bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Different Exercise Interventions on Quality of Life in Breast Cancer Patients: A Randomized Controlled Trial
Authors: Odynets Tetiana , Briskin Yuriy , Todorova Valentina
Published: October 2019

Purpose: The aim of the present study was to evaluate the effects of different exercise interventions on quality of life parameters in breast cancer patients during 1 year of outpatient rehabilitation. Material and Methods: A total of 115 breast cancer patients met the eligibility criteria and completed the study. Participants were randomly allocated for the water exercise interventions (group A, n = 45), for the Pilates exercise interventions (group B, n = 40), and yoga exercise interventions (group C, n = 30). The 3 groups attended relevant programs for 1 year and received 144 rehabilitation sessions. Quality of life parameters were assessed using the Functional Assessment of Cancer Therapy questionnaire with a specific module for breast cancer patients (FACT-B). Quality of life data were recorded at baseline and after 6 and 12 months of exercise interventions. Results: A significant increase in quality of life indicators was observed in participants of all groups. Based on the results of the 12-month monitoring, patients of group A scored significantly more points for emotional well-being compared with group B and group C by 1.40 points ( P < .05) and 1.69 points ( P < .01), respectively, as well as by breast cancer subscale by 2.15 points ( P < .05) compared with group B. Patients in group C scored significantly better compared with group A in social/family well-being by 2.80 points ( P < .01). Conclusions: It was found that using water exercise intervention is more effective for improving emotional well-being and decreasing negative symptoms associated with breast cancer treatment compared with Pilates and yoga interventions, while yoga was more effective in improving social/family well-being. Further research on water interventions for different populations is warranted.
The White Nationalist on Campus: Re-examining University Free Speech and Leading Through Crisis
Authors: Martin Kimberly , Tecklenburg H. Chris
Published: October 2019

One month after the Unite the Right Rally in Charlottesville, Virginia, left three dead and many injured and arrested, another university faces a tough decision about whether to allow controversial alt-right leader, Richard Spencer, to speak on campus. What seems like a simple decision to allow or deny a speaking request becomes a much deeper conversation about leadership, the value of free speech, and the role of the university to facilitate debate and critical analysis of controversial ideas and viewpoints.
Nonlinear adaptive sliding-mode control of the electronically controlled air suspension system
Authors: Rui Bai
Published: October 2019

Recent years, electronically controlled air suspension has been widely used in vehicles to improve the riding comfort and the road holding ability. This article presents a new nonlinear adaptive sliding-mode control method for electronically controlled air suspension. A nonlinear dynamical model of electronically controlled air suspension is established, where the nonlinear dynamical characteristic of the air spring is considered. Based on the proposed nonlinear dynamic model, an adaptive sliding-mode control method is presented to stabilize the displacement of electronically controlled air suspension in the presence of parameter uncertainties. Parameter adaptive laws are designed to estimate the unknown parameters in electronically controlled air suspension. Stability analysis of the proposed nonlinear adaptive sliding-mode control method is given using Lyapunov stability theory. At last, the reliability of the proposed control method is evaluated by the computer simulation. Simulation research shows that the proposed control method can obtain the satisfactory control performance for electronically controlled air suspension.
Middle leading and influence in two Australian schools
Authors: Lipscombe Kylie , Tindall-Ford Sharon , Grootenboer Peter
Published: October 2019

Increasingly, educational systems are appreciating the importance of middle leaders leading educational improvement in schools. Schools depend on middle leaders to lead site-based educational development in areas including curriculum development, teacher professional learning and student learning improvement. Middle leaders are in a unique but complex position where they influence both executive leadership and teachers within the school organisation. Adopting case study methodology to investigate the practices and influence of middle leaders leading a school-based educational development project, three semi-structured interviews and artefacts from two middle leaders were collected over eight months. The theory of practice architectures afforded an examination of data to explain the conditions and arrangements enabling and constraining the middle leaders’ practices of influence. The findings showed middle leaders’ influence was dependent on executive leadership support, time, formal role descriptions and trusting relationship. Furthermore, the results reveal middle leaders can influence educational development at the school level through advocating for, collaborating with, and empowering colleagues to support teacher ownership of site-based projects. Of interest, this study showed influence can be reciprocal, between middle leaders and colleagues, and between middle leaders and executive leadership.
Factors correlating with prolonged fatigue among emergency department nurses
Authors: Al-Abdallah Ashraf M , Malak Malakeh Z
Published: October 2019

Background

Fatigue affects nurses negatively and leads to physical, cognitive and emotional problems that may influence nurses' quality of life. However, there is a lack of studies about prolonged fatigue and its relationship with socio-demographic characteristics and job-related psychosocial factors among nurses, especially emergency nurses, worldwide and in Jordan.

Aims

This study aims to assess the relationship between demographic factors, physical health, psychological distress and job-related psychosocial factors (psychological job demands, job control and social support) and prolonged fatigue among emergency department nurses in Jordan.

Methods

A descriptive correlational study using a convenience sample was used to recruit 153 emergency nurses. Physical health Questionnaire, General Health Questionnaire, Job Content Questionnaire and Checklist Individual Strength were used.

