bluuebunny/crossref_metadata_2025 huggingface dataset:
Preventing Child Sexual Abuse: Screening for Hidden Child Molesters Seeking Jobs in Organizations That Care for Children
Authors: Abel Gene G. , Jordan Alan , Harlow Nora , Hsu Yu-Sheng
Published: November 2018

Approximately 10% of children and adolescents are sexually abused by adults caring for them outside the home. The current study tested the validity and reliability of a child protection screen to identify job applicants who pose a sexual risk to children. The screen uses three separate measures. In combination, they attempt to identify two types of sexually problematic job applicants: hidden abusers and people with cognitive distortions that encourage child sexual boundary violations by themselves or tolerate them by others. The high specificity (97.8% for males and 98.7% for females) favored the high number of job applicants and volunteers who have not crossed sexual boundaries with children. The study included over 19,000 participants, and the screen correctly identified 77% of the men and over 72% of the women who posed a sexual risk. The test–retest correlation was statistically significant at r(121) = .83, and the screening methodology is valid and reliable. By identifying most of the job applicants who are hiding their history of sexually abusing a child or hiding their belief that adult–child sex causes no harm from the organizations they are attempting to join, this new preemployment screen methodology can help child-centered organizations protect children and adolescents in their care.
Association Between the Rate of Diabetes and Quality of Patient Care in Home Health Agencies
Authors: Zikos Dimitrios , Ogunneye Yetunde , Delellis Nailya , Ivanitskaya Lana
Published: November 2018

The multitude of comorbidities and disabilities that are prevalent among diabetic patients make their care very challenging for providers. This, in turn, may have a negative effect on measures of patient satisfaction, quality, and outcomes. This study examines the correlation between diabetes ratio as a primary diagnosis in home health agencies (HHAs) with the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey and the Outcome and Assessment Information Set (OASIS) star ratings. Our result indicates that HHAs with a higher proportion of patients with diabetes have lower ratings in health outcomes (bathing, breathing, moving from the bed, moving around, and controlling pain). The association was stronger in the case of diabetic cases with complications.
Novel viruses: Update on the significance of papillomavirus infections in cats
Authors: Munday John S , Sharp Claire R , Beatty Julia A
Published: November 2018

Practical relevance:

Prior to 1990 papillomaviruses (PVs) were not recognised to infect or cause disease in domestic cats. Since this time, the use of histology, immunohistochemistry and, more recently, molecular techniques has revealed that PVs almost certainly cause feline viral plaques and Bowenoid in situ carcinomas, oral papillomas and feline sarcoids. In addition, there is increasing evidence that PVs play a significant role in the development of feline cutaneous squamous cell carcinomas, one of the most common skin cancers of cats. Recent studies have also revealed that most cats are asymptomatically infected with PVs. This raises a critical question that is currently unanswered: why do only a small proportion of infected cats develop disease? In the future it may be possible to prevent PV-induced diseases by using a vaccine to prevent PV infection. Alternatively, novel therapies may be developed that prevent PVs from causing clinical disease by stimulating the host immune response.

Clinical challenges:

A recognition of the skin diseases caused by PVs is important to more accurately predict disease progression. Unfortunately, there are currently no non-surgical treatments that have been proven to be beneficial in cats and clinical management of PV-induced skin disease in cats can be challenging.

Global importance:

PVs have a worldwide distribution and negatively impact feline health and welfare globally.

Audience:

This review is aimed at clinicians, especially those who regularly treat cats with skin disease. The review will also be useful to oncologists and researchers who have an interest in how cancer develops in cats.

Evidence base:

In producing this update the authors have drawn on recently published peer-reviewed literature.
Transfusion rates with intravenous tranexamic acid in total hip arthroplasty performed using the direct anterior approach
Authors: Free Matthew D , Owen David H , Pascoe Edward , Allen Penny , Yang Luke , Harvie Paul
Published: November 2018

Introduction:

Tranexamic acid (TXA) has been shown to reduce blood loss and transfusion requirements in patients undergoing total hip arthroplasty (THA). Most studies have focused on TXA in THA performed using a posterior approach (PA) or lateral approach. The aim of this study was to analyse the efficacy of TXA in patients undergoing THA using the direct anterior approach (DAA).

Patients and methods:

Using our institutional database, a retrospective analysis was conducted on consecutive primary THA performed for osteoarthritis to determine transfusion rates in patients undergoing THA with the DAA with and without TXA.

Results:

146 consecutive THA were performed using DAA: 83 (56.8%) patients had TXA and 63 (43.2%) did not have TXA. Among patients who had TXA, 1 patient required a blood transfusion compared to 7 patients among those who did not have TXA (1.2% vs. 11.12%, p = 0.02). The relative risk of 0.11 (95% confidence interval 0.01–0.86) indicates an 89% reduction in the risk of requiring blood transfusion with TXA administration compared to no TXA.

