bluuebunny/crossref_metadata_2025 huggingface dataset:
Preliminary results of the use of scalp microneedling in different types of alopecia
Authors: Starace Michela , Alessandrini Aurora , Brandi Nicolò , Piraccini Bianca Maria
Published: June 2019

Background

Androgenetic alopecia (AGA) is the result of progressive patterned hair density reduction and sometimes can be associated with telogen effluvium (TE). The efficacy of conventional therapy is variable, and therefore, there is a need for adjuvant and newer modalities of treatment in order to give faster and better outcomes. Microneedling has been reported to be a promising, effective, and safe new technique in the treatment of AGA.

Objective

The aim of this study was to prove that microneedling procedure should be offered to patients with AGA and TE along with the existing therapeutic modalities, in order to obtain faster hair regrowth and, therefore, a better patient compliance.

Patients and methods

We collected data of 36 females, 29 with AGA, and 7 with TE, and 14 males with AGA between January 2017 and December 2018 and then treated with 3 session of microneedling over a total period of 6 months.

Results

No serious adverse side effects were reported. All the patients reported a partial or complete reduction in hair loss, associated to the perception of improvement of hair density and thickening of the hair shaft diameter, results confirmed by clinical iconography and trichoscopy.

Conclusions

Scalp areas typical affected by AGA, that is, the vertex in males and the frontal area in females, are the ones that showed the greater percentage of improvement. Moreover, microneedling can have a role also in TE, especially when cosmetic procedures do not give enough results, because it induces a rapid arresting of the hair loss.
Mobility bridges a gap in care: Findings from an early mobilisation quality improvement project in acute care
Authors: Johnson Audrey M. , Howell Dana M.
Published: July 2019

Aims and objectives

To qualitatively evaluate an early mobilisation quality improvement project implemented on a general medicine unit.

Background

Early mobility quality improvement projects show promising quantitative results yet have failed to collect data from patient and staff experience associated with physical activity during illness and the impact of this change in clinical practice.

Design

A mixed methods case study was used to evaluate a mobility quality improvement project. Quantitative results will be published separately. The qualitative evaluation used a phenomenological lens to explore the patient and staff experience.

Methods

Semi‐structured interviews with twelve participants (four patients and eight staff) were performed during the project. Data were analysed using open coding, direct interpretation and then categorised into an overarching and four supporting themes. Findings are reported per the Standards for Reporting Qualitative Research.

Results

Participants reported that early mobilisation bridged a gap in care. Staff understood the benefits of early mobility. Patients expressed how mobility aligned with personal preferences and their need to prepare for hospital discharge. Greater functional independence and higher mobility levels in patients on the unit reduced staff level of care. When patients were consistently presented with opportunities to be mobile and active, they expected mobility to be a part of their daily care plan.

Conclusions

Findings suggest that early mobility quality improvement projects have the potential to transform clinical practice and improve the quality of care for patients in acute care.

Relevance to clinical practice

All members of the healthcare team, including the patient, recognise the importance of maintaining mobility and function during hospitalisation yet focus on these needs are often delayed or missed. Early mobility quality improvement projects help to set patient expectations and build a culture that promotes patient mobility and function during acute illness.
Women's Liberation as a Financial Innovation
Authors: HAZAN MOSHE , WEISS DAVID , ZOABI HOSNY
Published: June 2019

In one of the greatest extensions of property rights in human history, common law countries began giving rights to married women in the 1850s. Before this “women's liberation,” the doctrine of coverture strongly incentivized parents of daughters to hold real estate, rather than financial assets such as money, stocks, or bonds. We exploit the staggered nature of coverture's demise across U.S. states to show that women's rights led to shifts in household portfolios, a positive shock to the supply of credit, and a reallocation of labor toward nonagriculture and capital‐intensive industries. Investor protection thus deepened financial markets, aiding industrialization.
From Participation To Repurchase: Low Income Households And Micro‐insurance
Authors: Sane Renuka , Thomas Susan
Published: June 2019

The article asks what drives the time to repurchase for life and accident insurance contracts in low income households. We use data on customers of a financial services provider from three states in India and find that the probability of repurchase is highest in the first 2 months after the contract expires, and steadily declines after. This suggests a window of opportunity for financial firms and governments to target customers to ensure continuous insurance purchase. Nonmembership of microfinance groups and poor rainfall in the month of expiry affect the time to repurchase adversely. Customers who take longer to repurchase tend to increase the amount of insurance cover.
The Impact of Local Food Expenditure on School Foodservice Revenues
Authors: Motta Victor
Published: July 2019

BACKGROUND

Locally grown foods, through farm‐to‐school (FTS) activities, may be a key component to balancing foodservice budgets and alleviating financial constraints in school districts. Therefore, the purpose of this study is to examine the impact of local food expenditures on school foodservice revenues and earnings. We anticipated a positive impact of local food expenditures on foodservice revenues and earnings.

METHODS

Ordinary Least Squares (OLS) regression analysis was conducted using data from the 2013 US Department of Agriculture Farm to School Census. The questionnaire primarily asked all US public school districts about their FTS operations during 2011‐2012 school year.

