Time-frequency visualization of alcohol withdrawal tremors

In this paper, we propose a signal processing method of assessing the severity tremors caused by alcohol withdrawal (AW) syndrome. We have developed an iOS application to calculate the Clinical Institute Withdrawal Assessment (CIWA) score which captures iPod movements using the built-in accelerometer in order to reliably estimate the tremor severity component of the score. We report on the characteristics of AW tremor, the accuracy of electronic assessment of tremor compared to expert clinician assessment, and the potential for using signal processing assessment to differentiate factitious from real tremor in patients seen in the emergency department, as well as in nurses mimicking a tremor. Our preliminary results are based on 84 recordings from 61 subjects (49 patients, 12 nurses). In general we found a linear relationship between energy measured by the accelerometer (in the 4.4-10 Hz range) and the expert rating of tremor severity. Additionally, we demonstrate that 75% of the recordings from patients with actual AW syndrome had a mean peak frequency higher than 7 Hz whereas only 17% of the nurses' factitious tremors were above 7 Hz, suggesting that tremor above 7 Hz could be a potential discriminator of real versus factitious tremors.

Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial

BACKGROUND

Variations exist in the surgical techniques used for caesarean section and many have not been rigorously assessed in randomised controlled trials. We aimed to assess whether any surgical techniques were associated with improved outcomes for women and babies.

METHODS

CORONIS was a pragmatic international 2×2×2×2×2 non-regular fractional, factorial, unmasked, randomised controlled trial that examined five elements of the caesarean section technique in intervention pairs. CORONIS was undertaken at 19 sites in Argentina, Chile, Ghana, India, Kenya, Pakistan, and Sudan. Each site was assigned to three of the five intervention pairs: blunt versus sharp abdominal entry; exteriorisation of the uterus for repair versus intra-abdominal repair; single-layer versus double-layer closure of the uterus; closure versus non-closure of the peritoneum (pelvic and parietal); and chromic catgut versus polyglactin-910 for uterine repair. Pregnant women were eligible if they were to undergo their first or second caesarean section through a planned transverse abdominal incision. Women were randomly assigned by a secure web-based number allocation system to one intervention from each of the three assigned pairs. All investigators, surgeons, and participants were unmasked to treatment allocation. The primary outcome was the composite of death, maternal infectious morbidity, further operative procedures, or blood transfusion (>1 unit) up to the 6-week follow-up visit. Women were analysed in the groups into which they were allocated. The CORONIS Trial is registered with Current Controlled Trials: ISRCTN31089967.

FINDINGS

Between May 20, 2007, and Dec 31, 2010, 15 935 women were recruited. There were no statistically significant differences within any of the intervention pairs for the primary outcome: blunt versus sharp entry risk ratio 1·03 (95% CI 0·91-1·17), exterior versus intra-abdominal repair 0·96 (0·84-1·08), single-layer versus double-layer closure 0·96 (0·85-1·08), closure versus non-closure 1·06 (0·94-1·20), and chromic catgut versus polyglactin-910 0·90 (0·78-1·04). 144 serious adverse events were reported, of which 26 were possibly related to the intervention. Most of the reported serious adverse events were known complications of surgery or complications of the reasons for the caesarean section.

INTERPRETATION

These findings suggest that any of these surgical techniques is acceptable. However, longer-term follow-up is needed to assess whether the absence of evidence of short-term effects will translate into an absence of long-term effects.

FUNDING

UK Medical Research Council and WHO.

Composition, Mosquito Larvicidal, Biting Deterrent and Antifungal Activity of Essential Oils of Different Plant Parts of Cupressus arizonica var. glabra (‘Carolina Sapphire’)

Essential oils obtained by hydrodistillation of female cones (FC), male cones (MC), needle-twigs (NT) and wood-bark (WB) of ‘Carolina Sapphire’ [Cupressus arizonica var glabra (Sudw.) Little] were analyzed simultaneously by gas chromatography (GC) and gas chromatography-mass spectrometry (GC/MS). The main constituents of the investigated essential oils were as follows: FC: α-pinene 68.5% and myrcene 11.9%; MC: α-pinene 22.5%, epi- zonarene 9.9%, zonarene 6.9%, limonene 6.8% and cadina-3,5-diene 6.1%; NT: α-pinene 20.7%, epi-zonarene 10.4%, zonarene 7.6%, limonene 5.9% umbellulone 5.8% and cadina-3,5-diene 5.8%; WB: α-pinene 40.7%, limonene 3.2% and umbellulone 2.9%. Essential oils were evaluated for antifungal activity against the strawberry anthracnose causing fungal plant pathogens Colletotrichum acutatum, C. fragariae and C. gloeosporioides. Only WB essential oil showed moderate activity when compared with the commercial antifungal standards. Carolina Sapphire essential oils exhibited biting deterrent activity at 10 pg/cm2 with Biting Deterrence Index (BDI) values of 0.64, 0.59, 0.65 and 0.72, for FC, MC, NT and WB, respectively, and were significantly lower (P≤0.05) than the synthetic insect repellent, DEET (N,N-diethyl-meta-toluamide), at 25 nmol/cm2 against Aedes aegypti. The biting deterrence of NT and WB oils at 100 μg/cm2 with BDI values of 1.04 and 1.01, respectively, were similar, whereas the activity of MC (BDI=0.88) and FC (BDI=0.62) essential oils was lower than DEET at 25 nmol/cm2. Essential oil from FC with LD50 of 33.7 ppm was most toxic against 1-day-old Ae. aegypti larvae at 24-h post treatment. Female cone essential oil was significantly more toxic than MC (LD50=53.6 ppm), NT (LD50=55.5 ppm) and WB (LD50=44.6 ppm) essential oils.

