation Index. Studies eligible for inclusion met the following criteria: (1) included bereaved caregivers to patients diagnosed with HGG ≥18 years, (2) described the caregiver’s perspective at post bereavement (3) had been peer-reviewed. The papers included were assessed for methodological quality using the Critical Appraisal Skills Programme.

Results

Four qualitative articles, published from 2004 to 2015, met the eligibility criteria. Bereaved informal caregivers expressed profound grief and had unmet needs and questions related to the disease and their role as caregiver. Moreover, they experienced depressive symptoms and fatigue, resulting in a reduced work capability and social network.

Conclusions

We conclude that bereaved informal caregivers experience psychosocial consequences and emotional reactions after bereavement, resulting in feelings of isolation and loneliness. This review identified limited evidence on how the bereaved caregivers prefer to be supported, and further study is warranted. We suggest incorporating systematic information on bereavement in clinical practice and a cooperation across sectors.
Using high-fidelity simulation to teach fundamental principles of cardiac catheterisation to pharmacy students
Authors: Serag-Bolos Erini , Patel Radha V , Chudow Melissa , Chowdhury Rowshan , Miranda Aimon Chantara
Published: January 2018

Background

Pharmacy students often find the pathophysiology and treatment of comorbid heart conditions challenging to understand. The objective of this study is to evaluate the impact of a cardiac catheterisation lab simulation on pharmacy students’ knowledge related to cardiology and critical care pharmacotherapy.

Methods

Third-year pharmacy students at the University of South Florida completed a high-fidelity cardiac catheterisation simulation. Specific aspects within the activity involved review of clinical parameters and images during catheterisation, identification of access points for catheter insertion, review of the types of stents available and associated pharmacotherapeutic considerations, and discussion of protective measures to prevent radiation exposure. Students completed knowledge-based presimulation and postsimulation assessments regarding these aspects of cardiac catheterisation.

Results

All students (n=111, 100%) completed the presimulation and postsimulation assessments. There was an increase in knowledge after the simulation, which was statistically significant in five out of nine questions, P<0.001. Based on course evaluations, students believed this activity enhanced their learning and ability to apply the material due to the close alignment and timing with their acute coronary syndrome lectures and the critical care module in the Pharmacotherapeutics course.

Conclusions

Participation in the simulation improved students’ knowledge related to cardiology pharmacotherapy and associated acute procedures.
Orthostatic blood pressure recovery patterns in suspected syncope in the emergency department
Authors: van Wijnen Veera K , Ten Hove Dik , Gans Reinold O B , Nieuwland Wybe , van Roon Arie M , Ter Maaten Jan C , Harms Mark P M
Published: January 2018

Introduction

Orthostasis is a frequent trigger for (pre)syncope but some forms of orthostatic (pre)syncope have a worse prognosis than others. Routine assessment of orthostatic BP in the ED can detect classic orthostatic hypotension, but often misses these other forms of orthostatic (pre)syncope. This study aimed to determine the frequency of abnormal orthostatic BP recovery patterns in patients with (pre)syncope by using continuous non-invasive BP monitoring.

Methods

We performed a prospective cohort study in suspected patients with (pre)syncope in the ED of a tertiary care teaching hospital between January and August 2014. Orthostatic BP was measured during the active lying-to-standing test with Nexfin, a continuous non-invasive finger arterial pressure measurement device. Orthostatic BP recovery patterns were defined as normal BP recovery, initial orthostatic hypotension, delayed BP recovery, classic orthostatic hypotension and reflex-mediated hypotension.

Results

Of 116 patients recruited, measurements in 111 patients (age 63 years, 51% male) were suitable for analysis. Classic orthostatic hypotension was the most prevalent abnormal BP pattern (19%), but only half of the patients received a final diagnosis of orthostatic hypotension. Initial orthostatic hypotension and delayed BP recovery were present in 20% of the patients with (pre)syncope of whom 45% were diagnosed as unexplained syncope. Reflex-mediated hypotension was present in 4% of the patients.

Conclusion

Continuous non-invasive BP measurement can potentially identify more specific and concerning causes of orthostatic (pre)syncope. Correct classification is important because of different short-term and long-term clinical implications.
Does adiposity mediate the relationship between socioeconomic position and non-allergic asthma in childhood?
Authors: Lewis Kate Marie , Pikhart Hynek , Morrison Joana
Published: January 2018

Background

Despite its high prevalence, early onset and chronic nature, the causes of asthma are not clearly established. The present study examined a plausible but untested relationship in the development of non-allergic asthma; an asthma phenotype closely linked to deprivation and other preventable risk factors. Our aim was to determine the mediating role of adiposity in the relationship between socioeconomic position in infancy and non-allergic asthma emergence in mid-childhood.

Methods

To estimate the causal indirect effect of adiposity we applied the parametric g-computational procedure to 6203 singleton children from the UK Millennium Cohort Study. Adiposity was measured at age 7 by body mass index, waist circumference and waist circumference-to-height ratio. Children who developed non-allergic asthma between the age of 7 and 14 were compared with children without allergies or allergic asthma at these ages.