Conclusion:

TXA is effective in reducing blood transfusion requirements for patients undergoing DAA THA.
Metal ion concentrations after metal-on-metal hip arthroplasty are not correlated with habitual physical activity levels
Authors: Jelsma Jetse , Schotanus Martijn GM , Senden Rachel , Heyligers Ide C , Grimm Bernd
Published: November 2018

Introduction:

Metal-on-metal (MoM) hip arthroplasties have shown high clinical failure rates with many patients at risk for a revision and under surveillance for high metal ion concentrations. Implant wear releasing such ions is assumed to be a function of use, i.e. the patient’s physical activity. This study aimed to assess whether habitual physical activity levels of MoM patients are correlated with metal ion concentrations and are higher in patients with high (at risk) than in patients with low (safe) metal ion concentrations.

Methods:

A cohort study was conducted of patients with any type of MoM hip prosthesis. Metal ion concentrations were determined using ICP-MS. Habitual physical activity of subjects was measured in daily living using an acceleration-based activity monitor. Outcome consisted of quantitative and qualitative activity parameters.

Results:

In total, 62 patients were included. Mean age at surgery was 60.8 ± 9.3 years and follow-up was 6.3 ± 1.4 years. Cobalt concentrations were highly elevated overall (112.4 ± 137.9 nmol/L) and significantly more in bilateral (184.8 ± 106.5 nmol/L) than in unilateral cases (87.8 ± 139.4 nmol/L). No correlations were found between physical activity parameters and metal ion concentrations. Subgroup analysis of patients with low versus high cobalt concentration showed no significant differences in habitual physical activity.

Discussion:

No correlation was found between physical activity levels and metal ion concentrations. Implant use by normal habitual activities of daily living seems not to influence metal ion concentrations.
Longitudinal study of functional brain network reorganization in clinically isolated syndrome
Authors: Koubiyr Ismail , Deloire Mathilde , Besson Pierre , Coupé Pierrick , Dulau Cécile , Pelletier Jean , Tourdias Thomas , Audoin Bertrand , Brochet Bruno , Ranjeva Jean-Philippe , Ruet Aurélie
Published: November 2018

Background:

There is a lack of longitudinal studies exploring the topological organization of functional brain networks at the early stages of multiple sclerosis (MS).

Objective:

This study aims to assess potential brain functional reorganization at rest in patients with CIS (PwCIS) after 1 year of evolution and to characterize the dynamics of functional brain networks at the early stage of the disease.

Methods:

We prospectively included 41 PwCIS and 19 matched healthy controls (HCs). They were scanned at baseline and after 1 year. Using graph theory, topological metrics were calculated for each region. Hub disruption index was computed for each metric.

Results:

Hub disruption indexes of degree and betweenness centrality were negative at baseline in patients ( p < 0.05), suggesting brain reorganization. After 1 year, hub disruption indexes for degree and betweenness centrality were still negative ( p < 0.00001), but such reorganization appeared more pronounced than at baseline. Different brain regions were driving these alterations. No global efficiency differences were observed between PwCIS and HCs either at baseline or at 1 year.

Conclusion:

Dynamic changes in functional brain networks appear at the early stages of MS and are associated with the maintenance of normal global efficiency in the brain, suggesting a compensatory effect.
Patient and public involvement in the design, administration and evaluation of patient feedback tools, an example in psychiatry: a systematic review and critical interpretative synthesis
Authors: Baines Rebecca , Donovan John , Regan de Bere Sam , Archer Julian , Jones Ray
Published: November 2018

Background

Patient feedback is considered integral to healthcare design, delivery and reform. However, while there is a strong policy commitment to evidencing patient and public involvement (PPI) in the design of patient feedback tools, it remains unclear whether this happens in practice.

Methods

A systematic review using thematic analysis and critical interpretative synthesis of peer-reviewed and grey literature published between 2007 and 2017 exploring the presence of PPI in the design, administration and evaluation of patient feedback tools for practising psychiatrists. The research process was carried out in collaboration with a volunteer mental health patient research partner.

Results

Fourteen articles (10 peer-reviewed, four grey literature) discussing the development of nine patient feedback tools were included. Six of the nine tools reviewed were designed from a professional perspective only. Tool content and its categorization primarily remained at the professional’s discretion. Patient participation rates, presence of missing data and psychometric validation were used to determine validity and patient acceptability. In most instances, patients remained passive recipients with limited opportunity to actively influence change at any stage. No article reviewed reported PPI in all aspects of tool design, administration or evaluation.

Conclusions

The majority of patient feedback tools are designed, administered and evaluated from the professional perspective only. Existing tools appear to assume that: professional and patient agendas are synonymous; psychometric validation is indicative of patient acceptability; and psychiatric patients do not have the capacity or desire to be involved. Future patient feedback tools should be co-produced from the outset to ensure they are valued by all those involved. A reconsideration of the purpose of patient feedback, and what constitutes valid patient feedback, is also required.
Bargaining success in the reform of the Eurozone
Authors: Lundgren Magnus , Bailer Stefanie , Dellmuth Lisa M , Tallberg Jonas , Târlea Silvana
Published: November 2018