Results

The majority of emergency nurses experienced abnormally prolonged fatigue, moderate health, high psychological distress, high job demands and low job control and social support. Significant negative relationships were addressed between job control, social support and prolonged fatigue, whereas income had a negative weak relationship. Psychological distress and job demands had a positive weak relationship with prolonged fatigue. There was a significant positive weak relationship between psychological distress, job demands and prolonged fatigue. Job-related psychosocial factors (with exception of social support) and mental health were the predictors of prolonged fatigue.

Conclusions

Prolonged fatigue is a multidimensional phenomenon that can be affected by several factors such as job-related psychosocial factors and psychological health. These factors should be taken into consideration when testing and developing interventions to minimise prolonged fatigue among emergency nurses.
Does a higher training age attenuate injury risk in junior elite rugby league players?
Authors: Booth Mark , Cobley Stephen , Orr Rhonda
Published: October 2019

Our aim was to determine the relationships between three different training ages – TA domains (Rugby League specific – RLTA; Resistance training – RTA; Cardiovascular training – CVTA) on injury risk in junior elite rugby league players. Participants were 147 developmental rugby league players (mean age = 15.8 ± 1.1 years) playing for one rugby league club. Logistic regression with RLTA, CVTA and RTA as independent predictors was modelled on injured/uninjured outcomes. Relationships between TA and injury characteristics were examined using linear regression. CVTA was positively associated with absolute injury risk (odds ratio – OR 1.65, p = 0.02) and injury characteristics (muscle strain OR 1.12, p = 0.05) and ankle injuries (OR 1.24, p = 0.05). A positive association was demonstrated between RTA and high-intensity running injuries (OR 1.31, p = 0.01), and hamstring injuries (OR 1.66, p = 0.01). Our results suggest that a higher pre-study CVTA and RTA was associated with increased injury risk in an elite development rugby league team.
A study of the relationship between students’ engagement and their academic performances in an eLearning environment
Authors: Rajabalee Banoor Yousra , Santally Mohammad Issack , Rennie Frank
Published: October 2019

The concept of online learning has witnessed an increase in the higher education sector, where enrolment rates in online courses have significantly grown in recent years. According to the literature, one of the critical components of quality online education is to ensure learner engagement. In short, the need to effectively measure learner engagement is imperative to determine the performances and the successful achievements of learners. In this research, the aim was to understand the relationship between students’ engagement in an online module with their overall performances by analysing students’ learning activities in an online module. Three measurable indicators were identified and considered relevant within the current research context and based on the available data, and from research literature for assessing learner engagement within the module. These were (i) the number of completed learning activities; (ii) importance level (as per course outcomes) of completed learning activities; and (iii) activities requiring platform presence. It was found that there is a significant but weak positive correlation between the engagement of students in the online module and their performances in the final learning activity. It was further observed that when continuous learning activities were considered, there was a very strong positive correlation between engagement and performances. In general, the average engagement level of students was significantly higher for good performers as compared to low performers. Similarly the mean performance of highly engaged students was significantly better than those with low engagement levels.
The influence of visual working memory representations on attention bias to threat in individuals with high trait anxiety
Authors: Yao Nisha , Rodriguez Marcus A. , He Mengyao , Qian Mingyi
Published: October 2019

Experimental studies have yielded discrepant results regarding the relationship between anxiety and attention bias to threat. Cognitive factors modulating the presence of threat-related attention bias in anxiety have drawn growing attention. Previous research demonstrated that visual working memory (WM) representations can guide attention allocation in a top-down manner. Whether threat-related WM representations affected the presence of attention bias in anxiety awaits examination. Combining a memory task and a dot-probe task, this study investigated how WM representations of faces with neutral or negative expressions modulated the attention bias to threat among highly anxious individuals versus controls. Results showed that highly anxious individuals developed more pronounced attention bias to threat when maintaining WM representations of negative faces as compared to the control group. There were no significant between-group effects when the WM representations were neutral. These results suggested that highly anxious individuals were more susceptible to the influence of mental representations with negative valence on attention deployment.
Affective and cognitive responses to repeated performance feedback across adaptive and maladaptive dimensions of perfectionism
Authors: Lo Alice , Abbott Maree J.
Published: October 2019

The study investigated the affective and cognitive responses (including self-beliefs about personality attributes and the level of certainty associated with these beliefs) to the repeated delivery of performance feedback (failure vs. success) across adaptive and maladaptive dimensions of perfectionism. Participants completed questionnaires and a mental rotation computer task, to which they received feedback for. Performance feedback was delivered at Time point 1 (initial) and at Time point 2 (repeated). Results showed that maladaptive perfectionism predicted increased negative affect after initial failure and decreased confidence in self-descriptiveness ratings for negative-related personality attributes after initial success, with these confidence levels further decreasing following repeated success. Adaptive perfectionism predicted higher self-ratings on positive-related personality attributes but only after initial success. The findings suggest that changes in responses across adaptive and maladaptive perfectionism are influenced by experiences of success rather than failure. Adaptive perfectionism also seemed resilient to input from external sources while maladaptive perfectionism appeared more susceptible to such influence. However, given the preliminary nature of the present findings, further research in this area is needed to understand the impact of performance feedback on the self-concept across these two dimensions of perfectionism.
Linear discoid lupus erythematosus mimicking en coup de sabre morphea: A case report
Authors: Hassan Mahdi , Watters Kevin A , Netchiporouk Elena
Published: October 2019

