bluuebunny/crossref_metadata_2025 huggingface dataset:
Critics assail India's attempt to ‘validate’ folk remedy
Authors: Kumar Sanjay
Published: March 2017

Some perceive an insidious effort to infuse Indian science with a Hindu worldview.
Layer-specific modulation of neocortical dendritic inhibition during active wakefulness
Authors: Muñoz William , Tremblay Robin , Levenstein Daniel , Rudy Bernardo
Published: March 2017

Layer-specific interneuron activity

Somatostatin-expressing interneurons are an important group of inhibitory neurons in the brain that target and thus control the dendrites of pyramidal cells. These interneurons have recently been shown to play a role in sensorimotor integration, reinforcement encoding, and selective attention. Muñoz
et al.
used channelrhodopsin-assisted patching to investigate the spatiotemporal pattern of neocortical dendritic inhibition in vivo. They were able to record the activity of somatostatin-expressing interneurons in all neocortical layers in behaving mice. The results provide a framework for understanding the changes in dendritic inhibition that take place in the neocortex during active behaviors. This framework is very distinct from the view obtained from previous recordings that were restricted to interneurons in the superficial layers of the neocortex.

Science
, this issue p.
954
Hidden dynamics in the unfolding of individual bacteriorhodopsin proteins
Authors: Yu Hao , Siewny Matthew G. W. , Edwards Devin T. , Sanders Aric W. , Perkins Thomas T.
Published: March 2017

Pulling apart protein unfolding

Elucidating the details of how complex proteins fold is a longstanding challenge. Key insights into the unfolding pathways of diverse proteins have come from single-molecule force spectroscopy (SMFS) experiments in which proteins are literally pulled apart. Yu
et al.
developed a SMFS technique that could unfold individual bacteriorhodopsin molecules in a native lipid bilayer with 1-µs temporal resolution (see the Perspective by Müller and Gaub). The technique delivered a 100-fold improvement over earlier studies of bacteriorhodopsin and revealed many intermediates not seen before. The authors also observed unfolding and refolding transitions between intermediate states.

Science
, this issue p.
945
; see also p.
907
B-Cell Responses to Intramuscular Administration of a Bivalent Virus-Like Particle Human Norovirus Vaccine
Authors: Ramani Sasirekha , Neill Frederick H. , Ferreira Jennifer , Treanor John J. , Frey Sharon E. , Topham David J. , Goodwin Robert R. , Borkowski Astrid , Baehner Frank , Mendelman Paul M. , Estes Mary K. , Atmar Robert L.
Published: March 2017

Human noroviruses (HuNoVs) are a leading cause of acute gastroenteritis worldwide. A virus-like particle (VLP) candidate vaccine induces the production of serum histo-blood group antigen (HBGA)-blocking antibodies, the first identified correlate of protection from HuNoV gastroenteritis. Recently, virus-specific IgG memory B cells were identified to be another potential correlate of protection against HuNoV gastroenteritis. We assessed B-cell responses following intramuscular administration of a bivalent (genogroup I, genotype 1 [GI.1]/genogroup II, genotype 4 [GII.4]) VLP vaccine using protocols identical to those used to evaluate cellular immunity following experimental GI.1 HuNoV infection. The kinetics and magnitude of cellular immunity to G1.1 infection were compared to those after VLP vaccination. Intramuscular immunization with the bivalent VLP vaccine induced the production of antibody-secreting cells (ASCs) and memory B cells. ASC responses peaked at day 7 after the first dose of vaccine and returned to nearly baseline levels by day 28. Minimal increases in ASCs were seen after a second vaccine dose at day 28. Antigen-specific IgG memory B cells persisted at day 180 postvaccination for both GI.1 and GII.4 VLPs. The overall trends in B-cell responses to vaccination were similar to the trends in the responses to infection, where there was a greater bias of an ASC response toward IgA and a memory B-cell response to IgG. The magnitude of the ASC and memory B-cell responses to the GI.1 VLP component of the vaccine was also comparable to that of the responses following GI.1 infection. The production of IgG memory B cells and persistence at day 180 is a key finding and underscores the need for future studies to determine if IgG memory B cells are a correlate of protection following vaccination. (This study has been registered at ClinicalTrials.gov under registration no. NCT01168401.)
Factors associated with hospitalisations in chronic conditions deemed avoidable: ecological study in the Spanish healthcare system
Authors: Angulo-Pueyo Ester , Ridao-López Manuel , Martínez-Lizaga Natalia , García-Armesto Sandra , Peiró Salvador , Bernal-Delgado Enrique
Published: February 2017

Objectives

Potentially avoidable hospitalisations have been used as a proxy for primary care quality. We aimed to analyse the ecological association between contextual and systemic factors featured in the Spanish healthcare system and the variation in potentially avoidable hospitalisations for a number of chronic conditions.

Methods

A cross-section ecological study based on the linkage of administrative data sources from virtually all healthcare areas (n=202) and autonomous communities (n=16) composing the Spanish National Health System was performed. Potentially avoidable hospitalisations in chronic conditions were defined using the Spanish validation of the Agency for Health Research and Quality (AHRQ) preventable quality indicators. Using 2012 data, the ecological association between potentially avoidable hospitalisations and factors featuring healthcare areas and autonomous communities was tested using multilevel negative binomial regression.

