A Multicenter Randomized Controlled Trial Evaluating a Cx43-Mimetic Peptide in Cutaneous Scarring

The transmembrane protein Cx43 has key roles in fibrogenic processes including inflammatory signaling and extracellular matrix composition. aCT1 is a Cx43 mimetic peptide that in preclinical studies accelerated wound closure, decreased inflammation and granulation tissue area, and normalized mechanical properties after cutaneous injury. We evaluated the efficacy and safety of aCT1 in the reduction of scar formation in human incisional wounds. In a prospective, multicenter, within-participant controlled trial, patients with bilateral incisional wounds (≥10 mm) after laparoscopic surgery were randomized to receive acute treatment (immediately after wounding and 24 hours later) with an aCT1 gel formulation plus conventional standard of care protocols, involving moisture-retentive occlusive dressing, or standard of care alone. The primary efficacy endpoint was average scarring score using visual analog scales evaluating incision appearance and healing progress over 9 months. There was no significant difference in scar appearance between aCT1- or control-treated incisions after 1 month. At month 9, aCT1-treated incisions showed a 47% improvement in scar scores over controls (Vancouver Scar Scale; P = 0.0045), a significantly higher Global Assessment Scale score (P = 0.0009), and improvements in scar pigmentation, thickness, surface roughness, and mechanical suppleness. Adverse events were similar in both groups. aCT1 has potential to improve scarring outcome after surgery.

Pragmatic detection of anxiety and depression in a prospective cohort of voice outpatient clinic attenders

OBJECTIVE

To evaluate diagnostic performance of the emotional domain of the VoiSS questionnaire compared with the Hospital Anxiety and Depression Scale (HADS).

DESIGN

Cross-sectional questionnaire study.

SETTING

Tertiary referral centre voice clinic.

PARTICIPANTS

210 consecutive voice clinic patients.

MAIN OUTCOME MEASURES

Screening with VoiSS and HADS questionnaires. Paired comparison, correlation, multinomial logistic regression and receiver-operating characteristic (ROC) curve analysis.

RESULTS

A total of 177 returned complete data sets. Ninety-six patients (54.2%) had functional dysphonia, and 81 (45.8%) had organic laryngeal disorders. Mean total VoiSS score = 39.7/120 (standard deviation (sd) 22.2). Mean emotional VoiSS subscale = 7.6/22 (sd 7.5). Mean HADS anxiety = 6.5/21 (sd 5.2) and depression mean = 7.1/21 (sd 4.8). There were 35 (20%) borderline anxiety and/or depression scores and 30 (17%) scores considered positive for 'caseness'. There was strong correlation between emotional VoiSS and HADS anxiety (Spearman's Rho = 0.68, P < 0.001) and HADS depression (Spearman's Rho = 0.62, P < 0.001). ROC curve analysis exhibited significant association between emotional VoiSS and HADS 'caseness' (area under curve = 0.88). In addition, functional dysphonia patients had lower mean VoiSS and HADS scores than patients with identifiable laryngeal abnormalities.

CONCLUSION

The VoiSS emotional subscale strongly correlates with HADS anxiety and depression scores and could be used as a measure of psychological distress. This could allow targeted psychological strategies, without additional psychometric questionnaires. Functional dysphonia has less association with psychological distress than certain organic laryngological disorders.

Population distributions of time to collision at brake application during car following from naturalistic driving data

PROBLEM

Forward collision warning (FCW) systems are designed to mitigate the effects of rear-end collisions. Driver acceptance of these systems is crucial to their success, as perceived "nuisance" alarms may cause drivers to disable the systems. In order to make customizable FCW thresholds, system designers need to quantify the variation in braking behavior in the driving population. The objective of this study was to quantify the time to collision (TTC) that drivers applied the brakes during car following scenarios from a large scale naturalistic driving study (NDS).

METHODS

Because of the large amount of data generated by NDS, an automated algorithm was developed to identify lead vehicles using radar data recorded as part of the study. Using the search algorithm, all trips from 64 drivers from the 100-Car NDS were analyzed. A comparison of the algorithm to 7135 brake applications where the presence of a lead vehicle was manually identified found that the algorithm agreed with the human review 90.6% of the time.