Discoid or chronic lupus erythematosus is an autoimmune disease that produces skin lesions on the face and scalp. Rarely do lesions present with linear configuration, but when they do, the lesions often follow the lines of embryologic migration. A 24-year-old man presented with a slowly progressing asymptomatic violaceous linear patch running from the root of his frontal scalp to the nasal tip. A Doppler ultrasound and skin biopsy were performed and the histological findings demonstrated characteristic findings of discoid lupus erythematosus. A full physical examination, review of systems and laboratory investigations showed no indication of systemic lupus. High potency topical steroids and calcineurin inhibitors were prescribed along with photoprotection. At 4-month follow-up, all his lesions had mostly cleared. We report here the first case, to our knowledge, of discoid lupus erythematosus with en coup de saber presentation mimicking morphea.
Multidisciplinary Chronic Kidney Disease Clinic Practices: A Scoping Review
Authors: Collister David , Pyne Lonnie , Cunningham Jessie , Donald Maoliosa , Molnar Amber , Beaulieu Monica , Levin Adeera , Brimble K. Scott
Published: October 2019

Background:

Multidisciplinary chronic kidney disease (CKD) clinics improve patient outcomes but their optimal design is unclear.

Objective:

To perform a scoping review to identify and describe current practices (structure, function) associated with multidisciplinary CKD clinics.

Design:

Scoping review.

Setting:

Databases included Medline, EMBASE, Cochrane, and CINAHL.

Patients:

Patients followed in multidisciplinary CKD clinics globally.

Measurements:

Multidisciplinary CKD clinic composition, entry criteria, follow-up, and outcomes.

Methods:

We systematically searched the literature to identify randomized controlled trials, non-randomized interventional studies, or observational studies of multidisciplinary CKD clinics defined by an outpatient setting where two or more allied health members (with or without a nephrologist) provided longitudinal care to 50 or more adult or pediatric patients with CKD. Included studies were from 2002 to present. Searches were completed on August 10, 2018. Title, abstracts, and full texts were screened independently by two reviewers with disagreements resolved by a third. We abstracted data from included studies to summarize multidisciplinary CKD clinic team composition, entry criteria, follow-up, and processes.

Results:

40 studies (8 randomized controlled trials and 32 non-randomized interventional studies or observational studies) involving 23 230 individuals receiving multidisciplinary CKD care in 12 countries were included. Thirty-eight focused on adults (27 with CKD, 10 incident dialysis patients, one conservative therapy) while two studies focused on adolescents or children with CKD. The multidisciplinary team included a mean of 4.6 (SD 1.5) members consisting of a nephrologist, nurse, dietician, social worker, and pharmacist in 97.4%, 86.8%, 84.2%, 57.9%, and 42.1% of studies respectively. Entry criteria to multidisciplinary CKD clinics ranged from glomerular filtration rates of 20 to 70 mL/min/1.73m2 or CKD stages 1 to 5 without any proteinuria or risk equation-based criteria. Frequency of follow-up was variable by severity of kidney disease. Team member roles and standardized operating procedures were infrequently reported.

Limitations:

Unstandardized definition of multidisciplinary CKD care, studies limited to CKD defined by glomerular filtration rate, and lack of representation from countries other than Canada, Taiwan, the United States, and the United Kingdom.

Conclusions:

There is heterogeneity in multidisciplinary CKD team composition, entry criteria, follow-up, and processes with inadequate reporting of this complex intervention. Additional research is needed to determine the best model for multidisciplinary CKD clinics.

Trial registration:

Not applicable.
Assessment of Nutrition and Supplementation in Patients With Hip Fractures
Authors: Arkley James , Dixon Ján , Wilson Faye , Charlton Karl , Ollivere Benjamin John , Eardley William
Published: October 2019

Introduction:

Malnutrition is common in older people, is known to interact with frailty, and is a risk factor for wound complications and poor functional outcomes postoperatively. Sustaining a hip fracture is a significant life event, often resulting in a decline in mobility and functional ability. A poor nutritional state may further impede recovery and rehabilitation, so strategies to improve perioperative nutrition are of considerable importance. We provide a review of nutritional supplement practices in this vulnerable and growing population.

Method:

Systematic review of preoperative oral nutritional supplementation (ONS) in hip fracture patients.

Results:

We identified 12 articles pertaining to this important area of perioperative care. The findings suggest postoperative ONS can improve postoperative outcomes in hip fracture patients, especially in terms of increasing total serum protein, improving nutritional status to near-optimum levels, and decreasing postoperative complications.

Discussion:

There is an absence of evidence specific to preoperative ONS in patients admitted following hip fracture. Literature relating to other populations is encouraging but is yet to be robustly studied. It is unclear whether these results are generalizable to the frailer hip fracture population. There is a need for studies clearly defining outcome measurement and complication assessment pertaining to preoperative ONS. The potential benefit is considerable, and this review will provide a means to inform the construction of meaningful trials in preoperative ONS of patients sustaining hip fracture.

