bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of a Novel Pathway for Early Discharge Was Associated With a 48% Shorter Length of Stay After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis
Authors: Fletcher Nicholas D. , Andras Lindsay M. , Lazarus David E. , Owen Robert J. , Geddes Benjamin J. , Cao Jessica , Skaggs David L. , Oswald Timothy S. , Bruce Robert W.
Published: July 2015

Introduction:

Hospital stay after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) has decreased only modestly over time despite a healthy patient population. The purpose of this study was to evaluate the impact of a novel postoperative pathway on length of stay (LOS) and complications.

Methods:

A retrospective review of patients undergoing PSF for AIS in 2011 to 2012 was performed at 2 institutions evaluating demographics, preoperative Cobb angles, surgical duration, blood loss, LOS, and postoperative complications. Patients at one center were managed using an accelerated discharge (AD) pathway emphasizing early transition to oral pain medications mobilization with physical therapy 2 to 3 times/d, and discharge regardless of return of bowel function. Expectations were set with the family before surgery for early discharge. Patients at the other center were managed without a standardized pathway.

Results:

One hundred five patients underwent PSF and were treated by an AD pathway, whereas 45 patients were managed using a traditional discharge (TD) pathway. There was no difference in proximal thoracic and main thoracic Cobb magnitudes and a small difference in thoracolumbar curve magnitudes (35.2±13.0 degrees AD vs. 40.6±11.4 degrees TD, P=0.004) between groups. Surgical time was slightly shorter in AD patients (median 3.1 vs. 3.9 h, P=0.0003) with no difference in estimated blood loss. LOS was 48% shorter in the AD group (2.2 vs. 4.2 d, P<0.0001). There was no difference in readmissions or wound complications between groups.

Conclusions:

Hospital stay was nearly 50% shorter in patients managed by the AD pathway without any increase in readmissions or early complications.

Significance:

Discharge after PSF for AIS may be expedited using a coordinated postoperative pathway. No increase in complications was seen using the AD pathway. Earlier discharge may reduce health care costs and allow an earlier return to normalcy for families.

Level of Evidence:

Level III—case control study.
The Influence of Sex and Laterality on Clubfoot Severity
Authors: Zionts Lewis E. , Jew Michael H. , Ebramzadeh Edward , Sangiorgio Sophia N.
Published: July 2015

Background:

Idiopathic clubfoot is bilateral in approximately 50% of cases and has been widely reported to affect males more frequently than females. Despite these observations, the correlation between sex and severity of the deformity has not been established. As well, the difference in severity between unilateral and bilateral clubfeet has not been extensively investigated. Therefore, the goals of the present study were to: (1) examine the relationship between sex and severity of deformity and (2) determine the relationship between laterality and severity of deformity.

Methods:

The families of infants with idiopathic clubfoot deformity treated at our institution were prospectively invited to participate in this institutional review board–approved study. Severity of the deformity was assessed by a single surgeon for each patient using the Dimeglio criteria at the first clinic visit. After evaluating the distributions, the correlations were quantified by nonparametric analyses.

Results:

Over 8 years, 240 infants met the inclusion criteria. There was no significant difference in the severity of deformity due to sex (P=0.61): the median Dimeglio score for males was 13 (variance 4.8) and for females, the median was 13.0 (variance of 5.1). In contrast, severity was distributed differently among unilateral versus bilateral patients. Although both unilateral and bilateral patients had a median Dimeglio score of 13, the ratio of bilateral patients was higher among those with moderate or very severe deformities compared with those with severe deformities (P<0.01).

Conclusions:

Although idiopathic clubfoot is commonly considered to affect male patients disproportionately, this is the first study to document no difference in severity due to sex. Further, this study demonstrated that on average, bilateral patients did not have increased severity, but presented with a larger range of severity than those patients with unilateral deformity.

Level of Evidence:

Level III—prognostic.
Wound Closure in Nonidiopathic Scoliosis: Does Closure Matter?
Authors: Ward James P. , Feldman David S. , Paul Justin , Sala Debra A. , Errico Thomas J. , Otsuka Norman Y. , Margiotta Michael S.
Published: July 2015

Background:

Postoperative wound complications after posterior spinal fusion are difficult to manage. The incidence in the nonidiopathic patient population is significantly higher than the adolescent idiopathic population. A comparison of wound complications after posterior spinal fusion for nonidiopathic scoliosis between the utilization of the orthopaedic surgical team at the time of closure performing a nonstandardized wound closure versus a plastic surgeon with a plastic multilayered closure technique and rotational flap coverage when needed had not previously been evaluated. The purpose of this study was to compare the complication rate between nonstandardized and plastic multilayered closure of the surgical incision in patients undergoing posterior spinal fusion for nonidiopathic scoliosis.

Methods:

The charts of 76 patients with a primary diagnosis of scoliosis associated with a syndrome or neuromuscular disease and who underwent a posterior spinal fusion were reviewed. Forty-two patients had their incisions closed using the nonstandardized technique and 34 using the plastic multilayered technique. These 2 groups were compared for age, sex, primary diagnosis, number of levels fused, estimated blood loss, number of units transfused, operating room time, wound complication, and return to operating room.

