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24/09/2017 03:48 AM
Spatial methods for evaluating critical care and trauma transport: A scoping review
Publication date: February 2018
Source:Journal of Critical Care, Volume 43

Author(s): Katia Vasilyeva, Michael J. Widener, Samuel M. Galvagno, Zachary Ginsberg

Purpose The objective of this scoping review is to inform future applications of spatial research regarding transportation of critically ill patients. We hypothesized that this review would reveal gaps and limitations in the current research regarding use of spatial methods for critical care and trauma transport research. Materials and methods Four online databases, Ovid Medline, PubMed, Embase and Scopus, were searched. Studies were selected if they used geospatial methods to analyze a patient transports dataset. 12 studies were included in this review. Results Majority of the studies employed spatial methods only to calculate travel time or distance even though methods and tools for more complex spatial analyses are widely available. Half of the studies were found to focus on hospital bypass, 2 studies focused on transportation (air or ground) mode selection, 2 studies compared predicted versus actual travel times, and 2 studies used spatial modeling to understand spatial variation in travel times. Conclusions There is a gap between the availability of spatial tools and their usage for analyzing and improving medical transportation. The adoption of geospatially guided transport decisions can meaningfully impact healthcare expenditures, especially in healthcare systems looking to strategically control expenditures with minimum impact on patient outcomes.






24/09/2017 03:48 AM
Factors associated with crewmember survival of cold water immersion due to commercial fishing vessel sinkings in Alaska
Publication date: January 2018
Source:Safety Science, Volume 101

Author(s): Devin L. Lucas, Samantha L. Case, Jennifer M. Lincoln, Joanna R. Watson

Occupational fatality surveillance has identified that fishing vessel disasters, such as sinkings and capsizings, continue to contribute to the most deaths among crewmembers in the US fishing industry. When a fishing vessel sinks at sea, crewmembers are at risk of immersion in water and subsequent drowning. This study examined survival factors for crewmembers following cold water immersion after the sinking of decked commercial fishing vessels in Alaskan waters during 2000–2014. Two immersion scenarios were considered separately: immersion for any length of time, and long-term immersion defined as immersion lasting over 30min. Logistic regression was used to predict the odds of crewmember survival. Of the 617 crewmembers onboard 187 fishing vessels that sank in Alaska during 2000–2014, 557 (90.3%) survived and 60 died. For crewmembers immersed for any length of time, the significant adjusted predictors of survival were: entering a life-raft, sinking within three miles of shore, the sinking not being weather-related, and working as a deckhand. For crewmembers immersed for over 30min, the significant adjusted predictors of survival were: wearing an immersion suit, entering a life-raft, working asa deckhand, and the sinking not being weather-related. The results of this analysis demonstrate that in situations where cold water immersion becomes inevitable, having access to well-maintained, serviceable lifesaving equipment and the knowledge and skills to use it properly are critical.






24/09/2017 03:48 AM
Sex hormones and quantitative ultrasound parameters at the heel in men and women from the general population
Publication date: December 2017
Source:Bone Reports, Volume 7

Author(s): Konrad Pätzug, Nele Friedrich, Hanna Kische, Anke Hannemann, Henry Völzke, Matthias Nauck, Brian G. Keevil, Robin Haring

Purpose/introduction The present study investigates potential associations between liquid chromatography-mass spectrometry (LC-MS) measured sex hormones, dehydroepiandrosterone sulphate, sex hormone-binding globulin (SHBG) and bone ultrasound parameters at the heel in men and women from the general population. Methods Data from 502 women and 425 men from the population-based Study of Health in Pomerania (SHIP-TREND) were used. Cross-sectional associations of sex hormones including testosterone (TT), calculated free testosterone (FT), dehydroepiandrosterone sulphate (DHEAS), androstenedione (ASD), estrone (E1) and SHBG with quantitative ultrasound (QUS) parameters at the heel, including broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI) were examined by analysis of variance (ANOVA) and multivariable quantile regression models. Results Multivariable regression analysis showed a sex-specific inverse association of DHEAS with SI in men (Beta per SI unit=3.08, standard error (SE)=0.88), but not in women (Beta=0.01, SE=2.09). Furthermore, FT was positively associated with BUA in men (Beta per BUA unit=29.0, SE=10.1). None of the other sex hormones (ASD, E1) or SHBG was associated with QUS parameters after multivariable adjustment. Conclusions This cross-sectional population-based study revealed independent associations of DHEAS and FT with QUS parameters in men, suggesting a potential influence on male bone metabolism. The predictive role of DHEAS and FT as a marker for osteoporosis in men warrants further investigation in clinical trials and large-scale observational studies.






24/09/2017 03:48 AM
Effectiveness of physical activity intervention among government employees with metabolic syndrome
Publication date: December 2017
Source:Journal of Exercise Science & Fitness, Volume 15, Issue 2

Author(s): Chee Huei Phing, Hazizi Abu Saad, M.Y. Barakatun Nisak, M.T. Mohd Nasir

Background/Objective Our study aimed to assess the effects of physical activity interventions via standing banners (point-of-decision prompt) and aerobics classes to promote physical activity among individuals with metabolic syndrome. Methods We conducted a cluster randomized controlled intervention trial (16-week intervention and 8-week follow-up). Malaysian government employees in Putrajaya, Malaysia, with metabolic syndrome were randomly assigned by cluster to a point-of-decision prompt group (n = 44), an aerobics group (n = 42) or a control group (n = 103) based on sample size calculation formula. Step counts were evaluated by Lifecorder e-STEP accelerometers for all participants. Metabolic syndrome was defined according to the ‘harmonizing’ definition, in which individuals who have at least three of the five metabolic risk factors (waist circumference, high-density lipoprotein cholesterol, triglycerides, fasting glucose levels, systolic and diastolic blood pressure) will be classified as having metabolic syndrome. A total of 80% of the enrolled government employees with metabolic syndrome completed the programme. Data were analyzed using SPSS for Windows (version 20, SPSS, Chicago, IL). Results There were significantly higher step counts on average in the aerobics group compared to the control group over assessments. Assessments at baseline, post-intervention and follow-up showed a significant difference in step counts between the intervention and control groups. The greatest reductions in the proportions of individuals with metabolic syndrome were observed in the aerobics group with a reduction of 79.4% in the post-intervention assessment compared to the assessment at baseline. Conclusion The findings of this study suggest that physical activity intervention via aerobics classes is an effective strategy for improving step counts and reducing the prevalence of metabolic syndrome.






24/09/2017 03:48 AM
Mindfulness mediates the physiological markers of stress: Systematic review and meta-analysis
Publication date: December 2017
Source:Journal of Psychiatric Research, Volume 95

Author(s): Michaela C. Pascoe, David R. Thompson, Zoe M. Jenkins, Chantal F. Ski

Meditation is a popular form of stress management, argued to mediate stress reactivity. However, many studies in this field commonly fail to include an active control group. Given the frequency with which people are selecting meditation as a form of self-management, it is important to validate if the practice is effective in mediating stress-reactivity using well-controlled studies. Thus, we aimed to conduct a meta-analysis investigating the neurobiological effects of meditation, including focused attention, open monitoring and automatic self-transcending subtypes, compared to an active control, on markers of stress. In the current meta-analysis and systematic review, we included randomised controlled trials comparing meditation interventions compared to an active control on physiological markers of stress. Studied outcomes include cortisol, blood pressure, heart-rate, lipids and peripheral cytokine expression. Forty-five studies were included. All meditation subtypes reduced systolic blood pressure. Focused attention meditations also reduced cortisol and open monitoring meditations also reduced heart rate. When all meditation forms were analysed together, meditation reduced cortisol, C - reactive protein, blood pressure, heart rate, triglycerides and tumour necrosis factor-alpha. Overall, meditation practice leads to decreased physiological markers of stress in a range of populations.






24/09/2017 03:48 AM
Oxytocin receptor gene polymorphisms exert a modulating effect on the onset age in patients with obsessive-compulsive disorder
Publication date: December 2017
Source:Psychoneuroendocrinology, Volume 86

Author(s): Jee In Kang, Hae Won Kim, Chul Hoon Kim, Eun Hee Hwang, Se Joo Kim

The oxytocin receptor (OXTR) is a potential candidate in the pathophysiology of obsessive-compulsive disorder (OCD). The present study investigated the association between common single-nucleotide polymorphism (SNPs) of the OXTR gene and the affected status of OCD or distinct clinical subtypes of OCD including the age at onset and symptom dimensions. Ten SNPs of OXTR were examined in 615 patients with OCD and 581 healthy controls. Single-marker and haplotype-based association analyses were conducted. While OXTR variants were not associated with the affected status of OCD or its clinical symptom dimensions, rs2268493 (p = 0.00185) and rs13316193 (p = 0.00461) of the OXTR gene were associated with the age at onset in patients with OCD. In addition, in haplotype-based association analyses, there was a significant association between the OXTR gene and the onset age in patients with OCD. In particular, the G-C-G haplotype of rs2268493-rs2254298-rs11316193 and the T-G-A haplotype of rs237887-rs2268490-rs4686301 were positively associated with late-onset OCD. Our results suggest that common variants of OXTR may exert a modulating effect on the onset age in OCD pathophysiology. The potential involvement of the oxytocin system in the development and expression of OCD warrants further longitudinal research.