RESULTS

Although our results initially showed a negative impact of local milk and nonmilk expenditures on foodservice revenues from food sales, when combined with revenues from the federal government, the impact is positive. The positive effect seems to hold when adding foodservice revenues from both food sales and federal funds. Our study found a similar pattern for foodservice earnings.

CONCLUSIONS

This may indicate that competitive foods are still widely preferred in school districts. Revenue from the federal government is critical to maintain FTS activities viable to students and community members although federal funds and food sales may not cover total foodservice expenditures.
Conservation of old individual trees and small populations is integral to maintain species' genetic diversity of a historically fragmented woody perennial
Authors: Bezemer Nicole , Krauss Siegfried L. , Roberts David G. , Hopper Stephen D.
Published: July 2019

Historically fragmented and specialized habitats such as granite outcrops are understudied globally unique hot spots of plant evolution. In contrast to predictions based on mainstream population genetic theory, some granite outcrop plants appear to have persisted as very small populations despite prolonged geographic and genetic isolation. Eucalyptus caesia Benth. is a long‐lived lignotuberous tree endemic with a naturally fragmented distribution on granite outcrops in south‐western Australia. To quantify population to landscape‐level genetic structure, we employed microsatellite genotyping at 14 loci of all plants in 18 stands of E. caesia. Sampled stands were characterized by low levels of genetic diversity, small absolute population sizes, localized clonality and strong fine‐scale genetic subdivision. There was no significant relationship between population size and levels of heterozygosity. At the landscape scale, high levels of population genetic differentiation were most pronounced among representatives of the two subspecies in E. caesia as originally circumscribed. Past genetic interconnection was evident between some geographic neighbours separated by up to 20 km. Paradoxically, other pairs of neighbouring stands as little as 7 km apart were genetically distinct. There was no consistent pattern of isolation by distance across the 280 km range of E. caesia. Low levels of gene flow, together with strong drift within stands, provide some explanation of the patterns of genetic differentiation we observed. Individual genet longevity via the ability to repeatedly resprout and expand from a lignotuber may enhance the persistence of some woody perennial endemic plants despite small population size, minimal genetic interconnection and low heterozygosity.
Defining breakthrough invasive fungal infection–Position paper of the mycoses study group education and research consortium and the European Confederation of Medical Mycology
Authors: Cornely Oliver A. , Hoenigl Martin , Lass‐Flörl Cornelia , Chen Sharon C. ‐A. , Kontoyiannis Dimitrios P. , Morrissey C. Orla , Thompson George R. ,   for the Mycoses Study Group Education and Research Consortium (MSG‐ERC) and the European Confederation of Medical Mycology (ECMM)
Published: June 2019

Breakthrough invasive fungal infections (IFIs) have emerged as a significant problem in patients receiving systemic antifungals; however, consensus criteria for defining breakthrough IFI are missing. This position paper establishes broadly applicable definitions of breakthrough IFI for clinical research. Representatives of the Mycoses Study Group Education and Research Consortium (MSG‐ERC) and the European Confederation of Medical Mycology (ECMM) reviewed the relevant English literature for definitions applied and published through 2018. A draft proposal for definitions was developed and circulated to all members of the two organisations for comment and suggestions. The authors addressed comments received and circulated the updated document for approval. Breakthrough IFI was defined as any IFI occurring during exposure to an antifungal drug, including fungi outside the spectrum of activity of an antifungal. The time of breakthrough IFI was defined as the first attributable clinical sign or symptom, mycological finding or radiological feature. The period defining breakthrough IFI depends on pharmacokinetic properties and extends at least until one dosing interval after drug discontinuation. Persistent IFI describes IFI that is unchanged/stable since treatment initiation with ongoing need for antifungal therapy. It is distinct from refractory IFI, defined as progression of disease and therefore similar to non‐response to treatment. Relapsed IFI occurs after treatment and is caused by the same pathogen at the same site, although dissemination can occur. These proposed definitions are intended to support the design of future clinical trials and epidemiological research in clinical mycology, with the ultimate goal of increasing the comparability of clinical trial results.
Handedness in plant cell expansion: a mutant perspective on helical growth
Authors: Buschmann Henrik , Borchers Agnes
Published: June 2019

Many plant mutants are known that exhibit some degree of helical growth. This ‘twisted’ phenotype has arisen frequently in mutant screens of model organisms, but it is also found in cultivars of ornamental plants, including trees. The phenomenon, in many cases, is based on defects in cell expansion symmetry. Any complete model which explains the anisotropy of plant cell growth must ultimately explain how helical cell expansion comes into existence – and how it is normally avoided. While the mutations observed in model plants mainly point to the microtubule system, additional affected components involve cell wall functions, auxin transport and more. Evaluation of published data suggests a two‐way mechanism underlying the helical growth phenomenon: there is, apparently, a microtubular component that determines handedness, but there is also an influence arising in the cell wall that feeds back into the cytoplasm and affects cellular handedness. This idea is supported by recent reports demonstrating the involvement of the cell wall integrity pathway. In addition, there is mounting evidence that calcium is an important relayer of signals relating to the symmetry of cell expansion. These concepts suggest experimental approaches to untangle the phenomenon of helical cell expansion in plant mutants.
A high‐throughput BAC end analysis protocol (BAC‐anchor) for profiling genome assembly and physical mapping
Authors: Yang Xiaohui , Yang Yu , Ling Jian , Guan Jiantao , Guo Xiao , Dong Daofeng , Jin Liping , Huang Sanwen , Liu Jun , Li Guangcun
Published: June 2019

