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To identify potential participants for clinical trials, electronic health records (EHRs) are searched at potential sites. As an alternative, we investigated using medical devices used for real-time diagnostic decisions for trial enrollment.
To project cohorts for a trial in acute coronary syndromes (ACS), we used electrocardiograph-based algorithms that identify ACS or ST elevation myocardial infarction (STEMI) that prompt clinicians to offer patients trial enrollment. We searched six hospitals’ electrocardiograph systems for electrocardiograms (ECGs) meeting the planned trial’s enrollment criterion: ECGs with STEMI or > 75% probability of ACS by the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI). We revised the ACI-TIPI regression to require only data directly from the electrocardiograph, the e-ACI-TIPI using the same data used for the original ACI-TIPI (development set n = 3,453; test set n = 2,315). We also tested both on data from emergency department electrocardiographs from across the US (n = 8,556). We then used ACI-TIPI and e-ACI-TIPI to identify potential cohorts for the ACS trial and compared performance to cohorts from EHR data at the hospitals.
Receiver-operating characteristic (ROC) curve areas on the test set were excellent, 0.89 for ACI-TIPI and 0.84 for the e-ACI-TIPI, as was calibration. On the national electrocardiographic database, ROC areas were 0.78 and 0.69, respectively, and with very good calibration. When tested for detection of patients with > 75% ACS probability, both electrocardiograph-based methods identified eligible patients well, and better than did EHRs.
Using data from medical devices such as electrocardiographs may provide accurate projections of available cohorts for clinical trials.
UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors.
An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders.
An expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders.
157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Declaration of interest
G.B. received grants from the National Institute for Health Research during the study; and support from Illumina Ltd. and the European Commission outside the submitted work. B.C. received grants from the Scottish Executive Chief Scientist Office and from The Dr Mortimer and Theresa Sackler Foundation during the study. C.S. received grants from the Medical Research Council and Wellcome Trust during the study, and is the Chief Scientist for UK Biobank. M.H. received grants from the Innovative Medicines Initiative via the RADAR-CNS programme and personal fees as an expert witness outside the submitted work.
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
This paper describes the results of two seasons of excavation and associated palaeoenvironmental analyses of a wetland site on Beccles Marshes, Beccles, Suffolk. The site has been identified as a triple post alignment of oak timbers (0.6–2.0 m long), over 100 m in length, and 3–4 m wide, running north-west to south-east towards the River Waveney. It was constructed in a single phase which has been dated dendrochronologically to 75 BC, although discrete brushwood features identified as possible short trackways have been dated by radiocarbon to both before and after the alignment was built. It is unclear if the posts ever supported a superstructure but notches (‘halving lap joints’) in some of the posts appear to have held timbers to support the posts and/or aid in their insertion. In addition, fragments of both Iron Age and Romano-British pottery were recovered. A substantial assemblage of worked wooden remains appears to reflect the construction of the post row itself and perhaps the on-site clearance of floodplain vegetation. This assemblage also contains waste material derived from the reduction splitting of timbers larger than the posts of the alignment, but which have not been recovered from the site. Environmental analyses indicate that the current landscape context of the site with respect to the River Waveney is probably similar to that which pertained in prehistory. The coleoptera (beetle) record illustrates a series of changes in the on-site vegetation in the period before, during and after the main phase of human activity which may be related to a range of factors including floodplain hydrology and anthropogenic utilisation of Beccles Marshes. The possible form and function of the site is discussed in relation to the later prehistoric period in Suffolk.
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.
The Department of Materials and Metallurgical Engineering faculty at the South Dakota School of Mines and Technology (SDSM&T) has developed a unique undergraduate program that integrates research, extracurricular activities, and outreach experiences. A common thread throughout the program is an introduction to the artistic and historical background of metallurgical engineering. These activities use kinesthetic learning to promote student learning of metallurgical engineering, aspects often not traditionally included in engineering curricula. These programs are similar to those envisioned by the National Academy of Engineering in response to the changing needs of engineering. These are described in two visionary books published by the National Research Council.
A major focus of the program integrates blacksmithing activities with curricular, extracurricular, and outreach activities. All SDSM&T students are invited to a weekly blacksmithing activity called Hammer-in. Blacksmithing-related laboratories were added to the curriculum. Additionally, students developed a portable blacksmithing laboratory with faculty supervision. The laboratory has been taken to K-12 schools, including Native American schools on reservations, to reach out to regional students, thereby promoting interest in STEM careers. The success of these activities led to their incorporation into a National Science Foundation Research Experience for Undergraduate (REU) at SDSM&T called Back to the Future that focuses on understanding new technologies through historical antecedents. The SDSM&T students who participated in this REU used this experience as part of their junior/senior design courses. This program has increased enrollment in the department and has led to better learning outcomes for the students.
The development of emergency medical services (EMS) systems in the United States, incorporating various levels of sophistication in prehospital care and echelons of capability in hospital resource availability, has brought new connotations to the word “triage” (sorting).
Heretofore, triage consisted entirely of estimating treatment needs so that prioritized transfer of patients could be made to hospitals. The decision is no longer binary, since the introduction of Trauma Centers requires the triage decision maker to not only decide which patient first, but also which patient to which hospital. Clear cut decision rules for this process applied to routine civilian emergency medical practice have yet to emerge.
Anthropogenic releases of reactive nitrogen (Nr) can disturb natural systems and affect human health and welfare in many different ways. Scientific and policy views of the nitrogen cycle have typically addressed these problems from separate perspectives, looking in each case at only part of the overall issue.
Given the multi-faceted nature of the nitrogen cycle, it is a major challenge to develop a more-integrated understanding of how different areas of nitrogen science and policies fit together.
Observations from the first part of the European Nitrogen Assessment (ENA Part I) are summarized, considering the distinctive character of Nr in Europe, the benefits and threats, and the current policies. Approaches to developing the following parts of the Assessment are discussed with an emphasis on how to draw out the key issues.
Recognizing the multi-pollutant, multi-phase complexity of the nitrogen cycle, it is concluded that it is essential to focus on a limited set of priority issues to allow effective communication between nitrogen scientists and policy makers.
A pathway is developed for prioritization of the key environmental concerns of excess Nr. Starting with around twenty environmental effects, the list is reduced down, first to nine main concerns, and then to five key societal threats.
A new polysilicon surface micromachining technique for fabricating and assembling three- dimensional structures has been developed. Single-layer polysilicon elements and laminated polysilicon panels incorporating trapped-glass reinforcement ribs have been successfully fabri- cated on a silicon substrate with robust and continuous hinges that facilitate out-of-plane rotation and assembly. To realize a stable three-dimensional structure, one of the device's elevatable panel components is terminated with an array of open windows, and the mating rotatable element has a matched set of protruding arrowheads/microrivets with flexible barbs that readily flex to facilitate their joining and assembly. Because the arrowhead/microrivet barb tip-to-barb tip sepa- ration is larger than the opening in the mating window, the barbs flex inward as they pass through the open window and then expand to their original shape upon exiting the window, re- sulting in a permanently latched joint and a three-dimensional structure. Three novel arrow- head/microrivet designs have been micromachined to facilitate the latching process, including a simple arrowhead, a high-aspect ratio arrowhead, and a rivet-like structure with a hemispherical shaped cap and a flexible split shank.