RESULTS

This study examined 72,123 trips that resulted in 2.6 million brake applications. Population distributions of the minimum, 1st, and 10th percentiles were computed for each driver in speed ranges between 3 and 60 mph in 10 mph increments. As speed increased, so did the minimum TTC experience by drivers as well as variance in TTC. Younger drivers (18-30) had lower TTC at brake application compared to older drivers (30-51+), especially at speeds between 40 mph and 60 mph.

DISCUSSION

This is one of the first studies to use large scale NDS data to quantify braking behavior during car following. The results of this study can be used to design and evaluate FCW systems and calibrate traffic simulation models.

Reliability of self-reporting of antibiotic consumption in the community - Index of Reliability

WHAT IS KNOWN AND OBJECTIVE

To date, there is no evidence to indicate the reliability of how patients self-report their own antibiotic usage in the community. Such data are fundamental in supporting antimicrobial stewardship practices, and so there is a need to determine its accuracy and reliability.

COMMENT

Patients in the community (n = 476) were required to recollect their antibiotic usage in the past three months. Simultaneously, similar information was obtained by careful extraction from their respective medical notes, which was qualitatively compared with the patient's recollection. Overall, concordance was high (88·1%), but age (<20 and >80 years) and sex (female) were significant factors of reliability.

WHAT IS NEW AND CONCLUSION

This study suggests that basic self-reporting of antibiotic usage amongst patients is relatively reliable, with increasing accuracy with years until 80 years. Where such information is critical, the current study can help decide who to interview and whose notes to interrogate, in the quest to obtain reliable and accurate information.

Age and gender differences in time to collision at braking from the 100-Car Naturalistic Driving Study

OBJECTIVE

Forward collision warning (FCW) is an active safety system that aims to mitigate the effect of forward collisions by warning the driver of objects in front of the vehicle. Success of FCW relies on how drivers react to the alerts. Drivers who receive too many warnings that they deem as unnecessary-that is, nuisance alarms-may grow to distrust and turn the system off. To reduce the perception of nuisance alarms, FCW systems can be tailored to individual driving styles, but these driving styles must first be characterized. The objective of this study was to characterize differences in braking behavior between age and gender groups in car-following scenarios using data from the 100-Car Naturalistic Driving Study.

METHODS

The data source for this study was the 100-Car Naturalistic Driving Study, which recorded the driving of 108 primary drivers for approximately a year. Braking behavior was characterized in terms of time to collision (TTC) at brake application, a common metric used in the design of warning thresholds of FCW. Because of the large volume of data analyzed, the TTC at which drivers braked during car-following situations was collected via an automated search algorithm. The minimum TTC for each vehicle speed 10 mph increment from 10 mph to 80 mph was recorded for each driver. Mixed model analysis of variance was used to examine the differences between age and gender groups.

RESULTS

In total, 527,861 brake applications contained in 11,503 trips were analyzed. Differences in TTC at braking were statistically significant for age and gender (P<.01 for both cases). Males age 18-20 (n=7) had the lowest average minimum TTC at braking of 2.5±0.8 s, and females age 31-50 (n=6) had the highest average minimum TTC at braking of 6.4±0.9 s. On average, women (n=32) braked at a TTC 1.3 s higher than men (n=52). Age was a statistically significant factor for TTC at braking between participants under 30 (n=42) and participants over 30 (n=42), with the latter braking 1.7 s on average before the former. No statistical significance was found between ages 18-20 (n=15) and 21-30 (n=27) or between ages 31-50 (n=23) and 50+(n=19).

CONCLUSIONS

There are clear statistical differences in TTC at braking for both gender and those over 30 vs. those under 30. Designers of FCW systems can use the data found in this study to tailor alert timings to the target demographic of a vehicle when designing forward collision warning systems. Appropriate alert timings for FCW systems will maximize effectiveness in collision reduction and mitigation.