Traditional approaches for sequencing insertion ends of bacterial artificial chromosome (BAC) libraries are laborious and expensive, which are currently some of the bottlenecks limiting a better understanding of the genomic features of auto‐ or allopolyploid species. Here, we developed a highly efficient and low‐cost BAC end analysis protocol, named BAC‐anchor, to identify paired‐end reads containing large internal gaps. Our approach mainly focused on the identification of high‐throughput sequencing reads carrying restriction enzyme cutting sites and searching for large internal gaps based on the mapping locations of both ends of the reads. We sequenced and analysed eight libraries containing over 3 200 000 BAC end clones derived from the BAC library of the tetraploid potato cultivar C88 digested with two restriction enzymes, Cla I and Mlu I. About 25% of the BAC end reads carrying cutting sites generated a 60–100 kb internal gap in the potato DM reference genome, which was consistent with the mapping results of Sanger sequencing of the BAC end clones and indicated large differences between autotetraploid and haploid genotypes in potato. A total of 5341 Cla I‐ and 165 Mlu I‐derived unique reads were distributed on different chromosomes of the DM reference genome and could be used to establish a physical map of target regions and assemble the C88 genome. The reads that matched different chromosomes are especially significant for the further assembly of complex polyploid genomes. Our study provides an example of analysing high‐coverage BAC end libraries with low sequencing cost and is a resource for further genome sequencing studies.
Differential responses by two closely related native fishes to restoration actions
Authors: Raymond Scott , Koehn John , Tonkin Zeb , Todd Charles , Stoessel Daniel , Hackett Graeme , O'Mahony Justin , Berry Kelvin , Lyon Jarod , Sharley Joanne , Moloney Paul
Published: June 2019

Globally, river degradation has decimated freshwater fish populations. To help reverse this trend in a southeastern Australia river, we used multiple restoration actions, including reintroduction of instream woody habitat, riparian revegetation, removal of a weir hindering fish movement, fencing out livestock, and controlling riparian weeds. We monitored the responses of native fish at the segment scale (20 km) and reach scale (0.3 km) over 7 years to assess the effectiveness of the different restoration strategies. Two closely related species, Murray cod Maccullochella peeli and trout cod Maccullochella macquariensis, increased at the restored segment compared with the control segment. However, inherent differences between river segments and low sample size hampered assessment of the mechanisms responsible for segment‐scale changes in fish abundance. In contrast, at the reach scale, only M. peeli abundance significantly increased in reaches supplemented with wood. These differential responses by 2 closely related fish species likely reflect species‐specific responses to increased habitat availability and enhanced longitudinal connectivity when the weir improved passage around a fishway. Changes in M. peeli abundance in segments supplemented with and without wood suggest an increase in carrying capacity and not simply a redistribution of individuals within the segment, facilitated the observed expansion. Our findings confirm the need to consider individual fish species' habitat preferences carefully when designing restoration interventions. Further, species‐specific responses to restoration actions provide waterway managers with precise strategies to target fish species for recovery and the potential to predict fish outcomes based on ecological preferences.
Upper Pleistocene tectonics in western Sardinia (Italy): Insights from the Sinis peninsula structural high
Authors: Cocco Fabrizio , Andreucci Stefano , Sechi Daniele , Cossu Giulia , Funedda Antonio
Published: June 2019

The Corsica‐Sardinia block is a lithospheric fragment whose recent role in the geodynamics of the central‐Western Mediterranean basin is still enigmatic. The most recent regional structure in Sardinia is the Plio‐Pleistocene Campidano Basin, which is considered in a ‘post‐rift’ stage since the Middle Pleistocene. New structural and stratigraphic geological surveys along with luminescence ages provide evidence to support an ongoing tectonic activity since the Marine Isotopic Stage 7 (MIS7; ca. 220 ka) on the Sinis peninsula, the structural high that bounds the north‐western side of the Campidano Basin. In particular, this paper reveals for the first time the presence of N–S striking normal faults system offsetting late Pleistocene aeolianites (130 ± 12 ka; 82 ± 9 ka).
Outcome and failure patterns of localized sinonasal lymphoma in cats treated with first‐line single‐modality radiation therapy: A retrospective study
Authors: Meier Valeria S. , Beatrice Laura , Turek Michelle , Poirier Valerie J. , Cancedda Simona , Stiborova Katerina , Körner Maximilian , Marconato Laura , Weyland Mathias S. , Rohrer Bley Carla
Published: June 2019

