bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of overweight and obesity in low back disorders among men: a longitudinal study with a life course approach
Authors: Frilander Heikki , Solovieva Svetlana , Mutanen Pertti , Pihlajamäki Harri , Heliövaara Markku , Viikari-Juntura Eira
Published: August 2015

Objectives

To assess the association between being overweight or obese with low back pain (LBP) and clinically defined low back disorders across the life course.

Design

A longitudinal and cross-sectional study.

Setting

A nationwide health survey supplemented with data from records of prior compulsory military service.

Participants

Premilitary health records (baseline) were searched for men aged 30–50 years (n=1385) who participated in a national health examination survey (follow-up).

Methods and outcome measures

Height and weight were measured at baseline and follow-up, and waist circumference at follow-up. Weight at the ages of 20, 30, 40 and 50 years were ascertained, when applicable. Repeated measures of weight were used to calculate age-standardised mean body mass index (BMI) across the life course. The symptom-based outcome measures at follow-up included prevalence of non-specific and radiating LBP during the previous 30 days. The clinically defined outcome measures included chronic low back syndrome and sciatica.

Results

Baseline BMI (20 years) predicted radiating LBP in adulthood, with the prevalence ratio (PR) being 1.26 (95% CI 1.08 to 1.46) for one SD (3.0 kg/m2) increase in BMI. Life course BMI was associated with radiating LBP (PR=1.23; 95% CI 1.03 to 1.48 per 1 unit increment in Z score, corresponding to 2.9 kg/m2). The development of obesity during follow-up increased the risk of radiating LBP (PR=1.91, 95% CI 1.03 to 3.53). Both general and abdominal obesity (defined as waist-to-height ratio) were associated with radiating LBP (OR=1.64, 95% CI 1.02 to 2.65 and 1.44, 95% CI 1.02 to 2.04). No associations were seen for non-specific LBP.

Conclusions

Our findings imply that being overweight or obese in early adulthood as well as during the life course increases the risk of radiating but not non-specific LBP among men. Taking into account the current global obesity epidemic, emphasis should be placed on preventive measures starting at youth and, also, measures for preventing further weight gain during the life course should be implemented.
Remote ischaemic conditioning on recipients of deceased renal transplants, effect on immediate and extended kidney graft function: a multicentre, randomised controlled trial protocol (CONTEXT)
Authors: Krogstrup Nicoline V , Oltean Mihai , Bibby Bo M , Nieuwenhuijs-Moeke Gertrude J , Dor Frank J M F , Birn Henrik , Jespersen Bente
Published: August 2015

Introduction

Delayed graft function due to ischaemia-reperfusion injury is a frequent complication in deceased donor renal transplantation. Experimental evidence indicates that remote ischaemic conditioning (RIC) provides systemic protection against ischaemia-reperfusion injury in various tissues.

Methods and analysis

‘Remote ischaemic conditioning in renal transplantation—effect on immediate and extended kidney graft function’ (the CONTEXT study) is an investigator initiated, multicentre, randomised controlled trial investigating whether RIC of the leg of the recipient improves short and long-term graft function following deceased donor kidney transplantation. The study will include 200 kidney transplant recipients of organ donation after brain death and 20 kidney transplant recipients of organ donation after circulatory death. Participants are randomised in a 1:1 design to RIC or sham-RIC (control). RIC consists of four cycles of 5 min occlusion of the thigh by a tourniquet inflated to 250 mm Hg, separated by 5 min of deflation. Primary end point is the time to a 50% reduction from the baseline plasma creatinine, estimated from the changes of plasma creatinine values 30 days post-transplant or 30 days after the last performed dialysis post-transplant. Secondary end points are: need of dialysis post-transplant, measured and estimated-glomerular filtration rate (GFR) at 3 and 12 months after transplantation, patient and renal graft survival, number of rejection episodes in the first year, and changes in biomarkers of acute kidney injury and inflammation in plasma, urine and graft tissue.

Ethics and dissemination

The study is approved by the local ethical committees and national data security agencies. Results are expected to be published in 2016.

Trial registration number

NCT01395719.
RITPBC: B-cell depleting therapy (rituximab) as a treatment for fatigue in primary biliary cirrhosis: study protocol for a randomised controlled trial
Authors: Jopson Laura , Newton Julia L , Palmer Jeremy , Floudas Achilleas , Isaacs John , Qian Jessica , Wilkinson Jennifer , Trenell Mike , Blamire Andrew , Howel Denise , Jones David E
Published: August 2015

Introduction

Primary biliary cirrhosis (PBC) is an autoimmune liver disease with approximately 50% of patients experiencing fatigue. This can be a particularly debilitating symptom, affecting quality of life and resulting in social isolation. Fatigue is highlighted by patients as a priority for research and patient support groups were involved in designing this trial. This is the first randomised controlled trial to investigate a treatment for fatigue in PBC. The trial protocol is innovative as it utilises novel magnetic resonance spectroscopy (MRS) techniques as an outcome measure. The protocol will be valuable to research groups planning clinical trials targeting fatigue in PBC and also transferrable to other conditions associated with fatigue.