Results

In 2012, 151 468 admissions were flagged as potentially avoidable in Spain. After adjusting for differences in age, sex and burden of disease, the only variable associated with the outcome was hospitalisation intensity for any cause in previous years (incidence risk ratio 1.19 (95% CI 1.13 to 1.26)). The autonomous community of residence explained a negligible part of the residual unexplained variation (variance 0.01 (SE 0.008)). Primary care supply and activity did not show any association.

Conclusions

The findings suggest that the variation in potentially avoidable hospitalisations in chronic conditions at the healthcare area level is a reflection of how intensively hospitals are used in a healthcare area for any cause, rather than of primary care characteristics. Whether other non-studied features at the healthcare area level or primary care level could explain the observed variation remains uncertain.
Evaluating the relative effectiveness of high-intensity and low-intensity models of behaviour change communication interventions for abortion care-seeking in Bihar and Jharkhand, India: a cross-sectional study
Authors: Banerjee Sushanta K , Andersen Kathryn , Pearson Erin , Warvadekar Janardan , Khan Danish U , Batra Sangeeta
Published: February 2017

Background

This study aimed to compare the effectiveness of a high-intensity model (HIM) and a low-intensity model (LIM) of behaviour change communication interventions in Bihar and Jharkhand states of India designed to improve women's knowledge and usage of safe abortion services, as well as the dose effect of intervention exposure.

Methods

We conducted two cross-sectional household surveys among married women aged 15–49 years in intervention and comparison districts. Difference-in-difference models were used to assess the efficacy of the intervention, adjusting for sociodemographic characteristics.

Results

Although both intervention types improved abortion knowledge, the HIM intervention was more effective in improving comprehensive knowledge about abortion. In particular, there were improvements in knowledge on legality of abortion (AOR=2.2; 95% CI 1.6 to 2.9) and nearby sources of safe abortion care (AOR=1.7; 95% CI 1.2 to 1.3).

Conclusions

Higher level of exposure to abortion-related messages was related to more accurate knowledge about abortion within both intervention groups. Evidence was mixed on changes in abortion care-seeking behaviour. More work is needed to ensure that women seek safe abortion services in lieu of informal services that may be more likely to lead to postabortion complications.
What is the influence of single-entry models on access to elective surgical procedures? A systematic review
Authors: Damani Zaheed , Conner-Spady Barbara , Nash Tina , Tom Stelfox Henry , Noseworthy Tom W , Marshall Deborah A
Published: February 2017

Background

Single-entry models (SEMs) for the management of patients awaiting elective surgical services are designed to increase access and flow through the system of care. We assessed scope of use and influence of SEMs on access (waiting times/throughput) and patient-centredness (patient/provider acceptability).

Methods

Systematic review of articles published in 6 relevant electronic databases included studies from database inception to July 2016. Included studies needed to (1) report on the nature of the SEM; (2) specify elective service and (3) address at least 1 of 3 research questions related to (1) scope of use of SEMs; (2) influence on timeliness and access; (3) patient-centredness and acceptability. Article quality was assessed using a modified Downs and Black checklist.

Results

11 studies from Canada, Australia and the UK were included with mostly weak observational design—2 simulations, 5 before–after, 2 descriptive and 2 cross-sectional studies. 9 studies showed a decrease in patient waiting times; 6 showed that more patients were meeting benchmark waiting times; and 5 demonstrated that waiting lists decreased using an SEM as compared with controls. Patient acceptability was examined in 6 studies, with high levels of satisfaction reported. Acceptability among general practitioners/surgeons was mixed, as reported in 1 study. Research varied widely in design, scope, reported outcomes and overall quality.

Conclusions

This is the first review to assess the influence of SEMs on access to elective surgery for adults. This review demonstrates a potential ability for SEMs to improve timeliness and patient-centredness of elective services; however, the small number of low-quality studies available does not support firm conclusions about the effectiveness of SEMs to improve access. Further evaluation with higher quality designs and rigour is required.
Advance care planning uptake among patients with severe lung disease: a randomised patient preference trial of a nurse-led, facilitated advance care planning intervention
Authors: Sinclair Craig , Auret Kirsten Anne , Evans Sharon Frances , Williamson Fiona , Dormer Siobhan , Wilkinson Anne , Greeve Kim , Koay Audrey , Price Dot , Brims Fraser
Published: February 2017

Objective

Advance care planning (ACP) clarifies goals for future care if a patient becomes unable to communicate their own preferences. However, ACP uptake is low, with discussions often occurring late. This study assessed whether a systematic nurse-led ACP intervention increases ACP in patients with advanced respiratory disease.

Design

A multicentre open-label randomised controlled trial with preference arm.

Setting

Metropolitan teaching hospital and a rural healthcare network.

Participants

149 participants with respiratory malignancy, chronic obstructive pulmonary disease or interstitial lung disease.

Intervention

Nurse facilitators offered facilitated ACP discussions, prompted further discussions with doctors and loved ones, and assisted participants to appoint a substitute medical decision-maker (SDM) and complete an advance directive (AD).

Outcome measures

The primary measure was formal (AD or SDM) or informal (discussion with doctor) ACP uptake assessed by self-report (6 months) and medical notes audit. Secondary measures were the factors predicting baseline readiness to undertake ACP, and factors predicting postintervention ACP uptake in the intervention arm.

