Standardised Versioning of Datasets: a FAIR-compliant Proposal

This paper presents a standardised dataset versioning framework for improved reusability, recognition and data version tracking, facilitating comparisons and informed decision-making for data usability and workflow integration. The framework adopts a software engineering-like data versioning nomenclature ("major.minor.patch") and incorporates data schema principles to promote reproducibility and collaboration. To quantify changes in statistical properties over time, the concept of data drift metrics (d) is introduced. Three metrics (dP, dE,PCA, and dE,AE) based on unsupervised Machine Learning techniques (Principal Component Analysis and Autoencoders) are evaluated for dataset creation, update, and deletion. The optimal choice is the dE,PCA metric, combining PCA models with splines. It exhibits efficient computational time, with values below 50 for new dataset batches and values consistent with seasonal or trend variations. Major updates (i.e., values of 100) occur when scaling transformations are applied to over 30% of variables while efficiently handling information loss, yielding values close to 0. This metric achieved a favourable trade-off between interpretability, robustness against information loss, and computation time.

An Alternative One-Stage Exchange Arthroplasty Technique: For the Chronic Infected Total Hip

Background There are various algorithms for the treatment of prosthetic joint infections (PJI). Currently, a two-stage hip exchange is considered the "gold standard" of care for treatment of chronic hip PJIs. However, there has been recent debate whether a one- or two-stage exchange offers the correct treatment. One-stage exchange arthroplasty has particularly gained interest due to less morbidity, mortality, and functional impairment. Methods In a retrospective case series, the outcome of patients with chronic hip PJIs treated with our one-stage exchange arthroplasty was analyzed. Between January 2015 and January 2020, eight patients underwent a one-stage exchange hip arthroplasty by a single surgeon at a single institution for a chronically infected total hip arthroplasty (THA). Original diagnosis of PJI was made in accordance with the 2011 version of the Musculoskeletal Infection Society (MSIS) criteria. The femoral stem was cemented with antibiotic-impregnated cement, and the polyethylene acetabular liner was cemented directly onto the acetabular bone with antibiotic-impregnated cement. Results Of the eight patients, three were female and five were male with a mean age of 70.5 years (SD 11.2, range 53-87). Six patients (75%) had infection eradication with retention of a stable implant and no additional surgery at a mean follow-up of 35.7 months (range 17-50). One patient (12.5%) underwent closed reduction for a dislocated THA at one month; however, this patient remained infection-free at the most recent follow-up of 41 months. One patient (12.5%) who was the oldest patient (87 years) died 18 days postoperatively. Overall, all living patients (87.5%) retained their one-stage exchange THA. One patient (12.5%, CI 95% 0.3-52.7) required additional surgery in the form of a closed reduction and zero patients (0.0%, CI 95% 0.0-36.9) required additional open surgery.  Conclusion Single-stage exchange arthroplasty with an antibiotic-impregnated cemented femoral stem and antibiotic-impregnated cemented polyethylene acetabular liner may be a useful option for the treatment of chronic hip PJIs. Our case series provides evidence that infection eradication and function preservation are possible using our one-stage exchange arthroplasty technique in a chronically infected THA. However, a multi-center study with randomization is necessary to further validate our results.

Measuring Neighbourhood Deprivation: A Critique of the Index of Multiple Deprivation

There is now a sustained interest in measuring geographical variation in social and economic circumstances in order to guide urban policy resource allocation decisions. The most recent attempt to measure local area deprivation in England has come through the government's Index of Multiple Deprivation (IMD). The authors aim to consider the degree to which the IMD provides a reliable mechanism for doing so and to suggest the ways in which its successors might best be refined. They argue that although the IMD, in many respects, represents a commendable advance in terms of the development of techniques to quantify deprivation, there remain significant limitations that future approaches could profitably address.