Methods and analysis

RITPBC is a Medical Research Council (MRC) and National Institute for Health Research (NIHR) Efficacy and Mechanism Evaluation Programme (EME)-funded project. It is a phase II, single-centre, randomised controlled, double-blinded trial comparing rituximab with placebo in fatigued PBC patients. 78 patients with PBC and moderate to severe fatigue will be randomised to receive two infusions of rituximab or placebo. The study aims to assess whether rituximab improves fatigue in patients with PBC, the safety, and tolerability of rituximab in PBC and the sustainability of any beneficial actions. The primary outcome will be an improvement in fatigue domain score of the PBC-40, a disease-specific quality of life measure, evaluated at 12-week assessment. Secondary outcome measures include novel MRS techniques assessing muscle bioenergetic function, physical activity, anaerobic threshold and symptom, and quality of life measures. The trial started recruiting in October 2012 and recruitment is ongoing.

Ethics and dissemination

The trial has ethical approval from the NRES Committee North East, has Clinical Trial Authorisation from MHRA and local R&D approval. Trial results will be communicated to participants, presented at national and international meetings and published in peer-reviewed journals.

Trial registration number

ISRCTN03978701.
Association between lymphocyte-to-monocyte ratio (LMR) and the mortality of HBV-related liver cirrhosis: a retrospective cohort study
Authors: Zhang Jie , Feng Guofang , Zhao Ying , Zhang Juanwen , Feng Limin , Yang Jing
Published: August 2015

Objective

Infection with hepatitis B virus (HBV) remains a major cause of liver cirrhosis (LC) in China. Recent reports suggest that the lymphocyte-to-monocyte ratio (LMR) is a potential biomarker for predicting clinical outcomes. In our study, we investigated if LMR can be used as a prognostic marker of mortality in patients with HBV-related LC.

Design

A retrospective cohort study.

Setting

HBV-infected patients with LC and patients with chronic hepatitis B infection (CHB) from the Department of Infectious Disease were enrolled and 240 healthy individuals were recruited from the healthcare centre at the First Affiliated Hospital of Zhejiang University.

Participants

479 HBV-infected patients with LC, 134 patients with CHB and 240 healthy individuals were enrolled.

Primary and secondary outcome measures

The receiver operating characteristic (ROC) curve and multivariable logistic regression analysis after adjusting for total protein, albumin, total bilirubin and the model for end-stage liver disease (MELD) score were used to evaluate the power of LMR for predicting 1 year mortality in patients with LC.

Results

The LMR was statistically lower in patients with LC. The MELD score and mortality were statistically higher in patients with LC compared with the CHB and control groups. The area under the ROC curve, cut-off values, sensitivity and specificity of LMR for predicting mortality LC in the training cohort were 0.817 (95% CI 0.746 to 0.888; p<0.001), 2.10, 82.6 and 78.8%, and these data were confirmed in the validation cohort. The multivariate logistic regression analysis showed that LMR was an independent predictive factor of mortality in LC (OR 2.370, 95% CI (1.070 to 5.249); p=0.033).

Conclusions

Our results strongly suggest that low LMR can be considered as an independent biomarker for predicting mortality in patients with LC.
Data linkage errors in hospital administrative data when applying a pseudonymisation algorithm to paediatric intensive care records
Authors: Hagger-Johnson Gareth , Harron Katie , Fleming Tom , Gilbert Ruth , Goldstein Harvey , Landy Rebecca , Parslow Roger C
Published: August 2015

Objectives

Our aim was to estimate the rate of data linkage error in Hospital Episode Statistics (HES) by testing the HESID pseudoanonymisation algorithm against a reference standard, in a national registry of paediatric intensive care records.

Setting

The Paediatric Intensive Care Audit Network (PICANet) database, covering 33 paediatric intensive care units in England, Scotland and Wales.

Participants

Data from infants and young people aged 0–19 years admitted between 1 January 2004 and 21 February 2014.

Primary and secondary outcome measures

PICANet admission records were classified as matches (records belonging to the same patient who had been readmitted) or non-matches (records belonging to different patients) after applying the HESID algorithm to PICANet records. False-match and missed-match rates were calculated by comparing results of the HESID algorithm with the reference standard PICANet ID. The effect of linkage errors on readmission rate was evaluated.

Results

Of 166 406 admissions, 88 596 were true matches (where the same patient had been readmitted). The HESID pseudonymisation algorithm produced few false matches (n=176/77 810; 0.2%) but a larger proportion of missed matches (n=3609/88 596; 4.1%). The true readmission rate was underestimated by 3.8% due to linkage errors. Patients who were younger, male, from Asian/Black/Other ethnic groups (vs White) were more likely to experience a false match. Missed matches were more common for younger patients, for Asian/Black/Other ethnic groups (vs White) and for patients whose records had missing data.

Conclusions

The deterministic algorithm used to link all episodes of hospital care for the same patient in England has a high missed match rate which underestimates the true readmission rate and will produce biased analyses. To reduce linkage error, pseudoanonymisation algorithms need to be validated against good quality reference standards. Pseudonymisation of data ‘at source’ does not itself address errors in patient identifiers and the impact these errors have on data linkage.
Accessing primary care Big Data: the development of a software algorithm to explore the rich content of consultation records
Authors: MacRae J , Darlow B , McBain L , Jones O , Stubbe M , Turner N , Dowell A
Published: August 2015

Objective

To develop a natural language processing software inference algorithm to classify the content of primary care consultations using electronic health record Big Data and subsequently test the algorithm's ability to estimate the prevalence and burden of childhood respiratory illness in primary care.