Results

At 6 months, formal ACP uptake was significantly higher (p<0.001) in the intervention arm (54/106, 51%), compared with usual care (6/43, 14%). ACP discussions with doctors were also significantly higher (p<0.005) in the intervention arm (76/106, 72%) compared with usual care (20/43, 47%). Those with a strong preference for the intervention were more likely to complete formal ACP documents than those randomly allocated. Increased symptom burden and preference for the intervention predicted later ACP uptake. Social support was positively associated with ACP discussion with loved ones, but negatively associated with discussion with doctors.

Conclusions

Nurse-led facilitated ACP is acceptable to patients with advanced respiratory disease and effective in increasing ACP discussions and completion of formal documents. Awareness of symptom burden, readiness to engage in ACP and relevant psychosocial factors may facilitate effective tailoring of ACP interventions and achieve greater uptake.

Trial registration number

ACTRN12614000255684.
Status of patient safety culture in Arab countries: a systematic review
Authors: Elmontsri Mustafa , Almashrafi Ahmed , Banarsee Ricky , Majeed Azeem
Published: February 2017

Objectives

To explore the status of patient safety culture in Arab countries based on the findings of the Hospital Survey on Patient Safety Culture (HSPSC).

Design

Systematic review.

Methods

We performed electronic searches of the MEDLINE, EMBASE, CINAHL, ProQuest and PsychINFO, Google Scholar and PubMed databases, with manual searches of bibliographies of included articles and key journals. We included studies that were conducted in the Arab countries that were focused on patient safety culture. 2 reviewers independently verified that the studies met the inclusion criteria and critically assessed the quality of the studies.

Results

18 studies met our inclusion criteria. The review identified that non-punitive response to error is seen as a serious issue which needs to be improved. Healthcare professionals in the Arab countries tend to think that a ‘culture of blame’ still exists that prevents them from reporting incidents. We found an overall similarity between the reported composite score for dimension of teamwork within units in all of the reviewed studies. Teamwork within units was found to be better than teamwork across hospital units. All of the reviewed studies reported that organisational learning and continuous improvement was satisfactory as the average score of this dimension for all studies was 73.2%. Moreover, the review found that communication openness seems to be a concerning issue for healthcare professionals in the Arab countries.

Conclusions

There is a need to promote patient safety culture as a strategy for improving the patient safety in the Arab world. Improving patient safety culture should include all stakeholders, like policymakers, healthcare providers and those responsible for medical education. This review was limited only to English language publications. The varied settings in which the HSPSC was used may have influenced the areas of strengths and weaknesses as healthcare workers' perception of safety culture may differ.
Performance curves of medical researchers during their career: analysis of scientific production from a retrospective cohort
Authors: Duclos Antoine , Herquelot Eléonore , Polazzi Stéphanie , Malbezin Muriel , Claris Olivier
Published: February 2017

Objectives

To establish the pattern of change in individual scientific production over the career of medical researchers.

Design

Retrospective cohort based on prospectively collected data in a hospital information system.

Setting

Multicentre university hospital in France.

Participants

Two distinct populations of 1835 researchers (full professors vs non-academic physicians) having produced 44 723 publications between 1995 and 2014.

Main outcome measures

Annual number of publications referenced in Medline/PubMed with a sensitivity analysis based on publications as first/last author and in high impact journals. The individual volume of publications was modelled by age using generalised estimating equations adjusted for birth cohort, biomedical discipline and academic position of researchers.

Results

Averaged over the whole career, the annual number of publications was 5.28 (95% CI 4.90 to 5.69) among professors compared to 0.82 (95% CI 0.76 to 0.89) among non-academic physicians (p<0.0001). The performance curve of professors evolved in three successive phases, including an initiation phase with a sharp increase in scientific production between 25 and 35 years (adjusted incidence rate ratio 102.20, 95% CI 60.99 to 171.30), a maturation phase with a slower increase from 35 to 50 years (2.10, 95% CI 1.75 to 2.51) until a stabilisation phase with constant production followed by a potential decline at the end of career (0.90, 95% CI 0.77 to 1.06). The non-academic physicians experienced a slower pace of learning curve at the beginning of their careers (42.38, 95% CI 25.37 to 70.81) followed by a smaller increase in the annual number of publications (1.29, 95% CI 1.11 to 1.51).

Conclusions

Compared to full professors, non-academic physicians had a poor capacity to publish, indicating a low productivity when medical doctors have limited time or little interest in undertaking research. This finding highlights the potential for rethinking the missions of medical doctors towards an enlargement of scientific prerogatives in favour of progress in global knowledge.
Study protocol for a pragmatic randomised controlled trial evaluating efficacy of a smoking cessation e-‘Tabac Info Service’: ee-TIS trial
Authors: Cambon L , Bergman P , Le Faou Al , Vincent I , Le Maitre B , Pasquereau A , Arwidson P , Thomas D , Alla F
Published: February 2017

Introduction

A French national smoking cessation service, Tabac Info Service, has been developed to provide an adapted quitline and a web and mobile application involving personalised contacts (eg, questionnaires, advice, activities, messages) to support smoking cessation. This paper presents the study protocol of the evaluation of the application (e-intervention Tabac Info Service (e-TIS)). The primary objective is to assess the efficacy of e-TIS. The secondary objectives are to (1) describe efficacy variations with regard to users' characteristics, (2) analyse mechanisms and contextual conditions of e-TIS efficacy.