Results:

The wound complication rate in the nonstandardized closure group was 19% (8/42) compared with 0% (0/34) in the plastic multilayered closure group (P=0.007). The unanticipated return to the operating room rate was 11.9% (5/42) for the nonstandardized closure patients versus 0% (0/34) for the plastic multilayered closure patients (P=0.061).

Conclusions:

The use of the plastic multilayered closure technique in this patient population is important in an effort to decrease postoperative wound complications. The ability of the surgical team to decrease the infection rate of nonidiopathic scoliosis cannot be overstated. The method of wound closure plays a major role in lowering this incidence.

Level of Evidence:

Level III—therapeutic.
Ankle Range of Motion After Posterior Subtalar and Ankle Capsulotomy for Relapsed Equinus in Idiopathic Clubfoot
Authors: Jauregui Julio J. , Zamani Shirin , Abawi Hummira H. , Herzenberg John E.
Published: July 2015

Introduction:

Posterior capsulotomy can correct residual clubfoot deformity, but has been associated with ankle stiffness. The purpose of this study was to evaluate clinical ankle range of motion (ROM) following posterior capsulotomy immediately postsurgery and during long-term follow-up.

Methods:

A retrospective clinical and radiographic review of 257 patients (398 feet) was performed to evaluate all patients who required a posterior capsulotomy as part of their clubfoot management. Twenty feet (16 patients) were identified with a mean age of 73.3±37.7 months and mean Pirani score of 5.2±0.8 points. Following capsulotomy, a long-leg cast was placed and maintained for a mean of 26 days (range, 21 to 35 d). At cast removal, parents were trained and instructed to immediately begin home physiotherapy. The capsulotomy cohort was age and sex matched to a cohort treated exclusively with the Ponseti method for comparison. Children in the comparison cohort had a mean Pirani score of 5.7±0.8 points.

Results:

The mean dorsiflexion in the capsulotomy cohort significantly increased comparing the preoperative to the immediate postoperative ROM (from −6.5 to +9.7 degrees). No significant reduction in this gain was observed at latest follow-up (to +8.3 degrees). No significant difference in the plantar-flexion angle was found. Radiographically, a significant improvement in the lateral anterior tibial-calcaneal angle angles was found (P<0.05).

Conclusions:

If utilizing our protocol for early mobilization, limited use of capsulotomy to treat relapsed clubfoot does not necessarily reduce ankle ROM. Our protocol of placing the feet in casts for a shorter duration of time and providing early physiotherapy helps maintain ankle ROM after a posterior capsulotomy.

Level of Evidence:

Level III—therapeutic study.
Traumatic Brain Injury in Spinal Cord Injury: Frequency and Risk Factors
Authors: Budisin Bojana , Bradbury Cheryl C.L.B , Sharma Bhanu , Hitzig Sander L. , Mikulis David , Craven Cathy , McGilivray Colleen , Corbie Jasmine , Green Robin E.
Published: July 2015

Background:

The frequency of traumatic brain injury (TBI) co-occurring with traumatic spinal cord injury (tSCI) is unclear despite a number of past studies; as well, limited research has examined predictors of co-morbid TBI in tSCI patients.

Objectives:

(1a) To summarize past literature on comorbid diagnosis of TBI in tSCI in order to reexamine the frequency of dual diagnosis in a study designed to obviate past methodological limitations; (1b) to compare dual-diagnosis frequency with vs without the inclusion of diagnostically ambiguous cases; and (2) to measure risk factors for tSCI and comorbid TBI.

Methods:

Ninety-one of 135 eligible adults with tSCI, 3 to 6 months postinjury, were prospectively recruited from a tertiary inpatient tSCI rehabilitation program. TBI diagnosis was based on comprehensive, validated clinical neurological and neuroimaging measures.

Results:

Objective 1: 39.6% of the tSCI patients sustained a concomitant TBI, but when ambiguous cases were removed from analysis, frequency rose to 58.1%. Objective 2: Motor vehicle collisions were most likely to yield a comorbid TBI diagnosis, but 31.6% of falls also resulted in TBI. Patients with cervical and thoracic injuries showed a very similar frequency of comorbid TBI.

Conclusions:

Varied methodological approaches, particularly the decision to include/exclude ambiguous cases, likely explain disparate past estimates of TBI in tSCI. However, even this study's lower frequency estimate, at nearly 40%, is clinically important. The prevailing assumption that dual diagnosis is less common in thoracic than cervical spine injuries was not supported. Finally, while comorbid TBI most frequently occurred in motor vehicle collisions, nearly a third of tSCIs sustained in falls resulted in comorbid TBI in our sample.
Acute Cognitive and Physical Rest May Not Improve Concussion Recovery Time
Authors: Buckley Thomas A. , Munkasy Barry A. , Clouse Brandy P.
Published: July 2015

Objective:

To evaluate the effectiveness of an acute period of cognitive and physical rest on concussion.

Participants:

Fifty consecutive patients with a diagnosis of concussions.

Design:

Participants were evaluated before (n = 25) and after (n = 25) a policy change that incorporated cognitive and physical rest. Patients in the rest group were withheld from activities, including classes, for the remainder of the injury day and the following day, whereas patients in the no-rest group were not provided any postinjury accommodations.

Main Measures:

Patients were evaluated on a graded symptom checklist, Balance Error Scoring System, Standard Assessment of Concussion, and computerized neuropsychological tests. The number of days until each test achieved baseline values was compared between groups with independent-samples t test.

