Computerized reporting improves the clinical use of ambulatory blood pressure measurement

a Background Ambulatory blood pressure measurement (ABPM) is being used increasingly in clinical practice. One previous study has shown that there can be considerable variance between expert observers in the interpretation of ABPM data. The purpose of this study was to show whether computer-generated reports with the dabl s ABPM system would provide more consistency in the interpretation of data than reports from expert observers. Methods Twenty-six international experts in hypertension were invited to participate and 17 agreed to do so. Twelve ABPMs generated by the Spacelabs device that were considered representative of the patterns likely to be seen in practice were sent to each participant for reporting. The corresponding dabl reports with an automatic interpretation were generated according to the European Society of Hypertension guideline for comparison with the observer reports. Each of the observer-interpreted Spacelabs reports for the 12 ABPM patterns were coded, analysed and compared with the automatically interpreted dabl s ABPM reports. Both sets of data were analysed for interobserver variability, observer v dabl s ABPM consistency and the time taken for observer reportage. The main analysis determined issues of definite disagreement, namely the presence or absence of nocturnal dipping. Further analysis determined the presence or absence of white-coat phenomena and the severity of hypertension. Results Incorrect diagnoses were made in 13 instances. White-coat hypertension and white-coat effect, although obvious in many instances, were not identified in five ABPMs; the severity of hypertension was not reported in four ABPMs; the severity of nocturnal hypertension was not diagnosed in one ABPM by nine experts and isolated diastolic hypertension was not identified by six experts in two ABPMs. Conclusion This study provides evidence to show that observer variance in reporting ABPMs is common even among experts and that computer-generated interpretative reports of ABPM data improve the diagnostic decisions based on the data generated by 24-h blood pressure recording

The demand for public transport: The effects of fares, quality of service, income and car ownership

This paper reports on key findings from a collaborative study whose objective was to produce an up-to-date guidance manual on the factors affecting the demand for public transport for use by public transport operators and planning authorities, and for academics and other researchers. Whilst a wide range of factors was examined in the study, the paper concentrates on the findings regarding the influence of fares, quality of service and income and car ownership. The results are a distillation and synthesis of identified published and unpublished information on the factors affecting public transport demand. The context is principally that of urban surface transport in Great Britain, but extensive use was made in the study of international sources and examples

Corrosion of aluminium metal in OPC- and CAC-based cement matrices

Corrosion of aluminium metal in ordinary Portland cement (OPC) based pastes produces hydrogen gas and expansive reaction products causing problems for the encapsulation of aluminium containing nuclear wastes. Although corrosion of aluminium in cements has been long known, the extent of aluminium corrosion in the cement matrices and effects of such reaction on the cement phases are not well established. The present study investigates the corrosion reaction of aluminium in OPC, OPC-blast furnace slag (BFS) and calcium aluminate cement (CAC) based systems. The total amount of aluminium able to corrode in an OPC and 4:1 BFS:OPC system was determined, and the correlation between the amount of calcium hydroxide in the system and the reaction of aluminium obtained. It was also shown that a CAC-based system could offer a potential matrix to incorporate aluminium metal with a further reduction of pH by introduction of phosphate, producing a calcium phosphate cement

The Grizzly, April 29, 1983

Three Administrators to Leave: Harris, Layne Retire • Ursinus Makes Inquirer Headlines • Housing Shortage is Imminent • J-Board Changes to be Made • Ursinus Students Win German Awards • Computer Genius is Honored at Myrin • Renninger to go to Scotland • Ursinus Professor Sees Work Published • President\u27s Corner • Letters to the Editor • Bike-A-Thon Proves Successful • Film Reveals Nuclear Horror • Zacharias Ursinus to be Honored in Fall • Award Time • College Choir Turns Comic • Holocaust Survivor Speaks at Commemoration • Women\u27s Tennis Overcomes Adversities; Wins MAC Play-off Berth • Bears\u27 Softball Team Reaches Goal • Women\u27s Lacrosse Turns in Another Strong Season • Ursinus Sluggers Gear Up for Home Stretch • Sports Profile: The Mile Relay Team • Track Teams Close Out Seasons • Men\u27s Tennis Concludes Successful Campaign • Men\u27s Lacrosse Suffers Two Defeatshttps://digitalcommons.ursinus.edu/grizzlynews/1100/thumbnail.jp

Mouse Papillomavirus L1 and L2 Are Dispensable for Viral Infection and Persistence at Both Cutaneous and Mucosal Tissues.