This article provides a systematic assessment of bargaining success in the reform of the Eurozone 2010 to 2015. Theoretically, we develop an argument about preferences and institutions as determinants of bargaining success and contrast this argument with an alternative account privileging states’ power resources. Empirically, we conduct a statistical analysis of new data covering all key reform proposals. Our findings are three-fold. First, contrary to a conventional narrative of German dominance, the negotiations produced no clear winners and losers. Second, while power resources were of limited importance, holding preferences that were centrist or close to the European Commission favored bargaining success—particularly when adoption only required the support of a qualified majority. Third, these descriptive and explanatory results reflect dynamics of compromise and reciprocity.
The Two Row Wampum-Covenant Chain Tradition as a Guide for Indigenous-University Research Partnerships
Authors: Hill Richard W. , Coleman Daniel
Published: November 2018

This co-authored article examines the oldest known treaty between incoming Europeans and Indigenous North Americans to derive five basic principles to guide healthy, productive relationships between Indigenous community-based researchers and university-based ones. Rick Hill, Tuscarora artist and knowledge keeper from the Six Nations of the Grand River, publishes for the first time here the most complete oral history that exists today of that ancient treaty, from the early seventeenth century, known as the Two Row Wampum or the Covenant Chain agreement. Interspersed with Dr. Hill’s reflections, Daniel Coleman, a settler professor of English and Cultural Studies at McMaster University, outlines five principles for research partnerships derived from the discussions of the Two Row Research Partnership seminars that Hill and Coleman have been hosting at Deyohahá:ge: Indigenous Knowledge Centre for the past four years. Formed between the Hodinöhsö:ni’ confederacy and Dutch merchants arriving near Albany, New York in 1609, the Two Row Wampum-Covenant Chain treaty set the precedent for nation-to-nation treaties between European colonial powers and Indigenous peoples with two parallel rows representing the Hodinöhsö:ni’ canoe and the Dutch ship sailing down the shared river. Each party agreed to keep their beliefs and laws in their separate vessels, and on this basis of interdependent autonomy, they established a long-lasting friendship. This article suggests that by renewing our understanding of the Two Row Wampum-Covenant Chain treaty, Indigenous and non-Indigenous researchers alike can rebuild relationships of trust and cooperation that can decolonize Western presumptions and re-establish healthy and productive research partnerships.
Profiles and Predictors of Smart Home Technology Adoption by Older Adults
Authors: Arthanat Sajay , Wilcox John , Macuch Mackenzie
Published: November 2018

The commercial popularity of smart home (SH) technology has broadened the scope of aging-in-place and home health occupational therapy. The objective of this article is to examine ownership of SH technology by older adults, their readiness to adopt SH technology, and identify the client factors relating to the adoption. A survey of older adults aged 60 and above living in the community was conducted. Respondents ( N = 445) who were women; in the age group of 60 to 70 years; living in a two-level home, with a body function impairment; with a fall history; and experienced in information and communication technology (ICT) were significantly likely to be “brisk adopters” of SH ( p < .05). Stepwise regression model identified marital status, home security, and overall ICT ownership as the predictors of SH ownership, whereas being female, concern over home security, and perceived independence contributed to SH readiness ( p < .05). Consideration of the identified client profiles, health, and personal factors will strengthen SH integration for aging-in-place.
Effect of Cellulase Enzyme on the Mechanical and Surface Properties of Regular and Compact Yarns
Authors: Mettilda M. , Menaka T. , Subramaniam V. , Kothandaraman B.
Published: November 2018

The degrading property of cellulose by the enzyme is utilized in improving the surface properties by removing the protruding fibers from the surface of the yarn. In this work, the regular and compact yarns made out of same mixing at various stages of chemical processing were treated with cellulase enzyme with different levels of concentration and temperature. Measurement of the weight loss, bending rigidity, wicking rate, work of rupture, shrinkage loss, tenacity and elongation of the yarn were studied for the two different yarns. Bending rigidity and wicking rates were found to decrease and increase respectively in normal yarns compared to compact yarns. All the above trends therefore suggest that the compact yarns are not much affected by the concentration of the enzyme compared to the regular yarns. As the concentration of the enzyme was increased, the weight loss, bending rigidity, shrinkage loss, twist liveliness, tenacity, work of rupture, elongation and wicking rate were also found to vary irrespective of the spinning system.
Large Deformation Modelling of Tight Woven Fabric under High Air Pressure
Authors: Xiao Xueliang , Long Andrew , Lin Hua , Zeng Xuesen
Published: November 2018

Technical textiles used in airbag are usually in tight structure and subject to high air pressure in through-thickness direction. The pressure can deform fabric with changing its properties such as porosity and air permeability. This paper proposes an analytical approach to predict the out-of-plane deformation of tight fabric by analogy with membrane deformation. The model integrates the energies happened on the deformed fabric, that is, fabric strain energy, bending energy, and external work done. The fabric deformation can be predicted by minimizing the total fabric energy. The prediction was validated by experiment for fabric profile and the maximum displacement, and a good agreement was found for the cases of two typical fabrics. A sensitivity study shows that Young's modulus and Poisson's ratio can affect the fabric deformation significantly.
A strategy of electrical energy management for internal combustion engine vehicle based on driving cycle recognition and electrical load perception
Authors: Wang Yuefei , Zhang Nan , Wu Ye , Liu Baijun , Wu Yuan
Published: November 2018