Methods and analyses

The study design is a two-arm pragmatic randomised controlled trial including a process evaluation with at least 3000 participants randomised to the intervention or to the control arm (current practices). Inclusion criteria are: aged 18 years or over, current smoker, having completed the online consent forms, possessing a mobile phone with android or apple systems and using mobile applications, wanting to stop smoking sooner or later. The primary outcome is the point prevalence abstinence of 7 days at 6 months later. Data will be analysed in intention to treat (primary) and per protocol analyses. A logistic regression will be carried out to estimate an OR (95% CI) for efficacy. A multivariate multilevel analysis will explore the influence on results of patients' characteristics (sex, age, education and socioprofessional levels, dependency, motivation, quit experiences) and contextual factors, conditions of use, behaviour change techniques.

Ethics and dissemination

The study protocol was reviewed by the ethical and deontological institutional review board of the French Institute for Public Health Surveillance on 18 April 2016. The findings of this study will allow us to characterise the efficacy of e-TIS and conditions of its efficacy. These findings will be disseminated through peer-reviewed articles.

Trial registration number

NCT02841683; Pre-results.
Comparison of efficacy and safety between benidipine and hydrochlorothiazide in fosinopril-treated hypertensive patients with chronic kidney disease: protocol for a randomised controlled trial
Authors: Xue Cheng , Zhou Chenchen , Yang Bo , Lv Jiayi , Dai Bing , Yu Shengqiang , Wang Yi , Zhao Guanren , Mei Changlin
Published: February 2017

Introduction

Co-administration of a diuretic or calcium channel blocker with an ACE inhibitor are both preferred combinations in patients with hypertensive chronic kidney disease (CKD). According to the available evidence, it is still unknown which combination plays a more active role in renal protection. We hypothesised that a combination of fosinopril and benidipine may delay the progression of CKD more effectively than a combination of fosinopril and hydrochlorothiazide (HCTZ).

Methods and analysis

This study will be a multicentred, prospective, double-blind, randomised parallel controlled trial for hypertensive CKD patients in China. Patients will be randomised to one of two treatment groups: a combination of benidipine 4–8 mg/day and fosinopril 20 mg/day; or a combination of HCTZ 12.5–25 mg/day and fosinopril 20 mg/day. Patients will be followed up for 24 months after a month's fosinopril run-in. There will be dose-titration after 1 and 2 months. The primary endpoint is changes in estimated glomerular filtration rate (eGFR) from baseline to month 24. Secondary endpoints include changes in home blood pressure (BP), ambulatory BP, proteinuria, urinary albumin/creatinine ratio, and composite renal events in 24 months. Inclusion criteria are: age 18–80 years, non-dialysis CKD patients with eGFR >30 mL/min/1.73 m2, home BP >130 mm Hg systolic or BP >80 mm Hg diastolic at the screening and randomisation, and 24 hour proteinuria <3.5 g. Principal exclusions are hypertensive crisis, transplantation, cancer, severe diabetes complications, hyperkalaemia and severe allergy. The required sample size was 511 patients for detecting a difference in the change of eGFR (one sided α=0.025, power 1-β=0.90).

Ethics and dissemination

BEAHIT (Benidipine and Hydrochlorothiazide in Fosinopril Treated Chronic Kidney Disease Patients with Hypertension) was approved by Changzheng Hospital Ethics Committee (CZ-20160504-16). The outcomes will be published in a peer-reviewed journal.

Trial registration number

NCT02646397.
Healthcare usage and economic impact of non-treated obesity in Italy: findings from a retrospective administrative and clinical database analysis
Authors: Colao Annamaria , Lucchese Marcello , D'Adamo Monica , Savastano Silvia , Facchiano Enrico , Veronesi Chiara , Blini Valerio , Degli Esposti Luca , Sbraccia Paolo
Published: February 2017

Objectives

Investigate the prevalence of obesity in Italy and examine its resource consumption and economic impact on the Italian national healthcare system (NHS).

Design

Retrospective, observational and real-life study.

Setting

Data from three health units from Northern (Bergamo, Lombardy), Central (Grosseto, Tuscany) and Southern (Naples, Campania) Italy.

Participants

All patients aged ≥18 years with at least one recorded body mass index (BMI) measurement between 1 January 2009 and 31 December 2012 were included.

Interventions

Information retrieved from the databases included primary care data, medical prescriptions, specialist consultations and hospital discharge records from 2009–2013. Costs associated with these data were also calculated. Data are presented for two time periods (1 year after BMI measurement and study end).

Primary and secondary outcome measures

Primary—to estimate health resources consumption and the associated economic impact on the Italian NHS. Secondary—the prevalence and characteristics of subjects by BMI category.

