bluuebunny/crossref_metadata_2025 huggingface dataset:
Diffusion‐weighted whole‐body imaging with background suppression (DWIBS) is effective and economical for detection of metastasis or recurrence of lung cancer
Authors: Usuda Katsuo , Iwai Shun , Yamagata Aika , Iijima Yoshihito , Motono Nozomu , Matoba Munetaka , Doai Mariko , Yamada Sohsuke , Ueda Yoshimichi , Hirata Keiya , Uramoto Hidetaka
Published: January 2021

Background

Diffusion‐weighted whole‐body imaging with background suppression (DWIBS) is used for the diagnosis and staging of cancers. The medical cost of an MR examination including DWIBS is $123, which is 80% less expensive than the cost ($798) of F18‐fluorodeoxyglucose positron emission tomography/computed tomography (FDG‐PET/CT) examination.

Methods

This study examined the efficacy of DWIBS for relapses after lung cancer resection. A total of 55 patients who had pulmonary resection of lung cancer, postoperative computed tomography (CT) every six months, and DWIBS and FDG‐PET/CT (every year) were enrolled in this study. If a metastatic lesion was detected on CT scan, DWIBS and FDG‐PET/CT were also used.

Results

A total of 55 patients who underwent pulmonary resections for lung cancer, and had CT, DWIBS and FDG‐PET/CT examination during follow‐up after pulmonary resection were enrolled in this study. Lung cancer in 32 patients relapsed. Postoperative radiographic examinations revealed pulmonary metastases in 17 patients, bone metastases in seven, liver metastases in five, lymph node metastases in five, pleural metastases in four, metastases to the chest wall in two, brain metastases in two, adrenal gland metastasis in one, and renal metastasis in one. The mean apparent diffusion coefficient (ADC) value of the relapse was 0.9 to 1.70 × 10−3 mm2/s. The accuracy 0.98 (54/55) of DWIBS for detecting multiple metastatic lesions was likely to be higher than 0.94 (52/55) of CT or 0.94 (52/55) of FDG‐PET/CT, but there were no significant differences.

Conclusions

DWIBS can detect multiple metastatic lesions throughout the entire body and differentiate malignancy from benignity in only one examination. DWIBS has benefits of diagnostic accuracy and is less expensive in medical costs for the detection of a relapse. DWIBS could potentially replace FDG‐PET/CT after lung cancer resection.
Higher osimertinib introduction rate achieved by multiple repeated rebiopsy after acquired resistance to first/second generation EGFR‐TKIs
Authors: Ninomaru Taira , Hata Akito , Kokan Chiyuki , Okada Hideaki , Tomimatsu Hirotaka , Ishida Jun
Published: January 2021

Background

Indication for treatment with osimertinib after first/second generation (1/2G) epidermal growth factor receptor‐tyrosine kinase inhibitor (EGFR‐TKI) resistance depends on T790M mutation detected by rebiopsy. The aim of our study was to analyze the data on clinical practice at our hospital where histological rebiopsy is actively carried out multiple times.

Methods

We retrospectively reviewed our electronic medical records of EGFR‐mutant non‐small cell lung cancer (NSCLC) patients to examine clinical rebiopsy situation, T790M detection rate, osimertinib introduction rate and associated outcomes.

Results

Among 95 patients with EGFR‐mutant NSCLC, 72 patients received 1/2G EGFR‐TKIs. Of 60 with progressive disease on 1/2G EGFR‐TKIs, 50 (83%) underwent rebiopsy. T790M was detected in 40 (80%) of 50, resulting in a 79% osimertinib introduction rate, as one patient refused osimertinib. T790M was detected by first rebiopsy in 18 (36%) of 50 patients, and by second or subsequent rebiopsy in 22 (44%). Median time to treatment failure of T790M‐positive patients at first rebiopsy was 22.6 (95% confidence interval [CI]: 10.2–32.8) months, and those at multiple repeated rebiopsy was 20.9 (95% CI: 8.6–not reached) months (p = 0.64). Median overall survival (OS) in osimertinib introduced group was 92.5 (95% CI: 62.9–not reached), while in nonosimertinib median OS was 39.0 months (95% CI: 22.2–not reached) (p = 0.04).