Conclusion:

Oral nutritional supplementation in hip fracture patients may decrease postoperative complications while increasing elderly patient’s nutritional state to a near-optimum level. This is extrapolated from postoperative literature, however with a clear gap in research pertaining specifically to preoperative care. The need for well-constructed studies focused on the impact and assessment of early ONS in this population is transparent.
Inpatient Outcomes in Dialysis Dependent Patients Undergoing Elective Cervical Spine Surgery for Degenerative Cervical Conditions
Authors: Mitchell Sean M. , White Anthony M. , Campbell David H. , Chung Andrew , Chutkan Norman
Published: October 2019

Study Design:

Retrospective cohort study.

Objective:

To evaluate inpatient outcomes in dialysis dependent patients undergoing elective cervical spine surgery.

Methods:

A total of 1605 dialysis dependent patients undergoing elective primary or revision cervical spine surgery for degenerative conditions were identified from the National Inpatient sample from 2002 to 2012 and compared to 1 450 642 nondialysis-dependent patients undergoing the same procedures. The National Inpatient Sample is a de-identified database; thus, no institutional review board approval was needed.

Results:

Dialysis dependence was associated with higher inpatient mortality rates (7.5% vs 1.9%; P < .001) as well as both major (17.3% vs 0.6%; P < .001) and minor (36.8% vs 10.5%; P < .001) complication rates as compared with nondialysis-dependent patients. Dialysis-dependent patients had substantially increased mean lengths of stay (9.8 days compared with 2.0 days; P < .001) and total hospital charges ($141 790 compared with $46 562; P < .001).

Conclusion:

Dialysis-dependence is associated with drastically increased complication rates, risk of mortality, and represent a significant financial and psychosocial burden to patients undergoing elective cervical spine surgery. Both surgeons and patients should be aware of these risks while planning elective surgeries.
Using Improvisation to Develop Emotional Intelligence
Authors: Shivarajan Sridevi , Andrews Rick
Published: October 2019

Emotional intelligence (EI) is emerging as critical to success in today’s workplaces. Business schools must, therefore, equip students with techniques to develop their emotional intelligence. EI is learnable, and research indicates that active and experiential approaches are more effective in developing EI than lecture-based methods. We, therefore, suggest that the highly engaging style of improvisational theater can be used as an effective training technique to develop EI. Furthermore, improv’s foundational “yes-and” principle requires participants to listen nonjudgmentally and actively support each other. We present six improvisational exercises that will enable students to identify and develop some of the social skills relevant to EI, namely, empathy, collaboration, and understanding the emotional cues of others. Our detailed instructions to run and debrief the exercises ensure that instructors with no prior experience with improvisational theater can also easily use them in their classes.
Measuring urban social sustainability: Scale development and validation
Authors: Larimian Taimaz , Sadeghi Arash
Published: October 2019

Despite the significant role of social sustainability in the sustainable development agenda, there is a lack of research to clearly define and fully operationalise the concept of urban social sustainability. The aim of this study is to contribute to the existing literature by developing a comprehensive measurement scale to assess urban social sustainability at the neighbourhood level. We argue that urban social sustainability is a multidimensional concept that incorporates six main dimensions of social interaction, sense of place, social participation, safety, social equity and neighbourhood satisfaction. Failure to consider each of these dimensions may lead to an incomplete picture of social sustainability. Validity, reliability and dimensionality of the urban social sustainability scale are examined using factor analysis. We also illustrate the application of the urban social sustainability scale by investigating the influence of quality of design, as one of the least studied factors of urban form, on different dimensions of social sustainability. The paper uses data collected from the household questionnaire survey in a sample of 251 respondents from five case study neighbourhoods of Dunedin city, New Zealand. This study provides new evidence on the significance of improving neighbourhood quality of design and its positive and significant relationship with different dimensions of social sustainability and the overall social sustainability.
People at the Heart of Corporate Governance: Reimagining the Role of HRM
Authors: Sripada Chandrasekhar
Published: October 2019

People, talent and culture aspects are not yet the mainstream agenda for corporate governance. Corporate governance literature has been largely concerned with shareholder interests. Even where the broader discourse has moved to ‘stakeholder’ interests, the talent agenda has been rather muted. In this article, we examine the current literature on corporate governance and identify the gaps related to talent and culture topics. We argue that since people are not yet at the heart of corporate governance, human resource management (HRM) is not a priority for boards. However, we explain why the 4Cs of HRM, namely Compliance, Compensation, Competence and Culture—in their broader sense—should be central concerns of corporate governance. Apart from building a case for redirecting the agenda of corporate governance with people at its centre, this article provides some general guidance on how this can be operationalised in the near term. There is clearly a need for further research on how corporate governance can be enriched by including the people agenda. Simultaneously, we need to reimagine the HRM function as a vital arm in shaping and steering the future of corporate governance.
Molecular roulette: nucleophosmin mutations in AML are orchestrated through N-nucleotide addition by TdT
Authors: Borrow Julian , Dyer Sara A. , Akiki Susanna , Griffiths Michael J.
Published: October 2019

