bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evolution of cave suspension feeding in Protodrilidae (Annelida)
Authors: Martínez Alejandro , Kvindebjerg Kirsten , Iliffe Thomas M. , Worsaae Katrine 
Published: August 2016

Protodrilidae belongs in a lineage that until now entirely consisted of deposit‐feeding, highly adapted interstitial annelids. Except for a pair of anterior palps, all protodrilids lack appendages, parapodia and chaetae; and have slender bodies adapted to glide between the sand grains by ciliary motion. The first exception to these characteristics isMegadrilus pelagicus n. sp. inhabiting the water column of the anchialine La Corona cave system in Lanzarote. Its morphology and evolutionary history are here investigated by combining observations fromin vivovideo recordings and advanced microscopy with phylogenetic analyses. Our studies revealed a unique pelagic, suspension feeding behaviour attained by its long ciliated palps in combination with an autopomorphic dorsal ciliated keel and several longitudinal and transverse ciliary bands. Phylogenetic analyses recoveredMegadrilus pelagicusn. sp. nested within Protodrilidae indicating that its unique traits are derived within the family. These traits are traced in the tree topologies in correlation to cave colonization. The evolution of these traits can be functionally explained by the different demands of a pelagic suspension feeding strategy compared to the ancestral deposit‐feeding guild of the family. The origin of this suspension feeding strategy was presumably favoured by the partial isolation of the anchialine ecosystem, connected to the sea only through the highly porous volcanic subterranean bedrock. This crevicular connection limits the amount of predators and turbulence in the cave, but allows continuous water flow into the system carrying organic particles, which is the main source of food when photosynthetic primary production does not occur and sedimentation is limited. These conditions may select for pelagic suspension feeding as the most feasible life‐strategy in anchialine caves, which the dominance of pelagic, suspension feeding crustaceans and annelids in anchialine cave assemblages may also reflect. For species of ancestrally deposit‐feeding lineages entering the cave system, such as the annelid families Protodrilidae and Nerillidae, an adaptive‐shift from interstitial to crevicular habitats seemingly correlates with dramatic morphological changes and speciation. The dramatic changes observed in these primarily interstitial lineages compared to their relatives, point to alternative adaptive evolutionary pathways related to ecological fitness contrary to the previously proposed theories focusing on geological or stochastic processes.
Poster ‐ 40: Treatment Verification of a 3D‐printed Eye Phantom for Proton Therapy
Authors: Dunning Chelsea , Lindsay Clay , Unick Nick , Sossi Vesna , Martinez Mark , Hoehr Cornelia 
Published: August 2016

Purpose:Ocular melanoma is a form of eye cancer which is often treated using proton therapy. The benefit of the steep proton dose gradient can only be leveraged for accurate patient eye alignment. A treatment‐planning program was written to plan on a 3D‐printed anatomical eye‐phantom, which was then irradiated to demonstrate the feasibility of verifying in vivo dosimetry for proton therapy using PET imaging.Methods:A 3D CAD eye model with critical organs was designed and voxelized into the Monte‐Carlo transport code FLUKA. Proton dose and PET isotope production were simulated for a treatment plan of a test tumour, generated by a 2D treatment‐planning program developed using NumPy and proton range tables. Next, a plastic eye‐phantom was 3D‐printed from the CAD model, irradiated at the TRIUMF Proton Therapy facility, and imaged using a PET scanner.Results:The treatment‐planning program prediction of the range setting and modulator wheel was verified in FLUKA to treat the tumour with at least 90% dose coverage for both tissue and plastic. An axial isotope distribution of the PET isotopes was simulated in FLUKA and converted to PET scan counts. Meanwhile, the 3D‐printed eye‐phantom successfully yielded a PET signal.Conclusions:The 2D treatment‐planning program can predict required parameters to sufficiently treat an eye tumour, which was experimentally verified using commercial 3D‐printing hardware to manufacture eye‐phantoms. Comparison between the simulated and measured PET isotope distribution could provide a more realistic test of eye alignment, and a variation of the method using radiographic film is being developed.
Respiratory Syncytial Virus Infection Triggers Epithelial HMGB1 Release as a Damage-Associated Molecular Pattern Promoting a Monocytic Inflammatory Response
Authors: Hosakote Yashoda M. , Brasier Allan R. , Casola Antonella , Garofalo Roberto P. , Kurosky Alexander 
Published: August 2016