Conclusions

T790M detection rate was increased by multiple repeated rebiopsy, achieving a higher osimertinib introduction rate. This higher introduction rate could contribute to better prognosis of EGFR‐mutant NSCLC patients.
Transformation from adenocarcinoma to squamous cell lung carcinoma with MET amplification after lorlatinib resistance: A case report
Authors: Ueda Shoko , Shukuya Takehito , Hayashi Takuo , Suzuki Mario , Kondo Akihide , Arai Yuta , Takeshige Tomohito , Ninomiya Hironori , Takahashi Kazuhisa
Published: January 2021

To date, several studies have described the mechanism of resistance to first‐ or second‐generation anaplastic lymphoma kinase (ALK) inhibitors. Secondary ALK mutations, ALK gene amplification, and other bypass signal activations (i.e., KRAS mutation, EGFR mutation, amplification of KIT, and increased autophosphorylation of EGFR) are known as resistance mechanisms. However, little has been previously reported on acquired resistance mechanisms to lorlatinib. Here, we report a case of a patient with ALK‐positive lung adenocarcinoma that acquired resistance to lorlatinib during treatment for brain metastasis and showed histological transformation to squamous cell carcinoma with MET amplification. We also review the previous literature on the resistance mechanism to ALK inhibitors.
Intrathecal catheter use after accidental dural puncture in obstetric patients: literature review and clinical management recommendations
Authors: Orbach‐Zinger S. , Jadon A. , Lucas D. N. , Sia A. T. , Tsen L. C. , Van de Velde M. , Heesen M.
Published: January 2021

If an accidental dural puncture occurs, one option is to insert a catheter and use it as an intrathecal catheter. This avoids the need for a further injection and can rapidly provide labour analgesia and anaesthesia for caesarean section. However, there are no recommendations for managing intrathecal catheters and, therefore, significant variation in clinical practice exists. Mismanagement of the intrathecal catheter can lead to increased motor block, high spinal anaesthesia, drug error, hypotension and fetal bradycardia. Care must be taken with an intrathecal catheter to adhere to strict aseptic technique, meticulous labelling, cautious administration of medications and good communication with the patient and other staff. Every institution considering the use of intrathecal catheters should establish a protocol. For labour analgesia, we recommend the use of dilute local anaesthetic agents and opioids. For caesarean section anaesthesia, gradual titration to the level of the fourth thoracic dermatome, with full monitoring, in a facility equipped to manage complications, should be performed using local anaesthetics combined with lipophilic opioids and morphine or diamorphine. Although evidence of the presence and duration of intrathecal catheters on the development of post‐dural puncture headache and need for epidural blood patch is limited, we suggest considering leaving the intrathecal catheter in for 24 hours to reduce the chance of developing a post‐dural puncture headache while maintaining precautions to avoid drug error and cerebrospinal fluid leakage. Injection of sterile normal saline into the intrathecal catheter may reduce post‐dural puncture headache. The level of evidence for these recommendations was low.
Emergency hernia surgery at a high‐volume tertiary centre: a 3‐year experience
Authors: Russell Thomas B. , Elberm Hassan
Published: January 2021

Background

Hernia surgery is often considered minor. However, emergency abdominal wall hernia (AWH) surgery is associated with significant morbidity. This study reviews a high‐volume centre's experience.

Methods

This is a retrospective review of all emergency AWH operations performed between 2014 and 2017. The following were analysed: patient demographics, ASA grade, type of hernia, time from admission to surgery, use of pre‐operative imaging, sac content, details of bowel resection, rate of admission to high dependency unit (HDU)/intensive care unit (ICU), length of stay and morbidity/mortality.

Results

A total of 198 cases were included. Median age was 67.4 years (range 19–95). 52.2% of patients were ASA III or above. Median time from admission to surgery was 13 h (range 1–341) and median length of stay was 4 days (range 1–75). The sac contained bowel in 93 cases (47.0%). These patients had longer length of stay (P < 0.01) and were more frequently admitted to HDU/ICU (P < 0.01). Thirty‐one patients underwent bowel resection (33.3% of those with bowel involvement and 15.7% of the total). Twenty‐seven patients (13.6%) were admitted to HDU/ICU post‐operatively. Six patients (3.0%) had an unplanned return to theatre and 66 patients (33.3%) had a post‐operative complication. Inpatient mortality was three (1.51%).