24/09/2017 03:48 AM
An assessment of food safety information provision for UK chemotherapy patients to reduce the risk of foodborne infection
Publication date: December 2017
Source:Public Health, Volume 153

Author(s): E.W. Evans, E.C. Redmond

Objectives Given the increased risk of foodborne infection to cancer patients receiving chemotherapy treatment, and the risk of listeriosis reportedly five-times greater to this immunocompromised patient group, there is a need to ensure the implementation of domestic food safety practices among chemotherapy patients and their family caregivers. However, information regarding the adequacy of resources to inform and enable patients to implement domestic food safety practices to reduce the risk of foodborne infection is limited. Consequently, this study aimed to evaluate the provision of food safety information available to UK chemotherapy patients. Study design In-depth semi-structured interviews and content analysis of online patient information resources. Methods Interviews with patients and family caregivers (n = 15) were conducted to explore food-related experiences during chemotherapy treatment. Online food-related information resources for chemotherapy patients (n = 45) were obtained from 35 of 154 National Health Service chemotherapy providers in England, Scotland, and Wales, the Department of Health (DoH) and three of 184 identified UK cancer charities. Identified food-related information resources were reviewed using a content-analysis approach to assess the inclusion of food safety information for chemotherapy patients. Results In-depth interviews established that many patients indicated awareness of immunosuppression during treatment. Although patients reported practicing caution to reduce the risk of communicable diseases by avoiding crowded spaces/public transport, food safety was reported to be of minimal concern during treatment and the risk of foodborne infection was often underestimated. The review of online food-related patient information resources established that many resources failed to highlight the increased risk of foodborne infection and emphasize the importance of food safety for patients during chemotherapy treatment. Considerable information gaps exist, particularly in relation to listeriosis prevention practices. Cumulatively, information was inconsistent, insufficient, and varied between resources. Conclusion The study has identified the need for an effective, standardized food safety resource specifically targeting chemotherapy patients and family caregivers. Such intervention is essential to assist efforts in reducing the risks associated with foodborne infection among chemotherapy patients.






24/09/2017 03:48 AM
Trends and patterns of Boko Haram terrorist and militants' aggression in Nigeria
Publication date: November–December 2017
Source:Aggression and Violent Behavior, Volume 37

Author(s): Gilbert Enyidah-Okey Ordu

This study explores the trends and pattern of Islamic Boko Haram and Niger Delta militancy in Nigeria. The core of the problem was articulate in order to grapple with the complexities of this social problem. The study employed ex post facto research design and generated its data using secondary sources—the data were descriptively analysed. Boko Haram and militant groups have taken up arms against the State [Nigeria] and its defencible and defenceless citizens, resulting from frustration and social discontentment. They have been involved in series of kidnappings, destructions and killings, as predicted by the basic assumptions of our theoretical framework, frustration-aggression theory, which is empirically evidenced in the findings of this study. While Boko Haram engaged the State and members of the public in fierce attacks in the Northern Nigeria, the militants have mounted a deadly combat against the Nigerian government and expatriates, including their infrastructure and basic amenities in the Southern part of the country. The study recommends a total overhauling of the present frustration-ridden social structure and political economy of Nigeria, as well as timely implementation of proactive youth empowerment programmes and forward-looking social, political and economic policies will assist greatly in ameliorating the problem.






24/09/2017 03:48 AM
Expression of MyHC isoforms mRNA transcripts in different regions of the masseter and medial pterygoid muscles in chimpanzees
Publication date: November 2017
Source:Archives of Oral Biology, Volume 83

Author(s): Neus Ciurana, Rosa Artells, Carmen Muñoz, Júlia Arias-Martorell, Gaëlle Bello-Hellegouarch, Alejandro Pérez-Pérez, Juan Francisco Pastor, Josep Maria Potau

Objective The aim of this study is to examine the expression pattern of the different myosin heavy chain (MyHC) isoforms in the masseter and medial pterygoid muscles by real time quantitative polymerase chain reaction (RT-qPCR) to obtain information at molecular level which can be related to the functional characteristics of these two muscles. Design The masseter, deep and superficial portion, and medial pterygoid muscles of five adult Pan troglodytes were dissected in order to obtain samples of the anterior and posterior regions of each portion of the masseter and of the medial pterygoid. The expression of MyHC isoforms mRNA transcripts was analyzed by RT-qPCR. Results No significant differences in expression of MyHC isoforms between the masseter and the medial pterygoid were found. In contrast, when comparing the superficial and the deep portion of the masseter, we found that the MyHC-IIM isoform was expressed at a significantly higher level in the superficial portion. Conclusions The superficial portion of the masseter and the medial pterygoid muscle have the same expression pattern regarding the different MyHC isoforms. On the other hand, the deep portion of the masseter, which is activated mainly during lateral and repositioning movements of the mandible, has a lower MyHC-IIM isoform expression than the superficial portion. Our findings provide new data on functional aspects of the masseter and medial pterygoid that can complement results obtained by other techniques.






24/09/2017 03:48 AM
Molecular mechanisms of anticancer effects of Glucosamine
Publication date: November 2017
Source:Biomedicine & Pharmacotherapy, Volume 95

Author(s): Fatemeh Zahedipour, Razieh Dalirfardouei, Gholamreza Karimi, Khadijeh Jamialahmadi

Glucosamine is an amino sugar that is produced naturally in human body. It is an essential carbohydrate component of many cellular glycoproteins, glycolipids, and glycosaminoglycans (GAGs). This popular over-the-counter supplement is also found in the exoskeleton of crustaceans. Glucosamine and its derivatives have a long history in medicine for inflammatory conditions specially to relieve arthritis. This dietary supplement has numerous biological and pharmacological properties, including anti-inflammatory, antioxidant, anti-aging, anti-fibrotic, neuroprotective and cardioprotective activities. Many studies have shown that glucosamine has anti-cancer activity through influence on biological pathways involved in cell death, apoptosis, cell proliferation, and angiogenesis. Accordingly, this comprehensive review summarizes anti-cancer molecular mechanisms of glucosamine in details.






24/09/2017 03:48 AM
Community-based participatory research to design a faith-enhanced diabetes prevention program: The Better Me Within randomized trial
Publication date: November 2017
Source:Contemporary Clinical Trials, Volume 62

Author(s): Heather Kitzman, Leilani Dodgen, Abdullah Mamun, J. Lee Slater, George King, Donna Slater, Alene King, Surendra Mandapati, Mark DeHaven

Reducing obesity positively impacts diabetes and cardiovascular risk; however, evidence-based lifestyle programs, such as the diabetes prevention program (DPP), show reduced effectiveness in African American (AA) women. In addition to an attenuated response to lifestyle programs, AA women also demonstrate high rates of obesity, diabetes, and cardiovascular disease. To address these disparities, enhancements to evidence-based lifestyle programs for AA women need to be developed and evaluated with culturally relevant and rigorous study designs. This study describes a community-based participatory research (CBPR) approach to design a novel faith-enhancement to the DPP for AA women. A long-standing CBPR partnership designed the faith-enhancement from focus group data (N =64 AA adults) integrating five components: a brief pastor led sermon, memory verse, in class or take-home faith activity, promises to remember, and scripture and prayer integrated into participant curriculum and facilitator materials. The faith components were specifically linked to weekly DPP learning objectives to strategically emphasize behavioral skills with religious principles. Using a CBPR approach, the Better Me Within trial was able to enroll 12 churches, screen 333 AA women, and randomize 221 (M age =48.8±11.2; MBMI =36.7±8.4; 52% technical or high school) after collection of objective eligibility measures. A prospective, randomized, nested by church, design will be used to evaluate the faith-enhanced DPP as compared to a standard DPP on weight, diabetes and cardiovascular risk, over a 16-week intervention and 10-month follow up. This study will provide essential data to guide enhancements to evidence-based lifestyle programs for AA women who are at high risk for chronic disease.






24/09/2017 03:48 AM
Nefrectomia laparoscopica transperitoneale
Publication date: November 2017
Source:EMC - Tecniche Chirurgiche - Chirurgia Generale, Volume 17, Issue 1

Author(s): R. Sanchez-Salas, E. Barret

La nefrectomia laparoscopica transperitoneale è diventata la tecnica chirurgica standard per l’exeresi del rene lesionato o di tumori renali identificati. Dopo aver posizionato il paziente in decubito laterale bloccato, viene effettuata una minilaparotomia a livello dell’ombelico in modo da introdurre un trocar ottico di 10 mm nella cavità addominale. Dopo la creazione di uno pneumoperitoneo, sono posizionati sotto controllo visivo un trocar operatore di 10 mm e due o tre trocar operatori di 5 mm. L’apertura del peritoneo posteriore consente l’accesso diretto allo spazio retroperitoneale. L’accesso al peduncolo vascolare rappresenta un tempo chiave dell’intervento. L’arteria renale viene, in un primo tempo, legata con una clip senza essere tagliata. La vena renale viene completamente liberata prima di essere legata e tagliata, permettendo, così, il pieno controllo delle arterie. Dopo la sezione e la legatura dell’uretere, vengono liberate le diverse facce del rene. Il pezzo della nefrectomia è introdotto in un sacchetto sigillato e, poi, viene rimosso dalla cavità addominale. Dopo aver controllato l’emostasi, viene posizionato un drenaggio di Redon in aspirazione nella loggia della nefrectomia e vengono rimossi sotto visione diretta i trocar.