Results

20 159 adult subjects with at least one documented BMI measurement. Subjects with BMI ≥30 kg/m2were defined as obese. The prevalence of obesity was 22.2% (N=4471) and increased with age. At the 1-year observation period, obese subjects who did not receive treatment for their obesity experienced longer durations of hospitalisation (median length: 5 days vs 3 days), used more prescription drugs (75.0% vs 57.7%), required more specialised outpatient healthcare (mean number: 5.3 vs 4.4) and were associated with greater costs, primarily owing to prescription drugs and hospital admissions (mean annual cost per year per patient: €460.6 vs €288.0 for drug prescriptions, €422.7 vs € 279.2 for hospitalisations and €283.2 vs €251.7 for outpatient care), compared with normal weight subjects. Similar findings were observed for the period up to data cut-off (mean follow-up of 2.7 years).

Conclusions

Untreated obesity has a significant economic impact on the Italian healthcare system, highlighting the need to raise awareness and proactively treat obese subjects.
Realist evaluation of intersectoral oral health promotion interventions for schoolchildren living in rural Andean communities: a research protocol
Authors: Bergeron Dave A , Talbot Lise R , Gaboury Isabelle
Published: February 2017

Background

Intersectoral collaboration, known to promote more sustainable change within communities, will be examined in an oral health promotion program (OHPP). In Peru, an OHPP was implemented by the Ministry of Health, to reduce the incidence of caries in schoolchildren. In rural Andean communities, however, these initiatives achieved limited success. The objectives of this project are: (1) to understand the context and the underlying mechanisms associated with Peruvian OHPP's current effects among school children living in rural Andean communities and (2) to validate a theory explaining how and under which circumstances OHP intersectoral interventions on schoolchildren living in rural Andean communities produce their effects.

Methods and analysis

Through a realist evaluation, the context, underlying mechanisms and programme outcomes will be identified. This process will involve five different steps. In the first and second steps, a logic model and an initial theory are developed. In the third step, data collection will permit measurement of the OHHP's outcomes with quantitative data, and exploration of the elements of context and the mechanisms with qualitative data. In the fourth and fifth steps, iterative data analysis and a validation process will allow the identification of Context-Mechanism-Outcome configuration, and validate or refine the initial theory.

Ethics and dissemination

This research project has received approval from the Comité d’éthique de la recherche en santé chez l'humain du Centre hospitalier universitaire de Sherbrooke. The initial theory and research results will be published in relevant journals in public health and oral health. They will also be presented at realist evaluation and health promotion international conferences.
Inappropriate prescribing among older persons in primary care: protocol for systematic review and meta-analysis of observational studies
Authors: Lee Cia Sin , Liew Tau Ming
Published: February 2017

Introduction

Inappropriate prescribing has a significant impact on older persons in primary care. Previous reviews on inappropriate prescribing included a heterogeneous range of populations and may not be generalisable to primary care. In this study we aim to conduct a comprehensive systematic review and meta-analysis of the prevalence, risk factors and adverse outcome associated with inappropriate prescribing, specifically among older persons in primary care.

Methods and analysis

We will search PubMed, Embase, CINAHL, Web of Science, Scopus, PsycINFO and references of other review articles for observational studies related to the keywords ‘older persons’, ‘primary care’ and ‘inappropriate prescribing’. Two reviewers will independently select the eligible articles. For each included article, the two reviewers will independently extract the data and assess the risk of bias using the Newcastle–Ottawa Scale. If appropriate, meta-analyses will be performed to pool the data across all the studies. In the presence of heterogeneity, meta-regression and subgroup analyses will also be performed. The quality of the evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Ethics and dissemination

The results will be disseminated through conference presentations and peer-reviewed publications. They will provide consolidated evidence to support informed actions by policymakers to address inappropriate prescribing in primary care, thus reducing preventable and iatrogenic risk to older persons in primary care.

Trial registration number

CRD42016048874.
Reducing oral contamination during corneal scrapes
Authors: Samarawickrama Chameen , Li Yi-Chiao , Carnt Nicole , Willcox Mark , Dutta Debarun , Watson Stephanie
Published: February 2017

Aims

To identify potential contaminants of the corneal sampling procedure and examine the effect of wearing surgical face masks on the rate of contamination.

Methods

Ten surgeons recited out loud a 30 s standardised script for corneal scraping with blood agar plates positioned 30 cm away from them. Three groups were identified: in group 1 a surgical mask was worn; group 2 had no mask worn; and group 3 had no mask but used agar plates pretreated with 5% povidone-iodine as a negative control. Each surgeon repeated the process 10 times for all groups, totalling 30 plates per surgeon and 300 plates for the experiment. All plates were masked and incubated aerobically at 37°C for 24 hours, and the number of colony forming units (CFUs) was determined.

Results

At 24 hours, group 1 had a mean of 0.3 CFUs per surgeon; group 2 had 6.4 CFUs per surgeon and group 3 had 0.1 CFUs per surgeon. The difference between group 1 and group 2 was significant (p<0.001) whereas the difference between group 1 and group 3 was non-significant (p=0.4). Use of face masks decreased the number of plates with CFUs by 93% (from 29 to 2 plates) and decreased the total number of CFUs by 95% (from 63 to 3 CFUs). The most common microbiota identified wasStreptococcusspecies.

Conclusions

Oral bacterial microbiota may contaminate the slides and media used to collect samples during corneal sampling. Use of a face mask can significantly decrease the rate of contamination of such samples.
Fields of promoted actions for facilitating multitasking activity during a medical emergency
Authors: Morineau Thierry , Chapelain Pascal , Le Courtois Marion , Le Gac Jean-Marc
Published: March 2017

Background

An adverse clinical event requires emergency team coordination and multitasking activity. Based on studies in ecological psychology, we propose that a structured ambient environment can implicitly facilitate these requirements.