Failure rate and site are not well defined in localized sinonasal lymphoma in cats treated with radiotherapy. In this study, we describe (a) failure pattern, (b) outcome, (c) influence of previously reported prognostic variables on the outcome in cats with suspected localized sinonasal lymphoma. In this multi‐institutional retrospective study, we included 51 cats treated with single‐modality radiotherapy. Cats were irradiated using 10x4.2Gy (n = 32), 12x3Gy (n = 11) or 5x6Gy (n = 8). Regional lymph nodes were prophylactically irradiated in 24/51 cats (47.1%). Twenty‐five cats (49.0%) developed progressive disease: progression was local (nasal) in five (9.8%), locoregional (nodal) in two (3.9%), local and locoregional in three (5.9%), systemic in nine (17.6%) and both local and systemic in six cats (11.8%). No cat receiving prophylactic nodal irradiation had progression in the locoregional lymph nodes. The median time to progression was 974 days (95%CI: 283;1666), with 58% and 53% of cats free of progression at 1 and 2 years, respectively. Median overall survival was 922 days (95%CI: 66;1779) with 61% and 49% alive at 1 and 2 years, respectively. Half of the cats that died of relapse/progression (13/26) died within 6 months of treatment, suggesting possible shortcomings of staging, rapid dissemination of disease or sequential lymphomagenesis. None of the prognostic factors evaluated were predictive of outcome (prednisolone use, anaemia, nasopharyngeal involvement, modified canine Adams tumour stage, protocol, total dose). Radiotherapy is an effective treatment for localized sinonasal lymphoma with a long time to progression. However, in one‐third of the cats, systemic disease progression occurs soon after radiotherapy.
Phylogenetic relationships in the Sceloporus variabilis (Squamata: Phrynosomatidae) complex based on three molecular markers, continuous characters and geometric morphometric data
Authors: Solis‐Zurita Carolina , De Luna Efraín , González Dolores
Published: June 2019

The monophyly of the Sceloporus variabilis group is well established with five species and two species complexes, but phylogenetic relationships within species complexes are still uncertain. We studied 278 specimens in 20 terminals to sample all taxa in the “variabilis group,” including three subspecies in the “variabilis complex,” and two outgroups (Sceloporus grammicus and Sceloporus megalepidurus). We assembled an extensive morphological data set with discrete and continuous characters (distances and scale counts), including geometric morphometric data (landmark coordinates of three shapes), and a three‐marker molecular data set as well (ND4, 12S and RAG1). We conducted parsimony and Bayesian phylogenetic inferences on these data, including several partitioning and weighting schemes. We suggest elevating three subspecies to full species status. Therefore, we recommend recognition of nine species in the “variabilis group.” First, S. variabilis is sister to Sceloporus teapensis. In turn, Sceloporus cozumelae is sister to Sceloporus olloporus. These four species are a monophyletic group, which is sister to Sceloporus smithi. Finally, Sceloporus marmoratus is sister of the clade of five species. The other species in the “variabilis group” (Sceloporus chrysostictus, Sceloporus couchii and Sceloporus parvus) are a paraphyletic grade at the base of the tree. Our analyses reject the existence of the “variabilis complex.” We conducted a parsimony‐based ancestral reconstruction on body size (snout–vent length), femoral pores and dorsal scales and related morphological changes to geographic distribution of the species. Our phylogenetic hypothesis will allow best designs of comparative studies with species in the “variabilis group,” one of the earliest divergent lineages in the genus.
Mapping Together Kinetic and Kinematic Abilities of the Hand
Authors: Drost Joshua P. , Hong Hyokyoung G. , Bush Tamara Reid
Published: June 2019

Millions of people have reduced hand function; this loss of function can be due to injury, disease, or aging. Loss of hand function is identified as reduced motion abilities in the fingers or a decrease in the ability of the fingers to generate force. Unfortunately, there are limited data available regarding each finger's ability to produce force and how those force characteristics vary with changes in finger posture. To relate motion and force abilities of the fingers, first, an approach to measure and map them together is needed. The goal of this work was to develop and demonstrate a method to quantify the force abilities of the fingers and map these forces to the kinematic space associated with each finger. Using motion capture and multiaxis load cells, finger forces were quantified at different positions over their ranges of motion. These two sets of data were then converted to the same coordinate space and mapped together. Further, the data were normalized for the index finger and mapped as a population space model. The ability to quantify motion and force data for each finger and map them together will provide an improved understanding of the effects of treatments and rehabilitation, identifying functional loss due to injury or disease, and device design.
Seismic Fragility Curves of an Arch Dam With Special Regard to Ultimate Limit State
Authors: Gasser Christian , Goldgruber Markus , Bucher Christian
Published: June 2019

The seismic safety of an arch dam is analyzed by calculating fragility curves for different damage and failure mechanisms. The model includes fluid–structure–foundation interaction and considers contact and material type nonlinearities. The ultimate limit state (failure) is studied by means of a plastic-damage concrete model, especially developed for cyclic loadings. The time histories of the ground motions are generated randomly by means of Kanai–Tajimi filter. Moreover, ten parameters of the model are considered as random variables, including the water level. To the best knowledge of the authors, for the first time, water-level variability is accounted for in a probabilistic seismic analysis of a dam. It is studied if it is admissible to increase the efficiency of the Monte Carlo simulation (MCS) by assuming lognormal distributions for the fragility curves. In general, the aim of this work is to show the possibilities and difficulties of probabilistic seismic analysis tools when applied to a sophisticated mechanical model of a real structure.
Optimization Approaches for the Numerical Design of Structures Under Consideration of Polymorphic Uncertain Data
Authors: Edler Philipp , Freitag Steffen , Kremer Katharina , Meschke Günther
Published: June 2019