ABSTRACT
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in infant and elderly populations worldwide. Currently, there is no efficacious vaccine or therapy available for RSV infection. The molecular mechanisms underlying RSV-induced acute airway disease and associated long-term consequences remain largely unknown; however, experimental evidence suggests that the lung inflammatory response plays a fundamental role in the outcome of RSV infection. High-mobility group box 1 (HMGB1) is a nuclear protein that triggers inflammation when released from activated immune or necrotic cells and drives the pathogenesis of various infectious agents. Although HMGB1 has been implicated in many inflammatory diseases, its role in RSV-induced airway inflammation has not been investigated. This study investigates the molecular mechanism of action of extracellularly released HMGB1 in airway epithelial cells (A549 and small airway epithelial cells) to establish its role in RSV infection. Immunofluorescence microscopy and Western blotting results showed that RSV infection of human airway epithelial cells induced a significant release of HMGB1 as a result of translocation of HMGB1 from the cell nuclei to the cytoplasm and subsequent release into the extracellular space. Treating RSV-infected A549 cells with antioxidants significantly inhibited RSV-induced HMGB1 extracellular release. Studies using recombinant HMGB1 triggered immune responses by activating primary human monocytes. Finally, HMGB1 released by airway epithelial cells due to RSV infection appears to function as a paracrine factor priming epithelial cells and monocytes to inflammatory stimuli in the airways.

IMPORTANCE
RSV is a major cause of serious lower respiratory tract infections in young children and causes severe respiratory morbidity and mortality in the elderly. In addition, to date there is no effective treatment or vaccine available for RSV infection. The mechanisms responsible for RSV-induced acute airway disease and associated long-term consequences remain largely unknown. The oxidative stress response in the airways plays a major role in the pathogenesis of RSV. HMGB1 is a ubiquitous redox-sensitive multifunctional protein that serves as both a DNA regulatory protein and an extracellular cytokine signaling molecule that promotes airway inflammation as a damage-associated molecular pattern. This study investigated the mechanism of action of HMGB1 in RSV infection with the aim of identifying new inflammatory pathways at the molecular level that may be amenable to therapeutic interventions.
A systematic review and meta-analysis of Synacthen tests for assessing hypothalamic-pituitary-adrenal insufficiency in children
Authors: Ng Sze May , Agwu Juliana Chizo , Dwan Kerry 
Published: August 2016

BackgroundThe diagnostic value of tests used in assessing hypothalamic-pituitary-adrenal axis (HPA) in children remains controversial.DesignA systematic review and meta-analysis with receiver-operated-characteristic curve was undertaken to assess the diagnostic values of conventional standard dose 250 μg tetracosactrin (ACTH), short Synacthen test (SSST) and/or low-dose Synacthen test (LDSST) in the assessment of HPA insufficiency in children. Studies eligible for inclusion were any study that compared the use of the LDSST and/or SSST in the assessment of central adrenal insufficiency in children compared with reference standard test.ResultsThere were no randomised trials found. SSST resulted in higher specificity and positive likelihood ratio than LDSST. The LDSST had a higher sensitivity (86% vs 61%) but a lower specificity (88% vs 99%) than the SSST, but there was high heterogeneity from the LDSST studies with various doses of Synacthen used.ConclusionsLack of standardisation of assays and protocols with regard to timing, frequency and dose has resulted in diagnostic inaccuracies. There is no clear evidence to indicate that LDSST is superior to SSST in the assessment of HPA axis in children. The choice of either SSST or LDSST should be individualised based on clinical judgement for each patient. This systematic review has identified the need for a well-designed, adequately powered, randomised controlled trial on the use of diagnostic tests used in assessing HPA axis in children.
THE POTENTIAL FOR PHARMACISTS TO MANAGE CHILDREN ATTENDING EMERGENCY DEPARTMENTS
Authors: Terry David , Petridis Konstantinos , Aiello Matt , Sinclair Anthony , Huynh Chi , Mazard Louis , Ubhi Hirminder , Terry Alex , Hughes Elizabeth 
Published: August 2016