Results:

The no-rest group achieved asymptomatic status sooner than the rest group (5.2 ± 2.9 days and 3.9 ± 1.9 days, respectively; P = .047). There were no differences between groups for time to baseline values on the Balance Error Scoring System, Standard Assessment of Concussion, computerized neuropsychological tests, or time to clinical recovery.

Conclusion:

A prescribed day of cognitive and physical rest was not effective in reducing postconcussion recovery time. These results agree with a previous study and suggest that light activity postconcussion may not be deleterious to the concussion recovery process.
Ankle Plantarflexor Spasticity Does Not Restrict the Recovery of Ankle Plantarflexor Strength or Ankle Power Generation for Push-Off During Walking Following Traumatic Brain Injury
Authors: Williams Gavin , Banky Megan , Olver John
Published: July 2015

Objective:

The main aim of this project was to determine the impact of plantarflexor spasticity on muscle performance for ambulant people with traumatic brain injury (TBI).

Setting:

A large metropolitan rehabilitation hospital.

Participants:

Seventy-two ambulant people with TBI who were attending physiotherapy for mobility limitations. Twenty-four participants returned for a 6-month follow-up reassessment.

Design:

Cross-sectional cohort study.

Main Measures:

Self-selected walking speed, Tardieu scale, ankle plantarflexor strength, and ankle power generation (APG).

Results:

Participants with ankle plantarflexor spasticity had significantly lower self-selected walking speed; however, there was no significant difference in ankle plantarflexor strength or APG. Participants with ankle plantarflexor spasticity were not restricted in the recovery of self-selected walking speed, ankle plantarflexor strength, or APG, indicating equivalent ability to improve their mobility over time despite the presence of spasticity.

Conclusion:

Following TBI, people with ankle plantarflexor spasticity have significantly greater mobility limitations than those without spasticity, yet retain the capacity for recovery of self-selected walking speed, ankle plantarflexor strength, and APG.
Measuring Neurobehavioral Functioning in People With Traumatic Brain Injury: Rasch Analysis of Neurobehavioral Functioning Inventory
Authors: Czuba Karol J. , Kersten Paula , Kayes Nicola M. , Smith Greta A. , Barker-Collo Suzanne , Taylor William J. , McPherson Kathryn M.
Published: July 2015

Objective:

To examine internal construct validity of the Neurobehavioral Functioning Inventory (NFI) by applying Rasch analysis.

Setting:

An outpatient rehabilitation program trial in New Zealand employing a goal-setting intervention in people with traumatic brain injury (TBI).

Participants:

One hundred eight people (mean age = 46 years; 73% male) between 6 months and 5 years post-TBI.

Design:

Rasch analysis of the NFI (Partial Credit Model).

Results:

Three NFI subscales were not unidimensional and at least 4 items in each subscale had disordered response categories. Two items showed differential item functioning by age, 1 item by educational attainment, and 2 items were found to misfit the overall construct. These items were excluded from the total score calculation. The revised scale fit the Rasch model and supported the internal construct validity of the NFI.

Conclusions:

Current scoring of the NFI subscales for people with TBI in New Zealand does not meet the requirements of the Rasch model. The revised version of NFI can improve the interpretation of scores but should be further tested with people with TBI in other settings.
LAT gel for laceration repair in the emergency department: not only for children?
Authors: Vandamme Emily , Lemoyne Sabine , van der Gucht Anne , de Cock Pieter , van de Voorde Patrick
Published: July 2015

Objective

LAT (lidocaine, adrenaline, and tetracaine) gel is a topical anesthetic that can be applied on lacerations before suturing. It is considered easy to use and less painful than infiltrative anesthesia. Its use in laceration management has been studied the most in younger children.

We aimed to describe the potential value of the use of LAT gel in older children and adults with simple lacerations.

Materials and methods

As part of a quality audit project, we reviewed all emergency department records of patients who had LAT gel applied for laceration repair in a 3-month period following the initial protocol implementation. Patients younger than 8 years of age, under the influence of alcohol or drugs, or those who received additional sedation were excluded. The need for additional anesthesia after needle probing was used as the primary endpoint.

Results

Of the 89 patients included, 21 (23.6%) needed additional anesthesia. The length of the wound was significantly longer in the group who needed additional anesthesia (difference between medians 1 cm; 95% confidence interval 0.5–2; P<0.005). Lacerations located on the extremities/trunk/fingers/toes needed significantly more additional anesthesia compared with lacerations located on the head (19.1% difference between proportions; 95% confidence interval 1–34.8%; P<0.05).