These complementary papers by Borrow et al report persuasive but indirect evidence that the lymphoid enzyme terminal deoxynucleotidyl transferase (TdT) is the mutagen responsible for 2 common pathogenic genetic changes in acute myeloid leukemia (AML): FLT3-ITD and NPM1.
Toxicity and response after CD19-specific CAR T-cell therapy in pediatric/young adult relapsed/refractory B-ALL
Authors: Curran Kevin J. , Margossian Steven P. , Kernan Nancy A. , Silverman Lewis B. , Williams David A. , Shukla Neerav , Kobos Rachel , Forlenza Christopher J. , Steinherz Peter , Prockop Susan , Boulad Farid , Spitzer Barbara , Cancio Maria I. , Boelens Jaap Jan , Kung Andrew L. , Khakoo Yasmin , Szenes Victoria , Park Jae H. , Sauter Craig S. , Heller Glenn , Wang Xiuyan , Senechal Brigitte , O’Reilly Richard J. , Riviere Isabelle , Sadelain Michel , Brentjens Renier J.
Published: October 2019

Chimeric antigen receptor (CAR) T cells have demonstrated clinical benefit in patients with relapsed/refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL). We undertook a multicenter clinical trial to determine toxicity, feasibility, and response for this therapy. A total of 25 pediatric/young adult patients (age, 1-22.5 years) with R/R B-ALL were treated with 19-28z CAR T cells. Conditioning chemotherapy included high-dose (3 g/m2) cyclophosphamide (HD-Cy) for 17 patients and low-dose (≤1.5 g/m2) cyclophosphamide (LD-Cy) for 8 patients. Fifteen patients had pretreatment minimal residual disease (MRD; <5% blasts in bone marrow), and 10 patients had pretreatment morphologic evidence of disease (≥5% blasts in bone marrow). All toxicities were reversible, including severe cytokine release syndrome in 16% (4 of 25) and severe neurotoxicity in 28% (7 of 25) of patients. Treated patients were assessed for response, and, among the evaluable patients (n = 24), response and peak CAR T-cell expansion were superior in the HD-Cy/MRD cohorts, as compared with the LD-Cy/morphologic cohorts without an increase in toxicity. Our data support the safety of CD19-specific CAR T-cell therapy for R/R B-ALL. Our data also suggest that dose intensity of conditioning chemotherapy and minimal pretreatment disease burden have a positive impact on response without a negative effect on toxicity. This trial was registered at www.clinicaltrials.gov as #NCT01860937.
Primary treatment of light-chain amyloidosis with bortezomib, lenalidomide, and dexamethasone
Authors: Kastritis Efstathios , Dialoupi Ioanna , Gavriatopoulou Maria , Roussou Maria , Kanellias Nikolaos , Fotiou Despina , Ntanasis-Stathopoulos Ioannis , Papadopoulou Elektra , Ziogas Dimitrios C. , Stamatelopoulos Kimon , Manios Efstathios , Ntalianis Argyrios , Eleutherakis-Papaiakovou Evangelos , Papanikolaou Asimina , Migkou Magdalini , Papanota Aristea-Maria , Gakiopoulou Harikleia , Psimenou Erasmia , Tselegkidi Maria Irini , Tsitsilonis Ourania , Kostopoulos Ioannis , Terpos Evangelos , Dimopoulos Meletios A.
Published: October 2019

Key Points

Bortezomib with dexamethasone and low-dose lenalidomide is an active therapy for previously untreated patients with AL amyloidosis. VRD can induce MRD-negative responses, but nonhematologic toxicity may be significant in patients with advanced disease.
Pegylated interferon-2α invokes graft-versus-leukemia effects in patients relapsing after allogeneic stem cell transplantation
Authors: Henden Andrea S. , Varelias Antiopi , Leach Justine , Sturgeon Elise , Avery Judy , Kelly Jessica , Olver Stuart , Samson Luke , Hartel Gunter , Durrant Simon , Butler Jason , Morton Anthony J. , Misra Ashish , Tey Siok-Keen , Subramoniapillai Elango , Curley Cameron , Kennedy Glen , Hill Geoffrey R.
Published: October 2019

Key Points

Peg-IFNα is tolerated and induces disease response in patients who relapse after allogeneic SCT. Increased pretreatment MAIT and pDC proportions were associated with better progression-free and overall survival after peg-IFNα treatment.
Clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis: a retrospective observational study
Authors: Chen Yao , Hu Yanyan , Zhang Jin , Shen Yue , Huang Junling , Yin Jun , Wang Ping , Fan Ying , Wang Jianli , Lu Su , Yang Yilin , Yan Lei , Li Keyong , Song Zhenju , Tong Chaoyang , Du Shilin
Published: October 2019

Background

Secondary infection has a higher incidence in septic patients and affects clinical outcomes. This study aims to investigate the clinical characteristics, risk factors, immune status and prognosis of secondary infection of sepsis.

Methods

A four-year retrospective study was carried out in Zhongshan Hospital, Fudan University, enrolling septic patients admitted between January, 2014 and January, 2018. Clinical data were acquired from medical records. CD14+ monocyte human leukocyte antigen-D related (HLA-DR) expression and serum cytokines levels were measured by flow cytometry and enzyme-linked immunosorbent assay (ELISA) respectively.

