A multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines

Background Venous thromboembolism is a potentially fatal complication of hospitalisation, affecting approximately 3% of non-surgical patients. Administration of low molecular weight heparins to the appropriate patients adequately decreases venous thromboembolism incidence, but guideline adherence is notoriously low. Objective To determine the effect of a multifaceted intervention on thromboprophylaxis guideline adherence. The secondary objective was to study the effect on guideline adherence specifically in patients with a high venous thromboembolism risk. As an exploratory objective, we determined how many venous thromboembolisms may be prevented. Setting A Dutch general teaching hospital. Method A prospective study with a pre- and post-intervention measurement was conducted. A multifaceted intervention, consisting of Clinical Decision Support software, a mobile phone application, monitoring of duplicate anticoagulants and training, was implemented. Guideline adherence was assessed by calculating the Padua prediction and Improve bleeding score for each patient. The number of preventable venous thromboembolisms was calculated using the incidences of venous thromboembolism in patients with and without adequate thromboprophylaxis and extrapolated to the annual number of admitted patients. Main outcome measure Adherence to thromboprophylaxis guidelines in pre- and post-intervention measurements. Results 170 patients were included: 85 in both control and intervention group. The intervention significantly increased guideline adherence from 49.4 to 82.4% (OR 4.78; 95%CI 2.37-9.63). Guideline adherence in the patient group with a high venous thromboembolism risk also increased significantly from 54.5 to 84.3% (OR 2.46; 95%CI 1.31-4.62), resulting in the potential prevention of +/- 261 venous thromboembolisms per year. Conclusions Our multifaceted intervention significantly increased thromboprophylaxis guideline adherence

Construction of orthonormal wavelet-like bases

A general method for constructing wavelet-like bases in a Hilbert space H starting from any orthonormal basis in H and any periodic orthonormal wavelet basis is presented. With this method we can take advantage of the characteristics of both types of bases to obtain orthonormal wavelet-like bases that are suitable to represent functions and operators efficiently.Fil: Morillas, Patricia Mariela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico San Luis. Instituto de Matemática Aplicada de San Luis; Argentina. Universidad Nacional de San Luis; Argentin

Paternal peripartum depression:emerging issues and questions on prevention, diagnosis and treatment. A consensus report from the cost action Riseup-PPD

Introduction: Paternal peripartum depression (P-PPD) is a serious and understudied public health problem associated with impaired family functioning and child development. The lack of recognition of P-PPD may result in limited access to both information and professional help. Objective: The aim of the study was to review studies on paternal peripartum depression and to identify issues and questions where future research and theory formation are needed. Methods: A literature search for systematic reviews, meta-analyses and primary studies was conducted using PubMed, Web of Science, Embase, Scopus, Medline, PsychInfo and Informit databases. Key results within the retrieved articles were summarised and integrated to address the review objectives. Results: Based on the literature, the knowledge related to prevalence, screening, risk factorsunique to fathers, management strategies and outcomes of P-PPD is lacking. Currently, there is no consensual understanding of the definition of P-PPD and recommendations for dealing with P-PPD. Limited data were available regarding the barriers preventing fathers from accessing support systems. Conclusion: Emerging issues that need to be addressed in future research include: P-PPD definition and pathogenetic pathways; prevention strategies and assessment tools; self-help seeking and engagement with interventions; the cost-effectiveness of P-PPD management; needs of health professionals; effect on child development, and public awareness. Future studies and clinical practice should account the complexities that may arise from the father’s perceptions of health care services. Results from this review highlights the critical issues on how to plan, provide and resource health services, to meet the health needs of fathers.</p

Modelación del frijol en Latinoamérica: Estado del arte y base de datos para parametrización