Results

We found no evidence to suggest that adiposity is a mediator in the relationship between socioeconomic position and the development of non-allergic asthma in mid-childhood. After adjustment for risk factors, the direct effect of socioeconomic position remained; children in the lowest tertile of socioeconomic position had a 43% (OR 1.43, 95% CI 1.38 to 1.49) greater odds of developing non-allergic asthma compared with the highest tertile.

Conclusions

Adiposity at age 7 does not mediate the relationship between socioeconomic position and non-allergic asthma. The results suggest that improving socioeconomic conditions and promoting healthy weight are both important in reducing the development of non-allergic asthma in early to mid-childhood.
Effect of increasing the price of sugar-sweetened beverages on alcoholic beverage purchases: an economic analysis of sales data
Authors: Quirmbach Diana , Cornelsen Laura , Jebb Susan A , Marteau Theresa , Smith Richard
Published: January 2018

Background

Taxing soft-drinks may reduce their purchase, but assessing the impact on health demands wider consideration on alternative beverage choices. Effects on alcoholic drinks are of particular concern, as many contain similar or greater amounts of sugar than soft-drinks and have additional health harms. Changes in consumption of alcoholic drinks may reinforce or negate the intended effect of price changes for soft-drinks.

Methods

A partial demand model, adapted from the Almost Ideal Demand System, was applied to Kantar Worldpanel data from 31 919 households from January 2012 to December 2013, covering drink purchases for home consumption, providing ~6 million purchases aggregated into 11 groups, including three levels of soft-drink, three of other non-alcoholic drinks and five of alcoholic drinks.

Results

An increase in the price of high-sugar drinks leads to an increase in the purchase of lager, an increase in the price of medium-sugar drinks reduces purchases of alcoholic drinks, while an increase in the price of diet/low-sugar drinks increases purchases of beer, cider and wines. Overall, the effects of price rises are greatest in the low-income group.

Conclusion

Increasing the price of soft-drinks may change purchase patterns for alcohol. Increasing the price of medium-sugar drinks has the potential to have a multiplier-effect beneficial to health through reducing alcohol purchases, with the converse for increases in the price of diet-drinks. Although the reasons for such associations cannot be explained from this analysis, requiring further study, the design of fiscal interventions should now consider these wider potential outcomes.
Transformational leadership capabilities for medical leaders
Authors: Rooke David
Published: January 2018

Background/aim

This paper summarises and extends information presented at the Lilly Lecture 2017. It is based on the author’s experience and research in working to develop senior leaders in many sectors over the last 30 years. The aim is to provide practical, usable insights into an aspect of leadership capability that is often overlooked in order to enable greater effectiveness in leaders.

Methods

The paper draws on the author’s own experience, of the research of Harthill and other organisations working with the concepts that have been labelled constructivist development or more lately ‘vertical’ development.

Results

Research, both qualitative and quantitative, points to the need for leaders to develop the meaning-making capacities to deal with increased levels of complexity and ambiguity. Fewer than 5% of leaders across multisectors are seen to develop these capacities.

Conclusion

Leaders within the National Health Service are particularly challenged by complex and ambiguous contexts. They need to extend their leadership capacities to be able to lead effectively in such contexts. Leaders today are not being supported to develop these capacities and more needs to be done. There are actions that individuals as well as organisations can take to support this development.
Comparison of tricuspid annular plane systolic excursion with fractional area change for the evaluation of right ventricular systolic function: a meta-analysis
Authors: Lee Justin Z , Low See-Wei , Pasha Ahmed K , Howe Carol L , Lee Kwan S , Suryanarayana Prakash G
Published: January 2018

Background

Accurate determination of right ventricular ejection fraction (RVEF) is challenging because of the unique geometry of the right ventricle. Tricuspidannular plane systolic excursion (TAPSE) and fractional area change (FAC) are commonly used echocardiographic quantitative estimates of RV function. Cardiac MRI (CMRI) has emerged as the gold standard for assessment of RVEF. We sought to summarise the available data on correlation of TAPSE and FAC with CMRI-derived RVEF and to compare their accuracy.

Methods

We searched PubMed, EMBASE, Web of Science, CINAHL, ClinicalTrials.gov and the Cochrane Library databases for studies that assessed the correlation of TAPSE or FAC with CMRI-derived RVEF. Data from each study selected were pooled and analysed to compare the correlation coefficient of TAPSE and FAC with CMRI-derived RVEF. Subgroup analysis was performed on patients with pulmonary hypertension.

Results

Analysis of data from 17 studies with a total of 1280 patients revealed that FAC had a higher correlation with CMRI-derived RVEF compared with TAPSE (0.56vs0.40, P=0.018). In patients with pulmonary hypertension, there was no statistical difference in the mean correlation coefficient of FAC and TAPSE to CMR (0.57vs0.46, P=0.16).

