Medicine by Alexandros G.Sfakianakis: 04/13/16

Τετάρτη 13 Απριλίου 2016

Metformin use and survival of patients with pancreatic cancer: a cautionary lesson

Journal of Clinical Oncology

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Ischemic colitis as a complication of medication use: an analysis of the federal adverse event reporting system

Digestive Diseases and Sciences

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Cost-effectiveness of Crohn’s disease post-operative care

World Journal of Gastroenterology

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Sphingosine-1-phosphate receptor-1 (S1P₁) is expressed by lymphocytes, dendritic cells, and endothelium and modulated during inflammatory bowel disease

Mucosal Immunology

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Acceptability of rapid point-of-care hepatitis C tests among people who inject drugs that utilize syringe-exchange programs

Open Forum Infectious Diseases

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Metformin enhances the response to radiotherapy in diabetic patients with rectal cancer

Journal of Cancer Research & Clinical Oncology

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The prognostic value of lactate dehydrogenase levels in colorectal cancer: a meta-analysis

BMC Cancer

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The prognostic value of rectal invasion for stage IVA uterine cervical cancer treated with radiation therapy

BMC Cancer

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Gastrointestinal tract colonization dynamics by different enterococcus faecium clades

The Journal of Infectious Diseases

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Entropy, Vol. 18, Pages 133: Correction on Liu, X.; Jiang, A.; Xu, N.; Xue, J. Increment Entropy as a Measure of Complexity for Time Series. Entropy 2016, 18, 22

The authors wish to make the following correction to their paper [1].[...]

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Entropy, Vol. 18, Pages 136: Correction: Kay, B.S. Entropy and Quantum Gravity. Entropy 2015, 17, 8174–8186

The following corrections should be made to the published paper [1]: First, the paragraph beginning with "One might argue that . . . " and ending with ". . . increase monotonically with time."[...]

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Incidence and Etiology of Potentially Preventable ICU Readmissions.

Objectives: The rate of unplanned ICU readmissions is often considered a measure of hospital performance. However, the degree to which these readmissions are preventable and the causes of preventable readmissions are unknown, creating uncertainty about the feasibility and value of reducing ICU readmission rates. To inform this issue, we sought to determine the frequency and underlying causes of potentially preventable ICU readmissions. Design: Retrospective cohort study. Setting: Urban, academic medical center in the mid-Atlantic United States. Patients: Adult patients discharged alive from their first ICU admission with an unplanned readmission within 48 hours of discharge. Measurements and Main Results: Each patient's medical chart was reviewed by two independent investigators who rated each readmission's preventability according to standardized scale and assessed the etiology of both preventable and nonpreventable readmissions. We assessed concordance between raters using the [kappa] statistic and resolved disagreements through iterative discussion. Of 136 readmissions in the final analysis, 16 (11.8%; 95% CI, 6.9-18.4) were considered preventable and 120 (88.2%; 95% CI, 81.5-93.1) were considered nonpreventable. Of nonpreventable readmissions, 67 were due to a new clinical problem and 53 were due to an existing clinical problem. Among preventable readmissions, six were attributable to system errors, six were attributable to management errors, two were attributable to procedural events, one was attributable to a diagnostic error, and one was attributable to a medication error. Compared to nonpreventable readmissions, preventable readmissions tended to have shorter index ICU lengths of stay (2 vs 3 d; p = 0.05) and a shorter duration of time on the ward prior to readmission (16.6 vs 23.6 hr; p = 0.05). Conclusions: The majority of early ICU readmissions are nonpreventable, raising important concerns about ICU readmission rates as a measure of hospital performance. Copyright (C) by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Critical Illness Is Associated With Impaired Gallbladder Emptying as Assessed by 3D Ultrasound.

Objective: To quantify gallbladder dysfunction during critical illness. Design: Prospective observational comparison study of nutrient-stimulated gallbladder emptying in health and critical illness. Setting: Single-centre mixed medical/surgical ICU. Patients: Twenty-four mechanically ventilated critically ill patients suitable to receive enteral nutrition were compared with 12 healthy subjects. Interventions: Participants were studied after an 8-hour fast. Between 0 and 120 minutes, high-fat nutrient (20% intralipid) was infused via a postpyloric catheter into the duodenum at 2 kcal/min. Measurements and Main Results: Three-dimensional images of the gallbladder were acquired at 30-minute intervals from -30 to 180 minutes. Ejection fraction (%) was calculated as changes between 0 and 120 minutes. Blood samples were obtained at 30-minute intervals for plasma cholecystokinin. Data are mean (SD) or median [interquartile range]. In the critically ill, fasting gallbladder volumes (critically ill, 61 mL [36-100 mL] vs healthy, 22 mL [15-25] mL; p

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Cerebral Oximetry During Cardiac Arrest: A Multicenter Study of Neurologic Outcomes and Survival.

Objectives: Cardiac arrest is associated with morbidity and mortality because of cerebral ischemia. Therefore, we tested the hypothesis that higher regional cerebral oxygenation during resuscitation is associated with improved return of spontaneous circulation, survival, and neurologic outcomes at hospital discharge. We further examined the validity of regional cerebral oxygenation as a test to predict these outcomes. Design: Multicenter prospective study of in-hospital cardiac arrest. Setting: Five medical centers in the United States and the United Kingdom. Patients: Inclusion criteria are as follows: in-hospital cardiac arrest, age 18 years old or older, and prolonged cardiopulmonary resuscitation greater than or equal to 5 minutes. Patients were recruited consecutively during working hours between August 2011 and September 2014. Survival with a favorable neurologic outcome was defined as a cerebral performance category 1-2. Interventions: Cerebral oximetry monitoring. Measurements and Main Results: Among 504 in-hospital cardiac arrest events, 183 (36%) met inclusion criteria. Overall, 62 of 183 (33.9%) achieved return of spontaneous circulation, whereas 13 of 183 (7.1%) achieved cerebral performance category 1-2 at discharge. Higher mean +/- SD regional cerebral oxygenation was associated with return of spontaneous circulation versus no return of spontaneous circulation (51.8% +/- 11.2% vs 40.9% +/- 12.3%) and cerebral performance category 1-2 versus cerebral performance category 3-5 (56.1% +/- 10.0% vs 43.8% +/- 12.8%) (both p

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Pediatric Triage in a Severe Pandemic: Maximizing Survival by Establishing Triage Thresholds.