Method

We designed a new configuration of work in which spatial zones were specified as fields of promoted actions for doctors, nurses and nursing auxiliaries. 6 emergency teams were confronted with scenarios in a simulation setting, either with a traditional configuration of work or with the new configuration.

Results

Significantly, each kind of caregiver respected the delimited spatial zones: 91.5% of occupation time for doctors, 97.1% for nurses and 95.3% for nursing auxiliaries. The mean durations of occupation of a same zone by the nursing auxiliaries and another caregiver decreased significantly, thus reducing the likelihood of mutual disturbance. Readiness for multitasking activity measured before and after experiencing the work configuration increased significantly among caregivers. An ergonomic evaluation scale showed a high level of satisfaction among caregivers (68.5 points out of 100). Participants also indicated the advantages and disadvantages of this new work configuration.

Conclusions

This study is a first step towards recommendations to standardise the positioning of emergency team members and for a new spatial arrangement of equipment.
Comments on the dilemma in the February issue: When the client is away
Authors: McCulloch Steven
Published: March 2017

In the dilemma discussed in the February issue of In Practice, a 12‐year‐old German shepherd dog (Jasper) presents with vomiting and diarrhoea. A dog minder has Jasper while the client is away. Jasper has long‐standing degenerative myelopathy and before the client went away, they expressed concern that he might, at some stage, require euthanasia. The dog minder is uncertain and upset; should you advise euthanasia or wait until the client returns? (IP, February 2017, vol 39, pp 94–95). Simon Coghlan suggested that if Jasper could be kept relatively comfortable, it might be reasonable to treat him and to run some medical tests until the client can participate actively in decision making under your professional guidance. Allowing some time to assess Jasper's response to treatment might be wise. However, respecting client autonomy and respecting the patient's life and wellbeing are both ethically important.
Subclinical sleep apnoea and plasma levels of endothelin-1 among young and healthy adults
Authors: Schoen Tobias , Aeschbacher Stefanie , Leuppi Joerg D , Miedinger David , Werthmüller Ursina , Estis Joel , Todd John , Risch Martin , Risch Lorenz , Conen David
Published: March 2017

Objective

Obstructive sleep apnoea (OSA) is a risk factor for vascular disease and other adverse outcomes. These associations may be at least partly due to early endothelin-1 (ET-1)-mediated endothelial dysfunction (ED). Therefore, we assessed the relationships between subclinical sleep apnoea and plasma levels of ET-1.

Methods

We performed a population-based study among 1255 young and healthy adults aged 25–41 years. Cardiovascular disease, diabetes or a body mass index >35 kg/m2were exclusion criteria. Plasma levels of ET-1 were measured using a high-sensitivity, single-molecule counting technology. The relationships between subclinical sleep apnoea (OSA indices: respiratory event index (REI), oxygen desaturation index (ODI), mean night-time blood oxygen saturation (SpO2)) and ET-1 levels were assessed by multivariable linear regression analysis.

Results

Median age of the cohort was 35 years. Median ET-1 levels were 2.9 (IQR 2.4–3.6) and 2.5 pg/mL (IQR 2.1–3.0) among patients with (n=105; 8%) and without subclinical sleep apnoea (REI 5–14), respectively. After multivariable adjustment, subclinical sleep apnoea remained significantly associated with plasma levels of ET-1 (β=0.13 (95% CI 0.06 to 0.20) p=0.0002 for a REI 5–14; β=0.10 (95% CI 0.03 to 0.16) p=0.003 for an ODI≥5). Every 1% decrease in mean night-time SpO2increased ET-1 levels by 0.1 pg/mL, an association that remained significant after multivariable adjustment (β=0.02 (95% CI 0.003 to 0.033) p=0.02).

Conclusions

In this study of young and healthy adults, we found that participants with subclinical sleep apnoea had elevated plasma ET-1 levels, an association that was due to night-time hypoxaemia. Our results suggest that ED may already be an important consequence of subclinical sleep apnoea.
Limited functional responses of plankton food webs in northern lakes following diamond mining
Authors: St-Gelais Nicolas F. , Jokela Anneli , Beisner Beatrix E.
Published: March 2017

There is limited understanding of the impact of diamond mining on the aquatic communities of lakes that receive mining activity residue. For aquatic communities, assessing the response to mining, which can affect multiple variables concurrently, is not trivial, especially when a species-by-species approach is used. Thus, we assessed diamond mine impacts using changes in plankton functional composition, enabling an integrated evaluation of the ecological responses of aquatic ecosystems. Using a 19-year data set, we evaluated the functional responses of lake phytoplankton and zooplankton to water quality changes associated with mining activities in five downstream lakes of the Ekati Diamond Mine (Northwest Territories, Canada). Our results demonstrate that mining activity shifted phytoplankton functional composition toward edible diatoms and more recently the rotifer communities toward parallelepiped types, while for crustacean zooplankton we observed a reinforcement of the original functional composition. Following functional rather than taxonomic changes enabled a more mechanistic understanding of the processes behind the impacts and should facilitate the generalization of impacts to other sites, permitting comparison of community shifts caused by other types of mining.
Effects of trimetazidine on interleukin-2 and interleukin-8 concentrations in patients with coronary artery disease
Authors: Danikiewicz Aleksander , Szkodziński Janusz , Hudzik Bartosz , Korzonek-Szlacheta Ilona , Gąsior Mariusz , Zubelewicz-Szkodzińska Barbara
Published: February 2017