Electrical energy consumption is an important component of energy consumption for internal combustion engine vehicle, which directly affects the fuel economy. A bus-based electrical energy management system is built, and an electrical energy management strategy based on driving cycle recognition and electrical load perception is presented to achieve the refined management of vehicle energy. Six typical driving cycles are selected to establish an improved learning vector quantization neural network model for driving cycle recognition. The corresponding model training algorithm is designed by utilizing a similar driving cycle classification and the gradient optimization so that the better recognition accuracy and the less computation intensity can be obtained. An online recognition mechanism based on sliding time window is devised, and the optimal time window length is determined. To minimize fuel consumption, a dynamic optimal regulation strategy for the output power of the alternator and battery, which considers driving cycle recognition and electrical load perception, is proposed. Experimental results show that the strategy can effectually improve the vehicle fuel economy according to the driving cycle and the electrical load change and decrease the fuel consumption per 100 miles of vehicle.
Low flow in the left atrial appendage assessed by transesophageal echocardiography is associated with increased stroke severity—Results of a single-center cross-sectional study
Authors: Schnieder Marlena , Siddiqui Tariq , Karch André , Bähr Mathias , Hasenfuß Gerd , Schroeter Marco R , Liman Jan
Published: November 2018

Background

About 25% of strokes are thought to be cryptogenic. There is growing evidence that most of these cryptogenic strokes are thromboembolic and caused by an undetected atrial fibrillation. Measured slow flow in the left atrial appendage has been proposed to be an indicator for the thromboembolic risk since it is possibly associated with undetected atrial fibrillation.

Methods

We evaluated all patients (n = 909; mean of 62 years, 39% female) admitted with an ischemic stroke (84%) or transient ischemic attack to our university medical center who underwent transesophageal echocardiography examination 2012–2014. Baseline characteristics, cardio-/neurovascular risk factors, electrocardiogram monitoring data, National Institute of Health Stroke Scale values, the localization of the stroke, as well as transesophageal echocardiography findings were analyzed.

Results

Stroke severity measured by the National Institute of Health Stroke Scale in patients with a low flow in the left atrial appendage was significantly higher than in patients without left atrial appendage low flow (p < 0.001). There was a threshold phenomenon in flow velocity at about 60 cm/s above which no significant change in National Institute of Health Stroke Scale values could be observed. These patients were significantly different concerning incidence of heart failure (10.6% vs. 2.3%; p < 0.001) and atrial fibrillation (32.2% vs. 8.8%; p < 0.001). However, threshold phenomenon of left atrial appendage flow was unchanged when excluding atrial fibrillation and heart failure patients.

Conclusions

A low flow in the left atrial appendage was associated with clinically elevated stroke severity and could be indicated as an independent stroke risk factor. Further prospective studies are warranted to evaluate beneficial effects of therapeutic options in these patients also in the assumed absence of atrial fibrillation.
Alternative governance arrangements for modular water infrastructure: An exploratory review
Authors: Pakizer Katrin , Lieberherr Eva
Published: November 2018

This article presents an exploratory review of alternative governance arrangements for modular systems in the urban water sector in terms of policy instruments, organizational structure, and underlying mechanisms. We develop an analytical framework to review the literature on alternative arrangements for innovative technologies. The preliminary results highlight the importance of governmental involvement and formal policy instruments to ensure public and environmental health in the context of modular water infrastructures. This is in line with the status quo of conventional water governance arrangements. However, the findings also suggest that informal instruments supplement the formal ones and that instead of political-administrative accountability more horizontal mechanisms, such as answerability toward citizens and consumers, play an important role in the context of new water technologies.
What Are PWDs (People With Diabetes) Doing Online? A Netnographic Analysis
Authors: Tenderich Amy , Tenderich Burghardt , Barton Tanner , Richards Sarah Elizabeth
Published: November 2018

Background:

Social media have become a crucial channel for patient empowerment and peer support. New qualitative research underscores the fact that this “support” transcends mental health concerns, to actually provide patients with important practical tips and tricks for diabetes self-care, and product selection/decision-making information from peers.

Methods:

Netnography is an emerging methodology that applies an ethnographic research approach to studying activity on the social web. Researchers embed themselves in the online environment to take an observational “deep dive” into online conversations to identify themes, sentiments, and perceptions. Using this methodology in summer 2017, a team of researchers captured and analyzed hundreds of diabetes-related posts on prominent platforms Facebook, Twitter, YouTube, Instagram, Tumblr, Pinterest, Reddit, and Quora.

Results:

Our team identified 6 major trends, or “life themes,” in diabetes patient social media, providing insights into patient sentiments and needs. A topology of social media channels emerged, indicating which platforms are used most often for each life theme.