Design

Algorithm development and validation study. To classify consultations, the algorithm is designed to interrogate clinical narrative entered as free text, diagnostic (Read) codes created and medications prescribed on the day of the consultation.

Setting

Thirty-six consenting primary care practices from a mixed urban and semirural region of New Zealand. Three independent sets of 1200 child consultation records were randomly extracted from a data set of all general practitioner consultations in participating practices between 1 January 2008–31 December 2013 for children under 18 years of age (n=754 242). Each consultation record within these sets was independently classified by two expert clinicians as respiratory or non-respiratory, and subclassified according to respiratory diagnostic categories to create three ‘gold standard’ sets of classified records. These three gold standard record sets were used to train, test and validate the algorithm.

Outcome measures

Sensitivity, specificity, positive predictive value andF-measure were calculated to illustrate the algorithm's ability to replicate judgements of expert clinicians within the 1200 record gold standard validation set.

Results

The algorithm was able to identify respiratory consultations in the 1200 record validation set with a sensitivity of 0.72 (95% CI 0.67 to 0.78) and a specificity of 0.95 (95% CI 0.93 to 0.98). The positive predictive value of algorithm respiratory classification was 0.93 (95% CI 0.89 to 0.97). The positive predictive value of the algorithm classifying consultations as being related to specific respiratory diagnostic categories ranged from 0.68 (95% CI 0.40 to 1.00; other respiratory conditions) to 0.91 (95% CI 0.79 to 1.00; throat infections).

Conclusions

A software inference algorithm that uses primary care Big Data can accurately classify the content of clinical consultations. This algorithm will enable accurate estimation of the prevalence of childhood respiratory illness in primary care and resultant service utilisation. The methodology can also be applied to other areas of clinical care.
Trends and risk factors for HIV, HCV and syphilis seroconversion among drug users in a methadone maintenance treatment programme in China: a 7-year retrospective cohort study
Authors: Zou Xia , Ling Li , Zhang Lei
Published: August 2015

Objective

This study explores the trends and associated factors of HIV, hepatitis C virus (HCV) and syphilis seroconversion among Chinese methadone maintenance treatment (MMT) clients over a follow-up period of up to 7 years.

Design

Drug users from 14 MMT clinics in Guangdong Province were recruited during 2006–2014. Participants were seronegative with at least one HIV, HCV or syphilis infection at baseline and had completed at least one follow-up test during the study period. We estimated HIV, HCV and syphilis seroconversion rates in follow-up years and identified the underlying predictors using a multivariate Cox regression model.

Results

Among 9240 participants, the overall HIV seroconversion rate was 0.20 (0.13 to 0.28)/100 person-years (pys), 20.54 (18.62 to 22.46)/100 pys for HCV and 0.77 (0.62 to 0.93)/100 pys for syphilis, over the study period. HIV seroconversion rate showed a moderate but non-significant annual decline of 13.34% (−42.48% to 30.56%) (χ2trend test; p=0.369), whereas the decline of HCV seroconversion was 16.12% (5.53% to 25.52%) per annum (p<0.001). Syphilis seroconversion rate remained stable (p=0.540). Urine results positive for opioid predicted HIV seroconversion (≥60% vs <60%; HR=3.40, 1.07 to 10.85), being unmarried (HR=1.59, 1.15 to 2.20), injection drug use in the past 30 days (HR=2.17, 1.42 to 3.32), having sexual intercourse in the past 3 months (HR=1.74, 1.22 to 2.47) and higher daily dosage of methadone (≥60 mL vs <60 mL; HR=1.40, 1.01 to 1.94) predicted HCV seroconversion. Being female (HR=3.56, 2.25 to 5.64) and infected with HCV at baseline (HR=2.40, 1.38 to 8.36) were associated with subsequent syphilis seroconversion.

Conclusions

MMT in China has demonstrated moderate-to-good effectiveness in reducing HIV and HCV incidence but not syphilis infection among participating drug users.
Perceptions of healthcare professionals and managers regarding the effectiveness of GP-led walk-in centres in the UK
Authors: Arain Mubashir , Baxter Susan , Nicholl Jon P
Published: August 2015

Objectives

This study aimed to identify the perceptions of healthcare professionals regarding the effectiveness and the impact of a new general practitioner-led (GP-led) walk-in centre in the UK.

Setting

This qualitative study was conducted in a large city in the North of England. In the past few years, there has been particular concern about an increase in the use of emergency department (ED) services provided by the National Health Service and part of the rationale for introducing the new GP-led walk-in centres has been to stem this increase. The five institutes included in the study were EDs, a minor injuries unit, a primary care trust, a GP-led walk-in centre and GP surgeries.

Participants

Semistructured interviews were conducted with healthcare providers at an adult ED, an ED at a children's hospital, a minor injuries unit, a GP-led walk-in centre, GPs from surrounding surgeries and GPs.

Results

11 healthcare professionals and managers were interviewed. Seven key themes were identified within the data: the clinical model of the GP-led walk-in centre; public awareness of the services; appropriate use of the centre; the impact of the centre on other services; demand for healthcare services; choice and confusion and mixed views (positive and negative) of the walk-in services. There were discrepancies between the managers and healthcare professionals regarding the usefulness of the GP-led walk-in centre in the current urgent care system.