Results

A total of 297 septic patients were enrolled, 92 of whom developed 150 cases of secondary infections. Respiratory tract was the most common site of secondary infection (n = 84, 56%) and Acinetobacter baumanii the most commonly isolated pathogen (n = 40, 31%). Urinary and deep venous catheterization increased the risk of secondary infection. Lower HLA-DR expression and elevated IL-10 level were found in secondary infection group. The expected prolonged in-hospital stay owing to secondary infection was 4.63 ± 1.87 days. Secondary infection was also associated with higher in-hospital, 30-day and 90-day mortality. Kaplan-Meier survival analysis and Log-rank test revealed that secondary infection group had worse survival between day 15 and day 90.

Conclusions

Urinary and deep venous catheterization increased the risk of secondary infection, in which underlying immunosuppression might also play a role. Secondary infection affected the prognosis of septic patients and prolonged in-hospital length of stay.
Transarticular external fixation versus deltoid ligament repair in treating SER IV ankle fractures: a comparative study
Authors: Li Bohua , Wang Shanxi , Zhang Zhengdong , Yang Hai , Li Jun , Li Qin , Liu Lei
Published: October 2019

Background

The topic that whether the injured deltoid ligament should be repaired when associated with ankle joint fractures is still discussed. The objective of this study was to compare the clinical effect of open reduction and internal fixation (ORIF) with deltoid ligament repair (DLR) or transarticular external fixation (TEF) in treating supination-external rotation type IV (SER IV) ankle fractures.

Methods

Between January 2012 and December 2015, 43 patients were diagnosed as SER IV ankle fractures, 20 underwent ORIF and transarticular external fixation (TEF) without DLR (group 1), 23 were treated with ORIF and DLR (group 2). The pre- and post-operative radiographic examination were performed, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale (VAS), the Medical Outcomes Short Form 36-item questionnaire score (SF-36), and the ankle range of motion (ROM) were used for functional evaluation.

Results

In both groups, the three scores improved significantly after surgery, but there was no significant difference between the two groups. At 6 weeks after surgery, patients in group 2 had better ankle ROM than group 1 (29.35 ± 2.033 vs. 40.35 ± 3.550, P <  0.001), but there was no difference at 12 months postoperatively. No cases of bone nonunion or post-traumatic arthritic changes were seen during the follow-up. Patients in group 1 required a shorter time to achieve fracture union than patients in group 2.

Conclusions

ORIF with TIF is an optional strategy to manage SER IV ankle fractures as it achieves comparable functional results to ORIF with DLR. It also allows patients to start relatively earlier weight-bearing and may promote fracture union.
Chemical composition, antibacterial activity and related mechanism of valonia and shell from Quercus variabilis Blume (Fagaceae) against Salmonella paratyphi a and Staphylococcus aureus
Authors: Zhou Dan , Liu Ze-Hua , Wang Dong-Mei , Li Deng-Wu , Yang Li-Na , Wang Wei
Published: October 2019

Background

Plant secondary metabolites and phytochemicals that exhibit strong bioactivities have potential to be developed as safe and efficient natural antimicrobials against food contamination and addressing antimicrobial resistance caused by the overuse of chemical synthetic preservative. In this study, the chemical composition, antibacterial activities and related mechanism of the extracts of the valonia and the shell of Quercus variabilis Blume were studied to determine its potential as a safe and efficient natural antimicrobial.

Methods

The phenolic compositions of valonia and shell extracts were determined by folin-ciocalteau colourimetric method, sodium borohydride/chloranil-based assay and the aluminium chloride method and then further identified by the reverse-phase HPLC analysis. The antibacterial activities of valonia and shell extracts were evaluated by the agar disk diffusion method and agar dilution method. The related antibacterial mechanism was explored successively by the membrane of pathogens effect, phosphorous metabolism, whole-cell proteins and the microbial morphology under scanning electron microscopy.

Results

The n-butanol fraction and water fraction of valonia along with n-butanol fraction of the shell contains enrich phenolics including ellagic acid, theophylline, caffeic acid and tannin acid. The n-butanol fraction and ethanol crude extracts of valonia exhibited strong antibacterial activities against Salmonella paratyphi A (S. paratyphi A) and Staphylococcus aureus (S. aureus) with the DIZ values ranged from 10.89 ± 0.12 to 15.92 ± 0.44, which were greater than that of the Punica granatum (DIZ: 10.22 ± 0.18 and 10.30 ± 0.21). The MIC values of the n-butanol fraction and ethanol crude extracts of valonia against S. paratyphi A and S. aureus were 1.25 mg/ml and 0.625 mg/ml. The related antibacterial mechanism of n-butanol fraction and ethanol crude extracts of valonia may be attributed to their strong impact on membrane permeability and cellular metabolism. Those extracts exhibited strong antibacterial activity according to inhibit the synthesis of bacterial proteins and seriously change morphological structure of bacterial cells.