Conclusions

Patients who undergo emergency AWH surgery represent a relatively aged and co‐morbid group. This surgery is associated with significant morbidity and consumes considerable hospital resources. Efforts should be made to identify the higher risk subgroup with bowel involvement. Elderly and co‐morbid patients should be listed for timely elective surgery wherever suitable.
The Significance of the Insignificant: Borders, Urban Space, Everyday Life
Authors: Lafazani Olga
Published: January 2021

This paper can be read as a film sequence, as each scene is based on the narration of a different everyday encounter in the city. The aim of the paper is to start a discussion on the multiple ways borders proliferate in the urban: not only through laws, institutions or policing practices, but also through deeds, words, and feelings. Rather than analyse migration and borders by focusing only on the borderzones, this paper captures the multiple relations that connect the camp to the city square, the deportation regime to the train carriage, the newspaper headlines to the housing tenements in an attempt to work towards framing a broader theory of borders in geographical terms. Focusing on everyday encounters generates more complicated and nuanced understandings of subjectivity and power, while it brings to the fore the multiple borders that are simultaneously embodied and transcended, performed and challenged, established and subverted.
Prenatal origins of neuropsychiatric diseases
Authors: Amgalan Ariunzaya , Andescavage Nickie , Limperopoulos Catherine
Published: January 2021

Aim

The main objective is to review the available evidence in the literature for developmental origins of neuropsychiatric diseases and their underlying mechanisms. We also probe emerging cutting‐edge prenatal MR imaging tools and their future role in advancing our understanding the prenatal footprints of neuropsychiatric disorders.

Observations

Both human and animal studies support early intrauterine origins of neuropsychiatric disease, particularly autism spectrum disorders (ASD), attention and hyperactivity disorders, schizophrenia, depression, anxiety and mood disorders. Specific mechanisms of intrauterine injury include infection, inflammation, hypoxia, hypoperfusion, ischaemia polysubstance use/abuse, maternal mental health and placental dysfunction.

Conclusions and Relevance

There is ample evidence to suggest developmental vulnerability of the foetal brain to intrauterine exposures that increases and individual's risk for neuropsychiatric disease, especially the risk of ASD, depression and anxiety. Elucidating the exact timing and mechanisms of injury can be difficult and require novel, non‐invasive approaches to the study emerging structural and functional brain development of the foetus. Clinical care should both emphasise maternal health during pregnancy, as well as close, continued monitoring for at risk offspring throughout young adulthood for the early identification and treatment of neuropsychiatric diseases.
Impact of pharmacist‐led medication therapy management in ambulatory elderly patients with chronic diseases
Authors: Wang Xin , Wang Shihui , Yu Xiaojia , Ma Zhuo , Wang Huaguang , Yang Jing , Liu Lihong
Published: January 2021

Aims

This study aimed to assess the impact of pharmacist‐led medication therapy management (MTM) performed on ambulatory elderly patients with chronic diseases.

Methods

Patients who came to a pharmacist‐led outpatient clinic between January 2016 and June 2018 were enrolled in this study. Eligible subjects received MTM services from the pharmacists at least twice a year and the clinical data of these patients were complete. Drug‐related problems (DRPs) and recommendations were evaluated using The Pharmaceutical Care Network Europe Classification for Drug related problems V8.03.

Results

A total of 525 DRPs were identified during the study period. Treatment effectiveness (53.71%) was the most common DRP. The most frequently recommended intervention was changing the drug (48.76%). There were 92.38% patients accepting the interventions and 90.48% patients completely implemented. The number of drugs taken was the significant associated factor for DRPs. Postintervention data collection showed lower levels in systolic blood pressure (BP) and diastolic BP compared to the preintervention data collection. There were statistically significant changes in total cholesterol, low‐density lipoprotein cholesterol and triglycerides between the pre‐ and postintervention data collections. The average cost of medications per patient for every month decreased from 387.72 to 355.17 renminbi (P = .009).