Conclusions

Participants did not notice declines in the demand for EDs after the GP-led walk-in centre. Most of the healthcare professionals believed that the GP-led walk-in centre duplicated existing healthcare services. There is a need to have a better communication system between the GP-led walk-in centres and other healthcare providers to have an integrated system of urgent care delivery.
The long-term effect of minimalist shoes on running performance and injury: design of a randomised controlled trial
Authors: Fuller Joel T , Thewlis Dominic , Tsiros Margarita D , Brown Nicholas A T , Buckley Jonathan D
Published: August 2015

Introduction

The outcome of the effects of transitioning to minimalist running shoes is a topic of interest for runners and scientists. However, few studies have investigated the longer term effects of running in minimalist shoes. The purpose of this randomised controlled trial (RCT) is to investigate the effects of a 26 week transition to minimalist shoes on running performance and injury risk in trained runners unaccustomed to minimalist footwear.

Methods and analysis

A randomised parallel intervention design will be used. Seventy-six trained male runners will be recruited. To be eligible, runners must be aged 18–40 years, run with a habitual rearfoot footfall pattern, train with conventional shoes and have no prior experience with minimalist shoes. Runners will complete a standardised transition to either minimalist or control shoes and undergo assessments at baseline, 6 and 26 weeks. 5 km time-trial performance (5TT), running economy, running biomechanics, triceps surae muscle strength and lower limb bone mineral density will be assessed at each time point. Pain and injury will be recorded weekly. Training will be standardised during the first 6 weeks. Primary statistical analysis will compare 5TT between shoe groups at the 6-week time point and injury incidence across the entire 26-week study period.

Ethics and dissemination

This RCT has been approved by the Human Research Ethics Committee of the University of South Australia. Participants will be required to provide their written informed consent prior to participation in the study. Study findings will be disseminated in the form of journal publications and conference presentations after completion of planned data analysis.

Trial registration number

This RCT has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613000642785).
Aortic dissection in pregnancy in England: an incidence study using linked national databases
Authors: Banerjee Amitava , Begaj Irena , Thorne Sara
Published: August 2015

Objectives

To conduct the first population-level incidence study of aortic dissection in pregnancy using linked hospital-based data in England.

Setting

Hospital-based data (Hospital Episode Statistics (HES) linked with mortality data from the Office of National Statistics), national enquiries (Confidential Enquiries into Maternal Mortality) and surveys (UK Obstetric Surveillance System; UKOSS) of aortic dissection in pregnancy from 2003 to 2011 in England.

Participants

Between 2003 and 2011, all female patients admitted with diagnoses of aortic dissection (not necessarily as the primary cause of admission) and of pregnancy, childbirth and puerperium, were included.

Outcome measures

Diagnosis of aortic dissection during pregnancy, operated or not operated, with outcome of death or live patient from 2003 to 2011 in England.

Results

There were significant differences in characteristics of databases with respect to study population, time of study, recorded event and follow-up of outcomes. On the basis of HES, annual incidence of aortic dissection was 1.23 (95% CI 1.22 to 1.24) per 100 000 maternities. Incidence of aortic dissection with death within 1 year was 0.30 (0.29 to 0.31) per 100 000 maternities. Incidence of aortic dissection increased from 0.74 (0.73 to 0.75) per 100 000 maternities in 2003–2005 to 1.52 (1.51 to 1.53) per 100 000 maternities in 2009–2011. In the Confidential Enquiries into Maternal Deaths, incidence of deaths was highest for 2003–2005 (0.43/100 000 maternities) and lowest for 1997–1999 (0.21/100 000 maternities). In the UK Obstetric Surveillance System, national incidence of aortic dissection was 0.80 (0.50 to 1.50) per 100 000 maternities between 2009 and 2011.

Conclusions

The case of aortic dissection in pregnancy illustrates data limitations regarding complications in pregnancy from different sources in the UK, even for a diagnosis with seemingly few alternative coding and diagnostic possibilities. These limitations should be acknowledged when estimating incidence and outcome.
Combined exercise and transcranial direct current stimulation intervention for knee osteoarthritis: protocol for a pilot randomised controlled trial
Authors: Chang Wei-Ju , Bennell Kim L , Hodges Paul W , Hinman Rana S , Liston Matthew B , Schabrun Siobhan M
Published: August 2015

Introduction

Osteoarthritis (OA) is a major health problem and a leading cause of disability. The knee joint is commonly affected, resulting in pain and physical dysfunction. Exercise is considered the cornerstone of conservative management, yet meta-analyses indicate, at best, moderate effect sizes. Treatments that bolster the effects of exercise, such as transcranial direct current stimulation (tDCS), may improve outcomes in knee OA. The aims of this pilot study are to (1) determine the feasibility, safety and perceived patient response to a combined tDCS and exercise intervention in knee OA, and (2) provide data to support a sample size calculation for a fully-powered trial should trends of effectiveness be present.

Methods and analysis

A pilot randomised, assessor-blind and participant-blind, sham-controlled trial. 20 individuals with knee OA who report a pain score of 40 or more on a 100 mm visual analogue scale on walking, and meet a priori selection criteria will be randomly allocated to receive either: (1) active tDCS plus exercise, or (2) sham tDCS plus exercise. All participants will receive 20 min of either active or sham tDCS immediately prior to 30 min of supervised muscle strengthening exercise twice a week for 8 weeks. Participants in both groups will also complete unsupervised home exercises twice per week. Outcome measures of feasibility, safety, pain, disability and pain system function will be assessed immediately before and after the 8-week intervention. Analyses of feasibility and safety will be performed using descriptive statistics. Statistical analyses will be used to determine trends of effectiveness and will be based on intention-to-treat as well as per protocol.