AimThere have been concerns about maintaining appropriate clinical staff levels in Emergency Departments in England.1 The aim of this study was to determine if Emergency Department attendees aged from 0–16 years could be managed by community pharmacists or hospital independent prescriber pharmacists with or without further advanced clinical practice training.MethodA prospective, 48 site, cross-sectional, observational study of patients attending Emergency Departments (ED) in England, UK was conducted. Pharmacists at each site collected up to 400 admissions and paediatric patients were included in the data collection. The pharmacist independent prescribers (one for each site) were asked to identify patient attendance at their Emergency Department, record anonymised details of the cases—age, weight, presenting complaint, clinical grouping (e.g. medicine, orthopaedics), and categorise each presentation into one of four possible categories: CP, Community Pharmacist, cases which could be managed by a community pharmacist outside an ED setting; IP—cases that could be managed at ED by a hospital pharmacist with independent prescriber status; IPT, Independent Prescriber Pharmacist with additional training—cases which could be managed at ED by a hospital pharmacist independent prescriber with additional clinical training; and MT, Medical Team only—cases that were unsuitable for the pharmacist to manage. An Impact Index was calculated for the two most frequent clinical groupings using the formula: Impact index=percentage of the total workload of the clinical grouping multiplied by the percentage ability of pharmacists to manage that clinical group.Results1623 out of 18,229 (9%) attendees, from 45 of the 48 sites, were children aged from 0 to 16 years of age (median 8 yrs, range 0–16), 749 were female and 874 were male. Of the 1623 admissions, 9% of the cases were judged to be suitable for clinical management by a community pharmacist (CP), 4% suitable for a hospital pharmacist independent prescriber (IP), 32% suitable for a hospital independent pharmacist prescriber with additional training (IPT); and the remaining 55% were only suitable for the Medical Team (MT). The most frequent clinical groups and impact index for the attendees were General Medicine=10.78 and orthopaedics=10.60.ConclusionPaediatric patients attending Emergency Departments were judged by pharmacists to be suitable for management outside a hospital setting in approximately 1 in 11 cases, and by hospital independent prescriber pharmacists in 4 in 10 cases. With further training, it was found that the total proportion of cases that could be managed by a pharmacist was 45%. The greatest impact for pharmacist management occurs in general medicine and orthopaedics.
COMPARING ORAL PARACETAMOL DOSES IN PAEDIATRICS WITH THE NEW BNF-C DOSING
Authors: Ajjan Nour , Shenton Sian 
Published: August 2016

The BNF-C 2014–20151 highlighted some key changes to the dosing of paracetamol in paediatrics, including a change in maximum daily dosage of oral paracetamol from 90 mg/kg/day to 75 mg/kg/day for post-operative pain, and inclusion of age-banded dosing for pain and pyrexia.The local Trust Paediatric Acute Pain Management Manual2 has acknowledged this change, but advised a maximum daily dose of 80 mg/kg/day. This audit was undertaken to determine whether national proposed changes were implemented in practice, in comparison with local guidelines.AimsThe aims and objectives of the audit were to compare oral paracetamol dosing in both medical and surgical settings with the new BNF-C dosing.MethodData were collected over a two week period in September 2014, from two medical and two surgical paediatric wards. The criteria for data collection included paediatric patients above the age of one month and up to 18 years, prescribed oral paracetamol for pain or pyrexia.The following data were collected:▸ Initials of patients and age (for identification purposes and to prevent duplications)▸ Weight (to assess appropriate and safe prescribing)▸ Reason for admission (to distinguish between medical and surgical settings).ResultsData were collected from 24 medical and 48 surgical patients (age range 1 month–16 years).The key findings were:19/24 medical patients were dosed according to the BNF-C age banded guidelines; 5/24 were dosed according to weight: 3 followed the Trust Manual; 1/24 followed the BNF-C, and 1 miscellaneous. No patients had a dose exceeding 80 mg/kg/day.87% of surgical patients were dosed according to the weight based calculation, 69% of whom were within the maximum daily dose of 75 mg/kg. Of the 31% whose daily dose exceeded 75 mg/kg, all were less than 80 mg/kg/day.The Trust Pain Manual does not include the dose banding as per the BNF-C but recommends 20 mg/kg 6 hourly (max 80 mg/kg/day) for acute pain in this age group.ConclusionChildren on the medical wards were prescribed paracetamol following age banded dosing as per BNF-C, whereas surgical wards were more likely to dose by weight following the Trust Pain Manual.The Trust Pain Manual differs from the BNF-C and recommends a maximum daily dose of 80 mg/kg/day for acute severe pain, to ensure adequate pain control and minimise calculation errors. Despite the new guidance in the BNF-C, it was found that many patients were prescribed a maximal daily dose greater than 75 mg/kg/day; however no patient's daily dose exceeded 80 mg/kg/day as indicated in the Manual.The main finding from the audit was that prescribers were not aware of the change in maximal daily dose of oral paracetamol. To highlight this important point, a poster was designed and distributed amongst the medical and surgical staff on the wards, highlighting that the dose should not exceed 75 mg/kg in a 24 hour period.
CHANGING INFUSION PRACTICE GENERATES SIGNIFICANT EFFICIENCIES IN NURSING TIME AND RESOURCE USAGE IN PAEDIATRIC INTENSIVE CARE
Authors: Sutherland Adam , Jemmett Liz , Barber Rachael 
Published: August 2016