Objectives: To develop and validate an algorithm to guide selection of patients for pediatric critical care admission during a severe pandemic when Crisis Standards of Care are implemented. Design: Retrospective observational study using secondary data. Patients: Children admitted to VPS-participating PICUs between 2009-2012. Interventions: A total of 111,174 randomly selected nonelective cases from the Virtual PICU Systems database were used to estimate each patient's probability of death and duration of ventilation employing previously derived predictive equations. Using real and projected statistics for the State of Ohio as an example, triage thresholds were established for casualty volumes ranging from 5,000 to 10,000 for a modeled pandemic with peak duration of 6 weeks and 280 pediatric intensive care beds. The goal was to simultaneously maximize casualty survival and bed occupancy. Discrete Event Simulation was used to determine triage thresholds for probability of death and duration of ventilation as a function of casualty volume and the total number of available beds. Simulation was employed to compare survival between the proposed triage algorithm and a first come first served distribution of scarce resources. Measurements and Main Results: Population survival was greater using the triage thresholds compared with a first come first served strategy. In this model, for five, six, seven, eight, and 10 thousand casualties, the triage algorithm increased the number of lives saved by 284, 386, 547, 746, and 1,089, respectively, compared with first come first served (all p

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Cardiac Arrests Associated With Tracheal Intubations in PICUs: A Multicenter Cohort Study.

Objectives: To determine the incidence and epidemiologic characteristics of cardiac arrests among tracheal intubations in PICUs. Design: Retrospective cohort study of prospectively collected data. Setting: Twenty-five diverse PICUs. Patients: Critically ill children requiring tracheal intubation in PICUs. Interventions: Tracheal intubation quality improvement data were prospectively collected for all initial tracheal intubations in 25 PICUs from July 2010 to March 2014 using National Emergency Airway Registry for Children registry. Measurements and Main Results: Tracheal intubation-associated cardiac arrest was defined as chest compressions more than 1 minute occurring during tracheal intubation or within 20 minutes after tracheal intubation. A total of 5,232 pediatric tracheal intubations were evaluated. Tracheal intubation-associated cardiac arrest was reported in 87 (1.7%). Patient factors (demographics and indications for tracheal intubation), provider factors (discipline and training level), and practice factors (tracheal intubation method and use of neuromuscular blockade) were recorded. Hemodynamic instability and oxygenation failure as tracheal intubation indications were associated with cardiac arrests (adjusted odds ratio, 6.3; 95% CI, 3.9-10.3; and adjusted odds ratio, 4.3; 95% CI, 2.6-6.9, respectively). History of difficult airway and cardiac disease were also associated with cardiac arrests (adjusted odds ratio, 2.1; 95% CI, 1.2-3.5; and adjusted odds ratio, 2.1; 95% CI, 1.2-3.9, respectively). Provider and practice factors were not associated with cardiac arrests, and provider factors did not modify the effect of patient factors on cardiac arrests. Conclusions: Tracheal intubation-associated cardiac arrests occurred during 1.7% of PICU tracheal intubations. Tracheal intubation-associated cardiac arrests were much more common with tracheal intubations when the child had acute hemodynamic instability or oxygen failure and when the child had a history of difficult airway or cardiac disease. Copyright (C) by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Elevated Leukocyte Azurophilic Enzymes in Human Diabetic Ketoacidosis Plasma Degrade Cerebrovascular Endothelial Junctional Proteins.

Objective: Diabetic ketoacidosis in children is associated with vasogenic cerebral edema, possibly due to the release of destructive polymorphonuclear neutrophil azurophilic enzymes. Our objectives were to measure plasma azurophilic enzyme levels in children with diabetic ketoacidosis, to correlate plasma azurophilic enzyme levels with diabetic ketoacidosis severity, and to determine whether azurophilic enzymes disrupt the blood-brain barrier in vitro. Design: Prospective clinical and laboratory study. Setting: The Children's Hospital, London Health Sciences Centre. Subjects: Pediatric type 1 diabetes patients; acute diabetic ketoacidosis or age-/sex-matched insulin-controlled. Measurements and Main Results: Acute diabetic ketoacidosis in children was associated with elevated polymorphonuclear neutrophils. Plasma azurophilic enzymes were elevated in diabetic ketoacidosis patients, including human leukocyte elastase (p

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The Efficacy of Noble Gases in the Attenuation of Ischemia Reperfusion Injury: A Systematic Review and Meta-Analyses.

Objective: Noble gases have been attributed to organ protective effects in ischemia reperfusion injury in a variety of medical conditions, including cerebral and cardiac ischemia, acute kidney injury, and transplantation. The aim of this study was to appraise the available evidence by systematically reviewing the literature and performing meta-analyses. Data Sources: PubMed, EMBASE, and the Cochrane Library. Study Selection: Inclusion criteria specified any articles on noble gases and either ischemia reperfusion injury or transplantation. In vitro studies, publications without full text, review articles, and letters were excluded. Data Extraction: Information on noble gas, organ, species, model, length of ischemia, conditioning and noble gas dose, duration of administration of the gas, endpoints, and effects was extracted from 79 eligible articles. Study quality was evaluated using the Jadad scale. Effect sizes were extracted from the articles or retrieved from the authors to allow meta-analyses using the random-effects approach. Data Synthesis: Argon has been investigated in cerebral, myocardial, and renal ischemia reperfusion injury; helium and xenon have additionally been tested in hepatic ischemia reperfusion injury, whereas neon was only explored in myocardial ischemia reperfusion injury. The majority of studies show a protective effect of these noble gases on ischemia reperfusion injury across a broad range of experimental conditions, organs, and species. Overall study quality was low. Meta-analysis for argon was only possible in cerebral ischemia reperfusion injury and did not show neuroprotective effects. Helium proved neuroprotective in rodents and cardioprotective in rabbits, and there were too few data on renal ischemia reperfusion injury. Xenon had the most consistent effects, being neuroprotective in rodents, cardioprotective in rodents and pigs, and renoprotective in rodents. Conclusions: Helium and xenon show organ protective effects mostly in small animal ischemia reperfusion injury models. Additional information on timing, dosing, and comparative efficacy of the different noble gases, as well as confirmation in large animal models, is needed before designing clinical trials. Copyright (C) by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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Acute and Subchronic Oral Toxicity Evaluation of Aqueous Root Extract of Dicoma anomala Sond. in Wistar Rats