Ethics and dissemination

This study was approved by the institutional ethics committee (H10184). Written informed consent will be obtained from all participants. The results of this study will be submitted for peer-reviewed publication.

Trial registration number

ANZCTR365331.
Characteristics of women who practice yoga in different locations during pregnancy
Authors: Cramer Holger , Frawley Jane , Steel Amie , Hall Helen , Adams Jon , Broom Alex , Sibbritt David
Published: August 2015

Objectives

Yoga practice during pregnancy is gaining increasing popularity. This study examined the characteristics of pregnant women who practiced yoga in regard to the different locations (at home, in yoga classes, or both).

Design

The study sample was drawn from the Australian Longitudinal Study on Women's Health (ALSWH), a national longitudinal study of women to investigate multiple factors affecting health and well-being of women over a 20-year period.

Setting

Postal survey.

Participants

Women born between 1973 and 1978, who were randomly selected from the national Medicare database and identified as being pregnant or having recently given birth (n=2316).

Outcome measures

Relationships between yoga use (attending yoga classes and/or practising yoga at home) and women's characteristics (demographic measures, pregnancy-related health concerns, health service utilisation, attitudes to complementary and alternative medicine).

Results

Practising yoga both at home and in classes was associated with perceiving complementary and alternative medicine (CAM) as preventative (odds ratio (OR)=1.62); perceiving CAM as affording health control (OR=1.50); experiencing sadness (OR=1.72); preparing for labour (OR=2.31); birthing in a birth centre (OR=7.97); and experiencing less vomiting (OR=0.38). Practising at home only was associated with perceiving CAM as affording health control (OR=1.76); perceiving CAM as promoting a holistic health approach (OR=1.65); and birthing in a birth centre (OR=3.54). Practising in classes only was associated with experiencing stress (OR=1.97); and birthing in a birth centre (OR=4.85) (all p<0.05).

Conclusions

The findings suggest that the location in which a woman practices yoga is associated with attitudinal, health-related and birth environmental factors.
Community IntraVenous Antibiotic Study (CIVAS): protocol for an evaluation of patient preferences for and cost-effectiveness of community intravenous antibiotic services
Authors: Czoski Murray C , Twiddy M , Meads D , Hess S , Wright J , Mitchell E D , Hulme C , Dodd S , Gent H , Gregson A , McLintock K , Raynor D K , Reynard K , Stanley P , Vincent R , Minton J
Published: August 2015

Introduction

Outpatient parenteral antimicrobial therapy (OPAT) is used to treat a wide range of infections, and is common practice in countries such as the USA and Australia. In the UK, national guidelines (standards of care) for OPAT services have been developed to act as a benchmark for clinical monitoring and quality. However, the availability of OPAT services in the UK is still patchy and until quite recently was available only in specialist centres. Over time, National Health Service (NHS) Trusts have developed OPAT services in response to local needs, which has resulted in different service configurations and models of care. However, there has been no robust examination comparing the cost-effectiveness of each service type, or any systematic examination of patient preferences for services on which to base any business case decision.

Methods and analysis

The study will use a mixed methods approach, to evaluate patient preferences for and the cost-effectiveness of OPAT service models. The study includes seven NHS Trusts located in four counties. There are five inter-related work packages: a systematic review of the published research on the safety, efficacy and cost-effectiveness of intravenous antibiotic delivery services; a qualitative study to explore existing OPAT services and perceived barriers to future development; an economic model to estimate the comparative value of four different community intravenous antibiotic services; a discrete choice experiment to assess patient preferences for services, and an expert panel to agree which service models may constitute the optimal service model(s) of community intravenous antibiotics delivery.

Ethics and dissemination

The study has been approved by the NRES Committee, South West—Frenchay using the Proportionate Review Service (ref 13/SW/0060). The results of the study will be disseminated at national and international conferences, and in international journals.
Strengthening the afferent limb of rapid response systems: an educational intervention using web-based learning for early recognition and responding to deteriorating patients
Authors: Liaw Sok Ying , Wong Lai Fun , Ang Sophia Bee Leng , Ho Jasmine Tze Yin , Siau Chiang , Ang Emily Neo Kim
Published: August 2015

Background

The timely recognition and response to patients with clinical deteriorations constitute the afferent limb failure of a rapid response system (RRS). This area is a persistent problem in acute healthcare settings worldwide. In this study, we evaluated the effect of an educational programme on improving the nurses’ knowledge and performances in recognising and responding to clinical deterioration.

Method

The interactive web-based programme addressed three areas: (1) early detection of changes in vital signs; (2) performance of nursing assessment and interventions using airway, breathing, circulation, disability and expose/examine and (3) reporting clinical deterioration using identity, situation, background, assessment and recommendation. Sixty-seven registered nurses participated in the randomised control study. The experimental group underwent a 3 h programme while the control group received no intervention. Pretests and post-tests, a mannequin-based assessment and a multiple-choice knowledge questionnaire were conducted. We evaluated the participants’ performances in assessing, managing and reporting the deterioration of a patient using a validated performance tool.