24/09/2017 03:48 AM
Reducing diagnostic turnaround times of exome sequencing for families requiring timely diagnoses
Publication date: November 2017
Source:European Journal of Medical Genetics, Volume 60, Issue 11

Author(s): Aurélie Bourchany, Christel Thauvin-Robinet, Daphné Lehalle, Ange-Line Bruel, Alice Masurel-Paulet, Nolwenn Jean, Sophie Nambot, Marjorie Willems, Laetitia Lambert, Salima El Chehadeh-Djebbar, Elise Schaefer, Aurélia Jaquette, Judith St-Onge, Charlotte Poe, Thibaud Jouan, Martin Chevarin, Patrick Callier, Anne-Laure Mosca-Boidron, Nicole Laurent, Mathilde Lefebvre, Frédéric Huet, Nada Houcinat, Sébastien Moutton, Christophe Philippe, Frédéric Tran-Mau-Them, Antonio Vitobello, Paul Kuentz, Yannis Duffourd, Jean-Baptiste Rivière, Julien Thevenon, Laurence Faivre

Background and objective Whole-exome sequencing (WES) has now entered medical practice with powerful applications in the diagnosis of rare Mendelian disorders. Although the usefulness and cost-effectiveness of WES have been widely demonstrated, it is essential to reduce the diagnostic turnaround time to make WES a first-line procedure. Since 2011, the automation of laboratory procedures and advances in sequencing chemistry have made it possible to carry out diagnostic whole genome sequencing from the blood sample to molecular diagnosis of suspected genetic disorders within 50 h. Taking advantage of these advances, the main objective of the study was to improve turnaround times for sequencing results. Methods WES was proposed to 29 patients with severe undiagnosed disorders with developmental abnormalities and faced with medical situations requiring rapid diagnosis. Each family gave consent. The extracted DNA was sequenced on a NextSeq500 (Illumina) instrument. Data were analyzed following standard procedures. Variants were interpreted using in-house software. Each rare variant affecting protein sequences with clinical relevance was tested for familial segregation. Results The diagnostic rate was 45% (13/29), with a mean turnaround time of 40 days from reception of the specimen to delivery of results to the referring physician. Besides permitting genetic counseling, the rapid diagnosis for positive families led to two pre-natal diagnoses and two inclusions in clinical trials. Conclusions This pilot study demonstrated the feasibility of rapid diagnostic WES in our primary genetics center. It reduced the diagnostic odyssey and helped provide support to families.






24/09/2017 03:48 AM
Dietary supplementation with acetyl-l-carnitine counteracts age-related alterations of mitochondrial biogenesis, dynamics and antioxidant defenses in brain of old rats
Publication date: November 2017
Source:Experimental Gerontology, Volume 98

Author(s): Luigi Nicassio, Flavio Fracasso, Giuseppe Sirago, Clara Musicco, Anna Picca, Emanuele Marzetti, Riccardo Calvani, Palmiro Cantatore, Maria Nicola Gadaleta, Vito Pesce

We previously reported the ability of dietary supplementation with acetyl-l-carnitine (ALCAR) to prevent age-related decreases of mitochondrial biogenesis in skeletal muscle and liver of old rats. Here, we investigate the effects of ALCAR supplementation in cerebral hemispheres and cerebellum of old rats by analyzing several parameters linked to mitochondrial biogenesis, mitochondrial dynamics and antioxidant defenses. We measured the level of the coactivators PGC-1α and PGC-1β and of the factors regulating mitochondrial biogenesis, finding an age-related decrease of PGC-1β, whereas PGC-1α level was unvaried. Twenty eight-month old rats supplemented with ALCAR for one and two months showed increased levels of both factors. Accordingly, the expression of the two transcription factors NRF-1 and TFAM followed the same trend of PGC-1β. The level of mtDNA, ND1 and the activity of citrate synthase, were decreased with aging and increased following ALCAR treatment. Furthermore, ALCAR counteracted the age-related increase of deleted mtDNA. We also analyzed the content of proteins involved in mitochondrial dynamics (Drp1, Fis1, OPA1 and MNF2) and found an age-dependent increase of MFN2 and of the long form of OPA1. ALCAR treatment restored the content of the two proteins to the level of the young rats. No changes with aging and ALCAR were observed for Drp1 and Fis1. ALCAR reduced total cellular levels of oxidized PRXs and counteracted the age-related decrease of PRX3 and SOD2. Overall, our findings indicate a systemic positive effect of ALCAR dietary treatment and a tissue specific regulation of mitochondrial homeostasis in brain of old rats. Moreover, it appears that ALCAR acts as a nutrient since in most cases its effects were almost completely abolished one month after treatment suspension. Dietary supplementation of old rats with this compound seems a valuable approach to prevent age-related mitochondrial dysfunction and might ultimately represent a strategy to delay age-associated negative consequences in mitochondrial homeostasis.






24/09/2017 03:48 AM
Class I HDACs control a JIP1-dependent pathway for kinesin-microtubule binding in cardiomyocytes
Publication date: November 2017
Source:Journal of Molecular and Cellular Cardiology, Volume 112

Author(s): Weston W. Blakeslee, Ying-Hsi Lin, Matthew S. Stratton, Philip D. Tatman, Tianjing Hu, Bradley S. Ferguson, Timothy A. McKinsey

Class I histone deacetylase (HDAC) inhibitors block hypertrophy and fibrosis of the heart by suppressing pathological signaling and gene expression programs in cardiac myocytes and fibroblasts. The impact of HDAC inhibition in unstressed cardiac cells remains poorly understood. Here, we demonstrate that treatment of cultured cardiomyocytes with small molecule HDAC inhibitors leads to dramatic induction of c-Jun amino-terminal kinase (JNK)-interacting protein-1 (JIP1) mRNA and protein expression. In contrast to prior findings, elevated levels of endogenous JIP1 in cardiomyocytes failed to significantly alter JNK signaling or cardiomyocyte hypertrophy. Instead, HDAC inhibitor-mediated induction of JIP1 was required to stimulate expression of the kinesin heavy chain family member, KIF5A. We provide evidence for an HDAC-dependent regulatory circuit that promotes formation of JIP1:KIF5A:microtubule complexes that regulate intracellular transport of cargo such as autophagosomes. These findings define a novel role for class I HDACs in the control of the JIP1/kinesin axis in cardiomyocytes, and suggest that HDAC inhibitors could be used to alter microtubule transport in the heart.






24/09/2017 03:48 AM
The missing person: The outcome of the rule-based totalitarianism of too much contemporary healthcare
Publication date: November 2017
Source:Patient Education and Counseling, Volume 100, Issue 11

Author(s): Iona Heath

Objectives Medicine has an obsession with scientific progress and a misplaced belief in the perfectibility of the human body and mind and, as a result, there seems never to be time for the necessary backward glance. If we in healthcare are to learn any of the lessons of history, it seems important that we pay attention to those who have suffered at the sharp end of historical events. Methods and results This paper invokes thinkers and writers who lived lives scarred by totalitarian politics. Their testimony emphasises the importance of paying attention to the particularity of individual experience and demonstrates the importance of story, listening, seeing, imagination, and attention. Conclusion If we are to resist the secular totalitarianism of contemporary healthcare and reinstate the missing person at the centre of what we do, we as healthcare professionals must find the courage to disregard the rules. Practice implications In every consultation it is important to be aware of the wider historical, political and social context that may direct and constrain the choices available to both patients and professionals.






24/09/2017 03:48 AM
The effects of open vs. specific goals on flow and clutch states in a cognitive task
Publication date: November 2017
Source:Psychology of Sport and Exercise, Volume 33

Author(s): Matthew Schweickle, Scott Groves, Stewart A. Vella, Christian Swann

Objectives Recent qualitative evidence suggests that two optimal psychological states (flow and clutch) underlie excellent performance in sport. That research further suggests that the type of goal pursued influences which state is experienced. This study aimed to examine the effects of goal types (i.e., open, specific, and do-your-best goals) on flow and clutch states during performance in a cognitive task, which was developed and has been used in sport. Secondary aims were to investigate the effects of goal types on objective and subjective performance, confidence, and perceived challenge. Design This study employed a repeated measure design (mixed model). Method Participants (N = 95; M age  = 24.89, SD = 9.27) were randomised to one of three goal conditions and asked to perform a Letter and Number Identification Task, which was repeated for six attempts. Results Participants prescribed open or do-your-best goals experienced significantly higher levels of flow than those prescribed specific goals, who conversely experienced significantly higher levels of clutch states. Participants assigned specific goals performed significantly better than those prescribed open or do-your-best goals. Those assigned open or do-your-best-goals reported greater perceived performance, higher confidence, and feeling more optimally challenged. Conclusions These findings provide experimental support for the role of goal types in determining flow and clutch states, and further understanding of the psychological effects of these goal types. Implications are discussed, and recommendations are made for future research into the role of goals in experiencing flow and clutch states in sport and exercise.