In this paper, optimization approaches for the numerical design of structures are presented. The uncertainty of structural parameters is considered by means of random variables and interval design parameters within the optimization. A new space subdividing technique is introduced to substitute time-consuming failure probability constraint evaluations. In order to solve optimization problems with polymorphic uncertain parameters, surrogate objectives are formulated and solved by means of a particle swarm optimization (PSO) approach in combination with Monte Carlo simulation and interval analysis. Two computational schemes are presented and verified by a benchmark example. Finally, an application is shown, where the reinforcement layout of a reinforced concrete bridge structure is optimized by minimizing the crack widths at the reinforcement layers in order to improve the durability of the structure. A nonlinear finite element (FE) model is used to compute the uncertain crack patterns and the load bearing capacity. The stochastic objective function and the failure probability constraint are approximated by neural network based surrogate models.
Real-time separation of non-stationary sound fields on spheres
Authors: Ma Fei , Zhang Wen , Abhayapala Thushara D.
Published: July 2019

The sound field separation methods can separate the target field from the interfering noises, facilitating the study of the acoustic characteristics of the target source, which is placed in a noisy environment. However, most of the existing sound field separation methods are derived in the frequency-domain, thus they are best suited for separating stationary sound fields. In this paper, a time-domain sound field separation method is developed that can separate the non-stationary sound field generated by the target source over a sphere in real-time. A spherical array sets up a boundary between the target source and the interfering sources, such that the outgoing field on the array is only generated by the target source. The proposed method decomposes the pressure and the radial particle velocity measured by the array into spherical harmonic coefficients, and recovers the target outgoing field based on the time-domain relationship between the decomposition coefficients and the theoretically derived spatial filter responses. Simulations show the proposed method can separate non-stationary sound fields both in free field and room environments, and over a longer duration with small errors. The proposed method could serve as a foundation for developing future time-domain spatial sound field manipulation algorithms.
Complete Whole-Genome Sequences of Two Raoultella terrigena Strains, NCTC 13097 and NCTC 13098, Isolated from Human Cases
Authors: Fazal Mohammed-Abbas , Alexander Sarah , Grayson Nicholas E. , Deheer-Graham Ana , Oliver Karen , Holroyd Nancy , Parkhill Julian , Russell Julie E.
Published: July 2019

Raoultella terrigena
is a bacterial species associated with soil and aquatic environments; however, sporadic cases of opportunistic disease in humans have been reported. Here, we report the first two complete genome sequences from clinical strains isolated from human sources that have been deposited in the National Collection of Type Cultures (NCTC).
Tidal volumes at birth as predictor for adverse outcome in congenital diaphragmatic hernia
Authors: Mank Arenda , Carrasco Carrasco Cristina , Thio Marta , Clotet Jordi , Pauws Steffen C , DeKoninck Philip , te Pas Arjan B
Published: June 2019

Objective

To assess the predictive value of tidal volume (Vt) of spontaneous breaths at birth in infants with congenital diaphragmatic hernia (CDH).

Design

Prospective study.

Setting

Tertiary neonatal intensive care unit.

Patients

Thirty infants with antenatally diagnosed CDH born at Hospital Sant Joan de Déu in Barcelona from September 2013 to September 2015.

Interventions

Spontaneous breaths and inflations given in the first 10 min after intubation at birth were recorded using respiratory function monitor. Only expired Vt of uninterrupted spontaneous breaths was included for analysis. Receiver operating characteristics (ROC) analysis was performed and the area under the curve (AUC) was estimated to assess the predictive accuracy of Vt.

Main outcome measures

Mortality before hospital discharge and chronic lung disease (CLD) at day 28 of life.

Results

There were 1.233 uninterrupted spontaneous breaths measured, and the overall mean Vt was 2.8±2.1 mL/kg. A lower Vt was found in infants who died (n=14) compared with survivors (n=16) (1.7±1.6 vs 3.7±2.1 mL/kg; p=0.008). Vt was lower in infants who died during admission or had CLD (n=20) compared with survivors without CLD (n=10) (2.0±1.7 vs 4.3±2.2 mL/kg; p=0.004). ROC analysis showed that Vt ≤2.2 mL/kg predicted mortality with 79% sensitivity and 81% specificity (AUC=0.77, p=0.013). Vt ≤3.4 mL/kg was a good predictor of death or CLD (AUC=0.80, p=0.008) with 85% sensitivity and 70% specificity.