Results

A significantly higher number of nurses from the experimental group than the control group monitored respiratory rates (48.2% vs 25%, p<0.05) and pulse rates (74.3% vs 37.5%, p<0.01) in the simulated environment, after the intervention. The post-test mean scores of the experimental group was significantly higher than the control group for knowledge (21.29 vs 18.28, p<0.001), performance in assessing and managing clinical deterioration (25.83 vs 19.50, p<0.001) and reporting clinical deterioration (12.83 vs 10.97, p<0.001).

Conclusions

A web-based educational programme developed for hospital nurses to strengthen the afferent limb of the RRS significantly increased their knowledge and performances in assessing, managing and reporting clinical deterioration.
The impact of intervening in green space in Dutch deprived neighbourhoods on physical activity and general health: results from the quasi-experimental URBAN40 study
Authors: Droomers Mariël , Jongeneel-Grimen Birthe , Kramer Daniëlle , de Vries Sjerp , Kremers Stef , Bruggink Jan-Willem , van Oers Hans , Kunst Anton E , Stronks Karien
Published: August 2015

Background

Many problems concentrate in deprived neighbourhoods, among which is poor health. One possible way to address these health problems is to invest in the green space in deprived neighbourhoods. The number of evaluations of the public health impact of actual changes in neighbourhood green space is still limited. This study investigated the impact of real-life changes in the quality or quantity of green space in severely deprived neighbourhoods on physical activity and perceived general health.

Methods

Repeated cross-sectional surveys from 2004 till 2011 yielded self-reported information on leisure time walking, cycling and sports, and perceived general health of 48 132 adult residents. We fitted generalised mixed models to assess the rate of change per half year, estimate the linear trend, and the change in trends before and after the start of the urban regeneration mid-2008. Using a quasi-experimental design, we compared the trends in the intervention neighbourhoods with different selections of control areas.

Results

The deprived neighbourhoods that intervened in green space did not show more favourable changes in the trend of physical activity and good general health compared to all the different groups of control areas.

Conclusions

We did not observe short-term positive effects on physical activity and general health among adults from improvements in green space in deprived neighbourhoods. This suggests that greening interventions that have been carried out in the context of the Dutch District Approach did not achieve short-term health gains among adults.
Platelet reactivity and hemorrhage risk in neurointerventional procedures under dual antiplatelet therapy
Authors: Nishi Hidehisa , Nakahara Ichiro , Matsumoto Shoji , Hashimoto Tetsuya , Ohta Tsuyoshi , Sadamasa Nobutake , Ishibashi Ryota , Gomi Masanori , Saka Makoto , Miyata Haruka , Watanabe Sadayoshi , Okata Takuya , Sonoda Kazutaka , Kouge Junpei , Ishii Akira , Nagata Izumi , Kira Jun-ichi
Published: August 2015

Background and purpose

Hemorrhagic complications during neurointerventional procedures have various etiologies and can result in severe morbidity and mortality. This study investigated the possible association between low platelet reactivity measured by the VerifyNow assay and increased hemorrhagic complications during elective neurointervention under dual antiplatelet therapy.

Methods

From May 2010 to April 2013 we recorded baseline characteristics, P2Y12 reaction units (PRU), and aspirin reaction units using VerifyNow. The primary endpoint was post-procedural hemorrhagic complications.

Results

A total of 279 patients were enrolled and 31 major hemorrhagic complications (11.1%) were identified. From receiver-operating characteristic curve analysis, PRU values could discriminate between patients with and without major hemorrhagic complications (area under the curve 0.63). Aspirin reaction unit values had no association with the primary outcome. The optimal cut-off for the primary outcome (PRU ≤175) was used to identify the low platelet reactivity group. The incidence of hemorrhagic complications was 20.0% in this group and 8.9% in the non-low platelet reactivity group. Multivariate analysis identified low platelet reactivity as an independent predictor for hemorrhagic complications.

Conclusions

The risk of hemorrhagic complications during elective neurointervention including cerebral aneurysm coil embolization and carotid artery stenting under dual antiplatelet therapy is associated with the response to clopidogrel but not to aspirin. A PRU value of ≤175 discriminates between patients with and without hemorrhagic complications. Future prospective studies are required to validate whether a specific PRU value around 170–180 is predictive of hemorrhagic complications.
The value of aspartate aminotransferase and alanine aminotransferase in cardiovascular disease risk assessment
Authors: Weng Stephen F , Kai Joe , Guha Indra Neil , Qureshi Nadeem
Published: August 2015

Objective

Aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio, reflecting liver disease severity, has been associated with increased risk of cardiovascular disease (CVD). The aim of this study was to evaluate whether the AST/ALT ratio improves established risk prediction tools in a primary care population.

Methods

Data were analysed from a prospective cohort of 29 316 UK primary care patients, aged 25–84 years with no history of CVD at baseline. Cox proportional hazards regression was used to derive 10-year multivariate risk models for the first occurrence of CVD based on two established risk prediction tools (Framingham and QRISK2), with and without including the AST/ALT ratio. Overall, model performance was assessed by discriminatory accuracy (AUC c-statistic).