24/09/2017 03:48 AM
Exploring choking experiences in elite sport: The role of self-presentation
Publication date: November 2017
Source:Psychology of Sport and Exercise, Volume 33

Author(s): Denise M. Hill, Sarah Carvell, Nic Matthews, Neil J.V. Weston, Richard R.C. Thelwell

Objectives The aims of this study were twofold: first, to examine the role of self-presentation within the lived-experience of choking in sport; and second, to explore whether the 2 × 2 framework of self-presentation (Howle, Jackson, Conroy, & Dimmock, 2015) holds the potential to further our understanding of acute sporting failure under pressurized conditions. Design and Method An empirical phenomenological research design was adopted to address the research aims. Purposefully selected participants completed phenomenological interviews, which explored in detail their experiences of choking and clutch performance under pressure. The sample consisted of 9 elite athletes (6 male and 3 female) (Mage = 27.14; SD = 5.27) from a range of sports (netball, rugby union, golf, tennis, and cricket). Results Participants reported a tendency to hold protective-agentic self-presentation motives, low self-presentation efficacy, and self-presentational concerns prior to, and during the choke. Conversely, acquisitive-agentic self-presentation motives, and self-presentation efficacy were experienced before and during clutch performances. However, alongside self-presentation, other psychological constructs also preceded and accompanied the choking experience (e.g., unfamiliarity and perceived control). Conclusion This exploratory study is the first to identify the value of examining choking in sport through the lens of the 2 × 2 self-presentation framework, with self-presentation motives appearing to influence the choking experience. Yet, it is also evident that self-presentation may not explain all choking episodes.






24/09/2017 03:48 AM
The dynamics of prehospital/hospital care and modes of transport during civil conflict and terrorist incidents
Publication date: November 2017
Source:Public Health, Volume 152

Author(s): S. Celik, R. Dursun, A. Aycan, H. Gönüllü, C. Adanaş, M. Eryılmaz, E. Gönüllü, M.E. Akyol, S. Keskin, C. Güloğlu

Objective Prehospital and hospital care during incidents of mass violence and civil conflict involve a number of aspects that distinguish it from care during times of peace. We aimed to analyze the dynamics and outcomes of prehospital and hospital care during ongoing conflicts. Study design Multicentric prospective observational study. Method Patients enrolled in the study, which was conducted in Turkey, were all injured in armed conflict and taken to level 1 trauma centers. On admittance, patients were requested to complete a semistructured questionnaire containing questions on patient demographics, transport type, weapons used, injury severity score (ISS), and other incident-related factors. We analyzed patient outcomes (mortality, morbidity, complications, and length of hospital stay) and transfers of patients between hospitals. The present study evaluated the cases of 390 victims enrolled over a 9-month period and followed up for 6 months. Results The majority of patients were transported by ambulances (n = 334, 85.6%); other transport modes were helicopters (n = 32, 8.2%) and private vehicles (n = 24, 6.2%). Nearly half of patients (48.7%) did not benefit by changing hospitals. During transport to hospitals, 4.1% of the vehicles in the study were involved in accidents. Using multiple regression analysis, only ISS (odds ratio [OR]: 1.098, 95% confidence interval [CI]: 1.044–1.156) and the Glasgow Coma Scale (OR: 0.744, 95% CI: 0.639–0.866) were found to affect mortality. In Receiver-operator characteristic analysis, a cutoff value of 22.5 for ISS had a sensitivity of 100% and a specificity of 89.6% for mortality. Conclusions Despite lower ISS values, patient outcomes were worse in terror incidents/civil conflicts. Transport modes did not significantly affect outcomes, whereas hospital transport was found to be inefficiently used.






24/09/2017 03:48 AM
The development of the Schema-Action-World (SAW) taxonomy for understanding decision making in aeronautical critical incidents
Publication date: November 2017
Source:Safety Science, Volume 99, Part A

Author(s): Katherine L. Plant, Neville A. Stanton

The perceptual cycle model (PCM) offers a process-orientated approach to understanding decision making. This approach is distributed in nature as it considers how internally held schemata and external environmental information interact to produce actions and behaviour. This an essential component of any incident reporting system, although it is often lacking. In its current form the PCM only provides a very high-level of explanation. This research utilised data from critical decision making interviews to deconstruct the three high-level categories of the PCM into a 28 item taxonomy. In doing so, we were able to provide a more detailed description of aeronautical critical decision making (ACDM) by demonstrating the relevance of different concepts in different phases of dealing with an incident. The data were used to model the ACDM process. The taxonomy can be used for gaining a comprehensive understanding of both the contextual and cognitive components of decision making, something that existing taxonomies and models often fail to do.






24/09/2017 03:48 AM
Accidentology of mountain sports: An insight provided by the systemic modelling of accident and near-miss sequences
Publication date: November 2017
Source:Safety Science, Volume 99, Part A

Author(s): Maud Vanpoulle, E. Vignac, B. Soulé

Accidents are notoriously frequent in mountain sports, but thorough understanding of the mechanisms of accidentality remains limited by the fragmentation of sources and by mostly heterogeneous methodologies. Nonetheless, the effectiveness of prevention must rely on detailed knowledge of typical circumstances and scenarios. Rooted in the statement that an accident is never induced by a single cause but rather by a dynamic combination of factors, this paper explores the opportunities offered by a systemic analysis of experience feedbacks on accidents and close calls. The study identifies risk factors for several hundred mountaineering accident and near miss reports. In order to enhance the benefit of these descriptions and to show the interaction of a broad variety of contributing factors, it introduces graphic models. This is not an attempt to compress the unique richness of each story, but rather to create a tree structure using the concatenation of multiple testimonials, thus enabling researchers to build general lessons out of individual cases.






24/09/2017 03:48 AM
Learning from accidents: Interactions between human factors, technology and organisations as a central element to validate risk studies
Publication date: November 2017
Source:Safety Science, Volume 99, Part B

Author(s): Raphael Moura, Michael Beer, Edoardo Patelli, John Lewis, Franz Knoll

Many industries are subjected to major hazards, which are of great concern to stakeholders groups. Accordingly, efforts to control these hazards and manage risks are increasingly made, supported by improved computational capabilities and the application of sophisticated safety and reliability models. Recent events, however, have revealed that apparently rare or seemingly unforeseen scenarios, involving complex interactions between human factors, technologies and organisations, are capable of triggering major catastrophes. The purpose of this work is to enhance stakeholders’ trust in risk management by developing a framework to verify if tendencies and patterns observed in major accidents were appropriately contemplated by risk studies. This paper first discusses the main accident theories underpinning major catastrophes. Then, an accident dataset containing contributing factors from major events occurred in high-technology industrial domains serves as basis for the application of a clustering and data mining technique (self-organising maps – SOM), allowing the exploration of accident information gathered from in-depth investigations. Results enabled the disclosure of common patterns in major accidents, leading to the development of an attribute list to validate risk assessment studies to ensure that the influence of human factors, technological issues and organisational aspects was properly taken into account.






24/09/2017 03:48 AM
Effect of Shorter Door-to-Balloon Times Over 20 Years on Outcomes of Patients With Anterior ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Publication date: 15 October 2017
Source:The American Journal of Cardiology, Volume 120, Issue 8

Author(s): Amgad Mentias, Mohammad Q. Raza, Amr F. Barakat, Dalia Youssef, Russell Raymond, Venu Menon, Conrad Simpfendorfer, Irving Franco, Stephen Ellis, E. Murat Tuzcu, Samir R. Kapadia

Cardiovascular disease remains the most common cause of mortality. We studied the change in outcomes for anterior ST-elevation myocardial infarction (STEMI) between 1995 and 2014. Over the past 20 years, 1,658 patients presenting to our center with anterior STEMI underwent primary percutaneous coronary intervention within 12 hours of presentation. We divided these into 4 quartiles, 1995 to 1999 (n = 312), 2000 to 2004 (n = 408), 2005 to 2009 (n = 428), and 2010 to 2014 (n = 510). Across the 4 quartiles, mean age decreased (64.4, 62, 60.3, and 60 years, p <0.01). In all groups, there was a significant rise in prevalence of smoking, hypertension, and obesity. The median length of hospital stay decreased (6, 4.4, 4.2, and 3.6 days, p <0.01), as did the median door-to-balloon time (DBT) (217, 194, 135, and 38 minutes, p <0.01). Thirty-day and 1-year mortality improved over time (14.4%, 11.8%, 8.4%, and 7.8%; and 20.5%, 16.4%, 15.9%, and 13.9%) (p = 0.01 both). Also, 3-year mortality improved (25.3%, 21.6%, 21.3%, and 16.5%, p = 0.02). After adjusting for age, gender, co-morbidities, ejection fraction, clinical shock, and mitral regurgitation, shorter DBT was associated with lower long-term mortality (compared with DBT <60 minutes; 60 to 90 minutes hazard ratio [HR] 1.67, 95% confidence interval [CI] 0.93 to 3.00, p = 0.084; 90 to 120 minutes, HR 1.74, 95% CI 1.02 to 2.95, p = 0.04; >120 minutes, HR 1.91, 95% CI 1.23 to 2.96, p = 0.004). In conclusion, over the past 2 decades, long-term outcomes improved in patients presenting with anterior STEMI associated with shortening of DBT.