Conclusion

Vt of spontaneous breaths measured immediately after birth is associated with mortality and CLD. Vt seems to be a reliable predictor but is not an independent predictor after adjustment for observed/expected lung to head ratio and liver position.
Fatal influenza myocarditis with incessant ventricular tachycardia
Authors: Saraiya Nidhi , Singh Supriya , Corpuz Marilou
Published: July 2019

Influenza myocarditis is an underappreciated and severe complication of influenza infection, estimated to be present in about 10% of all influenza cases. We present a case of a woman who precipitously died of fulminant influenza myocarditis and then review the historical data, literature and expert recommendations for suspecting and managing influenza myocarditis.
Symptomatic patients with P369S–R408Q mutations: familial Mediterranean fever or mixed auto-inflammatory syndrome?
Authors: Davies Kristen , Lonergan Bradley , Patel Rikesh , Bukhari Marwan
Published: July 2019

A 51-year-old South African female of Ashkenazi Jewish descent was admitted with acute pleuritic chest pain, shortness of breath, fatigue and fever. She experienced vague abdominal and calf pains for 30 years. Her monozygotic twin was investigated independently for recurrent abdominal pain. Despite initially responding to antibiotics, treating suspected pneumonia, she developed recurrent fevers and pleuritic chest pain. After thorough investigation without significant findings, she re-attended days after discharge with similar symptoms. Familial Mediterranean fever (FMF) was suggested as she met diagnostic criteria and responded to colchicine, though FMF normally presents before 20 years old. Genetic testing showed no pathogenic mutations but heterozygous P369S and R408Q mutations. The significance of these mutations remains unclear, as they are found in asymptomatic patients, suggesting incomplete penetrance. She remains well, with full symptom resolution, but mixed auto-inflammatory syndrome may be a more appropriate diagnosis in symptomatic patients with both P369S and R408Q mutations.
Ischaemic stroke as the initial manifestation of systemic amyloidosis
Authors: Marques Patrícia , Beato-Coelho José , Durães João , Geraldo Argemiro
Published: June 2019

A previously healthy 54-year-old woman was admitted to the stroke unit with an acute ischaemic stroke attributed to atrial fibrillation newly diagnosed at the emergency room. Nevertheless, preliminary investigation on stroke aetiology revealed incidental hypoalbuminaemia in the context of nephrotic syndrome, while clinically, the patient developed progressive signs of cardiac failure raising the suspicion of an underlying disorder. Systemic amyloidosis was histologically confirmed a few weeks after hospital admission. The rare presentation and non-specific symptom constellation contributed to delayed institution of the appropriated treatment regimen at a point where multiorganic involvement was irreversible leading to death only 2 months after the first manifestation. The presented case reminds us of the importance of always keeping in mind this rarer cause of ischaemic stroke since an early diagnosis remains the key to a more hopeful prognosis.
Rapid Assessment of Avoidable Blindness: looking back, looking forward
Authors: Mactaggart Islay , Limburg Hans , Bastawrous Andrew , Burton Matthew J , Kuper Hannah
Published: July 2019

The Rapid Assessment of Avoidable Blindness, or RAAB, is a relatively simple and low-cost survey methodology to provide data on the prevalence and causes of visual loss. The aim of this article is to reflect on the achievements and challenges of RAAB, and to describe the future developments that are needed to ensure that it remains a relevant and widely used tool. To date, at least 331 RAABs have been undertaken in 79 countries, and these surveys provide an important source of information on visual loss at both the local and global level. A RAAB repository has been developed which includes the site and date of RAABs undertaken, and, where authors have agreed, the core indicators, reports or even raw data from the survey. This dataset has already been used for meta-analyses, and there are further opportunities for its use. Despite these achievements, there are core areas in which RAAB needs to be strengthened so that the full benefits of undertaking the survey can be reaped. Key developments of RAAB are underway, and will include greater use of mobile technologies using a cloud-based platform to enable both digital data collection, real-time survey reviews, reporting and analysis, and a greater emphasis on using the data for planning.
Development of a peer-led, network mapping intervention to improve the health of individuals with severe mental illnesses: protocol for a pilot study
Authors: Collom Jennifer Rose Deborah , Davidson Jonathan , Sweet Daryl , Gillard Steve , Pinfold Vanessa , Henderson Claire
Published: June 2019

Introduction

Adults with severe mental illness (SMI) have reduced life expectancy and many have comorbid physical health conditions. Primary care providers are experiencing increased demands for care for people with SMI. Barriers to accessing physical healthcare have been identified which negatively affect quality of care. We propose that peer support workers (PSWs) could deliver an intervention to service users to promote their physical health by drawing on existing social support. The aim of this research was to pilot a novel PSW-led intervention, including personal well-being network mapping, to improve access to primary care for physical health needs.

Methods and analysis

Twenty-four participants will be recruited from community-based mental health teams in two boroughs of London. Each participant will be offered a six-session intervention. Quantitative data will be collected before and after intervention (at 4-month follow-up). Qualitative interviews will be conducted with PSWs after completion of the intervention and with participants at a 4-month follow-up. Some intervention sessions will be observed by a member of the research team. This is a pilot study with a small sample aiming to assess acceptability and feasibility of an intervention. We aim to use the results to refine the existing theory of change and to optimise the intervention and its evaluation in a future randomised controlled trial. This study is strengthened by its potential clinical importance and origin in previous research where service users engaged with well-being network mapping.