Heterogeneity and disparities in the use of exception scores in pediatric liver allocation

Physicians apply for Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease exception points on a case-by-case basis to improve an individual patient's chances of receiving a liver transplant. This retrospective cohort study describes trends in the use of exceptions among the pediatric liver waitlist population with chronic liver disease. The cohort (n = 3728) included all children with a diagnosis of chronic liver disease listed in the United Network for Organ Sharing transplant database for first isolated liver transplant between February 27, 2002 and March 31, 2013. Exception score requests were common (34%); 90% of requests were approved. The rate of exception score requests in 2013 was five times that of 2002 (incident rate ratios [IRR] 5.25, 95% confidence interval [CI] 3.19-8.63, p < 0.01). Patients of non-White race had exception score request rates 13% lower than patients of White race (IRR 0.87, 95% CI 0.77-0.98, p = 0.02). Older patients had lower rates of exception score requests than younger patients (p = 0.03). Request rates varied by region. Time spent at an active exception status nearly tripled the hazard rate for transplantation (hazard ratio = 2.90, 95% CI 2.62-3.21, p < 0.01). There is disparity in use of exceptions by race that is not explained by clinical disease severity, diagnosis, geography or other demographic factors.

Quantitative catchment profiling to apportion faecal indicator organism budgets for the Ribble system, the UK's sentinel drainage basin for Water Framework Directive research

Under the EU Water Framework Directive (WFD) 20/60/EC and the US Federal Water Pollution Control Act 2002 management of water quality within river drainage basins has shifted from traditional point-source control to a holistic approach whereby the overall contribution of point and diffuse sources of pollutants has to be considered. Consequently, there is a requirement to undertake source-apportionment studies of pollutant fluxes within catchments. The inclusion of the Bathing Water Directive (BWD), under the list of 'protected areas' in the WFD places a requirement to control sources of faecal indicator organisms within catchments in order to achieve the objectives of both the BWD (and its revision - 2006/7/EC) and the WFD. This study was therefore initiated to quantify catchment-derived fluxes of faecal indicator compliance parameters originating from both point and diffuse sources. The Ribble drainage basin is the single UK sentinel WFD research catchment and discharges to the south of the Fylde coast, which includes a number of high profile, historically non-compliant, bathing waters. Faecal indicator concentrations (faecal coliform concentrations are reported herein) were measured at 41 riverine locations, the 15 largest wastewater treatment works (WwTWs) and 15 combined sewer overflows (CSOs) across the Ribble basin over a 44-day period during the 2002 bathing season. The sampling programme included targeting rainfall-induced high flow events and sample results were categorised as either base flow or high flow. At the riverine sites, geometric mean faecal coliform concentrations showed statistically significant elevation at high flow compared to base flow. The resultant faecal coliform flux estimates revealed that over 90% of the total organism load to the Ribble Estuary was discharged by sewage related sources during high flow events. These sewage sources were largely related to the urban areas to the south and east of the Ribble basin, with over half the load associated with the relatively small subcatchment of the River Douglas. The majority of this load was attributed to two WwTWs that discharge through a common outfall close to the tidal limit of this catchment. Budgets adjusted to accommodate the impact of proposed UV disinfection of these effluents showed that the load from these sources would be reduced significantly during base flow conditions. However, during high flow events loads would still remain high due to the operation of storm sewage overflows from stormwater retention tanks. The study identified untreated storm sewage spills from urban infrastructure and WwTW stormwater retention tanks as the dominant component of the high flow flux of faecal indicators to receiving waters of the Fylde coast and the associated bathing waters.

Attempted and completed incidents of stranger-perpetrated child sexual abuse and abduction

OBJECTIVE

To establish the prevalence, typology and nature of attempted or completed incidents of stranger-perpetrated sexual abuse or abduction of children "away from home".

METHODS

A questionnaire was completed by 2,420 children (83% response rate) aged 9-16 years in 26 elementary and high schools in North-West England.

RESULTS

Of these children, 19.0% (n=461) reported that they had been the victims of any attempted or completed sexual abuse or abduction incident away from home at some point in their lives. Of these children, 161 (6.7% of the original sample) reported that the "last" incident had been perpetrated by a stranger. Based upon these last incidents, four main types of attempted or completed CSA or abduction incident were identified: indecent exposure (40.8% of victims), touching (25.8%), and abduction (23.1%), each occurring on their own; and incidents involving multiple types of act (10.2%). The majority of these abductions (91.1%) and touching incidents (50.9%) were attempted as opposed to completed. Rates of victimization were generally higher among girls than boys (10.4% vs. 4.2%, p<.001). A sizeable minority of victims had experienced sexual abuse or abduction previously (28.8%). The large majority of incidents were carried out by males (88.2%). Most incidents occurred when children were accompanied by their peers (67.9%). Many victims were frightened by their experience (46.9% very frightened) and the large majority made a disclosure (79.9%). Only a minority of incidents were reported to the police (33.3%).