Conclusion

LAT gel is a valuable alternative to infiltrative anesthesia for laceration repair. Its use should not be limited to children. The application of LAT gel seems to be specifically suitable for short lacerations (<4 cm), lacerations located on the head, and simple finger lacerations.
Warfarin Discontinuation in Patients With Unprovoked Venous Thromboembolism: A Large US Insurance Database Analysis
Authors: Xie Lin , Liu Xianchen , Phatak Hemant , Mardekian Jack , Tan Wilson , Baser Onur , Ramacciotti Eduardo
Published: July 2015

This study examined warfarin therapy discontinuation and its risk factors among patients with unprovoked venous thromboembolism (VTE) in the US clinical practice setting. Adult patients with unprovoked VTE were identified from the MarketScan claims database from January 1, 2006 to December 31, 2012. The index date was defined as the date of first VTE diagnosis. Patients were required to have no VTE diagnosis in the 6 months before index date and continuous health plan enrollment for 6 months before and 12 months after the index date. Warfarin discontinuation rates and adjusted hazard ratios (HRs) were reported. Of 21,163 eligible patients, 15,463 were diagnosed with deep vein thrombosis (DVT) only (73.1%), 5027 with pulmonary embolism (PE) only (23.7%), and 673 with DVT and PE (3.2%). The average duration of warfarin therapy was 5.2 months (SD = 3.0). During 1-year follow-up, 21.4% patients discontinued therapy within 3 months, 42.8% within 6 months, and 70.1% within 12 months. PE versus DVT [HR = 0.77, 95% confidence interval (CI) = 0.74–0.80], comorbid atrial fibrillation (HR = 0.73, 95% CI = 0.66–0.81), thrombophilia (HR = 0.62, 95% CI = 0.54–0.71), and age >40 years (41–65 years: HR = 0.86, 95% CI = 0.81–0.91; >65 years: HR = 0.82, 95% CI = 0.77–0.87) were significantly associated with reduced risk of warfarin discontinuation. Alcohol abuse/dependence (HR = 1.36, 95% CI = 1.20–1.55), cancer history (HR = 1.13, 95% CI = 1.07–1.19), bleeding (HR = 1.07, 95% CI = 1.01–1.15), and catheter ablation (HR = 1.10, 95% CI = 1.00–1.20) in the 6 months before index date were significantly associated with increased risk for warfarin discontinuation. In conclusion, nearly 1 of 4 patients with unprovoked VTE discontinued warfarin within 3 months. Three of 4 patients discontinued therapy within 1 year. Younger age and multiple clinical factors are associated with warfarin therapy discontinuation.
Fogarty Maneuver to Restore Coronary Flow in ST-Segment Elevation Myocardial Infarction: Desperate Times Call for Desperate Measures
Authors: Larralde Mark J. , Afzal Ashwad , Brener Sorin J.
Published: July 2015

Nonatherosclerotic embolism is a rare cause (4%–7%) of coronary occlusion in ST-segment elevation myocardial infarction (STEMI) patients, approximately half of which occur in inadequately anticoagulated patients with prosthetic valves. We report a rare case of a patient with severe rheumatic heart disease and 3 mechanical valves presenting with STEMI that was successfully managed by Fogarty maneuver thrombus extraction after failed thrombus aspiration and balloon angioplasty. A 56-year-old woman presented with an acute anterior STEMI and Killip class III heart failure. She had severe rheumatic heart disease with mechanical tricuspid, mitral and aortic valve prostheses, and atrial fibrillation on warfarin anticoagulation. The international normalized ratio on admission was 1.1. Emergency coronary angiography revealed normal right and circumflex coronary arteries and a total occlusion in the mid left anterior descending artery with a meniscus appearance. Multiple attempts at thrombus aspiration and balloon angioplasty failed to restore flow in the left anterior descending artery. Ultimately, a Fogarty maneuver using a compliant balloon inflated at a low pressure was performed successfully, removing the thrombus into the guiding catheter. There was Thrombolysis in Myocardial Infarction flow grade 3 and near-normal myocardial blush at the end of the procedure. Signs and symptoms of heart failure resolved quickly.
Temporal patterns of damage and decay kinetics of DNA retrieved from plant herbarium specimens
Authors: Weiß Clemens L. , Schuenemann Verena J. , Devos Jane , Shirsekar Gautam , Reiter Ella , Gould Billie A. , Stinchcombe John R. , Krause Johannes , Burbano Hernán A.
Published: July 2015

Herbaria archive a record of changes of worldwide plant biodiversity harboring millions of specimens that contain DNA suitable for genome sequencing. To profit from this resource, it is fundamental to understand in detail the process of DNA degradation in herbarium specimens. We investigated patterns of DNA fragmentation -length and base composition at breaking points-, and nucleotide misincorporation by analyzing 86 herbarium samples spanning the last 300 years using Illumina shot-gun sequencing. We found an exponential decay relationship between DNA fragmentation and time, and estimated a per nucleotide fragmentation rate of 1.66 × 10−4per year, which is ten times faster than the rate estimated for fossilized bones. Additionally, we found that strand breaks occur specially before purines, and that depurination-driven DNA breakage occurs constantly through time and can to a great extent explain decreasing fragment length over time. Similar of what has been found analyzing ancient DNA from bones, we found a strong correlation between the deamination-driven accumulation of cytosine (C) to thymine (T) substitutions and time, which reinforces the importance of substitution patterns to authenticate the ancient/historical nature of DNA fragments. Accurate estimations of DNA degradation through time will allow informed decisions about laboratory and computational procedures to take advantage of the vast collection of worldwide herbarium specimens.
Dendrites enable a robust mechanism for neuronal stimulus selectivity
Authors: Cazé Romain D. , Jarvis Sarah , Foust Amanda J. , Schultz Simon R.
Published: July 2015