Papillomavirus L1 and L2, the major and minor capsid proteins, play significant roles in viral assembly, entry, and propagation. In the current study, we investigate the impact of L1 and L2 on viral life cycle and tumor growth with a newly established mouse papillomavirus (MmuPV1) infection model. MmuPV1 L1 knockout, L2 knockout, and L1 plus L2 knockout mutant genomes (designated as L1ATGko-4m, L2ATGko, and L1-L2ATGko respectively) were generated. The mutants were examined for their ability to generate lesions in athymic nude mice. Viral activities were examined by qPCR, immunohistochemistry (IHC), in situ hybridization (ISH), and transmission electron microscopy (TEM) analyses. We demonstrated that viral DNA replication and tumor growth occurred at both cutaneous and mucosal sites infected with each of the mutants. Infections involving L1ATGko-4m, L2ATGko, and L1-L2ATGko mutant genomes generally resulted in smaller tumor sizes compared to infection with the wild type. The L1 protein was absent in L1ATGko-4m and L1-L2ATGko mutant-treated tissues, even though viral transcripts and E4 protein expression were robust. Therefore, L1 is not essential for MmuPV1-induced tumor growth, and this finding parallels our previous observations in the rabbit papillomavirus model. Very few viral particles were detected in L2ATGko mutant-infected tissues. Interestingly, the localization of L1 in lesions induced by L2ATGko was primarily cytoplasmic rather than nuclear. The findings support the hypothesis that the L2 gene influences the expression, location, transport, and assembly of the L1 protein in vivo

Protecting infants against RSV disease: an impact and cost-effectiveness comparison of long-acting monoclonal antibodies and maternal vaccination

Background: Two new products for preventing Respiratory Syncytial Virus (RSV) in young children have been licensed: a single-dose long-acting monoclonal antibody (la-mAB) and a maternal vaccine (MV). To facilitate the selection of new RSV intervention programmes for large-scale implementation, this study provides an assessment to compare the costs of potential programmes with the health benefits accrued. Methods: Using an existing dynamic transmission model, we compared maternal vaccination to la-mAB therapy against RSV in England and Wales by calculating the impact and cost-effectiveness. We calibrated a statistical model to the efficacy trial data to accurately capture their immune waning and estimated the impact of seasonal and year-round programmes for la-mAB and MV programmes. Using these impact estimates, we identified the most cost-effective programme across pricing and delivery cost assumptions. Findings: For infants under six months old in England and Wales, a year-round MV programme with 60% coverage would avert 32% (95% CrI 22–41%) of RSV hospital admissions and a year-round la-mAB programme with 90% coverage would avert 57% (95% CrI 41–69%). The MV programme has additional health benefits for pregnant women, which account for 20% of the population-level health burden averted. A seasonal la-mAB programme could be cost-effective for up to £84 for purchasing and administration (CCPA) and a seasonal MV could be cost-effective for up to £80 CCPA. Interpretation: This modelling and cost-effectiveness analysis has shown that both the long-acting monoclonal antibodies and the maternal vaccine could substantially reduce the burden of RSV disease in the infant population. Our analysis has informed JCVI's recommendations for an RSV immunisation programme to protect newborns and infants. Funding: National Institute for Health Research

Branched macromonomers from catalytic chain transfer polymerisation (CCTP) as precursors for emulsion-templated porous polymers