CONCLUSIONS

Incidents of attempted and completed stranger CSA and abduction are distinct from CSA and abduction by known persons, go against stereotypes, are complex, and give rise to a number of key issues that may have implications for prevention and intervention.

PRACTICE IMPLICATIONS

Professionals involved in child protection should undertake work to reduce the risk of existing victims of CSA or abduction becoming victims of stranger CSA or abduction, and the risk of attempted incidents becoming completed ones. They also need to encourage the disclosure and reporting of attempted and completed stranger CSA and abduction incidents.

Faecal indicator organism concentrations and catchment export coefficients in the UK

Characterisation of faecal indicator organism (FIO) concentrations and export coefficients for catchments with particular combinations of land use and under specific climatic regimes is critical in developing models to predict daily loads and apportion sources of the microbial parameters used to regulate water quality. Accordingly, this paper presents a synthesis of FIO concentration and export coefficient data for the summer bathing season, with some comparative winter data, for 205 river/stream sampling points widely distributed across mainland UK. In terms of both geometric mean (GM) FIO concentrations and export coefficients (expressed as cfu km(-2) h(-1)), the results reveal (1) statistically significant elevations at high flow compared with base flow, with concentrations typically increasing by more than an order of magnitude and export coefficients by about two orders; (2) significantly higher values in summer than in winter under high-flow conditions; and (3) extremely wide variability between the catchments (e.g. four orders of magnitude range for GM faecal coliform concentrations), which closely reflects land use-with urban areas and improved pastures identified as key FIO sources. Generally, these two most polluting land uses are concentrated in lowland areas where runoff (m3 km(-2) h(-1)) is low compared with upland areas, which in the UK are dominated by rough grazing and forestry. Consequently, contrasts in export coefficients between land use types are less than for FIO concentrations. The GMs reported for most land use categories are based on 13 sites and exhibit quite narrow confidence intervals. They may therefore be applied with some confidence to other catchments in the UK and similar geographical regions elsewhere. Examples are presented to illustrate how the results can be used to estimate daily summer base- and high-flow FIO loads for catchments with different land use types, and to assess the likely effectiveness of certain strategies for reducing FIO pollutant loadings in areas with extensive areas of lowland improved pasture.

Predicting faecal indicator fluxes using digital land use data in the UK's sentinel Water Framework Directive catchment: the Ribble study

The Ribble drainage basin is the single UK sentinel study area chosen for examining the implementation of the EU Water Framework Directive (WFD 20/60/EC). The study which has generated the data for this paper was initiated to quantify 'catchment-derived' fluxes of faecal indicators originating from both point and diffuse sources to inform the competent authorities on the potential for, and prioritization of, further options for reducing the faecal indicator loadings to this crucial coastal environment. It represents the first UK drainage basin-scale 'profile' of faecal indicator sources as recommended by WHO [1999. Health Based Monitoring of Recreational Waters: The Feasibility of a New Approach; the "Annapolis Protocol". World Health Organisation Geneva, Switzerland; 2003. Guidelines for Safe Recreational-Water Environments Volume 1: Coastal and Fresh-Waters. World Health Organisation Geneva, Switzerland] and incorporated into current drafts of the revised Bathing Water Directive [Anon, 2004. Council of the European Communities Amended proposal for a Directive of the European Parliament and of the Council concerning the management of bathing water quality. Brussels 23rd June]. This paper focuses on the relationships between land use and faecal indicator organism concentrations in surface waters within this very large drainage basin (1583 km2) containing some extensive urban areas. A geographical information system comprising readily available digital elevation, remotely sensed land cover and digital map data was used to generate the land use variables for subcatchments draining to 41 locations across the study area. Presumptive concentrations of coliforms, Escherichia coli and enterococci (colony forming unit (cfu) 100 ml(-1)) were measured at each location on at least 20 occasions over a 44-day period within the 2002 bathing season. The sampling programme targeted hydrograph events. Hydrometric records were used to allocate results as either base flow or high flow. At each site, geometric mean faecal indicator organism concentrations were significantly elevated at high flow compared to base flow. Stepwise regression modelling produced statistically significant models predicting geometric mean base and high-flow faecal indicator organism concentrations from land use variables (r2: 49.5-68.1%). The dominant predictor variable in each case was the proportion of built-up land in subcatchments, suggesting that this land use type, with associated sewage-related inputs, is a critical source of faecal indicator organisms in this drainage basin.