Hearing, vision, touch-underlying all of these senses is stimulus selectivity, a robust information processing operation in which cortical neurons respond more to some stimuli than to others. Previous models assume that these neurons receive the highest weighted input from an ensemble encoding the preferred stimulus, but dendrites enable other possibilities. Non-linear dendritic processing can produce stimulus selectivity based on the spatial distribution of synapses, even if the total preferred stimulus weight does not exceed that of non-preferred stimuli. Using a multi-subunit non-linear model, we demonstrate that stimulus selectivity can arise from the spatial distribution of synapses. We propose this as a general mechanism for information processing by neurons possessing dendritic trees. Moreover, we show that this implementation of stimulus selectivity increases the neuron's robustness to synaptic and dendritic failure. Importantly, our model can maintain stimulus selectivity for a larger range of synapses or dendrites loss than an equivalent linear model. We then use a layer 2/3 biophysical neuron model to show that our implementation is consistent with two recent experimental observations: (1) one can observe a mixture of selectivities in dendrites, that can differ from the somatic selectivity, and (2) hyperpolarization can broaden somatic tuning without affecting dendritic tuning. Our model predicts that an initially non-selective neuron can become selective when depolarized. In addition to motivating new experiments, the model's increased robustness to synapses and dendrites loss provides a starting point for fault-resistant neuromorphic chip development.
Discriminating somatic and germline mutations in tumor DNA samples without matching normals
Authors: Hiltemann Saskia , Jenster Guido , Trapman Jan , van der Spek Peter , Stubbs Andrew
Published: July 2015

Tumor analyses commonly employ a correction with a matched normal (MN), a sample from healthy tissue of the same individual, in order to distinguish germline mutations from somatic mutations. Since the majority of variants found in an individual are thought to be common within the population, we constructed a set of 931 samples from healthy, unrelated individuals, originating from two different sequencing platforms, to serve as a virtual normal (VN) in the absence of such an associated normal sample. Our approach removed (1) >96% of the germline variants also removed by the MN sample and (2) a large number (2%–8%) of additional variants not corrected for by the associated normal. The combination of the VN with the MN improved the correction for polymorphisms significantly, with up to ∼30% compared with MN and ∼15% compared with VN only. We determined the number of unrelated genomes needed in order to correct at least as efficiently as the MN is about 200 for structural variations (SVs) and about 400 for single-nucleotide variants (SNVs) and indels. In addition, we propose that the removal of common variants with purely position-based methods is inaccurate and incurs additional false-positive somatic variants, and more sophisticated algorithms, which are capable of leveraging information about the area surrounding variants, are needed for optimal accuracy. Our VN correction method can be used to analyze any list of variants, regardless of sequencing platform of origin. This VN methodology is available for use on our public Galaxy server.
South‐East Asia study alliance guidelines on the management of acne vulgaris in South‐East Asian patients
Authors: Goh Chee Leok , Abad‐Casintahan Flordeliz , Aw Derrick Chen Wee , Baba Roshidah , Chan Lee Chin , Hung Nguyen Thanh , Kulthanan Kanokvalai , Leong Hoe Nam , Medina‐Oblepias Marie Socouer , Noppakun Nopadon , Sitohang Irma Bernadette , Sugito Titi Lestari , Wong Su‐Ni
Published: July 2015

The management of acne in South‐East Asia is unique, as Asian skin and local variables require a clinical approach unlike that utilized in other parts of the world. There are different treatment guidelines per country in the region, and a group of leading dermatologists from these countries convened to review these guidelines, discuss current practices and recent advances, and formulate consensus guidelines to harmonize the management of acne vulgaris in the region. Emphasis has been placed on formulating recommendations to impede the development of antibiotic resistance in Propionibacterium acnes. The group adopted the Acne Consensus Conference system for grading acne severity. The group recommends that patients may be treated with topical medications including retinoids, benzoyl peroxide (BPO), salicylic acid, a combination of retinoid and BPO, or a combination of retinoids and BPO with or without antibiotics for mild acne; topical retinoid with topical BPO and a oral antibiotic for moderate acne; and oral isotretinoin if the patient fails first‐line treatment (a 6‐ or 8‐week trial of combined oral antibiotics and topical retinoids with BPO) for severe acne. Maintenance acne treatment using topical retinoids with or without BPO is recommended. To prevent the development of antibiotic resistance, topical antibiotics should not be used as monotherapy or used simultaneously with oral antibiotics. Skin care, comprised of cleansing, moisturizing and sun protection, is likewise recommended. Patient education and good communication is recommended to improve adherence, and advice should be given about the characteristics of the skin care products patients should use.
3D fracture networks in the crystalline upper crust ‐ A new seismic model of the Continental Deep Drilling Site (South Germany)
Authors: Szalaiová Eva , Iwanowski‐Strahser Katja , Rabbel Wolfgang
Published: July 2015