Efforts in the synthesis of macroporous polymers have mostly been directed towards the formation of stable high internal phase emulsions (HIPEs) from commercially available monomers, limiting their scope of application. Therefore, the development of simple synthetic approaches to access tailor-made macromonomers that can be used as precursors for the formation of HIPEs, allowing the design of new generations of polyHIPE materials with bespoke chemical and physical properties, is desirable in the search for new applications. In this work, cobalt(II) mediated catalytic chain transfer polymerisation (CCTP) is used to polymerise ethylene glycol dimethacrylate (EGDMA), producing multi vinyl-terminated branched EGDMA polymers with tuneable branching density and degree of unsaturation. These materials are subsequently implemented as macromonomer crosslinking agents for the formulation of HIPEs. The use of acrylate comonomers as propagation promoters is found to be essential and 2-ethylhexyl acrylate (EHA), isobornyl acrylate (IBOA) and 2-methoxyethyl acrylate (MEA) are investigated as comonomers in the formulations to both facilitate the photochemical curing of the HIPEs and to impart material properties to the products. The CCTP derived branched macromonomers are fully charaterised by GPC, 1H-NMR and MALDI–ToF spectroscopy. Scanning electron microscopy (SEM) is used to explore the morphology of the produced materials. Surface wettability experiments are conducted to evaluate the hydrophilicity of the polyHIPE surface. Compression tests are used to investigate the influence of the branching density of the CCTP macromonomers as well as the nature of comonomers on the mechanical properties of the materials

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Codon Size Reduction as the Origin of the Triplet Genetic Code

The genetic code appears to be optimized in its robustness to missense errors and frameshift errors. In addition, the genetic code is near-optimal in terms of its ability to carry information in addition to the sequences of encoded proteins. As evolution has no foresight, optimality of the modern genetic code suggests that it evolved from less optimal code variants. The length of codons in the genetic code is also optimal, as three is the minimal nucleotide combination that can encode the twenty standard amino acids. The apparent impossibility of transitions between codon sizes in a discontinuous manner during evolution has resulted in an unbending view that the genetic code was always triplet. Yet, recent experimental evidence on quadruplet decoding, as well as the discovery of organisms with ambiguous and dual decoding, suggest that the possibility of the evolution of triplet decoding from living systems with non-triplet decoding merits reconsideration and further exploration. To explore this possibility we designed a mathematical model of the evolution of primitive digital coding systems which can decode nucleotide sequences into protein sequences. These coding systems can evolve their nucleotide sequences via genetic events of Darwinian evolution, such as point-mutations. The replication rates of such coding systems depend on the accuracy of the generated protein sequences. Computer simulations based on our model show that decoding systems with codons of length greater than three spontaneously evolve into predominantly triplet decoding systems. Our findings suggest a plausible scenario for the evolution of the triplet genetic code in a continuous manner. This scenario suggests an explanation of how protein synthesis could be accomplished by means of long RNA-RNA interactions prior to the emergence of the complex decoding machinery, such as the ribosome, that is required for stabilization and discrimination of otherwise weak triplet codon-anticodon interactions

Utilising Bayesian networks to demonstrate the potential consequences of a fuel gas release from an offshore gas-driven turbine

This research proposes the application of Bayesian networks in conducting quantitative risk assessment of the integrity of an offshore gas driven turbine, used for electrical power generation. The focus of the research is centred on the potential release of fuel gas from a turbine and the potential consequences that follow the said release, such as fire, explosion and damage to equipment within the electrical generation module. The Bayesian network demonstrates the interactions of potential initial events and failures, hazards, barriers and consequences involved in a fuel gas release. This model allows for quantitative analysis to demonstrate partial verification of the model. The verification of the model is demonstrated in a series of test cases and through sensitivity analysis. Test case 1 demonstrates the effects of individual and combined control system failures within the fuel gas release model; 2 demonstrates the effects of the 100% probability of a gas release on the Bayesian network model, along with the effect of the gas detection system not functioning; and 3 demonstrates the effects of inserting evidence as a consequence and observing the effects on prior nodes.© IMechE 2018