Frijol común (Phaseolus vulgaris L.) es la leguminosa de grano para consumo humano de mayor producción en el mundo, y es nativo de las Américas, donde juega un papel importante en la dieta. Los ambientes donde se cultiva el frijol varían desde zonas tropicales hasta alta montaña, con diversos hábitos de crecimiento (arbustivo determinado, arbustivo indeterminado, y voluble), y en sistemas de producción desde los tradicionales hasta los altamente tecnificados. Los esfuerzos en modelaje, por tanto, deben empezar desde identificar el tipo de frijol y el sistema objetivo. El frijol es muy sensible al estrés abiótico, hecho que ha animado el modelaje de su posible respuesta bajo escenarios de cambio climático. Se llevó a cabo una revisión de literatura para identificar quince ejercicios de modelaje ejecutados en América Latina, abarcando estudios de crecimiento (tazas de producción de nudos y área foliar), fenología, y de rendimiento. Los modelos empleados en dichos estudios incluyen EcoCrop, CROPGRO-DRYBEAN (implementado en la plataforma DSSAT), y en un caso cada uno, Maxent y CLIMEX. Se describen cuatro estudios en detalle: en los dos países de mayor producción en el mundo (Brasil y México), y en Centroamérica como región altamente vulnerable al cambio climático. Estos estudios concuerdan que la productividad del frijol podría sufrir serios efectos negativos en el transcurso del Siglo XXI a raíz del cambio climático. Finalmente, se informa sobre un ejercicio reciente de recopilar datos históricos de ensayos de frijol en Latinoamérica para alimentar futuros esfuerzos de modelaje. Common bean (Phaseolus vulgaris L.) is the grain legume of greatest volume of production for direct human consumption, and is native to the Americas where it plays an important role in the diet of consumers. Bean is cultivated in environments from lowland tropical areas to high mountainous zones; with growth habits ranging from determinate bush, to indeterminate bush, to climbing types; and in production systems varying from traditional low input agriculture to highly technified systems. As such, efforts at modelling should focus on a specific plant type and production system. Bean is very sensitive to abiotic stress, a fact that has motivated modelling of its response in light of the dangers of climate change. A review of literature was carried out revealing fifteen studies in Latin America considering different aspects of plant growth (rates of node and leaf area production), phenology, and yield. Models employed include EcoCrop, CROPGRO (a module within the DSSAT cropping system model), and in one instance each, Maxent and CLIMEX. Three studies in particular are detailed: in the two countries of greatest production in the world (Brazil and Mexico), and one study in Central America as a region under direct threat of climate change. These three studies confirm that bean productivity will likely suffer severe negative effects in the course of the 21st century, as a result of climate change. A recent effort has compiled data from historical yield trials in Latin America as a resource for future modelling efforts.JRC.D.5-Food Securit

A diagnostic evaluation of single screen testing for malaria in the returning traveler: A large retrospective cohort study

From Wiley via Jisc Publications RouterHistory: received 2020-10-02, rev-recd 2020-12-14, accepted 2021-01-15, pub-electronic 2021-02-27, pub-print 2021-07Article version: VoRPublication status: PublishedAbstract: Background: Screening for malaria in the returning traveler has often required repeat testing; however, audit data suggest that patients have not been reattending. We sought to ascertain if this was safe by examining the diagnostic efficacy of a single screen consisting of a rapid diagnostic test (RDT) and a thin film. Methods: We conducted a retrospective cohort study of patients with suspected malaria who attended in the past 5 years from two large teaching hospitals. We assessed the diagnostic accuracy of a single screen, reporting measures of sensitivity and specificity. To establish a reference standard, we cross‐linked data with the national malaria registry held at Public Health England and regional centers. Results: The cohort consisted of 1365 patients, of whom 33 opted out of the research and one did not have a complete initial screen. Of those 1331 screens there were 74 cases of Plasmodium falciparum (prevalence of 5.6%) and 104 of any malaria species (prevalence of 7.8%). Sensitivity for the detection of P. falciparum was 100.00% (95% confidence interval [CI] = 95.1 to 100), with a specificity of 99.4% (95% CI = 98.9 to 99.8). For the detection of any species of malaria the sensitivity was slightly lower due to the presence of one false negative; sensitivity was 99.0% (95% CI = 94.8 to 100) and specificity was 99.5% (95% CI = 98.9 to 99.8). Conclusions: A single thin film and RDT is likely to be sufficient as a first screen for falciparum malaria in the returning traveler with important caveats. For those sent home from emergency departments, appropriate safety netting must be provided. Further prospective study is required to investigate this approach

The prognostic value of emergency department measured hypertension: A systematic review and meta‐analysis