Based on three‐dimensional seismic reflection data, we present the first comprehensive three‐dimensional model of the fault and fracture inventory of the crystalline upper crust penetrated by the Continental Superdeep Drillhole (Kontinentale Tiefborung, Oberpfalz, Southeast Germany). The investigated volume spans ∼19×19 km2 down to 16‐km depth. It can be regarded as a typical example of metamorphic crust that has undergone numerous phases of ductile and brittle deformation since the start of the Variscan orogeny. We developed an automated workflow for identifying and quantifying the crustal fracture network in order to prepare a basis for an assessment of fluid pathways and geothermal potential of crystalline crust. The workflow comprises the following steps: determination of (i) a three‐dimensional model of major faults by structural tensor analysis and (ii) a three‐dimensional model of middle‐scale fractures by log‐Gabor filtering and image processing; (iii) validation of results by comparison with geophysical borehole data, with independent seismic and seismicity data; and (iv) definition of a three‐dimensional fracture density function serving for a statistical assessment of fracture connectivity and “relative permeability.” This assessment is based on probabilistic fractionation and percolation theories. The derived three‐dimensional distribution of “relative permeability” may be used as a kernel function for inverting hydraulic permeability from hydrothermal field experiments. By comparing borehole and three‐dimensional seismic data, we could confirm that the faults and fractures of the Kontinentale Tiefbohrung area follow a fractal law that is consistent with Turcotte's fractionation model. An important conclusion from this is that upscaling and downscaling between one‐dimensional borehole and three‐dimensional seismic data appear possible. The corresponding one‐, two‐, and three‐dimensional fractal dimension are about 0.8, 1.9, and 2.8, respectively.
Serial determinations of asymmetric dimethylarginine and homocysteine during pregnancy to predict pre‐eclampsia: a longitudinal study
Authors: López‐Alarcón M , Montalvo‐Velarde I , Vital‐Reyes VS , Hinojosa‐Cruz JC , Leaños‐Miranda A , Martínez‐Basila A
Published: July 2015

Objective

To evaluate the usefulness of serial determinations of asymmetric dimethylarginine (ADMA) and homocysteine (Hcy) concentrations during pregnancy to predict pre‐eclampsia, taking into account maternal obesity and B vitamin status.

Design

Longitudinal study.

Setting

Two obstetric referral hospitals.

Sample

Two hundred and fifty‐two of 411 women invited to participate in the study.

Methods

The women made monthly visits from ≤20 weeks of gestation until delivery for measurements of plasma ADMA, Hcy, and vitamins B6, B12, and folic acid, and for the recording of clinical information.

Main outcome measure

Early elevations in plasma ADMA and Hcy related to the development of pre‐eclampsia.

Results

Of the 252 women who completed the study, 179 had no complications, 49 developed pre‐eclampsia, and 24 presented with complications other than pre‐eclampsia. ADMA and Hcy increased gradually throughout pregnancy in the pre‐eclampsia group, independent of maternal B–vitamin status and obesity, but remained constant in women with no complications. Relative to the preceding month, ADMA and Hcy levels increased 1 month prior to the onset of pre‐eclampsia: 124 ± 27 nmol (P < 0.001) and 1177 ± 278 nmol (P = 0.001), respectively, in the pre‐eclampsia group. The group of women with no complications did not show any significant changes. Increases of 80 nmol ADMA and 1000 nmol Hcy at 1 month prior to the onset of pre‐eclampsia demonstrated the best potential for prediction.

Conclusions

Increased ADMA and Hcy levels precede clinical manifestations of pre‐eclampsia. Therefore, serial determinations of their concentrations may be helpful in identifying women at risk.

Tweetable abstract

Increased ADMA and Hcy precede clinical pre‐eclampsia and may identify women at risk.
Maternal and perinatal outcomes in women planning vaginal birth after caesarean (VBAC) at home in England: secondary analysis of the Birthplace national prospective cohort study
Authors: Rowe R , Li Y , Knight M , Brocklehurst P , Hollowell J
Published: July 2015

Objective

To compare vaginal birth rates in women planning vaginal birth after caesarean (VBAC) at home versus in an obstetric unit (OU) and explore transfer rates in women planning home VBAC.

Design

Prospective cohort study.

Setting

OUs and planned home births in England.

Population

1436 women planning VBAC in the Birthplace cohort, including 209 planning home VBAC.

Methods

We used Poisson regression to calculate relative risks adjusted for maternal characteristics.

Main outcome measures

Main outcomes: (i) vaginal birth and (ii) transfer from planned home birth to OU during labour or immediately after birth. Secondary outcomes: (i) composite of maternal blood transfusion or admission to higher level care, (ii) stillbirth or Apgar score <7 at 5 minutes, (iii) neonatal unit admission.

Results

Planned VBAC at home was associated with a statistically significant increase in the chances of having a vaginal birth compared with planned VBAC in an OU (adjusted relative risk 1.15, 95% confidence interval 1.06–1.24). The risk of an adverse maternal outcome was around 2–3% in both settings, with a similar risk of an adverse neonatal outcome. Transfer rates were high (37%) and varied markedly by parity (para 1, 56.7% versus para 2+, 24.6%).

Conclusion

Women in the cohort who planned VBAC at home had an increased chance of a vaginal birth compared with those planning VBAC in an OU, but transfer rates were high, particularly for women with only one previous birth, and the risk of an adverse maternal or perinatal outcome was around 2–3%. No change in guidance can be recommended.

Tweetable abstract

Higher vaginal birth rates in planned VBAC at home versus in OU but 2–3% adverse outcomes and high transfer rate.
Progression from severe sepsis in pregnancy to death: a UK population‐based case‐control analysis
Authors: Mohamed‐Ahmed O , Nair M , Acosta C , Kurinczuk JJ , Knight M
Published: July 2015

Objective

To identify factors associated with progression from pregnancy‐associated severe sepsis to death in the UK.

