Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial.

AIMS: To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. METHODS AND RESULTS: This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI -0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or €4356 (95% CI €284, €8323). CONCLUSION: An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective. CLINICAL TRIAL REGISTRATION: ISRCTN 48334791

Interpreting whole genome sequencing for investigating tuberculosis transmission: a systematic review

BACKGROUND: Whole genome sequencing (WGS) is becoming an important part of epidemiological investigations of infectious diseases due to greater resolution and cost reductions compared to traditional typing approaches. Many public health and clinical teams will increasingly use WGS to investigate clusters of potential pathogen transmission, making it crucial to understand the benefits and assumptions of the analytical methods for investigating the data. We aimed to understand how different approaches affect inferences of transmission dynamics and outline limitations of the methods. METHODS: We comprehensively searched electronic databases for studies that presented methods used to interpret WGS data for investigating tuberculosis (TB) transmission. Two authors independently selected studies for inclusion and extracted data. Due to considerable methodological heterogeneity between studies, we present summary data with accompanying narrative synthesis rather than pooled analyses. RESULTS: Twenty-five studies met our inclusion criteria. Despite the range of interpretation tools, the usefulness of WGS data in understanding TB transmission often depends on the amount of genetic diversity in the setting. Where diversity is small, distinguishing re-infections from relapses may be impossible; interpretation may be aided by the use of epidemiological data, examining minor variants and deep sequencing. Conversely, when within-host diversity is large, due to genetic hitchhiking or co-infection of two dissimilar strains, it is critical to understand how it arose. Greater understanding of microevolution and mixed infection will enhance interpretation of WGS data. CONCLUSIONS: As sequencing studies have sampled more intensely and integrated multiple sources of information, the understanding of TB transmission and diversity has grown, but there is still much to be learnt about the origins of diversity that will affect inferences from these data. Public health teams and researchers should combine epidemiological, clinical and WGS data to strengthen investigations of transmission

The effect of aortic morphology on peri-operative mortality of ruptured abdominal aortic aneurysm

Aims To investigate whether aneurysm shape and extent, which indicate whether a patient with ruptured abdominal aortic aneurysm (rAAA) is eligible for endovascular repair (EVAR), influence the outcome of both EVAR and open surgical repair. Methods and results The influence of six morphological parameters (maximum aortic diameter, aneurysm neck diameter, length and conicality, proximal neck angle, and maximum common iliac diameter) on mortality and reinterventions within 30 days was investigated in rAAA patients randomized before morphological assessment in the Immediate Management of the Patient with Rupture: Open Versus Endovascular strategies (IMPROVE) trial. Patients with a proven diagnosis of rAAA, who underwent repair and had their admission computerized tomography scan submitted to the core laboratory, were included. Among 458 patients (364 men, mean age 76 years), who had either EVAR (n = 177) or open repair (n = 281) started, there were 155 deaths and 88 re-interventions within 30 days of randomization analysed according to a pre-specified plan. The mean maximum aortic diameter was 8.6 cm. There were no substantial correlations between the six morphological variables. Aneurysm neck length was shorter in those undergoing open repair (vs. EVAR). Aneurysm neck length (mean 23.3, SD 16.1 mm) was inversely associated with mortality for open repair and overall: adjusted OR 0.72 (95% CI 0.57, 0.92) for each 16 mm (SD) increase in length. There were no convincing associations of morphological parameters with reinterventions. Conclusion Short aneurysm necks adversely influence mortality after open repair of rAAA and preclude conventional EVAR. This may help explain why observational studies, but not randomized trials, have shown an early survival benefit for EVAR. Clinical trial registration: ISRCTN 48334791