Conclusions

The n-butanol fraction and ethanol crude extracts of valonia had reasonably good antibacterial activities against S. paratyphi A and S. aureus. This study suggests possible application of valonia and shell as natural antimicrobials or preservatives for food and medical application.
First report of hare treponematosis seroprevalence of European brown hares (Lepus europaeus) in the Czech Republic: seroprevalence negatively correlates with altitude of sampling areas
Authors: Nováková Markéta , Najt David , Mikalová Lenka , Kostková Marcela , Vrbová Eliška , Strouhal Michal , Posautz Annika , Knauf Sascha , Šmajs David
Published: October 2019

Background

The aim of this study was to quantify the seroprevalence of hare treponematosis in European brown hare (Lepus europaeus) populations in the Czech Republic and to test for an association between treponematosis prevalence and the altitude of the areas in which hares were sampled. We tested 289 serum samples of brown hares collected between 2015 and 2017. The sampling areas included 12 districts (73 villages) distributed throughout the Czech Republic. Serum samples were tested for the presence of antibodies against the causative agent of hare treponematosis (Treponema paraluisleporidarum ecovar Lepus, TPeL) using two serological tests for human syphilis that cross-react with TPeL: the Treponema pallidum hemagglutination assay (TPHA) and the fluorescent treponemal antibody absorption (FTA-ABS) test. To account for the imperfect diagnostic sensitivity and specificity of each test, apparent prevalence estimates of TPeL were converted to true prevalence estimates using the Rogan Gladen estimator.

The correlation between TPeL true seroprevalence and altitude of sampling areas was analyzed using Pearson’s correlation coefficient at three levels of spatial resolution: (1) four groups, each composed of two merged districts, with ≥20 samples collected, differing in their altitude median (206, 348, 495, and 522 m above sea level); (2) separately tested eight districts, where ≥20 samples were collected per district; and (3) 27 groups composed of villages of the same altitude level distributed across the whole dataset.

Results

One hundred and seven of the 289 samples were seropositive to both tests, the FTA-ABS test was positive for an additional 47 samples. Seropositive samples were found in all 12 districts. True seroprevalence of TPeL in the sampled hares was 52% (95% confidence interval 46 to 58%).

A statistically significant negative correlation between TPeL seroprevalence and altitude was identified at the district level (Pearson’s r = − 0.722, p = 0.043).

Conclusions

Between 2015 and 2017 hare treponematosis was present at a relatively high prevalence in brown hares in all 12 districts in the Czech Republic where sampling was carried out. The seroprevalence of TPeL in brown hares was negatively correlated with the altitude of the areas in which hares were sampled.
Primary drug resistance of mycobacterium tuberculosis in Shandong, China, 2004–2018
Authors: Song Wan-mei , Li Yi-fan , Ma Xiao-bin , Liu Jin-yue , Tao Ning-ning , Liu Yao , Zhang Qian-yun , Xu Ting-ting , Li Shi-jin , Yu Chun-Bao , Gao Lei , Cui Liang-liang , Li Huai-chen
Published: October 2019

Background

Primary drug-resistant tuberculosis (DR-TB) has contributed to a significant health and economic burden on a global scale, especially in China. we sought to estimate epidemiological characteristics of primary DR-TB in China from 2004 to 2018.

Methods

Eleven thousand four hundred sixty-seven newly diagnosed and 1981 retreated TB cases with drug susceptibility data were included. Chi-Square test for trends, linear regression, a joinpoint regression model and temporal trend in proportions of the different resistance patterns were carried out.

Results

The proportion of primary DR-TB and mono-resistant TB (MR-TB) in China had reduced by more than 12% since 2004, and were 21.38%, 13.35% in 2018 respectively. Among primary DR-TB cases (2173,18.95%), the percentage of multiresistant TB (MDR-TB, from 5.41 to 17.46%), male (from 77.03 to 84.13%), cavity (from 13.51 to 43.92%), rifampicin(RFP)-resistant TB (from 8.11 to 26.98%), streptomycin(SM)-resistant TB (from 50.00 to 71.43%) increased significantly (P < 0.05). On the contrary, the proportion of female, non-cavity, isoniazide(INH)-resistant TB (from 55.41 to 48.15%) and MR-TB (from 82.43 to 62.43%) decreased significant (P < 0.05). The primary drug resistance rate among female, cavity, smoking, drinking, 15 to 44 year-old TB subgroups increased by 0.16, 6.24, 20.95, 158.85, 31.49%, respectively. The percentage of primary DR-TB, RFP-resistant TB dropped significantly during 2004–2007 in Joinpoint regression model.

