A hybrid EAV-relational model for consistent and scalable capture of clinical research data

Many clinical research databases are built for specific purposes and their design is often guided by the requirements of their particular setting. Not only does this lead to issues of interoperability and reusability between research groups in the wider community but, within the project itself, changes and additions to the system could be implemented using an ad hoc approach, which may make the system difficult to maintain and even more difficult to share. In this paper, we outline a hybrid Entity-Attribute-Value and relational model approach for modelling data, in light of frequently changing requirements, which enables the back-end database schema to remain static, improving the extensibility and scalability of an application. The model also facilitates data reuse. The methods used build on the modular architecture previously introduced in the CURe project

Tobacco and cigarette butt consumption in humans and animals

Discarded cigarette butts may present health risks to human infants and animals because of indiscriminate eating behaviours. Nicotine found in cigarette butts may cause vomiting and neurological toxicity; leachates of cigarette butts in aquatic environments may cause exposure to additional toxic chemicals including heavy metals, ethyl phenol and pesticide residues. This report reviews published and grey literature regarding cigarette butt waste consumption by children, pets and wildlife. Although reports of human and animal exposures number in the tens of thousands, severe toxic outcomes due to butt consumption are rare. Nonetheless, the ubiquity of cigarette butt waste and its potential for adverse effects on human and animal health warrants additional research and policy interventions to reduce the stream of these pollutants in the environment

A query tool enabling clinicians and researchers to explore patient cohorts

Due to the increasing amount of health information being gathered and the potential benefit of data reuse, it is now becoming a necessity for tools, which collect and analyse this data, to support integration of heterogeneous datasets, as well as provide intuitive user interfaces, which allow clinicians and researchers to query the data without needing to form complex SQL queries. The West Midlands Query Tool consists of an easy-to-use graph-based GUI, which interacts with a flexible middleware application. It has the main objective of querying heterogeneous data sources for exploring patient cohorts through a query builder and criteria set

The role of informatics in prehospital emergency resuscitation and defibrillation

Out-of-hospital cardiac arrests account for a large number of deaths as the time window for successful resuscitation is very short. Timely call for help, resuscitation and defibrillation by laypersons are crucial for the survival and outcome of cardiac arrest victims. Good quality data and informatics play an important role in the effectiveness of the chain of survival. Information about defibrillator location is vital for emergency services to direct bystanders; informatics also helps to strategically place defibrillators for optimal use. Technologies, such as location-based systems are being used to keep track of defibrillators and also alert volunteer responders to emergencies. Informatics also plays a role in post resuscitation care and research by facilitating the linkage and interoperability of health data between different systems, such as ambulance service, hospital, and other health data such as cardiac arrest registries

Perspectives of UK community first responders on a national public access defibrillator database

Background: Out-of-hospital cardiac arrest (OHCA) survival to hospital discharge in the United Kingdom is lower than in many other developed regions, with England 9% [1] and Scotland 5% [2], compared to North Holland Province, the Netherlands 21% [3] and Norway 25% [4]. In 2015, the British Heart Foundation commissioned a feasibility study into the establishment of a national Public Accessible Defibrillator (PAD) database for the UK and how it could improve OHCA survival. As part of this feasibility study, the views of a range of stakeholders were sought, including those of community first responders (CFRs). CFRs are volunteers from local communities who attend to emergency calls received by the ambulance service and provide care until an ambulance arrives. There were over 12,000 CFRs operating across the UK in 2014 [5]. Most of the PADs are static AEDs made available in public places. The alternative is the use of mobile defibrillators that are carried to the scene of an emergency by CFRs [6]. Methods: A survey was designed with 12 questions. It covered the areas of CFR demographics, experience with PADs, and their views on a national PAD database and the technologies and apps available for locating defibrillators and for alerting lay responders of an emergency. The survey questionnaire was made available via an online survey tool (SurveyMonkey). Between November and December 2015, links to the survey were sent via email to CFRs via the National Ambulance Services Responder Managers Forum [7]. Results: 760 responses were received (6.3% response rate) with 12 out 14 ambulance service regions represented. The experience of CFRs ranges from none (just finished training) to 16 years, with the largest proportion having under 2 years experience (47.28%, 322 of 681). Awareness of apps and their use was variable with a reasonable knowledge of GoodSAM, AED Locator and the South Central Ambulance Service app but 75% did not know if apps are routinely used in their area. 35.47% of respondents (255 of 719) felt a national database of AED locations would have a significant impact on awareness and use of defibrillators with a further 42.84% (308 of 719) thinking it would have some impact. Additionally, the use of apps linked to a national database was supported by over 85% of respondents. Conclusion: In the survey, CFRs expressed generally positive opinions about a national PAD database and linked apps. The need for it arises naturally from having defibrillators in the community and is an additional tool to help save lives. Issues that need to be considered however include information accuracy and maintenance; the need for training combined with first aid and CPR. CFRs identified the main barriers to defibrillator use as (1) not knowing how to use one, (2) not knowing where to find one and (3) fear of injury to the victim. Lack of awareness amongst the public about the availability and use of defibrillators was highlighted as a major challenge and the absolute need for a high profile and awareness raising campaign was flagged

Life saving apps : linking cardiac arrest victims to emergency services and volunteer responders

In cases of emergency, such as out-of-hospital cardiac arrests, the first few minutes are crucial for victims to receive care and have a positive outcome. However, emergency services often arrive on scene after those first few minutes, making any bridging solutions key. Finding a defibrillator or accessing a trained volunteer responder are some of the technologicalsolutions that are being developed to support the chain of survival. This paper looks at technologies, in particular those linked to mobile apps that have been used to locate defibrillators and responder apps that enable responders to attend to nearby emergencies. We review a selection of apps and also assess the challenges and considerations for such apps