From Wiley via Jisc Publications RouterHistory: received 2021-03-25, rev-recd 2021-06-07, accepted 2021-06-15, pub-electronic 2021-09-22Article version: VoRPublication status: PublishedFunder: Royal College of Emergency Medicine; Id: http://dx.doi.org/10.13039/501100007566Funder: National Institute of Health Research (UK)Abstract: Objectives: The objective was to assess the prognostic value of hypertension detected in the emergency department (ED). Methods: The ED presents a unique opportunity to predict long‐term cardiovascular disease (CVD) outcomes with its potential for high‐footfall, and large‐scale routine data collection applied to underserved patient populations. A systematic review and meta‐analyses were conducted to assess the prognostic performance and feasibility of ED‐measured hypertension as a risk factor for long‐term CVD outcomes. We searched MEDLINE and Embase databases and gray literature sources. The target populations were undifferentiated ED patients. The prognostic factor of interest was hypertension. Feasibility outcomes included prevalence, reliability, and follow‐up attendance. Meta‐analyses were performed for feasibility using a random effect and exact likelihood. Results: The searches identified 1072 studies after title and abstract review, 53 studies had their full text assessed for eligibility, and 26 studies were included. Significant heterogeneity was identified, likely due to the international populations and differing study design. The meta‐analyses estimate of prevalence for ED‐measured hypertension was 0.31 (95% confidence interval 0.25–0.37). ED hypertension was persistent outside the ED (FE estimate of 0.50). The proportion of patients attending follow‐up was low with an exact likelihood estimate of 0.41. Three studies examined the prognostic performance of hypertension and demonstrated an increased risk of long‐term CVD outcomes. Conclusion: Hypertension can be measured feasibly in the ED and consequently used in a long‐term cardiovascular risk prediction model. There is an opportunity to intervene in targeted individuals, using routinely collected data

Application of genomic tools to avocado (Persea americana) breeding : SNP discovery for genotyping and germplasm characterization

Avocado (Persea americana) is an important tropical and subtropical fruit tree crop. Traditional tree breeding programs face the challenges of long generation time and significant expense in land and personnel resources. Avocado selection and breeding can be more efficient and less expensive through the development of molecular markers for the estimation of germplasm genetic diversity, marker-assisted selection (MAS), and creation of linkage maps. Two important breeding resources, the world's two largest avocado mapping populations and an extensive germplasm collection, are housed at the USDA-ARS Subtropical Horticulture Research Station (SHRS) in Miami, Florida. However, to use these resources to their greatest advantage, many thousands of genetic markers are necessary. Here, we describe the development of the first set of avocado genetic markers based on single-nucleotide polymorphism (SNP) variation in expressed genes. RNA sequencing was used both to build a reference transcriptome from 'Hass', the most widely grown avocado cultivar worldwide, and to identify SNPs by alignment of RNA sequences from the mapping population parents to the ˈHassˈ transcriptome. This study provides a new genomic tool for the avocado community that can be used to assess the genetic diversity of avocado germplasm worldwide and to optimize avocado breeding and selection programs by complementing traditional breeding methods with molecular approaches, thus increasing the efficiency of avocado genetic improvement.http://www.elsevier.com/locate/scihortiam2019BiochemistryForestry and Agricultural Biotechnology Institute (FABI)GeneticsMicrobiology and Plant Patholog

Feasibility of the Manchester Acute Coronary Syndromes (MACS) decision rule to safely reduce unnecessary hospital admissions: a pilot randomised controlled trial

Background Observational studies suggest that the Manchester Acute Coronary Syndromes (MACS) decision rule can effectively rule out' and rule in' acute coronary syndromes (ACS) following a single blood test. In a pilot randomised controlled trial, we aimed to determine whether a large trial is feasible. Methods Patients presenting to two EDs with suspected cardiac chest pain were randomised to receive care guided by the MACS decision rule (intervention group) or standard care (controls). The primary efficacy outcome was a successful discharge from the ED, defined as a decision to discharge within 4 hours of arrival providing that the patient did not have a missed acute myocardial infarction (AMI) or develop a major adverse cardiac event (MACE: death, AMI or coronary revascularisation) within 30 days. Feasibility outcomes included recruitment and attrition rates. Results In total, 138 patients were included between October 2013 and October 2014, of whom 131 (95%) were randomised (66 to intervention and 65 controls). Nine (7%) patients had prevalent AMI and six (5%) had incident MACE within 30 days. All 131 patients completed 30-day follow-up and were included in the final analysis with no missing data for the primary analyses. Compared with standard care, a significantly greater proportion of patients whose care was guided by the MACS rule were successfully discharged within 4 hours (26% vs 8%, adjusted OR 5.45, 95% CI 1.73 to 17.11, p=0.004). No patients in either group who were discharged within 4 hours had a diagnosis of AMI or incident MACE within 30 days (0.0%, 95% CI 0% to 20.0% in the intervention group). Conclusions In this pilot trial, use of the MACS rule led to a significant increase in safe discharges from the ED but a larger, fully powered trial remains necessary. Our findings seem to support the feasibility of that trial. Trial registration number ISRCTN 86818215. Research Ethics Committee reference 13/NW/0081. UKCRN registration ID 14334