Ethics and dissemination

This study has been approved by the London-Chelsea Regional Ethics Committee (ref: 17/LO/0585). The findings will be disseminated to participants, the National Health Service trusts that we recruited from, primary care mental health leads, commissioners and in peer-reviewed journals and academic conferences.
Patterns and co-occurrence of risk factors for hepatocellular carcinoma in four Asian American communities: a cross-sectional study
Authors: Stewart Susan L , Dang Julie HT , Török Natalie J , Chen Moon S
Published: June 2019

Objectives

To investigate risk factor patterns and the simultaneous occurrence of multiple risk factors in the viral, metabolic and lifestyle domains among Asian Americans, who have had the highest mortality rates from hepatocellular carcinoma (HCC).

Setting

Sacramento County, California, USA.

Participants

Eligible participants were county residents ages 18 and older who had not been screened for chronic hepatitis B virus (HBV) and were born in a CDC-defined endemic area or whose parent was born in that area. Of 1004 enrolled, 917 were foreign-born Chinese (130 women, 94 men), Hmong (133 women, 75 men), Korean (178 women, 90 men) or Vietnamese (136 women, 81 men) with complete risk factor data.

Primary and secondary outcome measures

We tested participants for HBV and chronic hepatitis C virus (HCV); measured haemoglobin A1c and waist circumference; and recorded self-reported history of diabetes, hypertension, alcohol use and smoking status. We identified risk factor patterns using cluster analysis and estimated gender-specific age-standardised prevalence rates.

Results

We identified four patterns: (1) viral (chronic HBV or HCV); (2) lifestyle (current smoker or alcohol user, no viral); (3) metabolic (≥2 metabolic, no lifestyle or viral); and (4) lower risk (≤1 metabolic, no lifestyle or viral). Vietnamese men (16.3%, 95% CI 7.4% to 25.3%) and Hmong women (15.1%, 95% CI 7.8% to 22.5%) had the highest viral pattern prevalence. Hmong women had the highest metabolic (37.8%, 95% CI 29.8% to 45.9%), and Vietnamese men the highest lifestyle (70.4%, 95% CI 59.1% to 81.7%) pattern prevalence. In multiple domains, Hmong men and women were most likely to have viral+metabolic risk factors (men: 14.4%, 95% CI 6.0% to 22.7%; women: 11.9%, 95% CI 5.6% to 18.3%); Vietnamese men were most likely to have lifestyle+viral (10.7%, 95% CI 2.7% to 18.8%), and lifestyle+metabolic but not viral (46.4%, 95% CI 34.4% to 58.5%) risk factors.

Conclusions

Efforts to reduce HCC must comprehensively address multiple risk factors.

Trial registration number

NCT02596438.
Long-term trends of hospital admissions among patients with cancer following the 2015 earthquake: a single institution observational study in Kathmandu, Nepal
Authors: Uprety Anup , Ozaki Akihiko , Higuchi Asaka , Ghimire Bikal , Sawano Toyoaki , Tsuda Kenji , Nomura Shuhei , Leppold Claire , Tsubokura Masaharu , Tanimoto Tetsuya , Singh Yogendra Prasad
Published: June 2019

Objectives

Little is known regarding how natural disasters affect patients with cancer in low-income and middle-income countries. The objective of the present study was to assess the impact of the 2015 Nepal earthquake on the admission of patients with cancer at a core medical institution in Kathmandu.

Design, setting and participants

We considered all 3520 cancer patient admissions to Tribhuvan University Teaching Hospital, from 25 April 2013 to 24 April 2017 (2 years before and 2 years after the earthquake).

Outcome measures

The number of cancer patient admissions was calculated for each month. Using a negative binomial model, we estimated the incidence rate ratio (IRR) for admission numbers each month after the earthquake compared with the pre-earthquake baseline and investigated chronological change.

Results

The total admission number in the first month after the earthquake was decreased compared with that of the predisaster baseline (IRR=0.66, 95% CI 0.43 to 1.00), which largely reflected decreased admissions of patients from outside of the most disaster-affected districts. From the second month, the admission number consistently exceeded the predisaster baseline for the remaining postdisaster period. In contrast to the month of the disaster, the continuation of increased admissions was most prominent among those from outside of the most affected districts.

Conclusions

After a transient decrease immediately following the 2015 Nepal earthquake, there was a long-term increase in cancer patient admissions in a core hospital in Kathmandu. These changes were seen most prominently in patients from outside the most disaster affected areas.
French national health insurance database analysis and field study focusing on the impact of secure prescription pads on zolpidem consumption and sedative drug misuse: ZORRO study protocol
Authors: Gérardin Marie , Rousselet Morgane , Caillet Pascal , Grall-Bronnec Marie , Loué Pierre , Jolliet Pascale , Victorri-Vigneau C
Published: June 2019

Introduction

In recent years, data collected by the French Addictovigilance Network have shown the potential for abuse and addiction associated with zolpidem (the most sold hypnotic drug in France). Since 10 April 2017, new regulations have come into force that require zolpidem to be prescribed on special secure prescription pads, in order to reduce the risk of abuse or misuse. This measure has far-reaching repercussions that are not only limited to the consumption of zolpidem but also extend to the usage of sedative medication on a whole. The objective of the ZOlpidem and the Reinforcement of the Regulation of prescription Orders (ZORRO) study is to evaluate the overall impact of the new regulatory framework requiring zolpidem to be prescribed on special secure prescription pads. Three axes will be evaluated: the number of consumers, the type of consumption (chronic use versus occasional use, problematic consumption versus non-problematic use) and the consumption of other sedative molecules.The study has been registered in the Protocol Registration and Results System under the numberNCT03584542at stage "Pre-results".