The present study evaluated the safety of aqueous root extract of Dicoma anomala (AQRED) through acute and subchronic toxicity studies. Single oral dose of AQRED at the concentration of 0, 5, 300, and 2000 mg/kg as well as 125, 250, and 500 mg/kg/day was administered to rats for 14-day acute and 90-day subchronic oral toxicity studies. The results revealed no mortalities or observed clinical signs of toxicity in all the rats during both investigation periods. In subchronic toxicity testing, administration of AQRED also did not cause any changes in body weight as well as food and water consumption patterns. The haematological parameters and blood chemistry revealed no significant difference () between the treatment and the control except in platelet count, alkaline phosphatase, and sodium levels where there was a significant increase (), although there was also a significant reduction () in alanine transaminase, aspartate transaminase, and creatinine when compared to control. However, these changes were not reflecting the results from histology. Conclusively, the obtained results suggested that the LD50 of AQRED is in excess of 2000 mg/kg and its oral administration for 90 days revealed that it is unlikely to be toxic, hence, safe.

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Sustainability, Vol. 8, Pages 362: Solar Energy Block-Based Residential Construction for Rural Areas in the West of China

Based on the Great Western Development Strategy and the requirement for sustainable development in the west of China, rural affordable housing, energy conservation, and environmental protection are becoming development standards in the construction field. This paper mainly explores an innovative, sustainable, residential construction method for rural areas in western China, particularly the integration of solar energy technology with modern prefabricated building techniques, formally named solar energy block-based construction. The conscious approach of using volumetric blocks provides superior adaptability and expansibility in integration with a steel structure, thereby reducing the construction time and cost. Allowing a wide variety of configurations and styles in the building layout, this approach can be customized to the end-user's precise location and climate, making rural residential buildings much more flexible and modern. To take advantage of adequate solar energy resource in western China, the blocks are associated with active and passive solar energy technologies, thereby reducing pollution, mitigating global warming, and enhancing sustainability. Therefore, we concluded that solar energy block-based construction could bring significant benefits to the environment, economy, and society. It could also promote sustainable development in the rural regions of western China.

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Geosciences, Vol. 6, Pages 22: An Overview of the Use of Absolute Dating Techniques in Ancient Construction Materials

The reconstruction of the chronology of historical buildings is a tricky issue, as usually there are not historical documents that allow the assessment of construction phases, and some materials are hardly reliable for the use of dating techniques (e.g., stone). However, in the last two decades, important advances on the use of absolute dating methods on building materials have increased the possibilities of reconstructing building chronologies, although some advances are still scarcely known among archaeologists and architects. Recent studies performed on several kinds of mortars, fired bricks, mud-bricks, and even stone surfaces have shown that it is possible to date them. Both radiocarbon and luminescence dating have been the most frequently used techniques but others such as archaeomagnetism can also be used in some cases. This paper intends to give an overview of the recent achievements on the use of absolute dating techniques for building materials.

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Sustainability, Vol. 8, Pages 361: An Optimization System for Concrete Life Cycle Cost and Related CO2 Emissions

An optimization system that supports the production of concrete while minimizing carbon dioxide (CO2) emissions or costs is presented that incorporates an evolution algorithm for the materials' mix design stage, a trigonometric function for the transportation stage, and a stochastic model for the manufacturing stage. A case study demonstrates that applying the optimization system reduced CO2 emissions by 34% compared to the standard concrete production processes typically used. When minimizing the cost of concrete production was prioritized, the cost dropped by 1% compared to the cost of conventional concrete production. These findings confirm that this optimization system helps with the design of the concrete mix and the choice of a material supplier, thus reducing both CO2 emissions and costs.

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Crystals, Vol. 6, Pages 42: Rb2Na(NO3)3: A Congruently Melting UV-NLO Crystal with a Very Strong Second-Harmonic Generation Response

Crystals of congruently melting noncentrosymmetric (NCS) mixed alkali metal nitrate, Rb2Na(NO3)3, have been grown through solid state reactions. The material possesses layers with NaO8 hexagonal bipyramids and NO3 triangular units. Rb+ cations are residing in the interlayer space. Each NaO8 hexagonal bipyramid shares its corners and edges with two and three NO3 units, respectively, in order to fulfill a highly dense stacking in the unit cell. The NaO8 groups share their six oxygen atoms in equatorial positions with three different NO3 groups to generate a NaO6-NO3 layer with a parallel alignment. The optimized arrangement of the NO3 groups and their high density in the structure together produce a strong second-harmonic generation (SHG) response. Powder SHG measurements indicate that Rb2Na(NO3)3 has a strong SHG efficiency of five times that of KH2PO4 (KDP) and is type I phase-matchable. The calculated average nonlinear optical (NLO) susceptibility of Rb2Na(NO3)3 turns out to be the largest value among the NLO materials composed of only [NO3]− anion. In addition, Rb2Na(NO3)3 exhibits a wide transparency region ranging from UV to near IR, which suggests that the compound is a promising NLO material.

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Sustainability, Vol. 8, Pages 364: Conceptualizing the Limiting Issues Inhibiting Sustainability Embeddedness

There can be little doubt that sustainability has become one of the most important issues in business in recent years. In spite of sustainability's importance, there is agreement amongst leaders and practitioners that sustainability is not as embedded as desired. This study reports a framework on inhibitors that limit sustainability embeddedness in organizations. The framework can assist management to address the non-achievement antecedents of embeddedness specifically and holistically. This study obtained empirical data from employees on all management levels in a stock exchange-listed company. Through in-depth analysis in a case organization, valuable insights about embeddedness were inductively identified, interpreted and presented using descriptive labels, namely: "Professing What Is Right"; "Green Distraction"; the belief of "Not My Job"; "Firefighter"; the "Past Performance Anchor"; "Strategy Discourse" and "Harmony"—a mediator to sustainability embeddedness. All these were also found to be altered by the transformation of culture and the communication of the strategy message by sustainable leadership—the moderator. The findings were also corroborated by related and supporting literature as part of our contribution and pursuit for better understanding of this phenomenon.

