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Using existing data from clinical registries to support clinical trials and other prospective studies has the potential to improve research efficiency. However, little has been reported about staff experiences and lessons learned from implementation of this method in pediatric cardiology.
We describe the process of using existing registry data in the Pediatric Heart Network Residual Lesion Score Study, report stakeholders’ perspectives, and provide recommendations to guide future studies using this methodology.
The Residual Lesion Score Study, a 17-site prospective, observational study, piloted the use of existing local surgical registry data (collected for submission to the Society of Thoracic Surgeons-Congenital Heart Surgery Database) to supplement manual data collection. A survey regarding processes and perceptions was administered to study site and data coordinating center staff.
Survey response rate was 98% (54/55). Overall, 57% perceived that using registry data saved research staff time in the current study, and 74% perceived that it would save time in future studies; 55% noted significant upfront time in developing a methodology for extracting registry data. Survey recommendations included simplifying data extraction processes and tailoring to the needs of the study, understanding registry characteristics to maximise data quality and security, and involving all stakeholders in design and implementation processes.
Use of existing registry data was perceived to save time and promote efficiency. Consideration must be given to the upfront investment of time and resources needed. Ongoing efforts focussed on automating and centralising data management may aid in further optimising this methodology for future studies.
Introduction: The treatment of cutaneous abscesses in the Emergency Department (ED) is common. While most sources describe only incision and drainage (I&D) followed by healing through secondary intention, recent literature suggests that primary repair following I&D results in similar rates of healing as well as treatment failures when compared to standard care in the ED. The primary goal of this research project was to describe the variability in practice with respect to self-reported management of abscesses among Canadian ED physicians and explore potential reluctance in adopting primary repair as a management strategy. Methods: An electronic survey was distributed through the Canadian Association of Emergency Physicians (CAEP). Practicing physician members of CAEP were invited to complete the survey. The 9-question survey probed the willingness of physicians to perform primary closure of abscess in the ED as well as factors that dissuade them from performing this type of closure. The primary outcome was the quantification of practice variability among ED physicians with respect to abscess closure in the ED. The data was presented with simple descriptive statistics. Results: 217 surveys were completed out of 1145 eligible physicians. Physicians working at academic centres comprised 53% of responses, with 47% coming from community centres. Over half of responses were from physicians in practice at least ten years (65.9%). The overwhelming majority of physicians indicated that they manage abscesses following I&D by secondary closure (96.3%). The two main concerns dissuading respondents from performing primary closure of abscesses included risk of treatment failure (47.8%) and the procedure not being considered standard of care (36.7%). Despite these concerns, 67.3% of physicians indicated a willingness to perform primary closure if further evidence supported its use. These physicians were most likely to consider primary closure at the head and neck, breast, trunk, and extremities, however, only 1.5% considered primary closure appropriate for perianal or pilonidal abscesses. Conclusion: This study demonstrates that almost all Canadian ED physicians, regardless of experience or practice centre, manage cutaneous abscesses with I&D followed by healing via secondary intention. With increasing evidence supporting the use of primary closure, many physicians may be willing to adopt primary closure as part of the management of cutaneous abscesses in the ED.
We measured the disinfection of MRSA and Clostridium difficile spores using an ultraviolet C (UV-C) device, and we correlated those results to measurements and computer simulations of UV-C surface intensity. The results demonstrate both large differences in UV light intensity across various surfaces and how this leads to significant differences in disinfection.
Childhood obesity rates are higher among Indigenous compared with non-Indigenous Australian children. It has been hypothesized that early-life influences beginning with the intrauterine environment predict the development of obesity in the offspring. The aim of this paper was to assess, in 227 mother–child dyads from the Gomeroi gaaynggal cohort, associations between prematurity, Gestation Related-Optimal Weight (GROW) centiles, maternal adiposity (percentage body fat, visceral fat area), maternal non-fasting plasma glucose levels (measured at mean gestational age of 23.1 weeks) and offspring BMI and adiposity (abdominal circumference, subscapular skinfold thickness) in early childhood (mean age 23.4 months). Maternal non-fasting plasma glucose concentrations were positively associated with infant birth weight (P=0.005) and GROW customized birth weight centiles (P=0.008). There was a significant association between maternal percentage body fat (P=0.02) and visceral fat area (P=0.00) with infant body weight in early childhood. Body mass index (BMI) in early childhood was significantly higher in offspring born preterm compared with those born at term (P=0.03). GROW customized birth weight centiles was significantly associated with body weight (P=0.01), BMI (P=0.007) and abdominal circumference (P=0.039) at early childhood. Our findings suggest that being born preterm, large for gestational age or exposed to an obesogenic intrauterine environment and higher maternal non-fasting plasma glucose concentrations are associated with increased obesity risk in early childhood. Future strategies should aim to reduce the prevalence of overweight/obesity in women of child-bearing age and emphasize the importance of optimal glycemia during pregnancy, particularly in Indigenous women.