Conclusions:

Findings indicate that social media provides a significant source not only of moral support and camaraderie, but also critical education on thriving with diabetes. Importantly, we observed strong evidence of peer influence on patients’ therapy and diabetes technology purchasing decisions.
Organic Versus Solicited Hotel TripAdvisor Reviews: Measuring Their Respective Characteristics
Authors: Litvin Stephen W. , Sobel Reagan N.
Published: November 2018

Hotels that participate in TripAdvisor’s Review Express review solicitation programs add volume to their review count. But are the incremental reviews generated good for the hotel? This research note reports findings from a study comparing organic and solicited reviews on TripAdvisor for 50 hotel properties across 10 American cities. The mixed research results suggest that participating hotels carefully evaluate their property’s postings to determine the positive and/or negative impacts solicited reviews may be having upon their online review image. Multiple review attractiveness measures are provided to assist hotel management evaluate their property’s review postings and make informed decision regarding participation in review solicitation programs.
NAVIGATE I: Randomized, Placebo-Controlled, Double-Blind Trial of the Exhalation Delivery System With Fluticasone for Chronic Rhinosinusitis With Nasal Polyps
Authors: Sindwani Raj , Han Joseph K. , Soteres Daniel F. , Messina John C. , Carothers Jennifer L. , Mahmoud Ramy A. , Djupesland Per G.
Published: November 2018

Background

Chronic rhinosinusitis is a common, high-morbidity chronic inflammatory disease, and patients often experience suboptimal outcomes with current medical treatment. The exhalation delivery system with fluticasone (EDS-FLU) may improve care by increasing superior/posterior intranasal corticosteroid deposition.

Objective

To evaluate the efficacy and safety of EDS-FLU versus EDS-placebo in patients with nasal polyps (NP). Coprimary end points were change in nasal congestion and polyp grade. Key secondary end points were Sino-Nasal Outcome Test-22 (SNOT-22) and Medical Outcomes Study Sleep Scale-Revised (MOS Sleep-R). Other prespecified end points included all 4 cardinal symptoms of NP, 36-Item Short Form Health Survey (SF-36), Patient Global Impression of Change (PGIC), Rhinosinusitis Disability Index (RSDI), and key indicators for surgical intervention.

Design

Randomized, double-blind, EDS-placebo-controlled, multicenter study.

Methods

Three hundred twenty-three subjects with NP and moderate-severe congestion/obstruction, most with history of corticosteroid use (94.4%) and/or prior surgery (60.4%), were randomized to EDS-FLU 93 µg, 186 µg, or 372 µg or EDS-placebo twice daily (BID) for 24 weeks (16 double-blind + 8 single-arm extension with EDS-FLU 372 µg BID).

Results

All EDS-FLU doses produced significant improvement in both coprimary end points ( P < .05) and in SNOT-22 total score ( P ≤ .005). EDS-FLU significantly improved all 4 cardinal symptoms of NP ( P < .05), including congestion/obstruction, facial pain/pressure, rhinorrhea/post-nasal drip, and hyposmia/anosmia. Approximately 80% of subjects reported improvement with EDS-FLU, with 65% reporting “much” or “very much” improvement by week 16. Adverse events were generally local in nature and similar to other intranasal steroids studied for similar durations in similar populations, with the most common being epistaxis.

Conclusions

In patients with chronic rhinosinusitis with NP (CRSwNP) who were symptomatic despite high rates of prior intranasal steroid use and/or surgery, EDS-FLU produced statistically significant and clinically meaningful improvements compared to EDS-placebo in multiple subjective and objective outcomes (symptoms, SNOT-22, RSDI, SF-36, PGIC, and NP grade), including all 4 cardinal symptoms of CRSwNP.
Performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) in the prediction of hospital mortality in a mixed ICU in Singapore
Authors: Lew Charles Chin Han , Wong Gabriel Jun Yung , Tan Chee Keat , Miller Michelle
Published: November 2018

Background:

The Acute Physiology and Chronic Health Evaluation II (APACHE II) is used to quantify disease severity and hospital mortality risk in critically ill patients. It is widely used in intensive care units (ICUs) in Singapore, but its prognostic validity remains questionable as it has not been thoroughly assessed by established statistical methods.

Objectives:

This study aimed to: (a) evaluate the discrimination and calibration accuracy of the APACHE II in the prediction of hospital mortality in a mixed ICU, and (b) customise the APACHE II in an effort to maximise its prognostic performance.

Methods:

A prospective cohort study was conducted and all adult patients with >24 h of ICU admission in a tertiary care institution in Singapore were included. The outcome measure was hospital mortality, and all patients were followed-up until hospital discharge or death for up to one year after ICU admission.

Results:

There were 503 patients, and their mean (SD) age and APACHE II score were 61.2 (15.8) years and 24.5 (8.2), respectively. Hospital mortality was 31%, and no patients were lost to follow-up. The APACHE II has good discrimination (receiver operating characteristic: 0.76) but poor calibration (Hosmer–Lemeshow C test: <0.001). Customisation did not significantly improve calibration accuracy.

Conclusions:

The APACHE II and its customised version should not be used in the local setting as they both have poor calibration. There is an urgent need for larger studies to perform second-level customisation or to develop a new prognostic model tailored to the Singapore critical care setting.
Patterns of treatment with antiplatelet therapy after an acute coronary syndrome: Data from a large database in a community setting
Authors: Cimminiello Claudio , Dondi Letizia , Pedrini Antonella , Ronconi Giulia , Calabria Silvia , Piccinni Carlo , Polo Friz Hernan , Martini Nello , Maggioni Aldo P
Published: November 2018

Aims

Current guidelines strongly recommend antiplatelet therapy with aspirin plus a P2Y12 receptor inhibitor (dual therapy) for patients with acute coronary syndrome (ACS). To better understand how antiplatelet treatment is prescribed in clinical practice, the aim of this study was to provide a more detailed description of real-world patients with and without antiplatelet treatment after an ACS, their outcomes at one-year follow-up and the related integrated cost.