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Metals, Vol. 6, Pages 85: Corrosion Resistance of the Superhydrophobic Mg(OH)2/Mg-Al Layered Double Hydroxide Coatings on Magnesium Alloys

Coatings of the Mg(OH)2/Mg-Al layered double hydroxide (LDH) composite were formed by a combined co-precipitation method and hydrothermal process on the AZ31 alloy substrate in alkaline condition. Subsequently, a superhydrophobic surface was successfully constructed to modify the composite coatings on the AZ31 alloy substrate using stearic acid. The characteristics of the composite coatings were investigated by means of X-ray diffractometer (XRD), Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), scanning electronic microscope (SEM) and contact angle (CA). The corrosion resistance of the coatings was assessed by potentiodynamic polarization, the electrochemical impedance spectrum (EIS), the test of hydrogen evolution and the immersion test. The results showed that the superhydrophobic coatings considerably improved the corrosion resistant performance of the LDH coatings on the AZ31 alloy substrate.

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Buildings, Vol. 6, Pages 17: Design of Sustainable Agricultural Buildings. A Case Study of a Wine Cellar in Tuscany, Italy

This research concerns the design of an agricultural building with a high degree of sustainability, located in a farm in the south of the Tuscany region, Italy. The building, intended mainly as a wine cellar, offers innovative construction solutions of high deconstructability and has features of low environmental impact, economic competitiveness and constructive simplicity. In particular, the design of the basement cellar involves the use of gabions and stones for the realization of the foundations, the ground retaining walls and all other bearing walls. A different solution is adopted for the external wall which remains entirely above ground. It is also made by gabions, but it is externally covered with a coat of straw bales and is plastered with clay or lime. The roof-bearing structure is made of steel beams and galvanized steel sheets. A layer of fertile soil is arranged on the roof to form a green roof system. This research aims to spread the design criteria of deconstructable buildings, based on the use of natural materials with low environmental and economic impact. Where it is not possible to employ natural materials, reusable or recyclable materials are used.

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IJERPH, Vol. 13, Pages 420: Restoration in Its Natural Context: How Ecological Momentary Assessment Can Advance Restoration Research

More and more people use self-tracking technologies to track their psychological states, physiology, and behaviors to gain a better understanding of themselves or to achieve a certain goal. Ecological Momentary Assessment (EMA) also offers an excellent opportunity for restorative environments research, which examines how our physical environment (especially nature) can positively influence health and wellbeing. It enables investigating restorative health effects in everyday life, providing not only high ecological validity but also opportunities to study in more detail the dynamic processes playing out over time on recovery, thereby bridging the gap between laboratory (i.e., short-term effects) and epidemiological (long-term effects) research. We have identified four main areas in which self-tracking could help advance restoration research: (1) capturing a rich set of environment types and restorative characteristics; (2) distinguishing intra-individual from inter-individual effects; (3) bridging the gap between laboratory and epidemiological research; and (4) advancing theoretical insights by measuring a more broad range of effects in everyday life. This paper briefly introduces restorative environments research, then reviews the state of the art of self-tracking technologies and methodologies, discusses how these can be implemented to advance restoration research, and presents some examples of pioneering work in this area.

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Life, Vol. 6, Pages 18: Molecular Asymmetry in Prebiotic Chemistry: An Account from Meteorites

Carbonaceous Chondrite (CC) meteorites are fragments of asteroids, solar planetesimals that never became large enough to separate matter by their density, like terrestrial planets. CC contains various amounts of organic carbon and carry a record of chemical evolution as it came to be in the Solar System, at the time the Earth was formed and before the origins of life. We review this record as it pertains to the chiral asymmetry determined for several organic compounds in CC, which reaches a broad molecular distribution and enantiomeric excesses of up to 50%–60%. Because homochirality is an indispensable attribute of extant polymers and these meteoritic enantiomeric excesses are still, to date, the only case of chiral asymmetry in organic molecules measured outside the biosphere, the possibility of an exogenous delivery of primed prebiotic compounds to early Earth from meteorites is often proposed. Whether this exogenous delivery held a chiral advantage in molecular evolution remains an open question, as many others regarding the origins of life are.

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Water, Vol. 8, Pages 143: Can Rapid Assessments Predict the Biotic Condition of Restored Streams?

Five rapid visual stream assessment methods were applied to 65 restored streams in North Carolina, and the results were correlated with measured macroinvertebrate community metrics to evaluate predictive ability. The USEPA Rapid Bioassessment Protocol (RBP), USDA Stream Visual Assessment Protocol (SVAP), Peterson's Riparian Channel and Environmental Inventory (RCE), NCSU Eco-Geomorphological Assessment (EGA), and NCSU Stream Performance Assessment (SPA) were applied by teams with expertise in hydrology, fluvial geomorphology, and aquatic ecology. Predictions of most macroinvertebrate metrics were improved by re-weighting assessment variables using principal component analysis (PCA) and including watershed factors (e.g., size, slope, land use). The correlations of EGA, RCE, SPA and SVAP assessment results to macroinvertebrate metrics were most improved by variable re-weighting using PCA, while the correlations of RBP were most improved by adding watershed parameters. Akaike's Information Criterion (AIC) indicates that PCA re-weighting including watershed parameters improves the predictor model for the total number of dominant EPT taxa more than using the sum total raw points for all five assessment methods. To demonstrate the application of the study results, a single-value index was generated for the RBP method using principal component regression (PCR) based on the EPT (Ephemeroptera, Plecoptera and Trichoptera) taxa metric.