Trimetazidine (TMZ) exhibits metabolic and cardioprotective effects. The aim of this study was to assess the effects of TMZ on interleukin-2 (IL-2) and interleukin-8 (IL-8) serum concentrations in 156 patients with stable coronary artery disease. They underwent a treadmill exercise test (TET) before and after 3 months of TMZ treatment. IL-2 and IL-8 concentrations were determined before and after each TET. Before treatment, TET did not influence IL-2 concentrations, whereas IL-8 concentrations increased. TMZ treatment led to a decrease in IL-2 concentrations before TET, as well as it prevented the increase of IL-8 following the second TET. Obtained results confirmed the improvement in TET performance during TMZ treatment and they revealed a significant influence of TMZ on IL-2 and IL-8 concentrations both before and after TET. These changes may reflect potential anti-inflammatory effects of TMZ.
Long-acting PDE5 inhibitor tadalafil prevents early doxorubicin-induced left ventricle diastolic dysfunction in juvenile mice: potential role of cytoskeletal proteins
Authors: Nagiub Mohamed , Filippone Scott , Durrant David , Das Anindita , Kukreja Rakesh C.
Published: February 2017

The chemotherapeutic use of doxorubicin (Dox) is hindered due to the development of irreversible cardiotoxicity. Specifically, childhood cancer survivors are at greater risk of Dox-induced cardiovascular complications. Because of the potent cardioprotective effect of phosphodiesterase 5 (PDE5) inhibitors, we examined the effect of long-acting PDE5 inhibitor tadalafil (Tada) against Dox cardiotoxicity in juvenile mice. C57BL/6J mice (6 weeks old) were treated with Dox (20 mg/kg, i.v.) and (or) Tada (10 mg/kg daily for 14 days, p.o.). Cardiac function was assessed by echocardiography following 5 and 10 weeks after Dox treatment. The expression of cardiac proteins was examined by Western blot analysis. Dox treatment caused diastolic dysfunction in juvenile mice indicated by increasing the E/E’ (early diastolic myocardial velocity to early tissue Doppler velocity) ratio as compared with control at both 5 and 10 weeks after Dox treatment. Co-treatment of Tada and Dox preserved left ventricular diastolic function with reduction of E/E’. Dox treatment decreased the expression of SERCA2 and desmin in the left ventricle; however, only desmin loss was prevented with Tada. Also, Dox treatment increased the expression of myosin heavy chain (MHCβ), which was reduced by Tada. We propose that Tada could be a promising new therapy for improving cardiac function in survivors of childhood cancer.
Rock crevice morphology and forest contexts drive microhabitat preferences in the Green Salamander (Aneides aeneus)
Authors: Smith Walter H. , Slemp Skyla L. , Stanley Conner D. , Blackburn Melissa N. , Wayland John
Published: February 2017

Little is known about how vertical rock habitats are selected by organisms in forest ecosystems. Multiple lungless salamanders use rock outcrops in the Appalachian Mountains of eastern North America, with Green Salamanders (Aneides aeneus (Cope and Packard, 1881)) showing the strongest associations as an outcrop specialist. Although previous work has identified environmental correlates of rock face and arboreal habitat use in this species, it remains to be known if and how Green Salamanders select crevice refugia as a function of both outcrop morphology and the context of outcrops within the surrounding forest. We performed an intensive survey of an abundant Green Salamander population on Virginia’s Appalachian Plateau to examine which features of vertical habitats are associated with salamander occupancy. Occupancy was highest in deeper rock crevices closer to surrounding trees, a likely consequence of arboreal behavior and the ability for crevice refugia to modulate the surrounding microclimate. Although uncertainty exists with regards to the generality of these results across the species’ range, our results underscore linkages between embedded rock outcrop habitats and their surrounding forest contexts for amphibians. Our results also provide a model of Green Salamander habitat associations that may be valuable to efforts to elucidate its geographic distribution.
Silent sounds in the Andes: underwater vocalizations of three frog species with reduced tympanic middle ears (Anura: Telmatobiidae:Telmatobius)
Authors: Brunetti A.E. , Muñoz Saravia A. , Barrionuevo J.S. , Reichle S.
Published: February 2017