Modelling faecal indicator concentrations in large rural catchments using land use and topographic data

AIMS

To characterize and model spatial variations in faecal-indicator organism concentrations in watercourses draining a large rural catchment during the bathing season.

METHODS AND RESULTS

Presumptive coliform (PC), presumptive Eschericia coli (PE) and presumptive enterococci (PEnt) concentrations were determined under base- and high-flow conditions at 24 monitoring points in the Rheidol/Ystwyth catchment, Wales. Relationships with land use and topographic variables within their 'subcatchments' were investigated. Geometric mean (GM) concentrations typically increase more than 10-fold at high flow. The proportion of improved pasture within subcatchments explains 81.6, 73.0 and 85.8%, respectively, of the variance in high-flow GM PC, PE and PEnt concentrations. Distributed modelling suggests that organisms derived from more distant parts of subcatchments may be lost through die-off and sedimentation along watercourses at base flow, although not at high flow. Reductions in concentrations are also evident downstream of reservoir impoundments.

CONCLUSIONS

Large rural catchments may contribute substantially to faecal indicator loadings in coastal waters. Indicator concentrations can be modelled successfully using land use and topographic data.

SIGNIFICANCE AND IMPACT OF THE STUDY

Development of a modelling approach that provides valuable insight into faecal indicator sources and the transport and survival of these organisms within large catchments.

The nature and source of the head injuries sustained by restrained front-seat car occupants in frontal collisions

The paper examines the types of head injury sustained by restrained front-seat car occupants in frontal collisions. Injuries are classified into soft tissue, diffuse and focal brain injuries and facial bone or skull fractures. Survivors seldom sustain focal injuries although these are common amongst fatalities. The contact sources within the car are described. Intruding structures and high crash severities are typically associated with high rates of the more severe injuries from steering wheel contact, although some are sustained with intrusion below 11 cm. Low-speed impact testing on nondeployed airbag-equipped wheels is suggested. Toughened glass windscreens are overrepresented amongst those sustaining injuries from glazing materials. Test procedures to reduce injuries from pillar contacts should take account of the dynamic effects of an intruding pillar. Contacts with objects outside the car caused higher rates of severe fractures and brain injury; however, the total numbers are greater from interior contacts.

A review of cervical fractures and fracture-dislocations without head impacts sustained by restrained occupants

Crash injury reduction via lap-shoulder belt use has been well documented. Like any other interior car component, lap-shoulder belts may be related to injury in certain crashes. Relatively unknown is the fact that cervical fractures or fracture-dislocations to restrained front seat occupants occur where no head contact was evidenced by both medical records and car inspection. A review of the available literature on car crash injuries revealed more than 100 such cases. A review of the National Accident Severity Study (NASS) 80-88 file was also conducted, revealing more examples. Case capsule descriptions from the authors' files are also detailed along with examples of such injuries in infants and children in child restraints. However, cervical fractures or fracture dislocations are rare, as evidenced by the relatively few cases identified in the literature, in the author's files, and by an analysis of NASS 80-90 data that revealed a cervical spine injury frequency of only .4% at the AIS-3 level (Huelke, Morris, and Mackay 1992).

What people want to know about health

Brighton health authority and Brighton borough council are jointly planning a 'Healthy living centre' to provide a focal point for local health promotion activities. Sandra Winn and Martin Bradford report on a survey of community groups which not only provided information for the development of the centre but also gave useful insight into the community's concerns about health and people's needs for health information.

A seven-year experience with methicillin-resistant Staphylococcus aureus

From July 1983 through June 1990, 319 patients with methicillin-resistant Staphylococcus aureus (MRSA) were identified at the University of California, Davis Medical Center. Initially, our goal was eradication of MRSA from the hospital flora. Our approach was: (a) immediate notification of all MRSA isolates by the microbiology laboratory; (b) strict isolation; (c) cohorting; (d) bathing patients with an iodophor; (e) surveillance cultures of patients and staff; (f) treatment of all colonized persons; and (g) strict isolation on readmission. Control of spread was achieved but eradication was not. In 1987 our strategy was modified in order to establish the least restrictive methods to maintain control of the spread of MRSA. After notification by the microbiology laboratory, we now require: (a) contact isolation; (b) surveillance cultures of patients associated with each new case; and (c) contact isolation for all MRSA patients on readmission. Strict isolation and employee culturing are used only during major outbreaks. We have averaged four new cases of MRSA per month over the 7-year period, including four major outbreaks. Since 1987, we have averaged only three new cases per month with one major MRSA outbreak. Annual cost savings of greater than $50,000 have been realized through the policy modifications. We conclude that the use of contact isolation with some modifications has saved time and money and has successfully controlled the spread of MRSA in our university hospital.