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Sensors, Vol. 16, Pages 531: Towards A Self Adaptive System for Social Wellness

Advancements in science and technology have highlighted the importance of robust healthcare services, lifestyle services and personalized recommendations. For this purpose patient daily life activity recognition, profile information, and patient personal experience are required. In this research work we focus on the improvement in general health and life status of the elderly through the use of an innovative services to align dietary intake with daily life and health activity information. Dynamic provisioning of personalized healthcare and life-care services are based on the patient daily life activities recognized using smart phone. To achieve this, an ontology-based approach is proposed, where all the daily life activities and patient profile information are modeled in ontology. Then the semantic context is exploited with an inference mechanism that enables fine-grained situation analysis for personalized service recommendations. A generic system architecture is proposed that facilitates context information storage and exchange, profile information, and the newly recognized activities. The system exploits the patient's situation using semantic inference and provides recommendations for appropriate nutrition and activity related services. The proposed system is extensively evaluated for the claims and for its dynamic nature. The experimental results are very encouraging and have shown better accuracy than the existing system. The proposed system has also performed better in terms of the system support for a dynamic knowledge-base and the personalized recommendations.

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Toxins, Vol. 8, Pages 107: Review Over a 3-Year Period of European Union Proficiency Tests for Detection of Staphylococcal Enterotoxins in Food Matrices

Staphylococcal food poisoning outbreaks are a major cause of foodborne illnesses in Europe and their notifications have been mandatory since 2005. Even though the European regulation on microbiological criteria for food defines a criterion on staphylococcal enterotoxin (SE) only in cheese and dairy products, European Food Safety Authority (EFSA) data reported that various types of food matrices are involved in staphylococcal food poisoning outbreaks. The European Screening Method (ESM) of European Union Reference Laboratory for Coagulase Positive Staphylococci (EURL CPS) was validated in 2011 for SE detection in food matrices and is currently the official method used for screening purposes in Europe. In this context, EURLCPS is annually organizing Inter-Laboratory Proficiency Testing Trials (ILPT) to evaluate the competency of the European countries' National Reference Laboratories (NRLs) to analyse SE content in food matrices. A total of 31 NRLs representing 93% of European countries participated in these ILPTs. Eight food matrices were used for ILPT over the period 2013–2015, including cheese, freeze-dried cheese, tuna, mackerel, roasted chicken, ready-to-eat food, milk, and pastry. Food samples were spiked with four SE types (i.e., SEA, SEC, SED, and SEE) at various concentrations. Homogeneity and stability studies showed that ILPT samples were both homogeneous and stable. The analysis of results obtained by participants for a total of 155 blank and 620 contaminated samples allowed for evaluation of trueness (>98%) and specificity (100%) of ESM. Further to the validation study of ESM carried out in 2011, these three ILPTs allowed for the assessment of the proficiency of the NRL network and the performance of ESM on a large variety of food matrices and samples. The ILPT design presented here will be helpful for the organization of ILPT on SE detection by NRLs or other expert laboratories.

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JCM, Vol. 5, Pages 47: Management of Status Epilepticus in Children

Status epilepticus is a common pediatric neurological emergency. Management includes prompt administration of appropriately selected anti-seizure medications, identification and treatment of seizure precipitant(s), as well as identification and management of associated systemic complications. This review discusses the definitions, classification, epidemiology and management of status epilepticus and refractory status epilepticus in children.

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Polymers, Vol. 8, Pages 139: Enzyme-Catalyzed Synthesis of Water-Soluble Conjugated Poly[2-(3-thienyl)-Ethoxy-4-Butylsulfonate]

An environmentally friendly water-soluble conjugated polythiophene poly[2-(3-thienyl)-ethoxy-4-butylsulfonate] (PTEBS) has been found to be effective for making hybrid solar cells. In this work, we first report the enzyme-catalyzed polymerization of (3-thienyl)-ethoxy-4-butylsulfonate (TEBS) using horseradish peroxidase (HRP) enzyme as a catalyst and hydrogen peroxide (H2O2) as an oxidant in an aqueous buffer. This enzyme-catalyzed polymerization is a "green synthesis process" for the synthesis of water-soluble conjugated PTEBS, the benefits of which include a simple setting, high yields, and an environmentally friendly route. Fourier transform infrared spectra (FTIR) and UV–Vis absorption spectra confirm the successful enzyme-catalyzed polymerization of TEBS. The thermo gravimetric (TG) data show the obtained PTEBS is stable over a fairly high range of temperatures. The present PTEBS has a good solubility in water and ethanol, and photoluminescence quenching of PTEBS/titanium dioxide (TiO2) composite implies that the excitons dissociate and separate successfully at the interface of PTEBS and TiO2, which help to build solar cells using green processing methods.

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Micromachines, Vol. 7, Pages 66: Micro-Shaping of Nanopatterned Surfaces by Electron Beam Irradiation

We show that planar nanopatterned thin films on standard polycarbonate (PC) compact discs (CD) can be micro-shaped in a non-contact manner via direct e-beam exposure. The shape of the film can be controlled by proper selection of the e-beam parameters. As an example of application, we demonstrate a two-dimensional (2D) array of micro-lenses/reservoirs conformally covered by an Al 2D nanohole array (NHA) film on a PC CD substrate. It is also shown that such a curvilinear Al NHA layer can be easily transferred onto a flexible polymeric support. The presented technique provides a new tool for creating lab-on-CD architectures and developing multifunctional (flexible) non-planar nanostructured films and surfaces.

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Sensors, Vol. 16, Pages 528: Development of a Low-Cost Arduino-Based Sonde for Coastal Applications

This project addresses the need for an expansion in the monitoring of marine environments by providing a detailed description of a low cost, robust, user friendly sonde, built on Arduino Mega 2560 (Mega) and Arduino Uno (Uno) platforms. The sonde can be made without specialized tools or training and can be easily modified to meet individual application requirements. The platform allows for internal logging of multiple parameters of which conductivity, temperature, and GPS position are demonstrated. Two design configurations for different coastal hydrographic applications are highlighted to show the robust and versatile nature of this sensor platform. The initial sonde design was intended for use on a Lagrangian style surface drifter that recorded measurements of temperature; salinity; and position for a deployment duration of less than 24 h. Functional testing of the sensor consisted of a 55 h comparison with a regularly maintained water quality sensor (i.e., YSI 6600 sonde) in Mobile Bay, AL. The temperature and salinity data were highly correlated and had acceptable RMS errors of 0.154 °C and 1.35 psu for the environmental conditions. A second application using the sonde platform was designed for longer duration (~3–4 weeks); subsurface (1.5–4.0 m depths) deployment, moored to permanent structures. Design alterations reflected an emphasis on minimizing power consumption, which included the elimination of the GPS capabilities, increased battery capacity, and power-saving software modifications. The sonde designs presented serve as templates that will expand the hydrographic measurement capabilities of ocean scientists, students, and teachers.