Results

During a total follow-up of 120 462 person-years, 782 patients (59% men) experienced their first CVD event. Multivariate models showed that elevated AST/ALT ratios were significantly associated with CVD in men (Framingham: HR 1.37, 95% CI 1.05 to 1.79; QRISK2: HR 1.40, 95% CI 1.04 to 1.89) but not in women (Framingham: HR 1.06, 95% CI 0.78 to 1.43; QRISK2: HR 0.97, 95% CI 0.70 to 1.35). Including the AST/ALT ratio with all Framingham risk factors (AUC c-statistic: 0.72, 95% CI 0.71 to 0.74) or QRISK2 risk factors (AUC c-statistic: 0.73, 95% CI 0.71 to 0.74) resulted in no change in discrimination from the established risk prediction tools. Limiting analysis to those individuals with raised ALT showed that discrimination could improve by 5% and 4% with Framingham and QRISK2 risk factors, respectively.

Conclusions

Elevated AST/ALT ratio is significantly associated with increased risk of developing CVD in men but not women. However, the ratio does not confer any additional benefits over established CVD risk prediction tools in the general population, but may have clinical utility in certain subgroups.
Atherosclerotic aortic aneurysm in a steppe eagle (Aquila nipalensis)
Authors: Abou‐Zahr Tariq , Dutton Thomas Anthony George , Calvo Carrasco Daniel , Forbes Neil , Stidworthy Mark Frederick
Published: August 2015

A 23‐year‐old female imprinted steppe eagle (Aquila nipalensis) was presented by a public falconry centre for postmortem examination following sudden death with no previous clinical signs. Postmortem examination revealed the presence of 150 ml of blood within the coelomic cavity, with a packed cell volume of 42% indicating an acute, internal haemorrhage as a presumptive cause of death. A well‐demarcated, solid, hard, ovoid, approximately 3 cm×2 cm (in cross section) mass was discovered within the body of the aorta adjacent to the ovary. Histological examination confirmed this to be an aortic aneurysm underlain by severe atherosclerosis with a transmural rupture.
A fungal reproductive unit from the Lower Devonian Rhynie chert (Aberdeenshire, Scotland) that demonstrates an unusual hyphal investment pattern
Authors: Krings Michael , Taylor Thomas N.
Published: August 2015

The Early Devonian Rhynie chert has yielded the oldest evidence of hyphal investments (= mantles) in fungal reproductive units, with four different investment morphologies documented to date. This paper describes an unusual fungal reproductive unit from the Rhynie chert that is spheroid–elongate in outline, up to 60 μm in diameter, and consists of a thin-walled central cavity enveloped in a plectenchymatous or pseudoparenchymatous investment of tightly abutting, interwoven hyphae; pores extend through the investment. Several specimens contain a single spherical structure in the cavity. Because the structure of the investment differs from that seen in all other fossil fungal reproductive units, the new genus
Scepasmatocarpion
and species
S. fenestrulatum
are proposed for the new form. The systematic affinities of
S. fenestrulatum
remain unresolved. Nevertheless, the fossils support the hypothesis that the diversity of the fungi that produced hyphal envelopes was extensive by the Early Devonian.
The FQP Vision
Authors: Najafi Mohammadreza , Sadoghi Mohammad , Jacobsen Hans-Arno
Published: August 2015

The Flexible Query Processor (FQP) constitutes a family of hardware-based data stream processors that support dynamic changes to queries and streams, as well as static changes to the processor-internal fabric in order to maximize performance for given workloads. FQP is prototyped on field-programmable gate arrays (FPGAs). To this end, FQP supports select, project and window-join queries over data streams. While processing incoming tuples, FQP can accept new queries, a key characteristic distinguishing FQP from related approaches employing FPGAs for stream processing. In this paper, we present our vision of FQP, focusing on few internal details to support the flexibility dimension, in particular, the segment-at-a-time mechanism to realize processing of tuples of variable sizes. While many of these features are readily available in software, their hardware-based realizations have been one of the main shortcomings of existing research efforts
Instant recovery for data center savings
Authors: Graefe Goetz
Published: August 2015

Today's data centers routinely employ triple redundancy, i.e., each disk page of a database or of a key value store is stored three times (or even more, e.g., in database and file system backups). In contrast, writeahead logging can reduce the cost of database operations and of data centers, assuming suitable techniques for logging, log archiving, backing up, and recovery. The present paper summarizes our work todate on single-page repair, instant restart, and instant restore; it describes our techniques for self-repairing indexes, single-pass restore, and virtual backups; and outlines the opportunities for single-copy databases, for avoidance of ever taking a backup (full or incremental), yet for availability and reliability matching today's double- or triple-redundant data centers
Manipulation of KCNE2 expression modulates action potential duration and Ito and IK in rat and mouse ventricular myocytes
Authors: Liu Wen-juan , Deng Jian-xin , Wang Gang , Gao Kai-ping , Lin Ze-xun , Liu Shuai-ye , Wang Yong-hui , Liu Jie
Published: August 2015