Methods and analysis

The ZORRO study is an epidemiological, observational, national multicentre, non-controlled, prospective research project supported by the French National Agency for Medicines and Health Products Safety. The evaluation of the impact of the regulatory framework change relative to zolpidem will be done according to two axes: via an epidemiological study of the French National Health Insurance database and by the implementation of field studies of prescribers and consumers of zolpidem.

Ethics and dissemination

The Nantes Research Ethics Committee (Groupe Nantais d’Ethique dans le Domaine de la Santé), the Committee for the Protection of the Population and the Committee of Expertise in Research, Studies and Evaluations in the Field of Health approved this study. Results will be presented in national and international conferences and submitted to peer-reviewed journals.

Trial registration number

NCT03584542; Pre-results.
Prevalence of antimicrobial use and active healthcare-associated infections in acute care hospitals: a multicentre prevalence survey in Japan
Authors: Komagamine Junpei , Yabuki Taku , Kobayashi Masaki , Okabe Taro
Published: June 2019

Objective

To determine the prevalence of antimicrobial drug use and active healthcare-associated infections (HAIs) and to evaluate the appropriateness of antimicrobial therapy in acute care hospitals in Japan.

Design

A prospective multicentre cross-sectional study.

Participants

All hospitalised patients on a survey day.

Main outcome measures

The primary outcome was the proportion of patients receiving any antimicrobial agents. The secondary outcome was the proportion of patients with active HAIs. The reasons for antimicrobial drug use and appropriateness of antibiotic therapy were also investigated.

Results

Eight hundred twenty eligible patients were identified. The median patient age was 70 years (IQR 55–80); 380 (46.3%) were women, 150 (18.3%) had diabetes mellitus and 107 (13.1%) were immunosuppressive medication users. The proportion of patients receiving any antimicrobial drugs was 33.5% (95% CI 30.3% to 36.8%). The proportion of patients with active HAIs was 7.4% (95% CI 5.6% to 9.2%). A total of 327 antimicrobial drugs were used at the time of the survey. Of those, 163 (49.8%), 101 (30.9%) and 46 (14.1%) were used for infection treatment, surgical prophylaxis and medical prophylaxis, respectively. The most commonly used antimicrobial drugs for treatment were ceftriaxone (n=25, 15.3%), followed by piperacillin–tazobactam (n=22, 13.5%) and cefmetazole (n=13, 8.0%). In the 163 antimicrobial drugs used for infection treatment, 62 (38.0%) were judged to be inappropriately used.

Conclusions

The prevalence of antimicrobial use and active HAIs and the appropriateness of antimicrobial therapy in Japan were similar to those of other developed countries. A strategy to improve the appropriateness of antimicrobial therapy provided to hospitalised patients is needed.

Trial registration number

UMIN000033568
Population ageing and injurious falls among one million elderly people who used emergency medical services from 2010 to 2017 in Beijing, China: a longitudinal observational study
Authors: Zhao Siyu , Cao Yu , Lei Yanni , Liu Fangchao , Shao Shiyu , Liu Jue , Nie Dongni , Yang Nannan , Liu Min
Published: June 2019

Objectives

To access the epidemiological characteristics of elderly people using emergency medical services (EMS) in Beijing, as a consequence of injurious falls, and the association between an ageing population and injurious falls.

Design

A longitudinal observational study based on Beijing EMS data.

Setting

All citizens aged 60 years or above who used EMS from 2010 to 2017 in Beijing, China.

Participants

During 2010 to 2017, 2516 128 people used EMS in Beijing. Of these, 1528 938 people aged under 60 years were excluded and the remaining 987 190 people were included in our study.

Methods

Data were from the emergency dispatch database of Beijing’s Emergency Medical Centre. We described the proportion of elderly people using EMS in Beijing due to injurious falls with regard to region, time, sex, age and proportion of the elderly population.

Results

Among the 987 190 participants who used EMS, 82 694 (8.38%) had had a fall. The proportion of falls rose from 7.12% in 2010 to 9.45% in 2017, and was higher in urban (8.62%) than in suburban (7.80%) regions. Elderly people were more likely to use EMS due to injurious falls during September to November (8.99%) than during December to February (7.68%) (adjusted OR (aOR)=1.19), and during 08:00 to 09:59 (10.02%) than during 00:00 to 01:59 (4.11%) (aOR=2.52). Elderly people in districts with high (8.92%, aOR=1.15) and medium (8.23%, aOR=1.09) proportions of an elderly population were more likely to use EMS due to injurious falls than those in districts with a low proportion of elderly population (7.81%).

Conclusions

In Beijing, the proportion of elderly people using EMS due to injurious falls increased with age, and was positively correlated with the proportion of the elderly population. Taking care of elderly people and preventing injurious falls should be one of the key issues to be handled in a society with an ageing population.