Quantitative ultrasonic detection and classification of diffuse liver disease. Comparison with human observer performance

A multiparameter ultrasonic tissue characterization system has been developed and tested on several types of diffuse liver disease. The four tissue characterization parameters used are based on the first and second order statistics of the B-scan image. Performance of the system was evaluated using receiver operating characteristic (ROC) analysis and was compared with the performance of experienced human observers viewing B-scan images. The machine-based multiparameter system achieved an area under the ROC curve (Az) of 0.88 for detection of chronic hepatitis in more than 100 proven cases of the disease. This was dramatically better than the performance of human observers (Az = .64, P less than .05) and compares favorably to the performance of other accepted diagnostic tests such as head CT and the PAP smear. For detection of Gaucher's disease, the Az for the system was .92, whereas for separating hepatitis from Gaucher's disease Az was .84. Human observers also did well at these tasks (P greater than .8) using organomegaly as their major criterion for diagnosing Gaucher's disease. For primary biliary cirrhosis the system Az was .80, for glycogen storage disease Az was .94. These results suggest that use of multiparameter tissue characterization can significantly increase the usefulness of ultrasound for evaluation of diffuse liver disease.

Multilumen catheter sepsis and an educational program to combat it

Catheter-related sepsis is a problem with many variables. A process of elimination may eventually identify the actual cause(s) of this phenomenon. We began our problem-solving approach by observing personnel inserting and caring for central lines, which showed a lack of compliance with existing protocols. A program was designed to provide the correct procedural activities. This study plans to test whether ongoing educational programs and an infection control department that maintains a high degree of visibility are effective in reducing nosocomial line-related infections.

Inhibition of adenosine 3',5'-cyclic monophosphate phosphodiesterase by colchicine: implications for glucagon and corticosteroid secretion

In the study reported, colchicine, often regarded as a specific inhibitor of microtubular function, was shown to exert a concentration-dependent inhibition of the low Km cyclic AMP phosphodiesterases of the pancreatic islet, adrenal cortex and various other tissues of the rat. The results indicated that colchicine is only slightly less active as an inhibitor of the enzyme than theophylline on a molar basis and kinetic analysis revealed that both inhibitors acted competitively in the case of the liver enzyme. Our results show that the inhibitory effect of colchicine upon cyclic AMP phosphodiesterase is a general property of the alkaloid at concentrations of 5 x 10(-5)M and above in both endocrine and non-endocrine tissues. Thus, results obtained employing colchicine at concentrations significantly greater than those which are known to lead to microtubular disaggregation must be viewed with great caution if incorrect implication of microtubular participation in biological processes is to be avoided. For example, we propose that the previously reported paradoxical stimulatory effects of colchicine on the secretion of glucagon from the rat pancreatic islet and on steroidogenesis in the rat adrenal may be due to cyclic AMP accumulation consequent upon phosphodiesterase inhibition in these endocrine tissues and not to microtubular disaggregation as has hitherto been assumed.

Effects of pH on the early development and growth and otolith microstructure of chinook salmon, Oncorhynchus tshawytscha

Chinook salmon (Oncorhynchus tshawytscha) eggs, alevins, and fry were reared in pH 4.5, 5.0. 5.5, 6.2 (control), and 7.0 water from the eyed stage of development. Survival through hatching was >90% in all instances. Alevin mortality was high at pH 4.5 and 5.0. Fry were more tolerant of low pH than alevins. Growth rates of alevins and fry held at or above pH 5.0 and 4.5, respectively, were not affected by pH, nor did exposure to acidic water retard otolith development or result in their resorption. One otolith daily growth increment was formed every 24 h in alevins and fry irrespective of pH. Widths of otolith daily growth increments decreased when fry were transferred to pH 4.5 water and increased on their return to higher pH indicating changes in growth rate. Transfer of fry from pH 6.2 to pH 5.0 or 5.5 had no effect on increment widths.