24/09/2017 03:48 AM
Research Forum Educational Program 2017
Publication date: October 2017
Source:Annals of Emergency Medicine, Volume 70, Issue 4, Supplement










24/09/2017 03:48 AM
Nonphysician Out-of-Hospital Rapid Sequence Intubation Success and Adverse Events: A Systematic Review and Meta-Analysis
Publication date: October 2017
Source:Annals of Emergency Medicine, Volume 70, Issue 4

Author(s): Pieter F. Fouche, Christopher Stein, Paul Simpson, Jestin N. Carlson, Suhail A. Doi

Study objective Rapid sequence intubation performed by nonphysicians such as paramedics or nurses has become increasingly common in many countries; however, concerns have been stated in regard to the safe use and appropriateness of rapid sequence intubation when performed by these health care providers. The aim of our study is to compare rapid sequence intubation success and adverse events between nonphysician and physician in the out-of-hospital setting. Methods A systematic literature search of key databases including MEDLINE, EMBASE, and the Cochrane Library was conducted. Eligibility, data extraction, and assessment of risk of bias were assessed independently by 2 reviewers. A bias-adjusted meta-analysis using a quality-effects model was conducted for the primary outcomes of overall intubation success and first-pass intubation success and for adverse events when possible. Results Eighty-three studies were included in the meta-analysis. There was a 2% difference in successful intubation proportion for physicians versus nonphysicians, 99% (95% confidence interval [CI] 98% to 99%) versus 97% (95% CI 95% to 99%). A 10% difference in first-pass rapid sequence intubation success was noted between physicians versus nonphysicians, 88% (95% CI 83% to 93%) versus 78% (95% CI 65% to 89%). For airway trauma, bradycardia, cardiac arrest, endobronchial intubation, hypertension, and hypotension, lower prevalences of adverse events were noted for physicians. However, nonphysicians had a lower prevalence of hypoxia and esophageal intubations. Similar proportions were noted for pulmonary aspiration and emesis. Nine adverse events estimates lacked precision, except for endobronchial intubation, and 4 adverse event analyses showed evidence of possible publication bias. Consequently, no reliable evidence exists for differences between physicians and nonphysicians for adverse events. Conclusion This analysis shows that physicians have a higher rapid sequence intubation first-pass and overall success, as well as mostly lower rates of adverse events for rapid sequence intubation in the out-of-hospital setting. Nevertheless, for all success and adverse events no firm conclusion for a difference could be drawn because of lack of precision of meta-analytic estimates or selective reporting. First-pass success could be an area in which to focus quality improvement strategies for nonphysicians.






24/09/2017 03:48 AM
You’re in the ICU
Publication date: October 2017
Source:Annals of Emergency Medicine, Volume 70, Issue 4

Author(s): Joshua Lupton








24/09/2017 03:48 AM
35 Time is Money: The True Cost of Helicopter EMS
Publication date: October 2017
Source:Annals of Emergency Medicine, Volume 70, Issue 4, Supplement

Author(s): J.J. Rogich, E. Blohm, J. Tennyson








24/09/2017 03:48 AM
293 Goals of Care Determination Prior to Transfer: A Missed Opportunity
Publication date: October 2017
Source:Annals of Emergency Medicine, Volume 70, Issue 4, Supplement

Author(s): P.R.A. Atchinson, M.A. Roginski, A.H. Taenzer, M.A. MacMartin








24/09/2017 03:48 AM
IMPACT OF DEVICES AND ENVIRONMENTS ON AUTOMATED OFFICE BLOOD PRESSURE MEASUREMENTS
Publication date: October 2017
Source:Canadian Journal of Cardiology, Volume 33, Issue 10, Supplement

Author(s): F. Rinfret, L. Cloutier, P. Larochelle, R. Rabasa-Lhoret, R. Dufour, M. Lamarre-Cliche








24/09/2017 03:48 AM
P 166 Case presentation – apoplex due to partial occlusion of the medial cerebral artery with sinistral hemiparesis, word-finding disorder, memory impairment and writing disorder
Publication date: October 2017
Source:Clinical Neurophysiology, Volume 128, Issue 10

Author(s): K.R. Wiebelitz

Anamnesis S. had helped her sister to move. She experienced dizziness and everything went black. She choked on something to drink. Then she went out on the balcony, fell due to weakness of her right leg, and she could not move the right half of the body (right arm, right leg). The right angle of his mouth hung slightly with saliva, and she slurred her speech. She was put down. Then she was unconscious for about 5min and was hospitalised by the emergency physician with suspicion of epilepsy. Additional anamnestic data collected later: Was frequently beaten by a violent friend. After separation, day-hospital and then stationary child and adolescent psychiatric treatment for 3months for depression and self-injury followed. HWS- and BWS-distorsion, left-convex rotation-scoliosis in the proximal BWS-region, broad-base discrete disc protrusion in the disc compartment C5/ 6 with contact to the thekal tube with initial spinal constriction, diagnosed after an accident on trampoline 9months ago by MRT. Varicella with 3years. Drug history: fluoxetine for about 2–3weeks, melatonin for 2months, Jubrele since about 1year. Clinical findings 14year old girl, in a somnolent state, eyes open from time to time, but can not adequately speak. Coarse motor system normal, fine motor system disturbed. Cannot write. Left forearm with fresh and old scratches. Sensorium intact. Reflexes slowed. Other clinical examination normal. With suspected apoplex because of incomplete hemiparesis an MRI was immediately performed, which showed a fresh ischemia in the region of the artery cerebri media on the left side, a disturbed perfusion in the basal ganglia and in the insular region, swelling of the frontal and frontoparietal brain region and an incomplete occlusion of the artery cerebri media, suggesting a hemorrhagic transformation and occlusion of peripheral vessels. A standard lysis therapy with Actilyse followed by secondary prophylaxis with thrombocyte aggregation inhibitors was performed. Duplex sonography showed a high-grade ACM stenosis on the left in the M1 segment. After 20h, S. became more somnolent and showed no linguistic activities at the time. A new MRI examination showed a high-grade stenosis in the M1 segment on the left and peripherally a markedly reduced perfusion with increasing infarction. On the third day of treatment rudimentary communication returned. On the 4th day duplex sonography showed worsening of hemodynamics in the left arteria cerebri media and the EEG showed a light focus on the left temporal side, no signs of hyperexcitability. Then development of complete paresis of the right arm and progression of aphasia. The MRI proved an increase in the ischemic areas in the region supplied by the left arteria cerebri media and showed a frontoparietal substantial ischemic area as well as changes in the vascular area, which would be compatible with vasculitis. Laboratory chemistry: no elevated inflammation parameters, no coagulation disorder, no signs of an autoimmune process. Since the radiologists of the MHH Hanover considered an interventional therapy to be possible, but wanted to see the patient on the spot, the patient was transferred with helicopter to Hannover in a stable condition. Unfortunately, no additional interventional therapy was possible.






24/09/2017 03:48 AM
Effect of seabuckthorn seed oil in reducing cardiovascular risk factors: A longitudinal controlled trial on hypertensive subjects
Publication date: October 2017
Source:Clinical Nutrition, Volume 36, Issue 5

Author(s): Vivek Vashishtha, Kalpana Barhwal, Ashish Kumar, Sunil Kumar Hota, Om Prakash Chaurasia, Bhuvnesh Kumar

Background & aims The present study aimed at investigating whether dietary supplementation of seabuckthorn seed oil which is rich in omega fatty acids at an oral dose of 0.75 ml could affect cardiovascular risk factors and reduce hypertension and systolic blood pressure. Methods Toxicological evaluation and efficacy of seabuckthorn seed oil in reducing high fat diet induced dyslipidemia was initially conducted on adult male Sprague Dawley rats. 32 normal and 74 hypertensive and hypercholestrolemic human subjects participated in the randomized, controlled, double blind longitudinal study. Seabuckthorn seed oil or sunflower oil placebo was orally supplemented at a daily dose of 0.75 ml for 30 days. Results Supplementation of seabuckthorn seed oil at a daily dose of 0.75 ml for 30 days resulted in normalization of blood pressure in hypertensive subjects. Dietary supplementation of seabuckthorn seed oil markedly reduces cholesterol, oxy-LDL and triglycerides in hypercholesterolemic subjects though it's effect on subjects with normal blood pressure and cholesterol is less pronounced. Seabuckthorn seed oil supplementation also improves circulatory antioxidant status in both normal and hypertensive subjects. Conclusion The present study demonstrates the efficacy of seabuckthorn seed oil in reducing dyslipidemia, cardiovascular risk factors and hypertension in human population which may be due to presence of omega 3, 6 and 9 fatty acids in the oil. The improvement in antioxidant status can be attributed to presence of beta carotene and vitamin E in seabuckthorn seed oil. The trial was registered with Clinical Trial Registry of India (Clinical trial registration number – CTRI/2015/11/006368).