Underwater vocalization in anurans is restricted to a few, distantly related species. In some of them, sound is transmitted through tympanic and extra-tympanic pathways. Members of the Andean genus Telmatobius Wiegmann, 1834 lack a tympanic membrane, and earlier reports assumed the absence of vocalizations in the genus. We recorded underwater vocalizations and examined the middle-ear morphology in three species of Telmatobius with different lifestyles: Telmatobius oxycephalus Vellard, 1946 (semiaquatic, riverine); Telmatobius hintoni Parker, 1940 (markedly aquatic, riverine); Telmatobius culeus (Garman 1876) (fully aquatic, lacustrine). Males emit underwater calls, which in the three species are simple and stereotyped; they consist of a repeated train of notes, with a low fundamental frequency (309–941 Hz). In each of the three species, the tympanic membrane is absent and the tympanic cavity is extremely reduced or absent, whereas the opercular system is well developed. Our data, along with prior knowledge in other species of anurans, suggest that the species examined here probably perceived sound through extra-tympanic pathways. Given the limited knowledge about underwater calling in anurans, Telmatobius seems a logical candidate to study the functional and evolutionary bases of underwater hearing and tympanic middle-ear reduction in anurans.
Patterns of intraspecific aggression inferred from injuries in an aquatic turtle with male-biased size dimorphism
Authors: Keevil M.G. , Hewitt B.S. , Brooks R.J. , Litzgus J.D.
Published: February 2017

Patterns of sexual size dimorphism (SSD) in turtles are correlated with ecological mode, and it has been hypothesized that mating systems are also shaped by ecological mode. Male combat and coercive mating are competing explanations for male-biased SSD, but are difficult to assess empirically in aquatic species with cryptic behaviour. We quantified SSD and compiled observations of putative combat wounds collected from over 500 captures of Snapping Turtles (Chelydra serpentina (L., 1758)) in Algonquin Provincial Park, Ontario, to test hypotheses of mate competition and coercion. We found that both sex and body size were important predictors of risk of wounding, consistent with the hypothesis that male–male sexual competition is the primary driver of intraspecific aggression. Low wounding rates among females suggests that resource competition and coercive mating are not important causes of injuries. The risk of wounding increased monotonically with body size in adult males but not in adult females, and small males were less likely to be injured, suggesting that they employ a risk-averse strategy by avoiding direct competition for mates. There was no evidence of asymptotic or decreasing wounding probability in the largest males, which is consistent with the hypothesis that large males compete most intensively to monopolize mates.
Can Noether symmetry in modified f(G) gravity always yield cosmic evolution?
Authors: Dutta Malay Krishna , Modak B.
Published: March 2017

We discuss Noether symmetry approach in the modified theory of gravity with Gauss–Bonnet (GB) interaction-f(G) including an ideal fluid in Friedmann–Lemaître–Robertson–Walker (FLRW) background. It yields functional form of f(G) from the symmetry. The existence of Noether symmetry gives the scale factor in two cases, but these are not satisfied by field equations in general. In another case, the solution of field equations shows late-time transition to an accelerating expansion when matter is dust, however the solution including dust and radiation is always in accelerating era.
Review of the electric dipole moment of light nuclei
Authors: Yamanaka Nodoka
Published: March 2017

In this paper, we summarize the theoretical development on the electric dipole moment (CEDM) of light nuclei. We first describe the nucleon level CP violation and its parametrization. We then present the results of calculations of the EDM of light nuclei in the ab initio approach and in the cluster model. The analysis of the effect of several models beyond standard model (CBSM) is presented together with the prospects for its discovery. The advantage of the EDM of light nuclei is focused in the point of view of the many-body physics. The evaluations of the nuclear EDM generated by the [Formula: see text]-term and by the CP phase of the Cabibbo–Kobayashi–Maskawa (CKM) matrix are also reviewed.
PERSA: A Requirements Specification Process for Self-Adaptive Systems Based on Fuzzy Logic and NFR-Framework
Authors: Paraiba João Dionisio , Martins Luiz Eduardo G.
Published: March 2017

Self-Adaptive Systems are able to change their behavior at runtime according to the environment where they are. This study presents an approach to specify the requirements for self-adaptive systems based on the concepts of Fuzzy Logic, which deals with factors such as ambiguity, uncertainties and vague information on the solution of problems; and NFR-Framework, which deals with the non-functional requirements which, very often, vaguely and full of uncertainties present themselves. Adaptive systems consist of (functional and non-functional) requirements, which hold the capacity to modify themselves during the runtime with little or no human intervention at all. Requirements that carry out the feature of wide variability are called adaptive requirements. PERSA (acronym from “Processo de Especificação de Requisitos Adaptativos”, in Portuguese) is reported in this work, using the Fuzzy Logic and the NFR-Framework as a basis, since both offers resources to manage uncertainties, an inherent attribute of self-adaptive systems. This process aims the approach of specification of adaptive requirements in a systematic way providing a guide to support requirements engineers. PERSA Process is settled in three mains phases subdivided into several steps. Two case studies were developed to validate it: the first deals with an automated system to prepare steaks, which needs to adapt to its several types; the second relates to a system for automation for canine diets, which must be adapted to different breeds of dogs according to their size, weight and classification. The case studies provide a first approach of the use and benefits of PERSA Process. In these studied the theoretical proposal was evaluated and discussed in order to establish the degree of understanding, the clarity of activities and the necessary adjustments to improve the proposed achievements, thus obtaining a satisfactory though early assessment which answers the purpose of specifying the requirements for self-adaptive systems.
Enumerating extensions of (π)-adic fields with given invariants
Authors: Pauli Sebastian , Sinclair Brian
Published: March 2017

We give an algorithm that constructs a minimal set of polynomials defining all extensions of a [Formula: see text]-adic field with given inertia degree, ramification index, discriminant, ramification polygon, and residual polynomials of the segments of the ramification polygon.