Conclusion

We confirmed that pharmacists had a valuable role to perform MTM services for ambulatory elderly patients, not only in identifying and solving the DRPs, but also in improving clinical outcomes (BP and lipid level) and cost‐saving effect.
The role of school‐based relationships for school well‐being: How different are high‐ and average‐ability students?
Authors: Weyns Tessa , Colpin Hilde , Verschueren Karine
Published: January 2021

Background

Relationships with peers and teachers are keys for children’s psychosocial development. However, it is unclear whether this also applies for high‐ability children. This study adds to the literature by longitudinally examining the role of interpersonal relationships in the educational context for high‐ and average‐ability students.

Aims

In this study, we examined whether high‐ and average‐ability students differ in terms of peer acceptance, teacher conflict, and school well‐being. Further, we studied the potential bi‐directional effects between school well‐being, teacher conflict, and peer acceptance in late childhood and examined whether the relations between these concepts differ between high‐ and average‐ability students.

Sample

The total sample consisted of 3,101 Belgian students (49.9% boys, Mage = 9.76 years), with 348 high‐ability and 2,753 average‐ability students.

Methods

Cognitive ability was assessed in Grade 3 with two cognitive ability tests (for crystallized intelligence and fluid intelligence, respectively). The students were followed for three years (Grades 4, 5, and 6), and each year their current teacher filled out questionnaires regarding teacher–child conflict, peer acceptance, and school well‐being.

Results

High‐ability students showed lower teacher conflict, higher peer acceptance, and better school well‐being than average‐ability students. Cross‐lagged analyses showed that peer acceptance consistently predicted school well‐being over time, while Grade 4 school well‐being impacted Grade 5 teacher conflict. Also, better peer acceptance in Grade 5 predicted lower teacher–student conflict in Grade 6. Multigroup analyses revealed similar associations for both groups.

Conclusions

Our results show that high‐ability students in general display more positive school‐based social relationships and school well‐being than average‐ability students. We found no differences in the links between these variables for both groups (i.e., high‐ability students and average‐ability students).
Compartmentation of β2‐adrenoceptor stimulated cAMP responses by phosphodiesterase types 2 and 3 in cardiac ventricular myocytes
Authors: Rudokas Michael W. , Post John P. , Sataray‐Rodriguez Alejandra , Sherpa Rinzhin T. , Moshal Karni S. , Agarwal Shailesh R. , Harvey Robert D.
Published: January 2021

Background and Purpose

In cardiac myocytes, cyclic AMP (cAMP) produced by both β1‐ and β2‐adrenoceptors increases L‐type Ca2+ channel activity and myocyte contraction. However, only cAMP produced by β1‐adrenoceptors enhances myocyte relaxation through phospholamban‐dependent regulation of the sarco/endoplasmic reticulum Ca2+ ATPase 2 (SERCA2). Here we have tested the hypothesis that stimulation of β2‐adrenoceptors produces a cAMP signal that is unable to reach SERCA2 and determine what role, if any, phosphodiesterase (PDE) activity plays in this compartmentation.

Experimental Approach

The cAMP responses produced by β1‐and β2‐adrenoceptor stimulation were studied in adult rat ventricular myocytes using two different fluorescence resonance energy transfer (FRET)‐based biosensors, the Epac2‐camps, which is expressed uniformly throughout the cytoplasm of the entire cell and the Epac2‐αKAP, which is targeted to the SERCA2 signalling complex.

Key Results

Selective activation of β1‐ or β2‐adrenoceptors produced cAMP responses detected by Epac2‐camps. However, only stimulation of β1‐adrenoceptors produced a cAMP response detected by Epac2‐αKAP. Yet, stimulation of β2‐adrenoceptors was able to produce a cAMP signal detected by Epac2‐αKAP in the presence of selective inhibitors of PDE2 or PDE3, but not PDE4.