24/09/2017 03:48 AM
Smoking status is inversely associated with overall diet quality: Findings from the ORISCAV-LUX study
Publication date: October 2017
Source:Clinical Nutrition, Volume 36, Issue 5

Author(s): Ala'a Alkerwi, Burcu Baydarlioglu, Nicolas Sauvageot, Saverio Stranges, Paul Lemmens, Nitin Shivappa, James R. Hébert

Background & aims Relationships between food consumption/nutrient intake and tobacco smoking have been described in the literature. However, little is known about the association between smoking and overall diet quality. This study examined the associations between eight diet quality indices, namely, the Diet Quality Index-International (DQI-I), Recommendation Compliance Index (RCI), Dietary Approach to Stop Hypertension (DASH) score, Energy Density Score (EDS), Dietary Diversity Score (DDS), Recommended Food Score (RFS), non-Recommended Food Score (non-RFS), and Dietary Inflammatory Index (DII), and smoking status with a focus on smoking intensity. Methods Analyses were based on a sample of 1352 participants in the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) survey, a nationwide population-based cross-sectional study of adults aged 18–69 years. Nutritional data from food frequency questionnaire (FFQ) were used to compute selected diet quality indices. Participants were classified as never smoker, former smoker (≥12 months cessation period), occasional or light smokers (≤1 cig/d), moderate smokers (≤20 cig/d) and heavy smokers (>20 cig/d). Descriptive and linear regression analyses were performed, after adjustment for several potential covariates. Results Compared to the other groups, heavy smokers had significantly higher prevalence of dyslipidemia (83%), obesity (34%), and elevated glycemic biomarkers. About 50% of former smokers had hypertension. Diet quality of heavy smokers was significantly poorer than those who never smoked independent of several socioeconomic, lifestyle, and biologic confounding factors (all p < 0.001). Heavy smokers were less compliant with national or international dietary recommendations, expressed by RCI, DQI-I, and RFS. In addition, they consumed a more pro-inflammatory diet, as expressed by higher DII scores (P < 0.001) and self-reported less dietary diversity in their food choices, as expressed by DDS. Conclusion This study provides new evidence concerning an inverse relationship between the intensity of tobacco consumption and overall diet quality. The implication is that efforts aimed at tobacco control should target heavy smokers and intervention on smoking cessation should take into account diet quality of smokers and their nutritional habits, to increase effectiveness and relevance of public health messages.






24/09/2017 03:48 AM
The association between specific combat experiences and aspects of the Interpersonal Theory of Suicide
Publication date: October 2017
Source:Comprehensive Psychiatry, Volume 78

Author(s): Sarah E. Butterworth, Bradley A. Green, Michael D. Anestis

Background Studies examining the relationship between combat exposure and suicide risk typically focus on combat exposure overall, combining numerous different combat experiences. Our study expands upon prior research by examining the association between specific combat experiences and components of both suicidal desire and the capability for suicide. Method We hypothesized that most combat experiences would be associated with capability for suicide. Furthermore, we hypothesized that experiences that involved direct exposure to death and injury (e.g. personally witnessing the death or injury of other soldiers) would be associated with higher levels of thwarted belongingness, perceived burdensomeness, and suicidal ideation. Participants were 400 service members drawn largely from the Army National Guard who had been deployed at least once and endorsed having experienced combat. Results Consistent with hypotheses, combat experiences involving direct exposure to injury or death exhibited a more pronounced pattern of associations with suicide risk factors than did other experiences. However, only a minority of combat experiences were associated with the capability for suicide. Discussion These results, while preliminary, indicate that different combat experiences are associated with different outcomes and that, in this sense, not all combat experiences are created equal with respect to suicide risk.






24/09/2017 03:48 AM
Transport While on Extracorporeal Membrane Oxygenation Support
Publication date: October 2017
Source:Critical Care Clinics, Volume 33, Issue 4

Author(s): Kyle C. Niziolek, Thomas J. Preston, Erik C. Osborn



Teaser

Extracorporeal membrane oxygenation (ECMO) support for severe acute respiratory failure has been increasing. Evidence suggests that higher volume centers have better outcomes, leading to a need for specialized ECMO transport teams. The inherent nature of the prehospital environment adds an additional layer of complexity; however, the experience of multiple centers has demonstrated that cannulating and transporting a patient on ECMO can be performed safely. The purpose of this review article is to discuss the state of knowledge with respect to ECMO transport with special emphasis given to how to actually undertake such complex transports.




24/09/2017 03:48 AM
Outcome of treatment changes in patients with drug-resistant chronic epilepsy: A tertiary center experience
Publication date: October 2017
Source:Epilepsy Research, Volume 136

Author(s): E. Martínez-Lizana, F. Gil-Lopez, A. Donaire, J. Aparicio, A. Brandt, M. Carreño

Background Previous studies suggest that changing patients’ anti-epileptic drug regimen can reduce the frequency of seizures. The approval of new anti-epileptic drugs with different modes of action during the last decades has provided multiple options for the treatment of epilepsy, although the efficacy of these new drugs is controversial. We aimed to determine the effects of adding or changing to a previously untried anti-epileptic drug, including recently approved drugs, on the frequency of seizures in patients with drug-resistant epilepsy. Methods We analyzed treatment changes in drug-resistant patients at our outpatient clinic between 2010 and 2015. We classified patients’ frequency of seizures after changes as freedom from seizures, ≥50% reduction, <50% reduction, no change, increase in seizures <50% or increase in seizures ≥50%. Results We analyzed 189 drug changes in 144 consecutive drug-resistant patients followed up for at least 6 months after the change; 138 changes involved administering newly marketed drugs: lacosamide (n=65), perampanel (n=30), eslicarbazepine (n=29), and retigabine (n=14). Changes resulted in freedom from seizures in 20 (13.9%) patients and in ≥50% decrease in frequency in 55 (38.2%). The drugs most commonly associated with significant improvement (freedom from seizures or ≥50% reduction) were lacosamide (39.3%), clobazam (11.2%), and levetiracetam (11.2%). Conclusions In patients with drug-resistant epilepsy, sequential changes increase the possibility of seizure control, and newer anti-epileptic drugs offer additional options for effective changes. Best combinations must be chosen taking into account drug, epilepsy and patient features.






24/09/2017 03:48 AM
The fate of human remains in a maritime context and feasibility for forensic humanitarian action to assist in their recovery and identification
Publication date: October 2017
Source:Forensic Science International, Volume 279

Author(s): Sarah Theresa Dorothea Ellingham, Pierre Perich, Morris Tidball-Binz

The number of annual maritime fatalities reported in the Mediterranean has more than doubled in the last two years, a phenomenon closely linked to the increase of migrants attempting to reach Europe via the Mediterranean. The majority of victims reportedly never gets recovered, which in part relates to the fact that the mechanisms and interaction of factors affecting marine taphonomy are still largely not understood. These factors include intrinsic factors such as whether the individual was alive or dead at the time of submergence, the individual’s stature and clothing, as well as extrinsic factors such including ambient temperature, currents, water depth, salinity and oxygen levels. This paper provides a compilation of the current literature on factors influencing marine taphonomy, recovery and identification procedures for submerged remains, and discusses the implications for the retrieval and identification of maritime mass fatalities as part of the humanitarian response, specifically humanitarian forensic action, to the consequences of the current migration phenomenon.