In heterologous expression systems, KCNE2 has been demonstrated to interact with multiple α-subunits of voltage-dependent cation channels and modulate their functions. However, the physiological and pathological roles of KCNE2 in cardiomyocytes are poorly understood. The present study aimed to investigate the effects of bidirectional modulation of KCNE2 expression on action potential (AP) duration (APD) and voltage-dependent K+ channels in cardiomyocytes. Adenoviral gene delivery and RNA interference were used to either increase or decrease KCNE2 expression in cultured neonatal and adult rat or neonatal mouse ventricular myocytes. Knockdown of KCNE2 prolonged APD in both neonatal and adult myocytes, whereas overexpression of KCNE2 shortened APD in neonatal but not adult myocytes. Consistent with the alterations in APD, KCNE2 knockdown decreased transient outward K+ current ( Ito) densities in neonatal and adult myocytes, whereas KCNE2 overexpression increased Ito densities in neonatal but not adult myocytes. Furthermore, KCNE2 knockdown accelerated the rates of Ito activation and inactivation, whereas KCNE2 overexpression slowed Ito gating kinetics in neonatal but not adult myocytes. Delayed rectifier K+ current densities were remarkably affected by manipulation of KCNE2 expression in mouse but not rat cardiomyocytes. Simulation of the AP of a rat ventricular myocyte with a mathematical model showed that alterations in Ito densities and gating properties can result in similar APD alterations in KCNE2 overexpression and knockdown cells. In conclusion, endogenous KCNE2 in cardiomyocytes is important in maintaining cardiac electrical stability mainly by regulating Ito and APD. Perturbation of KCNE2 expression may predispose the heart to ventricular arrhythmia by prolonging APD.
Small-conductance Ca2+-activated K+ current is upregulated via the phosphorylation of CaMKII in cardiac hypertrophy from spontaneously hypertensive rats
Authors: Mizukami Kazuya , Yokoshiki Hisashi , Mitsuyama Hirofumi , Watanabe Masaya , Tenma Taro , Takada Shingo , Tsutsui Hiroyuki
Published: August 2015

Left ventricular hypertrophy is associated with an increased risk of ventricular arrhythmias. However, the underlying molecular basis is poorly understood. It has been reported that small-conductance Ca2+-activated K+ (SK) channels are involved in the pathogenesis of ventricular arrhythmias in heart failure. The present study aimed to test the hypothesis that SK channel activity is increased via the Ca2+/calmodulin-dependent protein kinase II (CaMKII)-dependent pathway in hypertensive cardiac hypertrophy. Normotensive Wistar-Kyoto (WKY) rats and spontaneous hypertensive rats (SHRs) were used. Whole cell membrane currents were recorded in isolated ventricular myocytes by the patch-clamp method, and apamin-sensitive K+ current ( IKAS), which is inhibited by apamin (100 nM), an SK channel blocker, was evaluated. IKAS at 40 mV was present in SHRs, whereas it was hardly detectable in WKY rats (0.579 ± 0.046 vs. 0.022 ± 0.062 pA/pF, both n = 6, P < 0.05). IKAS was almost completely abolished by 1 μM KN-93, a CaMKII inhibitor, in SHRs. Optical recordings of left ventricular anterior wall action potentials revealed that apamin prolonged the late phase of repolarization only in SHRs. Western blot analysis of SK channel protein isoforms demonstrated that SK2 was significantly increased in SHRs compared with WKY rats (SK2/GAPDH: 0.66 ± 0.07 vs. 0.40 ± 0.02, both n = 6, P < 0.05), whereas SK1 and SK3 did not differ between groups. In addition, autophosphorylated CaMKII was significantly increased in SHRs (phosphorylated CaMKII/GAPDH: 0.80 ± 0.06 vs. 0.58 ± 0.06, both n = 6, P < 0.05) despite a comparable total amount of CaMKII between groups. In conclusion, SK channels are upregulated via the enhanced activation of CaMKII in cardiac hypertrophy in SHRs.
Identification of TGF-β receptor-1 as a key regulator of carbon nanotube-induced fibrogenesis
Authors: Mishra Anurag , Stueckle Todd A. , Mercer Robert R. , Derk Raymond , Rojanasakul Yon , Castranova Vincent , Wang Liying
Published: August 2015

Carbon nanotubes (CNTs) induce rapid interstitial lung fibrosis, but the underlying mechanisms are unclear. Previous studies indicated that the ability of CNTs to penetrate lung epithelium, enter interstitial tissue, and stimulate fibroblasts to produce collagen matrix is important to lung fibrosis. In this study, we investigated the activation of transforming growth factor-β receptor-1 [TGF-β R1; i.e., activin receptor-like kinase 5 (ALK5) receptor] and TGF-β/Smad signaling pathway in CNT-induced collagen production in human lung fibroblasts. Human lung fibroblasts and epithelial cells were exposed to low, physiologically relevant concentrations (0.02–0.6 μg/cm2) of single-walled CNTs (SWCNT) and multiwalled CNTs (MWCNT) in culture and analyzed for collagen, TGF-β1, TGF-β R1, and SMAD proteins by Western blotting and immunofluorescence. Chemical inhibition of ALK5 and short-hairpin (sh) RNA targeting of TGF-β R1 and Smad2 were used to probe the fibrogenic mechanism of CNTs. Both SWCNT and MWCNT induced an overexpression of TGF-β1, TGF-β R1 and Smad2/3 proteins in lung fibroblasts compared with vehicle or ultrafine carbon black-exposed controls. SWCNT- and MWCNT-induced collagen production was blocked by ALK5 inhibitor or shRNA knockdown of TGF-β R1 and Smad2. Our results indicate the critical role of TGF-β R1/Smad2/3 signaling in CNT-induced fibrogenesis by upregulating collagen production in lung fibroblasts. This novel finding may aid in the design of mechanism-based risk assessment and development of rapid screening tests for nanomaterial fibrogenicity.