Children with hypoplastic left heart syndrome are at a risk for neurodevelopmental delays. Current guidelines recommend systematic evaluation and management of neurodevelopmental outcomes with referral for early intervention services. The Single Ventricle Reconstruction Trial represents the largest cohort of children with hypoplastic left heart syndrome ever assembled. Data on life events and resource utilisation have been collected annually. We sought to determine the type and prevalence of early intervention services used from age 1 to 4 years and factors associated with utilisation of services.
Data from 14-month neurodevelopmental assessment and annual medical history forms were used. We assessed the impact of social risk and geographic differences. Fisher exact tests and logistic regression were used to evaluate associations.
Annual medical history forms were available for 302 of 314 children. Greater than half of the children (52–69%) were not receiving services at any age assessed, whereas 20–32% were receiving two or more therapies each year. Utilisation was significantly lower in year 4 (31%) compared with years 1–3 (with a range from 40 to 48%) (p<0.001). Social risk factors were not associated with the use of services at any age but there were significant geographic differences. Significant delay was reported by parents in 18–43% of children at ages 3 and 4.
Despite significant neurodevelopmental delays, early intervention service utilisation was low in this cohort. As survival has improved for children with hypoplastic left heart syndrome, attention must shift to strategies to optimise developmental outcomes, including enrolment in early intervention when merited.
Indigenous Australians have high rates of chronic diseases, the causes of which are complex and include social and environmental determinants. Early experiences in utero may also predispose to later-life disease development. The Gomeroi gaaynggal study was established to explore intrauterine origins of renal disease, diabetes and growth in order to inform the development of health programmes for Indigenous Australian women and children. Pregnant women are recruited from antenatal clinics in Tamworth, Newcastle and Walgett, New South Wales, Australia, by Indigenous research assistants. Measures are collected at three time points in pregnancy and from women and their children at up to eight time points in the child’s first 5 years. Measures of fetal renal development and function include ultrasound and biochemical biomarkers. Dietary intake, infant feeding and anthropometric measurements are collected. Standardized procedures and validated tools are used where available. Since 2010 the study has recruited over 230 women, and retained 66 postpartum. Recruitment is ongoing, and Gomeroi gaaynggal is currently the largest Indigenous pregnancy-through-early-childhood cohort internationally. Baseline median gestational age was 39.1 weeks (31.5–43.2, n=110), median birth weight was 3180 g (910–5430 g, n=110). Over one third (39.3%) of infants were admitted to special care or neonatal nursery. Nearly half of mothers (47.5%) reported tobacco smoking during pregnancy. Results of the study will contribute to knowledge about origins of chronic disease in Indigenous Australians and nutrition and growth of women and their offspring during pregnancy and postpartum. Study strengths include employment and capacity-building of Indigenous staff and the complementary ArtsHealth programme.
We present a series of statistical tests using homogeneous data and measurements for a sample of Seyfert galaxies. These galaxies were selected from mostly isotropic properties, their far infrared fluxes and warm infrared colors, which provide a considerable advantage over the criteria used by most investigators in the past, like ultraviolet excess. Our results provide strong support for a Unified Model in which Seyferts 2’s contain a torus seen more edge-on than in Seyferts l’s and show that previous results showing the opposite were most likely due to selection effects.
A periodic modulation in the optical flux from Nova Cygni 1975 has been observed since shortly after outburst (Tempesti 1975) and the period is known to have varied by at least a few percent (Semeniuk et al. 1976). We account for the modulation in terms of a simple geometrical model in which the wind emanating from the nova is shadowed by its binary companion (see Fabian and Pringle 1977 for a fuller account). This produces an azimuthal variation in the radius of the surface of last scattering, RS, which an observer sees as a periodic modulation of the. continuum with period roughly equal to the orbital period. Variation of the observed period is accounted for in terms of variation of the size of RS.
This talk summarizes recent work that has been done on cataclysmic variables at Oxford and Cambridge. Full details should be sought elsewhere, either from the authors concerned or from the references given below.