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Toxins, Vol. 8, Pages 109: Metal Ion Activation of Clostridium sordellii Lethal Toxin and Clostridium difficile Toxin B

Lethal Toxin from Clostridium sordellii (TcsL) and Toxin B from Clostridium difficile (TcdB) belong to the family of the "Large clostridial glycosylating toxins." These toxins mono-O-glucosylate low molecular weight GTPases of the Rho and Ras families by exploiting UDP-glucose as a hexose donor. TcsL is casually involved in the toxic shock syndrome and the gas gangrene. TcdB—together with Toxin A (TcdA)—is causative for the pseudomembranous colitis (PMC). Here, we present evidence for the in vitro metal ion activation of the glucosyltransferase and the UDP-glucose hydrolysis activity of TcsL and TcdB. The following rating is found for activation by divalent metal ions: Mn2+ > Co2+ > Mg2+ >> Ca2+, Cu2+, Zn2+. TcsL and TcdB thus require divalent metal ions providing an octahedral coordination sphere. The EC50 values for TcsL were estimated at about 28 µM for Mn2+ and 180 µM for Mg2+. TcsL and TcdB further require co-stimulation by monovalent K+ (not by Na+). Finally, prebound divalent metal ions were dispensible for the cytopathic effects of TcsL and TcdB, leading to the conclusion that TcsL and TcdB recruit intracellular metal ions for activation of the glucosyltransferase activity. With regard to the intracellular metal ion concentrations, TcsL and TcdB are most likely activated by K+ and Mg2+ (rather than Mn2+) in mammalian target cells.

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IJERPH, Vol. 13, Pages 415: Pain Assessment–Can it be Done with a Computerised System? A Systematic Review and Meta-Analysis

Background: Mobile and web technologies are becoming increasingly used to support the treatment of chronic pain conditions. However, the subjectivity of pain perception makes its management and evaluation very difficult. Pain treatment requires a multi-dimensional approach (e.g., sensory, affective, cognitive) whence the evidence of technology effects across dimensions is lacking. This study aims to describe computerised monitoring systems and to suggest a methodology, based on statistical analysis, to evaluate their effects on pain assessment. Methods: We conducted a review of the English-language literature about computerised systems related to chronic pain complaints that included data collected via mobile devices or Internet, published since 2000 in three relevant bibliographical databases such as BioMed Central, PubMed Central and ScienceDirect. The extracted data include: objective and duration of the study, age and condition of the participants, and type of collected information (e.g., questionnaires, scales). Results: Sixty-two studies were included, encompassing 13,338 participants. A total of 50 (81%) studies related to mobile systems, and 12 (19%) related to web-based systems. Technology and pen-and-paper approaches presented equivalent outcomes related with pain intensity. Conclusions: The adoption of technology was revealed as accurate and feasible as pen-and-paper methods. The proposed assessment model based on data fusion combined with a qualitative assessment method was revealed to be suitable. Data integration raises several concerns and challenges to the design, development and application of monitoring systems applied to pain.

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Nanomaterials, Vol. 6, Pages 68: Gold Nanomaterial Uptake from Soil Is Not Increased by Arbuscular Mycorrhizal Colonization of Solanum Lycopersicum (Tomato)

Bioaccumulation of engineered nanomaterials (ENMs) by plants has been demonstrated in numerous studies over the past 5–10 years. However, the overwhelming majority of these studies were conducted using hydroponic systems and the degree to which the addition of the biological and chemical components present in the soil might fundamentally alter the potential of plant bioaccumulation of ENMs is unclear. Here, we used two genotypes of Solanum lycopersicum (tomato), reduced mycorrhizal colonization (rmc), a mutant which does not allow arbuscular mycorrhizal fungi (AMF) colonization, and its progenitor, 76R, to examine how colonization by AMF alters trends of gold ENM bioaccumulation from a natural soil. Gold was taken up and bioaccumulated by plants of both genotypes. Gold concentrations were significantly higher in the rmc treatment although this was likely attributable to the large differences in biomass between the 76R and rmc plants. Regardless, there was little evidence that AMF played a significant role in trafficking Au ENMs into the plants. Furthermore, despite very low NH4NO3 extractable Au concentrations, Au accumulated at the root-soil interface. Although this observation would seem to suggest that ENMs may have potential to influence this particularly biologically active and important soil compartment, we observed no evidence of this here, as the 76R plants developed a robust AMF symbiosis despite accumulation of Au ENMs at the rhizoplane.

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Applied Sciences, Vol. 6, Pages 108: WIPP: Wi-Fi Compass for Indoor Passive Positioning with Decimeter Accuracy

In recent decades, the proliferation of smart phones, tablets, and wireless networks has fostered a growing interest in indoor passive positioning. The Wi-Fi-based passive positioning systems can provide Location-Based Services (LBSs) to the third party such as market and security departments. Most of the existing systems are based on the Receive Signal Strength Indication (RSSI) information, which are generally time-consuming and susceptible to environmental change. To overcome this problem, we propose the Wi-Fi compass for indoor passive positioning system (WIPP), an Angle of Arrival (AOA) based passive positioning system using the existing commodity Wi-Fi network. In this paper, we first propose a new algorithm for the joint estimation of AOA and Time of Arrival (TOA) measurements based on the fine-grained Channel State Information (CSI), which is collected by an off-the-shelf Wi-Fi device equipped with only three antennas. Second, we use the affinity propagation clustering algorithm to identify the direct signal path from the target to each Wi-Fi Access Point (AP). Finally, we deploy the WIPP in an actual indoor environment to conduct the performance comparison with the well-known radio-frequency (RF) based system for locating and tracking users inside buildings (RADAR), as well as the conventional passive positioning system using the AOA solely. The experimental results show that the WIPP is able to achieve the median positioning error 0.7 m, which is much lower than the ones by the RADAR system and the conventional system using the AOA solely.