Conclusion and Implications

These results support the conclusion that cAMP produced by β2‐adrenoceptor stimulation was not able to reach subcellular locations where the SERCA2 pump is located. Furthermore, this compartmentalized response is due at least in part to PDE2 and PDE3 activity. This discovery could lead to novel PDE‐based therapeutic treatments aimed at correcting cardiac relaxation defects associated with certain forms of heart failure.
Parkinson‐like early autonomic dysfunction induced by vagal application of DOPAL in rats
Authors: Sun Jie , He Chao , Yan Qiu‐Xin , Wang Hong‐Dan , Li Ke‐Xin , Sun Xun , Feng Yan , Zha Rong‐Rong , Cui Chang‐Peng , Xiong Xue , Gao Shan , Wang Xue , Yin Rui‐Xue , Qiao Guo‐Fen , Li Bai‐Yan
Published: January 2021

Aim

To understand why autonomic failures, a common non‐motor symptom of Parkinson's disease (PD), occur earlier than typical motor disorders.

Methods

Vagal application of DOPAL (3,4‐dihydroxyphenylacetaldehyde) to simulate PD‐like autonomic dysfunction and understand the connection between PD and cardiovascular dysfunction. Molecular and morphological approaches were employed to test the time‐dependent alternation of α‐synuclein aggregation and the ultrastructure changes in the heart and nodose (NG)/nucleus tractus solitarius (NTS).

Results

Blood pressure (BP) and baroreflex sensitivity of DOPAL‐treated rats were significantly reduced accompanied with a time‐dependent change in orthostatic BP, consistent with altered echocardiography and cardiomyocyte mitochondrial ultrastructure. Notably, time‐dependent and collaborated changes in Mon‐/Tri‐α‐synuclein were paralleled with morphological alternation in the NG and NTS.

Conclusion

These all demonstrate that early autonomic dysfunction mediated by vagal application of DOPAL highly suggests the plausible etiology of PD initiated from peripheral, rather than central site. It will provide a scientific basis for the prevention and early diagnosis of PD.
Cardiac transplantation in adult congenital heart disease with prior sternotomy
Authors: Kainuma Atsushi , Ning Yuming , Kurlansky Paul A. , Axsom Kelly , Farr Maryjane , Sayer Gabriel , Uriel Nir , Lewis Matthew J. , Rosenbaum Marlon S. , Kalfa David , LaPar Damien J. , Bacha Emile A. , Takayama Hiroo , Naka Yoshifumi , Takeda Koji
Published: January 2021

Background

Adult congenital heart disease (ACHD) patients who require orthotopic heart transplantation are surgically complex due to anatomical abnormalities and multiple prior surgeries. In this study, we investigated these patients’ outcomes using our institutional database.

Methods

ACHD patients who had prior intracardiac repair and subsequent heart transplant were included (2008–2018). Adult patients without ACHD were extracted as a control. A comparison of patients with functional single ventricular (SV) and biventricular (BV) hearts was performed.

Results

There were 9 SV and 24 BV patients. The SV group had higher central venous pressure/pulmonary capillary wedge pressure (P = .028), hemoglobin concentration (P = .010), alkaline phosphatase (P = .022), and were more likely to have liver congestion (P = .006). Major complications included infection in 16 (48.5%), temporary dialysis in 12 (36.4%), and graft dysfunction requiring perioperative mechanical support in 7 (21.2%). Overall in‐hospital mortality was 15.2%. Kaplan‐Meier analysis showed a higher, but not statistically significant, survival after 10 years between the ACHD and control groups (ACHD 84.9% vs. control 67.5%, P = .429). There was no significant difference in 10‐year survival between SV and BV groups (78% vs. 88%, P = .467).

Conclusions

Complex ACHD cardiac transplant recipients have a high incidence of early morbidities after transplantation. However, long‐term outcomes were acceptable.
Critical need for pharmacologic treatment options in NAFLD: A pediatric perspective
Authors: Friesen Chance S. , Chan Sherwin S. , Wagner Jonathan B. , Hosey‐Cojocari Chelsea , Csanaky Iván L. , Shakhnovich Valentina
Published: January 2021