Conclusions

FAC provides a more accurate estimate of RV systolic function (RVSF) compared with TAPSE. Adoption of FAC as a routine tool for the assessment of RVSF should be considered, especially since it is also an independent predictor of morbidity and mortality. Further studies will be needed to compare other methods of echocardiographic measurement of RV function.
Body mass index as a risk factor for coronary events and mortality in patients with type 1 diabetes
Authors: Vestberg Daniel , Rosengren Annika , Eeg-Olofsson Katarina , Miftaraj Mervete , Franzen Stefan , Svensson Ann-Marie , Lind Marcus
Published: January 2018

Objective

To investigate the potential relationship between body mass index (BMI) and the risk for myocardial infarction and coronary death in patients with type 1 diabetes.

Methods

We studied patients with type 1 diabetes included in the Swedish National Diabetes Registry during 2002–2004 and followed them until a discharge diagnosis for myocardial infarction, acute coronary event, death or until 31 December 2011. Cox regression was used to estimate relative risks.

Results

In 17 499 patients with type 1 diabetes (mean age 39.4 years; mean BMI 25.2 kg/m2), 819 were diagnosed with myocardial infarction as a primary or secondary diagnosis during a mean follow-up of 8.5 years (maximum 9.9 years). Estimated with Cox regression, there was no significant effect of increased BMI on the risk of myocardial infarction (HR 1.4 (95% CI 0.7 to 2.5) in the group with BMI >35 kg/m2compared with BMI 18.5–25 kg/m2. There was no association between BMI and coronary mortality, acute coronary events or all-cause mortality after adjusting for other known risk factors. Underweight patients (BMI <18.5 kg/m2) had increased hazard for coronary (HR 5.0 (95% CI 1.5 to 16.9)) and all-cause mortality (HR 5.4 (95% CI 3.1 to 9.6)) compared with BMI 18.5–25 kg/m2.

Conclusions

Among patients with type 1 diabetes, increased BMI is not a significant independent risk factor for myocardial infarction or coronary death after adjustment for other risk factors. Low BMI (less than 18.5 kg/m2) is associated with mortality from coronary or any cause.
Beating heart minimally invasive mitral valve surgery in patients with previous sternotomy: the operative technique and early outcomes
Authors: Xu Robert B , Rahnavardi Mohammad , Nadal Mart , Viana Fabiano , Stuklis Robert G , Worthington Michael , Edwards James
Published: January 2018

Objective

Reoperative mitral valve surgery is increasingly required and can be associated with significant morbidity and mortality. The beating heart minimally invasive mitral valve surgery has a proposed benefit in avoiding the risks of repeat sternotomy, with reducing the need for adhesiolysis and cardioplegia reperfusion injury. We describe our experience with such a technique in patients with previous sternotomy.

Methods

A retrospective study was performed and all patients undergoing surgery of mitral valve through a right limited thoracotomy without application of an aortic cross-clamp (beating heart) as a redo cardiac surgery between January 2006 and January 2015 were included (n=25). Perioperative data as well as the operative technique are presented.

Results

Six patients (24%) had two previous sternotomies and one (4%) had three previous sternotomies. Mitral valve repair was performed in 11 patients (44%). No patient required conversion to median sternotomy. Inotropic support beyond 4 hours after operation was required in seven patients (28%). Ventilation time was less than 12 hours in 14 patients (56%) with another six patients (24%) extubated within 24 hours after surgery. Postoperative course was complicated with cerebrovascular accident in two patients (8%). In-hospital mortality was 4% (n=1). There was no 30-day mortality after discharge.

Conclusions

Reoperative mitral valve surgery can be safely performed through a limited right thoracotomy approach on a beating heart while on full cardiopulmonary bypass. The technique can be associated with potentially shorter operation, shorter cardiopulmonary bypass and a less complicated recovery.
Why governments cannot afford Codentify to support their track and trace solutions
Authors: Ross Hana , Eads Michael , Yates Michael
Published: January 2018

Background

In anticipation of the Protocol to Eliminate Illicit Trade in Tobacco Products (ITP) entering into force in 2018, there is a growing demand for information on track and trace (T&T) solutions for tobacco products. This article contrasts the efficacy of Codentify from the perspective of authentication with that of material-based multilayered security technologies.

Method

To calculate the probability of detecting one fraudulent pack under Codentify, we relied on a modified Bernoulli trial experiment with independent repeated sampling without replenishment. The probability is calculated using a multinomial distribution formula adjusted for the fact that both legitimate and non-legitimate packs may be sold in the market.

Results

In a relatively small market, a law enforcement authority would have to inspect over 27 000 (almost 31 000) packs per week to have a 90% (95%) certainty that it did not miss a fraudulent pack under the Codentify system. A material based T&T solution would require only 45 (59) pack inspections a week to have the same level of confidence.

Conclusions

This study demonstrates the inefficiency of Codentify compared to other solutions that incorporate material-based security features. Signatories to the ITP should reject Codentify due to both its low efficacy and its clear violation of the ITP’s requirement that T&T shall not be performed by or delegated to the tobacco industry or its front groups.