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Atmosphere, Vol. 7, Pages 56: Assessment of Air Quality Status in Wuhan, China

In this study, air quality characteristics in Wuhan were assessed through descriptive statistics and Hierarchical Cluster Analysis (HCA). Results show that air quality has slightly improved over the recent years. While the NO2 concentration is still increasing, the PM10 concentration shows a clearly downward trend with some small fluctuations. In addition, the SO2 concentration has steadily decreased since 2008. Nevertheless, the current level of air pollutants is still quite high, with the PM10 and NO2 levels exceeding the air quality standard. Seasonal variation exists consistently for all the pollutants, with the highest concentration in winter and the lowest in summer. Cluster analysis evidenced that nine urban monitoring sites could be classified into three clusters. Cluster I consists of only the LY site, which is located in the famous East Lake scenic area with the best air quality. Cluster II corresponds to three monitoring sites with heavily trafficked roads nearby, where relatively severe NO2 pollution occurred. Cluster III is comprised of the remaining five sites, characterized by PM10 and SO2 pollution.

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Sensors, Vol. 16, Pages 530: MGRA: Motion Gesture Recognition via Accelerometer

Accelerometers have been widely embedded in most current mobile devices, enabling easy and intuitive operations. This paper proposes a Motion Gesture Recognition system (MGRA) based on accelerometer data only, which is entirely implemented on mobile devices and can provide users with real-time interactions. A robust and unique feature set is enumerated through the time domain, the frequency domain and singular value decomposition analysis using our motion gesture set containing 11,110 traces. The best feature vector for classification is selected, taking both static and mobile scenarios into consideration. MGRA exploits support vector machine as the classifier with the best feature vector. Evaluations confirm that MGRA can accommodate a broad set of gesture variations within each class, including execution time, amplitude and non-gestural movement. Extensive evaluations confirm that MGRA achieves higher accuracy under both static and mobile scenarios and costs less computation time and energy on an LG Nexus 5 than previous methods.

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Toxins, Vol. 8, Pages 109: Metal Ion Activation of Clostridium sordellii Lethal Toxin and Clostridium difficile Toxin B

Plants, Vol. 5, Pages 17: Canola/Rapeseed Protein: Future Opportunities and Directions—Workshop Proceedings of IRC 2015

At present, canola meal is primarily streamlined into the animal feed market where it is a competitive animal feed source owing to its high protein value. Beyond animal feed lies a potential game-changer with regards to the value of canola meal, and its opportunity as a high quality food protein source. An economic and sustainable source of protein with high bioavailability and digestibility is essential to human health and well-being. Population pressures, ecological considerations, and production efficiency underscore the importance of highly bioavailable plant proteins, both for the developed and developing world. Despite decades of research, several technologies being developed, and products being brought to large scale production, there are still no commercially available canola protein products. The workshop entitled "Canola/Rapeseed Protein—Future Opportunities and Directions" that was held on 8 July 2015 during the 14th International Rapeseed Congress (IRC 2015) addressed the current situation and issues surrounding canola meal protein from the technological, nutritional, regulatory and genomics/breeding perspective. Discussions with participants and experts in the field helped to identify economic barriers and research gaps that need to be addressed in both the short and long term for the benefit of canola industry.

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Vision, Vol. 1, Pages 2: Comparing Macular Thickness Measurements in Patients with Diabetic Macular Edema with the Optos Spectral OCT/SLO and Heidelberg Spectralis HRA + OCT

The aim of this study was to compare measurements of macular thickness, obtained from patients with diabetic macular edema, using two spectral-domain optical coherence tomography (SD-OCT) devices. These were the Spectralis Heidelberg Retina Angiograph + Optical Coherence Tomography (HRA + OCT) (Heidelberg Engineering), which is often considered the gold-standard for OCT measurement, and the Spectral Optical Coherence Tomography/Scanning Laser Ophthalmoscopy (OCT/SLO) (Optos plc), which can additionally perform microperimetry, a useful measure of visual function. In this prospective observational study, each eye had SD-OCT performed with both devices on the same day by the same investigator. Mean retinal thickness was calculated, and compared between the devices, for central and parafoveal zones within 3 mm of the fovea. 62 eyes were included. In the central, superior, temporal, inferior and nasal zones respectively, mean retinal thickness with Spectralis HRA+OCT was (in microns) 310, 343, 344, 332 and 340; measurements with Spectral OCT/SLO were 237, 298, 297, 289 and 290. Pearson correlations between the devices were 0.752, 0.85, 0.928, 0.839, and 0.823 (p < 0.0001). Although absolute measurements between the devices were significantly different and therefore not interchangeable, the correlation between the devices was over 75% and statistically significant in all zones. Thus, the Spectral OCT/SLO could reliably be used for SD-OCT in patients who may also require microperimetry assessment.

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Improving distress in dialysis (iDiD): a feasibility two-arm parallel randomised controlled trial of an online cognitive behavioural therapy intervention with and without therapist-led telephone support for psychological distress in patients undergoing haemodialysis

Introduction

Psychological distress is common in end-stage kidney disease (ESKD) and is associated with poorer health outcomes. Cognitive behavioural therapy (CBT) is recommended in UK clinical guidelines for the management of depression in people with long-term conditions. Access to skilled therapists competent in managing the competing mental and physical health demands of ESKD is limited. Online CBT treatments tailored to the needs of the ESKD population offers a pragmatic solution for under-resourced services. This study examines the feasibility and acceptability of implementing a two-arm parallel randomised controlled trial of online CBT with (intervention arm) and without (control arm) therapist support to improve psychological distress in patients undergoing haemodialysis.

Methods

Patients will be screened for depression and anxiety while attending for their haemodialysis treatments. We aim to recruit 60 adult patients undergoing haemodialysis who meet criteria for mild to moderately severe symptoms of depression and/or anxiety. Patients will be randomised individually (using a 1:1 computerised sequence ratio) to either online CBT with therapist telephone support (intervention arm), or online CBT with no therapist (control arm). Outcomes include feasibility and acceptability descriptive data on rates of recruitment, randomisation, retention and treatment adherence. Self-report outcomes include measures of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), quality of life (Euro-QoL), service use (client service receipt inventory) and illness cognitions (brief illness perception questionnaire). A qualitative process evaluation will also be conducted. The statistician will be blinded to treatment allocation.