Nonalcoholic fatty liver disease (NAFLD) affects up to 70% of children with obesity and has become the number one etiology for liver transplant in the United States. Early, effective intervention is critical to prevent disease progression into adulthood. Yet, it is seldom achieved through lifestyle modification alone. Thus, children must be included in NAFLD pharmacology trials, which, to date, continue to focus primarily on adult populations. This commentary serves as a call to action.
Foreign body reaction toward hydrophilic polymer at the site of endovascular procedure: A report of two cases
Authors: Shah Nirav , Javeed Masi , Patel Nishit , Rodriguez‐Waitkus Paul , Chen Wei‐Shen
Published: January 2021

Hydrophilic polymer‐coated devices have been increasingly utilized for various endovascular procedures, however not been without adverse effects. We report two cases of subacute cutaneous lesions on the neck encountered in our dermatology clinic. Histopathologic findings were significant for a nodular aggregate of epithelioid histiocytes and lymphocytes with numerous foreign body giant cells in the dermis. The granulomatous infiltrate was associated with an amorphous basophilic non‐polarizable material. Further chart review reveals both patients receiving a central venous procedure in the past, thus attributing the hydrophilic polymers as the likely source of the foreign material found at the insertion site. Our cases contrast to the more commonly reported distal embolization by these hydrophilic polymer layers. We suspect the incidence of retained hydrophilic polymer at the site of prior endovascular procedures may be underreported in the literature with the more inconspicuous presentations. Therefore, retained foreign material should be considered by both treating physicians and dermatopathologists in presenting cases of lesions that occur at common sites of endovascular procedures.
Efficacy and safety of oral sulfate solution for bowel preparation in Japanese patients undergoing colonoscopy: Noninferiority‐based, randomized, controlled study
Authors: Saito Yutaka , Oka Shiro , Tamai Naoto , Kudo Toyoki , Kuniyoshi Nobutoshi , Shirakura Tatsuya , Omae Yoshio , Hamahata Yukihiro , Arai Takehiro , Tanaka Shinji , Uedo Noriya , Shimizu Seiji , Fukuzawa Masakatsu , Uraoka Toshio , Ichinose Shiori , Ogata Haruhiko , Kobayashi Kiyonori , Saito Shoichi , Tajiri Hisao
Published: January 2021

Objectives

To compare the efficacy and safety of oral sulfate solution administered using the same‐day dose and the split‐dose regimens with those of polyethylene glycol plus ascorbate solution, used for bowel preparation in Japanese patients undergoing colonoscopy.

Methods

This multicenter (n = 13), randomized, active‐controlled, colonoscopist‐ and image evaluator‐blinded, noninferiority study with parallel‐group comparison recruited 632 patients from December 2018 to June 2019. Of these, 602 patients were divided into the oral sulfate solution same‐day dose group (n = 200); oral sulfate solution split‐dose group (n = 202); and polyethylene glycol plus ascorbate same‐day dose group (n = 200). Differences in the efficacy rates between the polyethylene glycol plus ascorbate group and each oral sulfate solution group were calculated using the asymptotic method. The safety of the oral sulfate solution was evaluated, based on the occurrence of adverse events and reactions.

Results

Both oral sulfate solution protocols were confirmed as noninferior to the polyethylene glycol plus ascorbate protocol for bowel‐cleansing. The occurrence of adverse reactions was significantly lower in the oral sulfate solution same‐day dose group than in the polyethylene glycol plus ascorbate group (P = 0.010). The occurrence of adverse reactions was not significantly different between the oral sulfate solution split‐dose and the polyethylene glycol plus ascorbate group.

Conclusions

Oral sulfate solution is not only safe and efficacious but also not inferior to polyethylene glycol plus ascorbate solution (active control). It could be used for bowel preparation in Japanese patients scheduled for colonoscopy (Clinical trial registration number: NCT03794310).
Early childhood poverty and adult executive functioning: Distinct, mediating pathways for different domains of executive functioning
Authors: Evans Gary W. , Farah Martha J. , Hackman Daniel A.
Published: January 2021