Design

A population‐based case‐control analysis using data from the UK Obstetric Surveillance System (UKOSS) and the UK Confidential Enquiry into Maternal Death (CEMD).

Setting

All pregnancy care and death settings in UK hospitals.

Population

All non‐influenza sepsis‐related maternal deaths (January 2009 to December 2012) were included as cases (n = 43), and all women who survived severe non‐influenza sepsis in pregnancy (June 2011 to May 2012) were included as controls (n = 358).

Methods

Cases and controls were identified using the CEMD and UKOSS. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals.

Main outcome measures

Odds ratios for socio‐demographic, medical, obstetric and management factors in women who died from sepsis, compared with those who survived.

Results

Four factors were included in the final regression model. Women who died were more likely to have never received antibiotics [aOR = 22.7, 95% confidence interval (CI) 3.64–141.6], to have medical comorbidities (aOR = 2.53, 95%CI 1.23–5.23) and to be multiparous (aOR = 3.57, 95%CI 1.62–7.89). Anaemia (aOR = 13.5, 95%CI 3.17–57.6) and immunosuppression (aOR = 15.0, 95%CI 1.93–116.9) were the two most important factors driving the association between medical comorbidities and progression to death.

Conclusions

There must be continued vigilance for the risks of infection in pregnant women with medical comorbidities. Improved adherence to national guidelines, alongside prompt recognition and treatment with antibiotics, may reduce the burden from sepsis‐related maternal deaths.

Tweetable abstract

Medical comorbidities, multiparity and antibiotic delays increase the risk of death from maternal sepsis.
Should the Mantel test be used in spatial analysis?
Authors: Legendre Pierre , Fortin Marie‐Josée , Borcard Daniel
Published: July 2015

The Mantel test is widely used in biology, including landscape ecology and genetics, to detect spatial structures in data or control for spatial correlation in the relationship between two data sets, for example community composition and environment. The study demonstrates that this is an incorrect use of that test.

The null hypothesis of the Mantel test differs from that of correlation analysis; the statistics computed in the two types of analyses differ. We examined the basic assumptions of the Mantel test in spatial analysis and showed that they are not verified in most studies. We showed the consequences, in terms of power, of the mismatch between these assumptions and the Mantel testing procedure.

The Mantel test H0 is the absence of relationship between values in two dissimilarity matrices, not the independence between two random variables or data tables. The Mantel R2 differs from the R2 of correlation, regression and canonical analysis; these two statistics cannot be reduced to one another. Using simulated data, we show that in spatial analysis, the assumptions of linearity and homoscedasticity of the Mantel test (H1: small values of D1 correspond to small values of D2 and large values of D1 to large values of D2) do not hold in most cases, except when spatial correlation extends over the whole study area. Using extensive simulations of spatially correlated data involving different representations of geographic relationships, we show that the power of the Mantel test is always lower than that of distance‐based Moran's eigenvector map (dbMEM) analysis and that the Mantel R2 is always smaller than in dbMEM analysis, and uninterpretable. These simulation results are novel contributions to the Mantel debate. We also show that regression on a geographic distance matrix does not remove the spatial structure from response data and does not produce spatially uncorrelated residuals.

Our main conclusion is that Mantel tests should be restricted to questions that, in the domain of application, only concern dissimilarity matrices, and are not derived from questions that can be formulated as the analysis of the vectors and matrices from which one can compute dissimilarity matrices.
Shared additive genetic influences on DSM‐IV criteria for alcohol dependence in subjects of European ancestry
Authors: Palmer Rohan H. C. , McGeary John E. , Heath Andrew C. , Keller Matthew C. , Brick Leslie A. , Knopik Valerie S.
Published: July 2015

Background and Aims

Genetic studies of alcohol dependence (AD) have identified several candidate loci and genes, but most observed effects are small and difficult to reproduce. A plausible explanation for inconsistent findings may be a violation of the assumption that genetic factors contributing to each of the seven DSM‐IV criteria point to a single underlying dimension of risk. Given that recent twin studies suggest that the genetic architecture of AD is complex and probably involves multiple discrete genetic factors, the current study employed common single nucleotide polymorphisms in two multivariate genetic models to examine the assumption that the genetic risk underlying DSM‐IV AD is unitary.

Design, Setting, Participants, Measurements

AD symptoms and genome‐wide single nucleotide polymorphism (SNP) data from 2596 individuals of European descent from the Study of Addiction: Genetics and Environment were analyzed using genomic‐relatedness‐matrix restricted maximum likelihood. DSM‐IV AD symptom covariance was described using two multivariate genetic factor models.

Findings

Common SNPs explained 30% (standard error = 0.136, P = 0.012) of the variance in AD diagnosis. Additive genetic effects varied across AD symptoms. The common pathway model approach suggested that symptoms could be described by a single latent variable that had a SNP heritability of 31% (0.130, P = 0.008). Similarly, the exploratory genetic factor model approach suggested that the genetic variance/covariance across symptoms could be represented by a single genetic factor that accounted for at least 60% of the genetic variance in any one symptom.