24/09/2017 03:48 AM
NRAMP1 D543N and INT4 polymorphisms in susceptibility to pulmonary tuberculosis: A meta-analysis
Publication date: October 2017
Source:Infection, Genetics and Evolution, Volume 54

Author(s): Leyong Yuan, Zunqiong Ke, Yi Guo, Xueyan Xi, Zhiguo Luo

The association of natural resistance associated macrophage protein 1 (NRAMP1) polymorphisms (D543N, INT4) with pulmonary tuberculosis (PTB) risk have been widely reported. However, the findings of previous studies were inconsistent. To clarify the role of these polymorphisms in PTB, we performed a meta-analysis of all available and relevant published studies. Based on comprehensive searches of the PubMed, Medline, Embase, Web of Science, Elsevier Science Direct and Cochrane Library database, we identified outcome data from all articles estimating the association between NRAMP1 polymorphisms and PTB risk. For D543NA/G polymorphism, no associations were found in all genetic models. For INT4C/G polymorphism, significant increased PTB risk was observed in recessive model (CC vs. GC+GG: P =0.025, OR=1.35, 95% CI=1.04–1.75). In the subgroup analysis by ethnicity, significantly increased risk were observed for D543NA/G polymorphism in Americans (GA vs. GG: P =0.03, OR=1.31, 95% CI=1.03–1.67; AA+AG vs. GG: P =0.032, OR=1.29, 95% CI=1.02–1.63). Moreover, the INT4C/G polymorphism was also associated with increased risk of TB for Africans in allele model (A vs. G: P =0.012, OR=1.41, 95% CI=1.08–1.85), heterozygous model (GA vs. GG: P =0.004, OR=1.53, 95% CI=1.14–2.04) and dominant model (AA+AG vs. GG: P =0.007, OR=1.49, 95% CI=1.12–1.98). This meta-analysis provides evidences that INT4C/G was associated with increased susceptibility to pulmonary tuberculosis in overall population in recessive model. D543NA/G polymorphism was associated with PTB increased risk in Americans, while INT4C/G polymorphism in Africans. Further well-designed, large scale studies are required to confirm this conclusion.






24/09/2017 03:48 AM
Pediatric leukodystrophies: The role of the otolaryngologist
Publication date: October 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101

Author(s): Emily Kay-Rivest, Léticia Khendek, Geneviève Bernard, Sam J. Daniel

Background Leukodystrophies consist of degenerative neurogenetic diseases often associated with comorbidities that extend beyond the neurological system. Despite their impacts on patients' quality of life and risks of complications, head and neck symptomology is poorly reported in the literature. The objective of this study was to identify and quantify the main head and neck complaints among a cohort of patients diagnosed with leukodystrophies and define the role of the otolaryngologist as part of a multidisciplinary team for treating these patients. Methods During the First Canadian National Conference on Leukodystrophies held at the Montreal's Children Hospital, a cohort of 12 patients diagnosed with leukodystrophies were recruited and evaluated by a multidisciplinary team. An otolaryngology-focused assessment was done through history and physical examination, and included a screening questionnaire for 23 common otolaryngology issues. If families reported a history of sialorrhea, a validated questionnaire (Drool Quality of Life Assessment Questionnaire (DroolQoL)) was subsequently distributed. Results from the questionnaires were then compiled and analyzed. Results Of the 12 recruited patients, 83% (10/12) were known to an otolaryngologist. Drooling affected 67% (8/12) of patients although only 37.5% (3/8) of patients had undergone medical or surgical therapies for this issue. Four patients experienced at least one aspiration pneumonia. 58% (7/12) of the patients had dysphagia, of whom 43% (3/12) were fed exclusively via gastrostomy tube and 28% (2/7) required thickening of feeds. Two patients, despite suspicion of dysphagia and aspiration, had never undergone evaluation. As for otologic issues, it was noted that 25% (3/12) of patients had a history of pressure equalizing tubes (PETs) and one patient had a history of hearing loss. Conclusion Head and neck comorbidities affect children with leukodystrophies. Therefore, the otolaryngologist should be part of the multidisciplinary team, specifically for the management of dysphagia and sialorrhea.






24/09/2017 03:48 AM
P4-5 A Case Report of Left Ventricular Noncompaction With Syncope Due to Adams-Stokes Syndrome, Requiring ICD Implantation
Publication date: October 2017
Source:Journal of Cardiac Failure, Volume 23, Issue 10, Supplement

Author(s): Yusuke Mizuno, Hideki Saito








24/09/2017 03:48 AM
Respiratory support techniques to avoid desaturation in critically ill patients requiring endotracheal intubation: A systematic review and meta-analysis
Publication date: October 2017
Source:Journal of Critical Care, Volume 41

Author(s): Vincenzo Russotto, Andrea Cortegiani, Santi Maurizio Raineri, Cesare Gregoretti, Antonino Giarratano

Purpose To evaluate which respiratory support method for critically ill patients undergoing endotracheal intubation (ETI) is associated with less desaturation. Methods We searched PubMed, Cochrane Library, Scopus and CINAHL databases. We included randomized (RCT) and non-randomized (non-RCT) studies investigating any method of respiratory support before/during ETI compared to a reference control. Results Apneic oxygenation (ApOx) was the most commonly investigated respiratory support technique for critically ill patients undergoing intubation (4 RCTs, 358 patients). Three of these studies investigated high-flow nasal cannula (HFNC) for ApOx while standard nasal cannula was used in one. Globally, ApOx was associated with higher minimum SpO2 value compared to those receiving ETI without ApOx (mean difference 2.31%, 95% CI 0.42 to 4.20, p=0.02, I2 =0%) but there were not significant differences between groups in severe hypoxemia and intubation related – complications. Concerning other techniques, noninvasive ventilation (NIV) was compared to bag-valve mask in only one RCT and it reduced the degree of desaturation. Conclusions ApOx was significantly associated with higher minimum SpO2 registered during the intubation procedure. Further studies are needed to increase the number of included patients and demonstrate the benefit of ApOx and of other respiratory support methods (e.g. NIV, HFNC).






24/09/2017 03:48 AM
LB940 Role of graft versus host disease in the development of secondary skin cancers in hematopoietic stem cell transplant recipients: A meta-analysis
Publication date: October 2017
Source:Journal of Investigative Dermatology, Volume 137, Issue 10

Author(s): P. Rambhia, R. Conic, M. Piliang, W. Bergfeld








24/09/2017 03:48 AM
The Enright phenomenon. Stereoscopic distortion of perceived driving speed induced by monocular pupil dilation
Publication date: October–December 2017
Source:Journal of Optometry, Volume 10, Issue 4

Author(s): Andrew Carkeet, Joanne M. Wood, Kylie M. McNeill, Hamish J. McNeill, Joanna A. James, Leigh S. Holder

Purpose The Enright phenomenon describes the distortion in speed perception experienced by an observer looking sideways from a moving vehicle when viewing with interocular differences in retinal image brightness, usually induced by neutral density filters. We investigated whether the Enright phenomenon could be induced with monocular pupil dilation using tropicamide. Methods We tested 17 visually normal young adults on a closed road driving circuit. Participants were asked to travel at Goal Speeds of 40km/h and 60km/h while looking sideways from the vehicle with: (i) both eyes with undilated pupils; (ii) both eyes with dilated pupils; (iii) with the leading eye only dilated; and (iv) the trailing eye only dilated. For each condition we recorded actual driving speed. Results With the pupil of the leading eye dilated participants drove significantly faster (by an average of 3.8km/h) than with both eyes dilated (p =0.02); with the trailing eye dilated participants drove significantly slower (by an average of 3.2km/h) than with both eyes dilated (p <0.001). The speed, with the leading eye dilated, was faster by an average of 7km/h than with the trailing eye dilated (p <0.001). There was no significant difference between driving speeds when viewing with both eyes either dilated or undilated (p =0.322). Conclusions Our results are the first to show a measurable change in driving behaviour following monocular pupil dilation and support predictions based on the Enright phenomenon.






24/09/2017 03:48 AM
In by helicopter out by cab: the financial cost of aeromedical overtriage of trauma patients
Publication date: October 2017
Source:Journal of Surgical Research, Volume 218

Author(s): SriGita Krishna Madiraju, Joseph Catino, Candace Kokaram, Thomas Genuit, Marko Bukur

Background Helicopter transport of injured patients is controversial and costly. This study aims to show that a complex trauma algorithm leads to significant aeromedical overtriage at substantial cost. Our secondary outcomes were to compare adjusted mortality and outcomes between air and ground transport and determine predictors of overtriage. Materials and methods A 6-y retrospective analysis was conducted of all trauma activations at a Level I center. Patients were dichotomized by transportation method as well as trauma activation criteria. Overtriage was defined as those who were discharged from the emergency department, medically admitted without injuries, or admitted to observation status only. Overtriage and associated charges were calculated for each patient cohort, and multivariate regression models were created to derive adjusted mortality rates and predictors of overtriage. Results A total of 4218 patients were treated with 28% arriving by helicopter. Overtriage increased significantly from 51% to 77% with lower tier activation criteria (P < 0.001). Median charges for air-evacuated patients was $10,478 (versus $1008 ground). Eliminating overtriage of air patients would result in a cost savings of $1,316,036 annually. Adjusted mortality between air and ground transport was not significantly different (8.5% versus 10.9%, P = 0.548). Predictors of overtriage included decreasing age, Injury Severity Score, Head Abbreviated Injury Score, nonoperative treatment, and lower tier activation criteria. Conclusions Significant overtriage (52%) and unnecessary air evacuation of minimally injured patients occurs at great financial cost. Revision of trauma activation protocols may result in more judicious air transport use and significant reductions in health care costs.