Methods

The ReS database, including more than 12 million inhabitants, was evaluated. During the accrual period ACS patients discharged alive were identified on the basis of ICD-IX-CM code. Antiplatelet drug prescriptions and healthcare costs were analysed over one-year follow-up.

Results

In 2014, of the 25,129 patients discharged alive after an ACS, 5796 (23%) did not receive any antiplatelet therapy during the first month after hospital discharge. Among them, 3846 (66%) subjects were prescribed an antiplatelet drug subsequently, while 7.7% did not receive any antiplatelet treatment during the whole following year. Dual therapy in the subgroup of patients undergoing a revascularization procedure ( n = 8436) was prescribed to 79.2% of cases and to 46.1% ( n = 4009) of medically managed patients. The patients not treated with an antiplatelet treatment in the first month showed the highest one-year healthcare costs, mostly due to hospital re-admissions.

Conclusions

This analysis of a large patient community shows that a considerable proportion of patients remained untreated with antiplatelet treatment after an ACS event. A clearer characterization of these subjects can help to improve the adherence to the current guidelines and recommendations.
A data-zone scoring system to assess the generalizability of clinical trial results to individual patients
Authors: Laffin Luke J , Besser Stephanie A , Alenghat Francis J
Published: November 2018

Introduction

Evaluating the applicability of a clinical trial to a specific patient is difficult. A novel framework, the Trial Score, was created to quantify the generalizability of a trial's result based on participants' baseline characteristics and not on the trial's inclusion and exclusion criteria.

Methods

For each Systolic Blood Pressure Intervention Trial (SPRINT) participant, the Euclidean distance in six-dimensional space from the theoretical “average” participant was calculated to produce an individual Trial Score that incorporates multiple distinct continuous-variable baseline characteristics. We prospectively defined the “data-rich,” “data-limited,” and “data-free” zones as Trial Scores < 90th percentile, the 90th–97.5th percentile, and >97.5th percentile, respectively. Trial Scores were then calculated for National Health and Nutrition Examination Survey participants to map data zones of the general population. Individual participant data from the Action to Control Cardiovascular Risk in Diabetes blood pressure trial (ACCORD-BP) was used to test if participants further from the average SPRINT participant behave differently than the overall SPRINT results.

Results

The National Health and Nutrition Examination Survey cohort and the ACCORD-BP trial demonstrate large percentages of participants in SPRINT's data-free and data-limited zones. Time-to-event rates seen with intensive and standard blood pressure control in SPRINT were the same as ACCORD-BP participants within SPRINT's data-rich zone (hazard ratio 0.97, p = 0.84 and hazard ratio 0.95, p = 0.70). However, these rates were significantly different than those of ACCORD-BP participants outside SPRINT's data-rich zone (hazard ratio 0.64, p < 0.01 and hazard ratio 0.77, p < 0.01).

Conclusions

ACCORD-BP participants with SPRINT Trial Scores in the 90th percentile or below have similar event rates to SPRINT participants in both the intensive and standard blood pressure groups. Quantifying the difference between an individual patient and the average clinical trial participant holds promise as a tool to more precisely determine applicability of a specific trial to individual patients.
MRI findings, including diffusion-weighted imaging and apparent diffusion coefficient value, in two cats with nasopharyngeal polyps and one cat with lymphoma
Authors: Tanaka Toshiyuki , Akiyoshi Hideo , Mie Keiichiro , Nishida Hidetaka
Published: November 2018

Objectives

Most nasopharyngeal masses in cats are lymphomas or polyps. To our knowledge, there is no report of MRI findings, including diffusion-weighted imaging (DWI) or apparent diffusion coefficient (ADC) values, of nasopharyngeal lymphomas and nasopharyngeal polyps in cats. This study aimed to evaluate the MRI findings of nasopharyngeal lymphomas and nasopharyngeal polyps, including DWI and ADC values.

Methods

MRI examination was performed on two cats with a histologically confirmed nasopharyngeal polyp and one cat with lymphoma. The magnetic resonance scanning protocol included T2-weighted imaging (T2WI), T1-weighted imaging (T1WI) and DWI. An ADC map was created based on DWI. ADC values were then calculated.

Results

MRI of the nasopharyngeal polyps revealed well-defined masses with strong rim enhancement, mass-associated stalk-like structures and asymmetric tympanic bulla lesions. The polyps appeared hyperintense on T2WI, hypo- to isointense on T1WI, and of mixed intensity or hypointense on DWI. On the ADC map, the masses appeared hyperintense. The ADC values of the polyps were 2.07 × 10−3 mm2/s and 2.28 × 10−3 mm2/s. MRI examination of the nasopharyngeal lymphoma revealed a strongly enhancing heterogeneous lesion. The mass appeared mildly hyperintense on T2WI, isointense on T1WI and hyperintense on DWI. On the ADC map, the mass appeared hypointense. The ADC value of the mass was 0.46 ×10−3 mm2/s. The ADC values of the nasopharyngeal polyps were higher than the ADC value of the nasopharyngeal lymphoma.