Ethics and dissemination

A National Health Service (NHS) research ethics committee approved the study. Data from this study will provide essential information for the design and testing of further interventions to ameliorate distress in patients undergoing dialysis. Any amendments to the protocol will be submitted to the NHS committee and study sponsor.

Trial registration number

NCT023528702; Pre-results.

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Opportunistic screening of atrial fibrillation by automatic blood pressure measurement in the community

Objective

Timely detection of atrial fibrillation (AF) may effectively prevent cardiovascular consequences. However, traditional diagnostic tools are either poorly reliable (pulse palpation) or not readily accessible (ECG) in general practice. We tested whether an automatic oscillometric blood pressure (BP) monitor embedded with an algorithm for AF detection might be effective for opportunistic screening of asymptomatic AF in the community.

Setting

A community-based screening campaign in an unselected population to verify the feasibility of AF screening with a Microlife WatchBP Office BP monitor with a patented AFIB algorithm. When possible AF was detected (≥2 of 3 BP measurements reporting AF), a doctor immediately performed a single-lead ECG in order to confirm or exclude the presence of the arrhythmia. The main demographic and clinical data were also collected.

Participants

220 consecutive participants from an unselected sample of individuals in a small Italian community.

Primary and secondary outcome measures

Number of patients detected with AF and diagnosed risk factors for AF.

Results

In 12 of 220 participants, the device detected possible AF during the BP measurement: in 4 of them (1.8%), the arrhythmia was confirmed by the ECG. Patients with AF were more likely to be older (77.0±1.2 vs 57.2±15.2 years, p=0.010), obese (50.0 vs 14.4%, p=0.048) and to suffer from a cardiovascular disease (50.0 vs 10.6%, p=0.014) than patients without AF. Participants with a positive BP AF reading and non-AF arrhythmias (n=8) did not differ in their general characteristics from participants with a negative BP AF reading and were younger than patients with AF (mean age 56.4±14.8, p=0.027; 5 of 8 participants aged <65 years).

Conclusions

Opportunistic screening of AF by BP measurement is feasible to diagnose this arrhythmia in unaware participants, particularly in those older than 65 years, who are the target patient group recommended by current AF screening guidelines.

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Combined early and adult life risk factor associations for mid-life obesity in a prospective birth cohort: assessing potential public health impact

Objective

The combined effect of life-course influences on obesity development and thus their potential public health impact is unclear. We evaluated combined associations and predicted probabilities for early and adult life risk factors with central and general obesity in mid-adulthood.

Setting

1958 British birth cohort.

Participants

4629 males and 4670 females with data on waist circumference.

Outcome measures

45 year obesity measured via waist circumference, waist–hip ratio (WHR) and BMI.

Results

At 45 years, approximately a third of the population were centrally obese and a quarter were generally obese. Three factors (parental overweight, maternal smoking during pregnancy and adult inactivity) were consistently associated with central and general obesity. Predicted probabilities for waist obesity increased from those with none to all three risk factors (0.15–0.33 in men; 0.19–0.39 in women (p_trend<0.001)), with a similar trend for general obesity. Additional factors (adult smoking, low fibre and heavy alcohol consumption) were associated with WHR obesity, although varying by gender. Prevalence of risk factors was higher in manual than non-manual groups: for example, in men 38% versus 25%, respectively, had ≥2 risk factors for waist and general obesity.

Conclusions

Early-life and adult factors that are amenable to change are highly prevalent and accumulate in association with central and general obesity in mid-adulthood. The increase in probabilities for mid-adult obesity associated with cumulative levels of risk factors suggests the potential for public health impact.

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Molecular genetics and epigenetics of nonfamilial (sporadic) parathyroid tumours

Abstract

Primary hyperparathyroidism (pHPT) is a common endocrine disease characterized by excessive secretion of parathyroid hormone and an increased level of serum calcium. Overall, 80–85% of pHPT cases are due to a benign, single parathyroid adenoma (PA), and 15% to multiglandular disease (multiple adenomas/hyperplasia). Parathyroid carcinoma (PC) is rare, accounting for <0.5–1% of pHPT cases. Secondary hyperparathyroidism (sHPT) is a complication of renal failure, with the development of parathyroid tumours and hypercalcaemia. Recurrent mutations in the MEN1 gene have been confirmed by the whole-exome sequencing in 35% of PAs, suggesting that non-protein-coding genes, regulatory elements or epigenetic derangements may also have roles in the majority of PAs. DNA translocations with cyclin D1 overexpression occur in PAs (8%). In PCs, mutations in CDC73/HRPT2 are common. Activation of the WNT/β-catenin signalling pathway (accumulation of nonphosphorylated β-catenin) by an aberrantly truncated LRP5 receptor has been seen for the majority of investigated PAs and sHPT tumours, and possibly by APC inactivation through promoter methylation in PCs. Promoter methylation of several other genes and repressive histone H3 lysine 27 trimethylation by EZH2 of the HIC1 gene may also contribute to parathyroid tumorigenesis. It is possible that a common pathway exists for parathyroid tumour development. CCND1 (cyclin D1) and EZH2 overexpression, accumulation of nonphosphorylated β-catenin and repression of HIC1 have all been observed to occur in PAs, PCs and sHPT tumours. In addition, hypermethylation has been observed for the same genes in PAs and PCs (e.g. SFRP1, CDKN2A and WT1). Whether β-catenin represents a 'hub' in parathyroid tumour development will be discussed.

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Development and significance of automated history-taking software for clinical medicine, clinical research and basic medical science

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The effect of tailored Web-based interventions on pain in adults: a systematic review protocol

Information technologies can facilitate the implementation of health interventions, especially in the case of widespread conditions such as pain. Tailored Web-based interventions have been recognized for healt...

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Αρχειοθήκη ιστολογίου

Αναζήτηση αυτού του ιστολογίου

Τετάρτη 13 Απριλίου 2016

Abstract