A numerical simulation of equilibrium gas flow in a binary system is presented for the case in which an accretion disc forms around the accreting star (primary). Preliminary results are shown for the mass ratios 0.4, 1.0 and 2.5. Two main conclusions are reached. First, the accretion disc is quite well defined and is comparable in size to the Roche lobe of the primary. Second, all but a few per cent of the mass transferred is accreted by the primary.
On 23 May 2011, CDC identified a multistate cluster of Salmonella Heidelberg infections and two multidrug-resistant (MDR) isolates from ground turkey retail samples with indistinguishable pulsed-field gel electrophoresis patterns. We defined cases as isolation of outbreak strains in persons with illness onset between 27 February 2011 and 10 November 2011. Investigators collected hypothesis-generating questionnaires and shopper-card information. Food samples from homes and retail outlets were collected and cultured. We identified 136 cases of S. Heidelberg infection in 34 states. Shopper-card information, leftover ground turkey from a patient's home containing the outbreak strain and identical antimicrobial resistance profiles of clinical and retail samples pointed to plant A as the source. On 3 August, plant A recalled 36 million pounds of ground turkey. This outbreak increased consumer interest in MDR Salmonella infections acquired through United States-produced poultry and played a vital role in strengthening food safety policies related to Salmonella and raw ground poultry.
Human salmonellosis linked to contact with live poultry is an increasing public health concern. In 2012, eight unrelated outbreaks of human salmonellosis linked to live poultry contact resulted in 517 illnesses. In July 2012, PulseNet, a national molecular surveillance network, reported a multistate cluster of a rare strain of Salmonella Braenderup infections which we investigated. We defined a case as infection with the outbreak strain, determined by pulsed-field gel electrophoresis, with illness onset from 25 July 2012–27 February 2013. Ill persons and mail-order hatchery (MOH) owners were interviewed using standardized questionnaires. Traceback and environmental investigations were conducted. We identified 48 cases in 24 states. Twenty-six (81%) of 32 ill persons reported live poultry contact in the week before illness; case-patients named 12 different MOHs from eight states. The investigation identified hatchery D as the ultimate poultry source. Sampling at hatchery D yielded the outbreak strain. Hatchery D improved sanitation procedures and pest control; subsequent sampling failed to yield Salmonella. This outbreak highlights the interconnectedness of humans, animals, and the environment and the importance of industry knowledge and involvement in solving complex outbreaks. Preventing these infections requires a ‘One Health’ approach that leverages expertise in human, animal, and environmental health.
The ability to efficiently harvest heat as a source of sustainable energy would make a significant contribution to reducing our current reliance on fossil fuels. Waste heat sources, such as those produced in industrial processes or through geothermal activity, are extensive, often continuous, and at present severely underutilised. Thermoelectrochemical cells offer an alternative design to the traditional semiconductor-based thermoelectric devices and offer thepromise of continuous and cheap operation at moderate temperatures, low maintenance and with no carbon emissions. They utilise two electrodes, held at different temperatures, separated by an electrolyte containing a redox couple. It is the temperature dependence of the electrochemical redox potential that generates the potential difference across the device as a result of the appliedtemperature difference. The magnitude of this redox potential temperature dependence is given by the Seebeck coefficient, Se. Until recently, research into thermoelectrochemical cells had primarily focused on aqueous media, predominantly with the Fe(CN)63-/4- redox couple. However, the good thermal and electrochemical stability, non-volatility and non-flammability ofmany ionic liquids make them promising alternative electrolytes for these devices. The use of ionic liquid (IL) electrolytes offers potential advantages that include increased thermoelectrochemical device efficiencies and lifetimes and the ability to utilise low temperature (often “waste”) heat sources in the 100 – 200 °C temperature range. Here we discuss our research into the use of the Fe(CN)63-/4- redox couple in protic IL electrolytes, with different amounts of added water, in a thermoelectrochemical device with platinum and single walled carbon nanotube (SWNT) electrodes.
In November 2009, we initiated a multistate investigation of Salmonella Montevideo infections with pulsed-field gel electrophoresis pattern JIXX01.0011. We identified 272 cases in 44 states with illness onset dates ranging from 1 July 2009 to 14 April 2010. To help generate hypotheses, warehouse store membership card information was collected to identify products consumed by cases. These records identified 19 ill persons who purchased company A salami products before onset of illness. A case-control study was conducted. Ready-to-eat salami consumption was significantly associated with illness (matched odds ratio 8·5, 95% confidence interval 2·1–75·9). The outbreak strain was isolated from company A salami products from an environmental sample from one manufacturing plant, and sealed containers of black and red pepper at the facility. This outbreak illustrates the importance of using membership card information to assist in identifying suspect vehicles, the potential for spices to contaminate ready-to-eat products, and preventing raw ingredient contamination of these products.