Conclusions and relevance

Measurement of ADC values may be useful for differentiating between nasopharyngeal polyps and nasopharyngeal lymphomas.
Can a stress management programme reduce stress and improve quality of life in people diagnosed with multiple sclerosis?
Authors: Agland Susan , Lydon Amanda , Shaw Sally , Lea Rodney , Mortimer-Jones Sheila , Lechner-Scott Jeannette
Published: November 2018

Background

Despite evidence of perceived stress as a risk factor for multiple sclerosis activity, the evidence for managing stress is limited. Objective To evaluate a stress management programme on perceived stress and quality of life, over 6 months.

Methods

One hundred people with multiple sclerosis were randomly assigned to either a stress management programme of mindfulness, meditation and progressive muscle relaxation, or wait list. Perceived stress and quality of life were assessed at three intervals across 6 months. Salivary cortisol levels were assessed at two intervals: baseline and first follow-up.

Results

The stress management programme did not significantly reduce perceived stress, when comparing mean scores. Secondary analysis using median scores found a significant improvement for quality of life, favouring the intervention group.

Conclusion

Stress management had no significant effect on the primary outcome of perceived stress but did improve quality of life in a secondary analysis of median scores.
An Interorganellar Bidding War: Vps13 Localization by Competitive Organelle-Specific Adaptors
Authors: Dziurdzik Samantha K. , Bean Björn D.M. , Conibear Elizabeth
Published: November 2018

Membrane contact sites are regulated through the controlled recruitment of constituent proteins. Yeast vacuolar protein sorting 13 (Vps13) dynamically localizes to membrane contact sites at endosomes, vacuoles, mitochondria, and the endoplasmic reticulum under different cellular conditions and is recruited to the prospore membrane during meiosis. Prior to our recent work, the mechanism for localization at contact sites was largely unknown. We identified Ypt35 as a novel Vps13 adaptor for endosomes and the nucleus-vacuole junction. Furthermore, we discovered a conserved recruitment motif in Ypt35 and found related motifs in the prospore membrane and mitochondrial adaptors, Spo71 and Mcp1, respectively. All three adaptors compete for binding to a six-repeat region of Vps13, suggesting adaptor competition regulates Vps13 localization. Here, we summarize and discuss the implications of our work, highlighting key outstanding questions.
Neuroscience in HR: Steer and Take Charge
Authors: Mathai Sajan , Mathai Aparna Anna
Published: November 2018

A leader builds an organisation and her/his mood and behaviour often drives the mood and behaviour of the team, and this has implications for the organisation. Current advances in neuroscience have revealed underlying brain patterns possibly associated with certain components of leadership. A leader could build her/his team by learning to manage herself/himself and others in an organisation during critical, challenging situations by using resources on their own volition to balance themselves. When leaders manage, attune themselves and lead, they create a climate of emotional and social intelligence, thereby building a culture leading an organisation into the future with sustained business results. This article attempts to look at why leaders need to continually work on themselves and explores different ways of building socially and emotionally intelligent leaders.
A Measurement of Self-Efficacy Among Oklahoma Secondary Band Directors in Concert, Marching, and Jazz Ensemble Pedagogy
Authors: Regier Bradley J.
Published: November 2018

The purpose of this study was to examine secondary band directors’ self-efficacy toward concert, marching, and jazz ensemble pedagogy. Secondary purposes were to investigate potential relationships between secondary band directors’ self-efficacy in concert, marching, and jazz ensemble pedagogy and their respective (a) demographics and (b) previous professional and preservice experiences. Oklahoma high school band directors were invited to participate in a researcher-designed survey that included questions pertaining to their professional teaching background and preservice music teaching experiences. Participants ( N = 133) also identified their level of agreement to items on the Band Director Pedagogy Self-Efficacy Measure. Results indicated that mean differences for self-efficacy beliefs for all three ensemble settings were significantly different. Self-efficacy for concert band pedagogy was the highest, followed by marching and jazz band, respectively. Professional and undergraduate experiences significantly affected director pedagogy self-efficacy, particularly in the jazz setting.
Can Serious Games Improve Project Management Decision Making Under Complexity?
Authors: Rumeser David , Emsley Margaret
Published: November 2018

The existing literature on project management serious games tends to ignore the effect of project complexity levels on decision-making performance. This research fills this gap by conducting an experiment whereby two similar project management games with different complexity levels were applied. Our findings suggest that these games can improve players’ decision-making performance both in the less complex and more complex scenarios. We also discover that game complexity levels do not affect teams’ decision-making performance improvement, and that teams with more project work experience tend to improve more than those with less experience in the more complex game.
Carfilzomib vs bortezomib in patients with multiple myeloma and renal failure: a subgroup analysis of ENDEAVOR
Authors: Dimopoulos Meletios , Siegel David , White Darrell J. , Boccia Ralph , Iskander Karim S. , Yang Zhao , Kimball Amy S. , Mezzi Khalid , Ludwig Heinz , Niesvizky Ruben
Published: November 2018