Composition, mosquito larvicidal, biting deterrent and antifungal activity of essential oils of different plant parts of Cupressus arizonica var. glabra ('Carolina Sapphire')

Essential oils obtained by hydrodistillation of female cones (FC), male cones (MC), needle-twigs (NT) and wood-bark (WB) of 'Carolina Sapphire' [Cupressus arizonica var glabra (Sudw.) Little] were analyzed simultaneously by gas chromatography (GC) and gas chromatography-mass spectrometry (GC/MS). The main constituents of the investigated essential oils were as follows: FC: alpha-pinene 68.5% and myrcene 11.9%; MC: alpha-pinene 22.5%, epi-zonarene 9.9%, zonarene 6.9%, limonene 6.8% and cadina-3,5-diene 6.1%; NT: alpha-pinene 20.7%, epi-zonarene 10.4%, zonarene 7.6%, limonene 5.9% umbellulone 5.8% and cadina-3,5-diene 5.8%; WB: alpha-pinene 40.7%, limonene 3.2% and umbellulone 2.9%. Essential oils were evaluated for antifungal activity against the strawberry anthracnose causing fungal plant pathogens Colletotrichum acutatum, C. fragariae and C. gloeosporioides. Only WB essential oil showed moderate activity when compared with the commercial antifungal standards. Carolina Sapphire essential oils exhibited biting deterrent activity at 10 microg/cm2 with Biting Deterrence Index (BDI) values of 0.64, 0.59, 0.65 and 0.72, for FC, MC, NT and WB, respectively, and were significantly lower (P < or = 0.05) than the synthetic insect repellent, DEET (N,N-diethyl-meta-toluamide), at 25 nmol/cm2 against Aedes aegypti. The biting deterrence of NT and WB oils at 100 microg/cm2 with BDI values of 1.04 and 1.01, respectively, were similar, whereas the activity of MC (BDI = 0.88) and FC (BDI = 0.62) essential oils was lower than DEET at 25 nmol/cm2. Essential oil from FC with LD50 of 33.7 ppm was most toxic against 1-day-old Ae. aegypti larvae at 24-h post treatment. Female cone essential oil was significantly more toxic than MC (LD50 = 53.6 ppm), NT (LD50 = 55.5 ppm) and WB (LD50 = 44.6 ppm) essential oils.

An unusual transmission event of Neisseria meningitidis serogroup W135 type 2a in a healthcare setting, England, 2012

We report an outbreak of Neisseria meningitidis serogroup W135, associated with a transient transmission event between asymptomatic individuals in a healthcare setting. Two elderly persons subsequently developed invasive meningococcal disease. The duration and type of close contact for those directly involved in the probable transmission incident would not have warranted chemoprophylaxis according to current guidelines. Meningococcal infection in older persons usually presents with pneumonia rather than meningitis or septicaemia with purpura.

Chemotherapy uptake and wait times in early-stage non-small-cell lung cancer

BACKGROUND

Treatment uptake and elapsed times along the care path have emerged as potential quality indicators for cancer care delivery. This retrospective study examined changes in adjuvant chemotherapy uptake and elapsed times along the care path for patients in 2005 and in 2007 who had early-stage non-small-cell lung cancer (nsclc) and who underwent curative-intent surgery in Nova Scotia, Canada.

METHODS

All patients who underwent curative-intent surgery for stages i-iii nsclc in the two years of interest were included. Logistic regression and general linear models were used to examine factors associated with chemotherapy uptake patterns and, at various resolutions (low, intermediate, high), elapsed times between all care events in the care path.

RESULTS

In the 223 patients who underwent curative-intent surgery (108 in 2005, 115 in 2007), several factors were associated with uptake patterns and elapsed times. Cohort year (2007 vs. 2005) was not associated with referral to medical oncology [odds ratio (or): 1.05; 95% confidence interval (ci): 0.51 to 2.15; p = 0.905], but it was associated with less treatment after referral (or: 0.34; 95% ci: 0.11 to 1.00; p = 0.057) and less overall uptake (or: 0.35; 95% ci: 0.13 to 0.95; p = 0.040). Patients were referred sooner to medical oncology in 2007 than in 2005 (21 days vs. 35 days, p = 0.008), but experienced longer waits between consultation and chemotherapy delivery (18 days vs. 7 days, p = 0.001).

CONCLUSIONS

Significant differences were observed in care patterns over time. Frequent monitoring of care patterns at high resolution may optimize insights into emerging trends within cancer care systems.