An exploration of patients’ experiences of participation in a randomised controlled trial of the Manchester Acute Coronary Syndromes (MACS) decision rule

Background As an important part of a pilot study to determine the feasibility of a large randomised controlled trial (RCT) comparing use of the Manchester Acute Coronary Syndromes (MACS) decision rule to standard care, we aimed to explore patient attitudes and potential barriers to participation in a trial of this nature. Methods We conducted a qualitative study nested within a pilot RCT comparing use of the MACS rule (which could enable some patients with chest pain to be discharged earlier) to standard care. Semi-structured interviews with consenting participants were conducted with reference to a bespoke topic guide. Interviews were audio recorded, transcribed verbatim and analysed using the Framework method with an inductive approach. Results The ten interviewees expressed that participation in the trial was generally acceptable. All but one recommended participation to others. Participants who were in pain or anxious at the time of arrival reported that the initial invitation to participate in the trial was sometimes made too early. The approach was welcome providing they had been given time to settle. Interviewees welcomed the opportunity that trial participation offered for them to play a more active role in their healthcare and to reduce unnecessary waiting time. Participants appeared to like that participation in the trial might mean they could return home sooner and welcomed the provision of follow-up. Although several participants described being generally sceptical of medical research, they were amenable to participation in this trial. This appears to be because they agreed with the need for research in this field and perceived the intervention as non-invasive. Conclusions Patients were positive about their participation in this RCT comparing the MACS rule to standard care. A number of areas for improving trial design were identified and should be considered in the planning of future large trial

Creation of an avocado unambiguous genotype SNP database for germplasm curation and as an aid to breeders

Avocado (Persea americana) is an important tropical and subtropical fruit tree crop. Traditional tree breeding programs face the challenges of long generation times and significant expense in land and personnel resources. Avocado selection and breeding can be more efficient and less expensive through the development and application of molecular markers. A total of 1524 individuals were genotyped with 384 SNPs creating the largest SNP genotype database for avocado. These individuals correspond to four extensive germplasm collections including two housed in Florida and two in California. In addition, hybrids and selections from two rootstock breeding programs have been genotyped. Genotype data were analyzed using an affinity propagation method to define 155 groups. The 384 SNP markers provided accurate genotype data for individuals from different Persea species as well as half-siblings. Therefore, the majority of the genetic diversity of the avocado germplasm and related species that were genotyped has been captured. A simple visual method can also be used to identify self-pollinated individuals among the half-siblings of known maternal parents and, in some cases, to infer likely candidates for the paternal parent. Finally, this dataset is unambiguous so breeders can determine the genetic diversity of their breeding stock to optimize avocado breeding and selection programs by identifying outcrossed individuals at the seedling stage, thus increasing the efficiency of avocado genetic improvement.Supplementary Table 1. The sequences of the 384 SNP assays with the associated linkage group (LG), map position in centimorgans (cM), and annotation where available.Supplementary Table 2. Colored data file with affinity propagation groups, silhouette scores, and related data for biallelic SNP markers (384) used to genotype 1,524 germplasm individuals. Data were curated to remove markers with greater than 5% missing data and individuals with greater than 5% missing data in a recursive fashion, resulting in a dataset of genotypes of 377 markers for 1,461 individuals.Supplementary Table 3. Examples of SNP markers that distinguish between landraces.Data archiving statement. All SNP data from this study can be found in Supplementary Table 2.Trust Fund Cooperative Agreement 58-6038-7-006 with the California Avocado Commission and USDA-ARS CRIS 58-6038-21000-022-00D.http://link.springer.com/journal/11295hj2020BiochemistryGeneticsMicrobiology and Plant Patholog