Conclusion

The total rate of drug resistance among new TB cases showed a downward trend in Shandong, China, from 2004 to 2018. Primary drug resistance patterns were shifting from female, non-cavity, INH-resistant TB, and MR-TB groups to male, cavity, RFP/SM-resistant TB, and MDR-TB groups. Considering the rising drug resistance rate among some special population, future control of primary DR-TB in China may require an increased focus on female, cavity, smoking, drinking, or 15 to 44 year-old TB subgroups.
Learning and transfer of complex motor skills in virtual reality: a perspective review
Authors: Levac Danielle E. , Huber Meghan E. , Sternad Dagmar
Published: October 2019

The development of more effective rehabilitative interventions requires a better understanding of how humans learn and transfer motor skills in real-world contexts. Presently, clinicians design interventions to promote skill learning by relying on evidence from experimental paradigms involving simple tasks, such as reaching for a target. While these tasks facilitate stringent hypothesis testing in laboratory settings, the results may not shed light on performance of more complex real-world skills. In this perspective, we argue that virtual environments (VEs) are flexible, novel platforms to evaluate learning and transfer of complex skills without sacrificing experimental control. Specifically, VEs use models of real-life tasks that afford controlled experimental manipulations to measure and guide behavior with a precision that exceeds the capabilities of physical environments. This paper reviews recent insights from VE paradigms on motor learning into two pressing challenges in rehabilitation research: 1) Which training strategies in VEs promote complex skill learning? and 2) How can transfer of learning from virtual to real environments be enhanced? Defining complex skills by having nested redundancies, we outline findings on the role of movement variability in complex skill acquisition and discuss how VEs can provide novel forms of guidance to enhance learning. We review the evidence for skill transfer from virtual to real environments in typically developing and neurologically-impaired populations with a view to understanding how differences in sensory-motor information may influence learning strategies. We provide actionable suggestions for practicing clinicians and outline broad areas where more research is required. Finally, we conclude that VEs present distinctive experimental platforms to understand complex skill learning that should enable transfer from therapeutic practice to the real world.
Comparison of clinical and patient-reported outcomes of three procedures for recurrent anterior shoulder instability: arthroscopic Bankart repair, capsular shift, and open Latarjet
Authors: Xu Yingjie , Wu Kailun , Ma Qianli , Zhang Lei , Zhang Yong , Xu Wu , Guo Jiong Jiong
Published: October 2019

Background

Best surgical of recurrent anterior shoulder instability remained controversial. We knew little about the superiority and choice between traditional open and modern arthroscopic techniques. We hypothesized that outcomes of all patients will be similar regardless of surgical technique.

Methods

A retrospective case-cohort analysis of 168 patients who had recurrent anterior shoulder instability was conducted from September 2010 to December 2013. All cases (mean age 30.8 [range 18–50] years) were performed with arthroscopic Bankart repair (33 males/20 females), open Latarjet (34 males/18 females), and capsular shift (31 males/14 females). The average follow-up was 67.6 months (range 60–72). The shoulder instability index score (ISIS) was more than 3 with an average of 6.4.

Results

All treatments proved to be effective in improving shoulder functional status and reducing symptoms, while Latarjet had an advantage over subjective perception. The Rowe scores in arthroscopic Bankart, open Latarjet, and capsular shift group were 92.3 ± 1.5, 96.2 ± 2.1, and 93.2 ± 2.3, respectively, with significant difference. There was no significant difference in other functional outcomes. However, the Latarjet group in subjective results (subjective shoulder value (SSV) and subjective shoulder value for sport practice (SSV Sport)) was superior to the others (P < 0.05). There were two relapsed cases in arthroscopic Bankart and capsular shift group, respectively, and no recurrence in open Latarjet group.

Conclusion

Arthroscopic Bankart repair has the advantage of mini-invasion and rapid recovery. Capsular shift offers stabilizing of inferior or multidirectional type, especially for little bone defect. Latarjet was more effective in reducing recurrence with higher stability.

Level of evidence

Therapeutic level III
Patient experiences of participation in a radical thoracic surgical trial: findings from the Mesothelioma and Radical Surgery Trial 2 (MARS 2)
Authors: Warnock Clare , Lord Karen , Taylor Bethany , Tod Angela
Published: October 2019

Background

The Mesothelioma and Radical Surgery Trial (MARS 2) aims to evaluate a surgical procedure by comparing chemotherapy and surgery against chemotherapy alone. The pilot study for MARS 2 evaluated the viability of recruitment. Challenges have been reported in conducting clinical research into thoracic surgical treatments and evidence is required to improve our understanding of patient experiences of trial procedures, trial treatments and the factors that influence participation.

Methods

This longitudinal qualitative study was nested within the MARS 2 pilot. Semi-structured telephone interviews were conducted with 15 participants in the MARS 2 trial. Interviews were conducted post-randomisation, post-surgery (surgery arm) and at 6 and 12 months. Altogether, 41 interviews were carried out. The data were analysed using framework techniques.

Results

Challenges were identified regarding the volume and complexity of information given to participants, and their understanding of clinical equipoise and randomisation. Factors influencing participation included having an opportunity to undergo surgery, a self-assessment of their ability to cope with trial treatments, maintaining a positive approach and altruism. Obstacles included the logistics of traveling for treatment in an unfamiliar setting. Negative consequences of trial participation included increased uncertainty amplified by multiple care providers and unclear transition arrangements after the trial.

Conclusions

Participants’ descriptions provided insights that have implications for care for mesothelioma trial patients. The need for healthcare staff to be alert to the potential for misunderstanding, particularly when presenting treatment options, was identified. Patients perceived and derived benefits from taking part in the trial but experienced some negative consequences. These should be anticipated and managed proactively.

Trial registration

ClinicalTrials.gov, NCT02040272. Registered on 20 January 2014.