IntroductionInfusion preparation in British PICUs uses the Rule of Six (ROS) which was developed for administration without infusion devices. This method is inaccurate.1 Regulators recommend standardised approaches to IV infusions to improve patient safety and quality of care.2 Administration set changes also have an association with resource use and central line infections.3 We report the impact of fixed concentration infusions and reduced administration set changes on nursing time and infusion equipment cost.MethodsMorphine and midazolam infusions were standardised in September 2014. Direct observation of infusion preparation was carried out beforeand after the introduction of fixed-concentration (FC) infusions to quantify the nursing time required to prepare infusions. Administration was prospectively documented using purposive sampling until a population-representative sample for age and weight was obtained (1 month). This data was then scaled up to predict activity over one year. Syringe use and administration set use was calculated. Reducing frequency of administration set changes to 72 hrs in accordance with infection control policy was then calculated retrospectively.ResultsIt takes 40 minutes (2 nurses×20 minutes) to prepare ROS syringes and 30 minutes (2 nurses×15 minutes) for FC syringes.In total ROS infusions required 2433 hrs of nursing time to prepare. FC infusions reduced this time by 25% (608 hrs) releasing 0.5 WTE nursing time back to patient care.Mean duration of IV sedation in these patients was 100 hrs. The cost associated with replacing administration sets with each syringe was £16,060. By changing every 72 hrs, this cost is reduced to £4,400 – a cost saving of £11,660.ConclusionsFC syringes are more efficient than ROS. FC preparations have released 0.5 WTE nurses back to patient care. Changing administration sets 72 hrly realises significant cost efficiencies.
PN FOR CHILDREN – INFORMATION LEAFLET
Authors: Riddell Rebecca , Lewis Anthony , Tuthill David 
Published: August 2016

AimTo produce a leaflet for parents and carers of children receiving parenteral nutrition (PN) explaining:▸ What PN is▸ Why it is given▸ How it will be given▸ Risks & Complications▸ Other useful information▸ Nutrition team contact informationCurrent practice is for the nutrition team pharmacist to give a verbal account of the above information to parents/carers. It was felt that providing this information in a written format would introduce consisitency and allow parents/carers more time to take information on board.MethodAn internet search and discussions with other organisations with paediatric gastroenterology specialists was conduted to see if something similar was in existence. A similar information leaflet to what we hoped to produce was not found. Members of the paediatric nutrition team, which included consultants, nurse specialists, pharmacist and dietician, provided input to the type of information that should be included in the information leaflet. A first draft of the leaflet was produced and shown to the parents of current paediatric PN inpatients. Feedback was received and the leaflet updated following consultation with the nutrition team.ConclusionProduction of a very useful information leaflet for parents/carers, containing all the relevant information and detail. The leaflet uses colour and pictures to aid the transfer of information and makes it more attractive to read. The pharmacist is the main point of contact for the paediatric nutrition team and will be the individual responsible for distributing them.
THE DEVELOPMENT OF A QUALITY IMPROVEMENT SYSTEM TO MONITOR, ASSESS AND FEEDBACK PRESCRIBING ERRORS IN PAEDIATRIC INTENSIVE CARE
Authors: Morris Stephen , Rivett Claire 
Published: August 2016

BackgroundPrescribing errors are a major contributing factor to many medication errors and therefore are at the forefront of strategies to reduce errors and improve patient safety.1 Many paediatric intensive care units have attempted to implement “Zero Tolerance Prescribing” to improve standards of prescribing. However the enforcement of these standards can be difficult and time consuming with varied success.2
AimsThe aim of this project was to reduce prescribing errors by adapting a previous study3 that had developed a novel way of analysing, interpreting and publishing prescribing audit data. This would allow us to promote an educational approach to our prescribing audits and allow us to provide constructive feedback and learning points for all prescribers on the unit. The main element would be to use a spreadsheet to automate this process to reduce the time required to produce the reports.MethodsPrescriptions were assessed over a 2 week period according to local “Zero Tolerance” standards. An Excel spreadsheet was designed to provide individual feedback forms for prescribers. This contained data such as error rates and types, examples of specific errors and anonymous results from other prescribers for comparison. Additional reports were also generated to create posters that could be displayed around the unit and discussed at clinical governance meetings. This cycle was repeated after approximately 1 month.ResultsIn total 376 and 275 prescription were assessed in each cycle. The overall unit mean error rate remained consistent between the two cycles at 12.5% and 13.0% respectively. In prescribers who prescribed at least 5 items in both cycles (n=7), there was a decrease in error rate over 5.9% from cycle 1 (M=15.3, SD=14.6) compared with cycle 2 (M=9.4 SD=7.3); t(6)=1.1710 p=0.29 although this was not statistically significant using a paired t-test.ConclusionThe audits that we completed did not show any reduction in mean error rate. However, when we looked more closely at the data we had gathered, it was noticeable that there was a reduction when comparing individuals between each cycle. This demonstrated that our system of feedback for prescribers did lead to changes in practice and improvements.The main limitation of our method was the lack data for each prescriber and that prescribers had varied total prescribing volume that resulted in easily skewed data.