Galactose and its Metabolites Deteriorate Metaphase II Mouse Oocyte Quality and Subsequent Embryo Development by Disrupting the Spindle Structure

Premature ovarian insufficiency (POI) is a frequent long-term complication of classic galactosemia. The majority of women with this disorder develop POI, however rare spontaneous pregnancies have been reported. Here, we evaluate the effect of D-galactose and its metabolites, galactitol and galactose 1-phosphate, on oocyte quality as well as embryo development to elucidate the mechanism through which these compounds mediate oocyte deterioration. Metaphase II mouse oocytes (n=240), with and without cumulus cells (CCs), were exposed for 4hours to D-galactose (2μM), galactitol (11μM) and galactose 1-phosphate (0.1mM), (corresponding to plasma concentrations in patients on galactoserestricted diet) and compared to controls. The treated oocytes showed decreased quality as a function of significant enhancement in production of reactive oxygen species (ROS) when compared to controls. The presence of CCs offered no protection, as elevated ROS was accompanied by increased apoptosis of CCs. Our results suggested that D-galactose and its metabolites disturbed the spindle structure and chromosomal alignment, which was associated with significant decline in oocyte cleavage and blastocyst development after in-vitro fertilization. The results provide insight into prevention and treatment strategies that may be used to extend the window of fertility in these patients

High-field MR imaging in pediatric congenital heart disease: Initial results

BackgroundComprehensive assessment of pediatric congenital heart disease (CHD) at any field strength mandates evaluation of both vascular and dynamic cardiac anatomy for which diagnostic quality contrast-enhanced magnetic resonance angiography (CEMRA) and cardiac cine are crucial.ObjectiveTo determine whether high-resolution (HR) CEMRA and steady-state free precession (SSFP) cine can be performed reliably at 3.0 T in children with CHD and to compare the image quality to similar techniques performed at 1.5 T.Materials and methodsTwenty-eight patients with a median age of 5 months and average weight 9.0 ± 7.8 kg with suspected or known CHD were evaluated at 3.0 T. SSFP cine (n = 86 series) and HR-CEMRA (n = 414 named vascular segments) were performed and images were scored for image quality and artifacts. The findings were compared to those of 28 patients with CHD of similar weight who were evaluated at 1.5 T.ResultsOverall image quality on HR-CEMRA was rated as excellent or good in 96% (397/414) of vascular segments at 3.0 T (k = 0.49) and in 94% (349/371) of vascular segments at 1.5 T (k = 0.36). Overall image quality of SSFP was rated excellent or good in 91% (78/86) of cine series at 3.0 T (k = 0.55) and in 81% (87/108) at 1.5 T (k = 0.47). Off-resonance artifact was common at both field strengths, varied over the cardiac cycle and was more prevalent at 3.0 T. At 3.0 T, off-resonance dark band artifact on SSFP cine was absent in 3% (3/86), mild in 69% (59/86), moderate in 27% (23/86) and severe in 1% (1/86) of images; at 1.5 T, dark band artifact was absent in 16% (17/108), mild in 69% (75/108), moderate in 12% (13/108) and severe in 3% (3/108) of cine images. The signal-to-noise ratio and contrast-to-noise ratio of both SSFP cine and HR-CEMRA images were significantly higher at 3.0 T than at 1.5 T (P < 0.001).ConclusionSignal-to-noise ratio and contrast-to-noise ratio of high-resolution contrast-enhanced magnetic resonance angiography and SSFP cine were higher at 3.0 T than at 1.5 T. Artifacts on SSFP cine were cardiac phase specific and more prevalent at 3.0 T such that frequency-tuning was required in one-third of exams. In neonates, high spatial resolution CEMRA was highly reliable in defining extracardiac vascular anatomy

Use of a Semi-field System to Evaluate the Efficacy of Topical Repellents under user Conditions Provides a Disease Exposure free Technique Comparable with Field Data.

Before topical repellents can be employed as interventions against arthropod bites, their efficacy must be established. Currently, laboratory or field tests, using human volunteers, are the main methods used for assessing the efficacy of topical repellents. However, laboratory tests are not representative of real life conditions under which repellents are used and field-testing potentially exposes human volunteers to disease. There is, therefore, a need to develop methods to test efficacy of repellents under real life conditions while minimizing volunteer exposure to disease. A lotion-based, 15% N, N-Diethyl-3-methylbenzamide (DEET) repellent and 15% DEET in ethanol were compared to a placebo lotion in a 200 sq m (10 m x 20 m) semi-field system (SFS) against laboratory-reared Anopheles arabiensis mosquitoes and in full field settings against wild malaria vectors and nuisance-biting mosquitoes. The average percentage protection against biting mosquitoes over four hours in the SFS and field setting was determined. A Poisson regression model was then used to determine relative risk of being bitten when wearing either of these repellents compared to the placebo. Average percentage protection of the lotion-based 15% DEET repellent after four hours of mosquito collection was 82.13% (95% CI 75.94-88.82) in the semi-field experiments and 85.10% (95% CI 78.97-91.70) in the field experiments. Average percentage protection of 15% DEET in ethanol after four hours was 71.29% (CI 61.77-82.28) in the semi-field system and 88.24% (84.45-92.20) in the field. Semi-field evaluation results were comparable to full-field evaluations, indicating that such systems could be satisfactorily used in measuring efficacy of topically applied mosquito repellents, thereby avoiding risks of exposure to mosquito-borne pathogens, associated with field testing