Open and shut (or not): Conversations about data, access and openness

In this BoF [Birds of a Feather Discussion Session] we seek engagement with researchers and eResearch professionals to explore different approaches to having conversations about research data access and reuse. Rather than typifying open data as an all-or-nothing dichotomy, the discussion will be framed around the idea of a continuum of openness. Key areas to be explored include research communities expectations of reciprocity, and the changing expectations of funding agencies and publishers. Another topic for discussion is the current and future roles for libraries, data librarians and eResearch intermediaries in research data management. One of the biggest hurdles in beginning the eResearch discussion with researchers is explaining about this spectrum of open data and quelling fears that all data will have to be completely open. This discussion will look at the complexities involved with supporting researchers and informing them about all the different levels of openness.This BoF will also look at education and training as it relates to open data and building capabilities among both support professionals and researchers

Research infrastructure for problem based research: Aligning research, policy and practice

The paper draws on a case study of Australian social and policy research in HIV and hepatitis C. With reference to philosophical and functional considerations, it presents a research infrastructure project designed to support a national problem-based research program comprising partners and stakeholders from various health and social science disciplines, government and community-based organisations, and affected communities.

Selective Harvesting: Creating and Ingesting Custom OAI-PMH Sets

The Selective Harvester provides a flexible and customisable mechanism to select and re-use metadata records from open access repositories. The open-source Java-based application developed at the University Library, University of New South Wales (UNSW) integrates an existing OAI-PMH harvesting tool (jOAI), with an application which filters and ingests selected records into a Fedora repository. This model has applications in scholarly communication and eResearch services, especially in relation to populating subject-based repositories

Selective Harvesting: Creating and ingesting selected data without OAI-PMH sets

The Selective Harvester supports scholarly communication and eResearch by providing a flexible and customisable mechanism to select and re-use metadata records from open access repositories. This workflow can assist subject-based repositories in the selection and addition of relevant content. The open-source Selective Harvester developed at the University Library, University of New South Wales (UNSW) integrates an existing OAI-PMH harvester and provider tool (jOAI) with a custom built Java-based application. The Selective Harvester has been implemented on the NCHSR Clearinghouse, a subject-based repository developed jointly by UNSW Library and researchers at the National Centre in HIV Social Research (NCHSR) and on Membrane Research Environment (MemRE), a component infrastructure project of the Advanced Membrane Technologies for Water Treatment Research Cluster funded by the CSIRO Water for a Healthy Country Flagship

Citation Builder: Dynamic display of publication lists on academic webpages

The Citation Builder application enables the display of dynamic lists of publications on academic webpages, based on data from a Fedora repository. Developed at the University Library, University of New South Wales in 2008, Citation Builder was funded within the ARROW (Australian Research Repositories Online to the World) Project. Open access Institutional Repositories (IRs) are storing increasing quantities of publication metadata. By enabling the repurposing of this information, Citation Builder reduces the time and effort involved in data-entry and maintenance of publication lists. Once bibliographic details have been added to the IR, citations can be automatically created and displayed on external websites, such as an academic's personal homepage or a faculty publications webpage. The initial version of Citation Builder software was written using PHP technology. The Java-based Version 2 is Open Source and available via Google Code: http://code.google.com/p/unswlibrary/downloads/list When embedded in an external webpage, Citation Builder uses the latest data in the repository to dynamically generate formatted citations. The application can be readily implemented by web administrators, and does not require any knowledge of programming. At the client side, two files are uploaded and a few lines inserted into the HTML. Editing this HTML enables publications to be selected for display based on specific criteria, for example, all publications by a particular author, or all PhD theses completed within a particular department of the University. There are two display options: the Publications List and the Search Script. The former generates a list of matching publications. The Search Script displays query boxes which enable searches within the specified set of publications, with results displayed as formatted citations. In both display options, publication titles can be hyperlinked to matching objects in the repository. Citation Builder has been designed to be highly configurable. For example, other Fedora repositories could configure the application to fetch the relevant descriptive metadata from Fedora (e.g. Dublin Core; MODS). While Harvard is the default citation style, the XSL could also be modified to display citations in other styles. By integrating an institutionally-managed repository service with school and faculty-based websites, Citation Builder directly supports existing scholarly communication practices of the University research community