Conclusion

Additive genetic effects on DSM‐IV alcohol dependence criteria overlap. The assumption of common genetic effects across alcohol dependence symptoms appears to be a valid assumption.
Natural outcome of cannabis use disorder: a 3‐year longitudinal follow‐up
Authors: Feingold Daniel , Fox Jonah , Rehm Jürgen , Lev‐Ran Shaul
Published: July 2015

Aims

To assess the prevalence and correlates of remission from cannabis use disorders (CUDs), focusing on the proportion of individuals with CUDs that remit without abstaining from cannabis use.

Design

Three‐year longitudinal study.

Setting

Wave 1 (2001) and wave 2 (2004) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of US adults aged 18 years and over.

Participants

Our sample included 444 individuals diagnosed with DSM‐IV cannabis abuse and/or dependence during the 12 months prior to wave 1 of the NESARC.

Measurements

Baseline socio‐demographic and clinical correlates were analysed for possible outcomes of CUDs after 3 years: abstinent remission, non‐abstinent remission and sustained disorder.

Findings

Approximately two‐thirds (67%) of individuals with baseline CUD remitted at follow‐up. Approximately 37% of those who remitted were non‐abstinent. Remission was associated with Hispanic ethnicity [odds ratio (OR) = 2.59; 95% confidence interval (CI) = 1.27–4.87], baseline daily or almost daily use of cannabis (OR = 1.91; 95% CI = 1.15–3.16), baseline use of other drugs (OR = 1.63; 95% CI = 1.04–2.56) and two or more medical conditions at baseline (OR = 8.40; 95% CI = 2.67–26.41). Non‐abstinent remission was associated with baseline daily or almost daily use of cannabis (OR = 1.92; 95% CI = 1.05–3.51).

Conclusions

A substantial level of remission from cannabis use disorders (CUDs), including non‐abstinent remission, suggests that the nature of CUDs may be more unstable than reported previously.
Lay epidemiology and the interpretation of low‐risk drinking guidelines by adults in the United Kingdom
Authors: Lovatt Melanie , Eadie Douglas , Meier Petra S. , Li Jessica , Bauld Linda , Hastings Gerard , Holmes John
Published: July 2015

Aims

To explore how the concept of lay epidemiology can enhance understandings of how drinkers make sense of current UK drinking guidelines.

Methods

Qualitative study using 12 focus groups in four sites in northern England and four sites in central Scotland. Participants were 66 male and female drinkers, aged between 19 and 65 years, of different socio‐economic backgrounds. Data were analysed thematically using a conceptual framework of lay epidemiology.

Results

Current drinking guidelines were perceived as having little relevance to participants' drinking behaviours and were generally disregarded. Daily guidelines were seen as irrelevant by drinkers whose drinking patterns comprised heavy weekend drinking. The amounts given in the guidelines were seen as unrealistic for those motivated to drink for intoxication, and participants measured alcohol intake in numbers of drinks or containers rather than units. Participants reported moderating their drinking, but this was out of a desire to fulfil work and family responsibilities, rather than concerns for their own health. The current Australian and Canadian guidelines were preferred to UK guidelines, as they were seen to address many of the above problems.

Conclusions

Drinking guidelines derived from, and framed within, solely epidemiological paradigms lack relevance for adult drinkers who monitor and moderate their alcohol intake according to their own knowledge and risk perceptions derived primarily from experience. Insights from lay epidemiology into how drinkers regulate and monitor their drinking should be used in the construction of drinking guidelines to enhance their credibility and efficacy.
A cost‐effectiveness analysis of opioid substitution therapy upon prison release in reducing mortality among people with a history of opioid dependence
Authors: Gisev Natasa , Shanahan Marian , Weatherburn Don J. , Mattick Richard P. , Larney Sarah , Burns Lucy , Degenhardt Louisa
Published: July 2015

Aim

Although opioid substitution therapy (OST) immediately after prison release reduces mortality, the cost‐effectiveness of treatment has not been examined. Therefore, we undertook a cost‐effectiveness analysis of OST treatment upon prison release and the prevention of death in the first 6 months post‐release.

Design

Population‐based, retrospective data linkage study using records of OST entrants (1985–2010), charges and court appearances (1993–2011), prison episodes (2000–11) and death notifications (1985–2011).

Setting

New South Wales, Australia.

Participants

A cohort of 16 073 people with a history of opioid dependence released from prison for the first time between 1 January 2000 and 30 June 2011.

Intervention

OST treatment compared to no OST treatment at prison release.

Measurements

Mortality and costs (treatment, criminal justice system—court, penalties, prison—and the social costs of crime) were evaluated at 6 months post‐release. Analyses included propensity score matching, bootstrapping and regression.

Findings

A total of 13 468 individuals were matched (6734 in each group). Twenty (0.3%) people released onto OST died, compared with 46 people (0.7%) not released onto OST. The final average costs were lower for the group that received OST post‐release ($7206 versus $14 356). The incremental cost‐effectiveness ratio showed that OST post‐release was dominant, incurring lower costs and saving more lives. The probability that OST post‐release is cost‐effective per life‐year saved is 96.7% at a willingness to pay of $500.

Conclusion

Opioid substitution treatment (compared with no such treatment), given on release from prison to people with a history of opioid dependence, is cost‐effective in reducing mortality in the first 6 months of release.