In ENDEAVOR, carfilzomib (56 mg/m2) and dexamethasone (Kd56) demonstrated longer progression-free survival (PFS) over bortezomib and dexamethasone (Vd) in patients with relapsed/refractory multiple myeloma (RRMM). Here we evaluated Kd56 vs Vd by baseline renal function in a post hoc exploratory subgroup analysis. The intent-to-treat population included 929 patients (creatinine clearance [CrCL] ≥15 to <50 mL/min, n = 85 and n = 99; CrCL 50 to <80 mL/min, n = 186 and n = 177; and CrCL ≥80 mL/min, n = 193 and n = 189 for Kd56 and Vd arms, respectively). In these respective subgroups, median PFS was 14.9 vs 6.5 months (hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.320-0.757), 18.6 vs 9.4 months (HR, 0.48; 95% CI, 0.351-0.652), and not reached (NR) vs 12.2 months (HR, 0.60; 95% CI, 0.434-0.827) for those receiving Kd56 vs Vd, respectively; median overall survival (OS) was 42.1 vs 23.7 months (HR, 0.66; 95% CI, 0.443-0.989), 42.5 vs 32.8 months (HR, 0.83; 95% CI, 0.626-1.104), and NR vs 42.3 months (HR, 0.75; 95% CI, 0.554-1.009). Complete renal response (ie, CrCL improvement to ≥60 mL/min in any 2 consecutive visits if baseline CrCL <50 mL/min) rates were 15.3% (95% CI, 8.4-24.7) and 14.1% (95% CI, 8.0-22.6) for those receiving Kd56 vs Vd, respectively. In a combined Kd56 and Vd analysis, complete renal responders had longer median PFS (14.1 vs 9.4 months; HR, 0.805; 95% CI, 0.438-1.481) and OS (35.3 vs 29.7 months; HR, 0.91; 95% CI, 0.524-1.577) vs nonresponders. Grade ≥3 adverse event rates in the respective subgroups were 87.1% vs 79.4%, 84.4% vs 71.8%, and 77.1% vs 65.9% for those receiving Kd56 vs Vd, respectively. Thus, Kd56 demonstrated PFS and OS improvements over Vd in RRMM patients regardless of their baseline renal function. The ENDEAVOR trial was registered at www.clinicaltrials.gov as #NCT01568866.
No free rides: management of toxicities of novel immunotherapies in ALL, including financial
Authors: Jain Tania , Litzow Mark R.
Published: November 2018

Therapeutic options for acute lymphoblastic leukemia, especially in the relapsed/refractory setting, have expanded significantly in recent times. However, this comes at the cost of toxicities: medical as well as financial. We highlight some of the unique toxicities associated with the novel agents to apprise our readers about what to expect, how to recognize them, and how to manage these toxicities. One of the toxicities seen with inotuzumab, a CD22 antibody drug conjugate, is sinusoidal obstruction syndrome, which can be fatal in >80% of patients if associated with multiorgan failure. Blinatumomab, a monoclonal antibody targeting CD19, is associated with cytokine release syndrome (CRS) and neurotoxicity, both of which require prompt recognition and management primarily with corticosteroids. CRS and neurotoxicity are more common and more severe with chimeric antigen receptor T-cell therapy (CAR-T). The fact that CAR-T cannot be discontinued on demand adds a layer of complexity to the management of related toxicities of this therapy. Tocilizumab, an interleukin-6 receptor blocker, is used to treat severe CRS from CAR-T, whereas corticosteroids remain the mainstay for neurotoxicity management. Although effective, these drugs carry a high price tag, and we review the available data on cost-effectiveness of these agents, keeping in mind that median follow-up on most of these studies is limited and that long-term data on durability of response remain to be seen.
Clinical consequences of clonal hematopoiesis of indeterminate potential
Authors: Steensma David P.
Published: November 2018

Clonally restricted hematopoiesis is a common aging-associated biological state that predisposes to subsequent development of a hematological malignancy or cardiovascular death. Clonal expansion driven by leukemia-associated somatic mutations, such as DNMT3A, ASXL1, or TET2, is best characterized, but oligoclonality can also emerge without recognized leukemia-driver mutations, perhaps as a result of stochastic neutral drift. Murine models provide compelling evidence that a major mechanism of increased cardiovascular mortality in the context of clonal hematopoiesis is accelerated atherogenesis driven by inflammasome-mediated endothelial injury, resulting from proinflammatory interactions between endothelium and macrophages derived from circulating clonal monocytes. Altered inflammation likely influences other biological processes as well. The rate of development of overt neoplasia in patients with clonal hematopoiesis of indeterminate potential (CHIP), as currently defined, is 0.5% to 1% per year. Contributing factors to clonal progression other than acquisition of secondary mutations in hematopoietic cells (ie, stronger leukemia drivers) are incompletely understood. Disordered endogenous immunity in the context of increased proliferative pressure, short telomeres leading to chromosomal instability, an unhealthy marrow microenvironment that favors expansion of clonal stem cells and acquisition of new mutations while failing to support healthy hematopoiesis, and aging-associated changes in hematopoietic stem cells, including altered DNA damage response, an altered transcriptional program, and consequences of epigenetic alterations, are all potential contributors to clonal progression. Clinical management of patients with CHIP includes monitoring for hematological changes and reduction of modifiable cardiovascular risk factors; eventually, it will also likely include anti-inflammatory therapies and targeted approaches to prune emergent dangerous clones.