24/09/2017 03:48 AM
Increased BACE1 activity inhibits peripheral nerve regeneration after injury
Publication date: October 2017
Source:Neurobiology of Disease, Volume 106

Author(s): Carolyn Tallon, Edward Rockenstein, Eliezer Masliah, Mohamed H. Farah

Axons of the peripheral nervous system possess the capacity to regenerate following injury. Previously, we showed that genetically knocking out Beta-Site APP-Cleaving Enzyme 1 (BACE1) leads to increased nerve regeneration. Two cellular components, macrophages and neurons, contribute to enhanced nerve regeneration in BACE1 knockout mice. Here, we utilized a transgenic mouse model that overexpresses BACE1 in its neurons to investigate whether neuronal BACE1 has an inverse effect on regeneration following nerve injury. We performed a sciatic nerve crush in BACE1 transgenic mice and control wild-type littermates, and evaluated the extent of both morphological and physiological improvements over time. At the earliest time point of 3days, we observed a significant decrease in the length of axonal sprouts growing out from the crush site in BACE1 transgenic mice. At later times (10 and 15days post-crush), there were significant reductions in the number of myelinated axons in the sciatic nerve and the percentage of re-innervated neuromuscular junctions in the gastrocnemius muscle. Transgenic mice had a functional electrophysiological delay in the recovery up to 8weeks post-crush compared to controls. These results indicate that BACE1 activity levels have an inverse effect on peripheral nerve repair after injury. The results obtained in this study provide evidence that neuronal BACE1 activity levels impact peripheral nerve regeneration. This data has clinical relevance by highlighting a novel drug target to enhance peripheral nerve repair, an area which currently does not have any approved therapeutics.






24/09/2017 03:48 AM
A whole brain volumetric approach in overweight/obese children: Examining the association with different physical fitness components and academic performance. The ActiveBrains project
Publication date: 1 October 2017
Source:NeuroImage, Volume 159

Author(s): Irene Esteban-Cornejo, Cristina Cadenas-Sanchez, Oren Contreras-Rodriguez, Juan Verdejo-Roman, Jose Mora-Gonzalez, Jairo H. Migueles, Pontus Henriksson, Catherine L. Davis, Antonio Verdejo-Garcia, Andrés Catena, Francisco B. Ortega

Obesity, as compared to normal weight, is associated with detectable structural differences in the brain. To the best of our knowledge, no previous study has examined the association of physical fitness with gray matter volume in overweight/obese children using whole brain analyses. Thus, the aim of this study was to examine the association between the key components of physical fitness (i.e. cardiorespiratory fitness, speed-agility and muscular fitness) and brain structural volume, and to assess whether fitness-related changes in brain volumes are related to academic performance in overweight/obese children. A total of 101 overweight/obese children aged 8–11 years were recruited from Granada, Spain. The physical fitness components were assessed following the ALPHA health-related fitness test battery. T1-weighted images were acquired with a 3.0 T S Magnetom Tim Trio system. Gray matter tissue was calculated using Diffeomorphic Anatomical Registration Through Exponentiated Lie algebra (DARTEL). Academic performance was assessed by the Batería III Woodcock-Muñoz Tests of Achievement. All analyses were controlled for sex, peak high velocity offset, parent education, body mass index and total brain volume. The statistical threshold was calculated with AlphaSim and further Hayasaka adjusted to account for the non-isotropic smoothness of structural images. The main results showed that higher cardiorespiratory fitness was related to greater gray matter volumes (P < 0.001, k = 64) in 7 clusters with β ranging from 0.493 to 0.575; specifically in frontal regions (i.e. premotor cortex and supplementary motor cortex), subcortical regions (i.e. hippocampus and caudate), temporal regions (i.e. inferior temporal gyrus and parahippocampal gyrus) and calcarine cortex. Three of these regions (i.e. premotor cortex, supplementary motor cortex and hippocampus) were related to better academic performance (β ranging from 0.211 to 0.352; all P < 0.05). Higher speed-agility was associated with greater gray matter volumes (P < 0.001, k = 57) in 2 clusters (i.e. the inferior frontal gyrus and the superior temporal gyrus) with β ranging from 0.564 to 0.611. Both clusters were related to better academic performance (β ranging from 0.217 to 0.296; both P < 0.05). Muscular fitness was not independently associated with greater gray matter volume in any brain region. Furthermore, there were no statistically significant negative association between any component of physical fitness and gray matter volume in any region of the brain. In conclusion, cardiorespiratory fitness and speed-agility, but not muscular fitness, may independently be associated with greater volume of numerous cortical and subcortical brain structures; besides, some of these brain structures may be related to better academic performance. Importantly, the identified associations of fitness and gray matter volume were different for each fitness component. These findings suggest that increases in cardiorespiratory fitness and speed-agility may positively influence the development of distinctive brain regions and academic indicators, and thus counteract the harmful effect of overweight and obesity on brain structure during childhood.






24/09/2017 03:48 AM
22nd WMS Congress – 2017 – Program
Publication date: October 2017
Source:Neuromuscular Disorders, Volume 27, Supplement 2










24/09/2017 03:48 AM
P.235 Circulating miRs biomarkers for therapeutic monitoring in utrophin based DMD therapy
Publication date: October 2017
Source:Neuromuscular Disorders, Volume 27, Supplement 2

Author(s): N. Ramadan, S. Guiraud, B. Edwards, S. Squire, S. Hemming, K. Davies








24/09/2017 03:48 AM
P.308 Discovery of small molecule utrophin modulators for the therapy of Duchenne muscular dystrophy
Publication date: October 2017
Source:Neuromuscular Disorders, Volume 27, Supplement 2

Author(s): G. Wynne, A. Vuorinen, E. Emer, D. Conole, M. Chatzopoulou, S. Davies, A. Russell, S. Guiraud, S. Squire, A. Berg, B. Edwards, S. Hemming, T. Kennedy, L. Moir, K. Davies, S. Harriman, J. Tinsley, F. Wilson








24/09/2017 03:48 AM
Survival of cardiac arrest patients on ski slopes: A 10-year analysis of the Northern French Alps Emergency Network
Publication date: October 2017
Source:Resuscitation, Volume 119

Author(s): Damien Viglino, Maxime Maignan, Arnaud Michalon, Julien Turk, Sarah K. Buse, Marc Blancher, Tom P. Aufderheide, Loïc Belle, Dominique Savary, François-Xavier Ageron, Guillaume Debaty

Aim Intense physical activity, cold and altitude make mountain sports a cause of increased risk of out-of-hospital cardiac arrest (OHCA). The difficulties of pre-hospital management related to this challenging environment could be mitigated by the presence of ski-patrollers in ski areas and use of helicopters for medical rescue. We assess whether this particular situation positively impacts the chain of survival compared to the general population. Methods Analysis of prospectively collected data from the cardiac arrest registry of the Northern French Alps Emergency Network (RENAU) from 2004 to 2014. Results 19,341 OHCAs were recorded during the period, including 136 on-slope events. Compared to other OHCAs, on-slope patients were younger (56 [40–65] vs. 66 [52–79] years, p< 0.001) and more often in shockable initial rhythm (41.2% vs 20.1%, p< 0.001). Resuscitation was more frequently started by a witness (43.4% vs 26.8%, p< 0.001) and the time to the first electric shock was shorter (7.5min vs 14min, p< 0.001), whereas time to the advanced life support (ALS) rescue arrival did not differ. The 30-day survival rate was higher for on-slope arrests (21.3% vs 5.9%, p <0.001, RR=3.61). In multivariate analysis, on-slope CA remained a positive 30-day survival factor with a 2.6 odds ratio (95% confidence interval, 1.42–4.81, p =0.002). Conclusion Despite difficult access and management conditions, patients undergoing OHCAs on ski slopes presented a higher survival rate, possibly explained by a healthier population, the efficiency of resuscitation by ski-patrols and similar time to ALS facilities compared to other cardiac arrests.






24/09/2017 03:48 AM
Care interrupted: Poverty, in-migration, and primary care in rural resource towns
Publication date: October 2017
Source:Social Science & Medicine, Volume 191

Author(s): Kathleen Rice, Fiona Webster

Internationally, rural people have poorer health outcomes relative to their urban counterparts, and primary care providers face particular challenges in rural and remote regions. Drawing on ethnographic fieldnotes and 14 open-ended qualitative interviews with care providers and chronic pain patients in two remote resource communities in Northern Ontario, Canada, this article examines the challenges involved in providing and receiving primary care for complex chronic conditions in these communities. Both towns struggle with high unemployment in the aftermath of industry closure, and are characterized by an abundance of affordable housing. Many of the challenges that care providers face and that patients experience are well-documented in Canadian and international literature on rural and remote health, and health care in resource towns (e.g. lack of specialized care, difficulty with recruitment and retention of care providers, heavy workload for existing care providers). However, our study also documents the recent in-migration of low-income, largely working-age people with complex chronic conditions who are drawn to the region by the low cost of housing. We discuss the ways in which the needs of these in-migrants compound existing challenges to rural primary care provision. To our knowledge, our study is the first to document both this migration trend, and the implications of this for primary care. In the interest of patient health and care provider well-being, existing health and social services will likely need to be expanded to meet the needs of these in-migrants.