Theoretical and experimental studies have been made of the scintillation pulse shapes of organic scintillators. In a unitary crystal the pulse shape is characterised by the scintillation decay time τs. In solution scintillators additional parameters are required to describe the pulse shape: Δt, the pulse width (FWHM); tm, the time at which the intensity reaches a maximumpmax; and t½, the time at which the intensity reaches ½pmax. General relations are derived for τs, Δτ, τm, τ½, and pmax for binary liquid solutions in terms of molecular parameters, and the corresponding expression is given for the scintillation pulse shape of a binary plastic solution.
The scintillation pulse shapes of 4 binary liquid solutions and 12 binary and 15 ternary plastic solutions were measured using a single-photon sampling fluorometer. The results confirm the theoretical analysis. A new plastic scintillator (NE 111) with improved timing characteristics has thus been developed, and some of its applications in nuclear physics are briefly discussed. The time association of nuclear events can be measured to within 130 ps with this scintillator, the limiting factor being the time jitter of the photomultiplier itself.
Post-auricular incisions are performed for a range of otological procedures. Anecdotally, many patients suffer some numbness of the pinna or post-auricular skin post-operatively, but for most this appears to reduce with time. This study aimed to investigate this phenomenon.
A single centre, questionnaire-based study was undertaken, assessing the presence of numbness beyond eight months post-surgery, its location, how it changed, and its impact on the patient. Patients whose numbness had resolved provided details of any temporary deficit. Data were acquired for 35 primary and 16 revision procedures.
Results and conclusion:
Sixty-nine per cent of patients undergoing primary surgery experienced post-operative numbness. Twenty-six per cent had continued numbness after at least eight months' recovery, but only 3 per cent were constantly aware of the deficit. Of those with an ongoing deficit, 78 per cent felt there had been a reduction in the severity, and 67 per cent in the area size, over time. Recovery appeared to be slightly worse in revision cases.
We have studied the structural and magnetic properties of La0.7Sr0.3Mn1-xNixO3 (x=0.05, 0.10, 0.20, 0.30, and 0.40) perovskites using x-ray and neutron diffraction and magnetic measurements. To our knowledge, there exists no neutron diffraction data available for this group of perovskite compositions. Neutron (λ = 1.479Å) and x-ray (λ = 1.5481Å; Cu Kα) powder diffraction indicate that for x ≥ 0.1 all samples are two-phase with a rhombohedral perovskite structure (space group R-3c) and a small amount of NiO (space group Fm3m). Neutron diffraction data for the perovskite phase at 12K and 300K show ferromagnetic ordering for x ≤ 0.2 and antiferromagnetic ordering for x = 0.4. However, for x = 0.3, neutron diffraction data at 12K show coexisting ferromagnetic and antiferromagnetic ordering while at 300K no magnetic ordering is found. Magnetic measurements indicate that the Curie temperature decreases with increasing Ni content. The NiO phase for all samples was found to have antiferromagnetic ordering at 12K and 300K. The magnetic measurements are consistent with the neutron diffraction data and together indicate long-range magnetic ordering for samples at low temperature and transitions from ferromagnetic to paramagnetic to antiferromagnetic ordering for samples at room temperature.
Processing emotional facial expressions is of interest in eating disorders (EDs) as impairments in recognizing and understanding social cues might underlie the interpersonal difficulties experienced by these patients. Disgust and anger are of particular theoretical and clinical interest. The current study investigated the neural response to facial expressions of anger and disgust in bulimia nervosa (BN).
Participants were 12 medication-free women with BN in an acute episode (mean age 24 years), and 16 age-, gender- and IQ-matched healthy volunteers (HVs). Functional magnetic resonance imaging (fMRI) was used to examine neural responses to angry and disgusted facial expressions.
Compared with HVs, patients with BN had a decreased neural response in the precuneus to facial expressions of both anger and disgust and a decreased neural response to angry facial expressions in the right amygdala.
The neural response to emotional facial expressions in BN differs from that found in HVs. The precuneus response may be consistent with the application of mentalization theory to EDs, and the amygdala response with relevant ED theory. The findings are preliminary, but novel, and require replication in a larger sample.