Executive functioning in adulthood is associated with early‐in‐life disadvantage. Furthermore, distinct and independent underlying processes account for differences in specific domains of adult executive functioning. The duration of poverty from birth to age 9 is associated with reduced adult inhibitory control assessed by the Flanker task (n = 233, M = 23.52 years). This effect is largely explained by lower levels of maternal responsiveness in adolescence. Early poverty also related to worse working memory in adulthood, and this effect is partially explained by elevated allostatic load during adolescence, an index of chronic physiological stress.
Students’ learning environment perception and the transition to clinical training in dentistry
Authors: Serrano Carlos M. , Lagerweij Maxim D. , de Boer Ilse R. , Bakker Dirk R. , Koopman Pepijn , Wesselink Paul R. , Vervoorn Johanna M.
Published: January 2021

Introduction

The learning environment (LE) influences students’ behaviour, and predicts academic achievement, satisfaction and success. Measuring students’ perception of the LE provides relevant information for curricular quality assurance. In this study, a LE assessment was used to observe variations in students’ LE perception throughout the curriculum, to illustrate the possible influence that preclinical training (Pt) and clinical training (Ct) have on students’ learning experience.

Materials and Methods

All students in the six‐year undergraduate dental programme (n = 849) at the Academic Centre for Dentistry Amsterdam (ACTA) were approached and divided into Pt and Ct groups according to their training phase in the curriculum. The LE was assessed using the Dundee Ready Educational Environment Measure (DREEM), and the results were evaluated using the Statistical Package for the Social Sciences (SPSS) software for distribution (Kolmogorov‐Smirnov normality test), internal reliability (Cronbach's alpha) and comparative analysis (one‐way ANOVA).

Results

The questionnaire was completed by 216 (response rate=65%) Pt students and by 379 (response rate=75%) Ct students. With a general DREEM score of 124.3, significantly higher scores were found during Pt (DREEM=133.4) in comparison with the Ct phase of the curriculum (DREEM=119.2). DREEM scores steadily decreased throughout the 6‐year curriculum, with the highest drops in LE perception observed in the second and third years of the programme. Significant differences in all DREEM domains were observed, with lower scores for Ct.

Conclusion

Students’ LE perception deteriorates throughout the curriculum, especially within the Pt‐Ct transition, during the second and third years of the programme. An inferior LE perception was observed in every domain of the LE questionnaire within this transition showing a learning experience, which requires an educational intervention. Further research is required to better understand the educational needs of the Pt‐Ct transition at this school.
Understanding the well‐being of dentistry students
Authors: Stormon Nicole , Sexton Christopher , Ford Pauline J. , Eley Diann S.
Published: January 2021

Introduction

The transactional model of stress is a framework describing the process for coping with stressful events as a relationship between the individual person and environment. This study aimed to investigate the associations between personality, learning environment and experiences of mental health for a cohort of Australian dentistry students.

Materials and methods

Students were invited in 2017 to complete an online questionnaire including the Depression, Anxiety and Stress Scale (DASS‐21), The Dundee Ready Education Environment Measure (DREEM) and Cloninger’s Temperament and Character Inventory (TCIR‐140). Students were followed‐up one year later, and generalised estimating equations were used.

Results

A total of 219 (response 73.5%) students participated in the study. Two personality profiles of dentistry students were identified. Group 1 were significantly higher in the traits persistence, self‐directedness, cooperativeness and reward dependence, whereas Group 2 were significantly higher in harm avoidance. Students with Group 2 personality had a 3.12 (CI:1.72‐5.65) increased odds of depression compared to Group 1 students. Compared to students with positive perceptions of the learning environment, students with negative perceptions had increased odds of stress (3.48, CI: 1.85‐6.53), depression (2.71, CI: 1.57‐ 4.65) and anxiety (2.59, CI: 1.56‐4.28).

Conclusion

Students with personalities high in levels of self‐directedness, cooperativeness and persistence and low in harm avoidance, as found in Group 1, demonstrate high levels of general well‐being. Positive perceptions of the dentistry learning environment were found to be an important influence on students stress. This study highlighted a number of factors important to student well‐being and provides direction for further investigation of interventions aimed at enhancing student well‐being.
Seizures in autoimmune encephalitis—A systematic review and quantitative synthesis
Authors: Yeshokumar Anusha K. , Coughlin Arielle , Fastman Jarrett , Psaila Kendall , Harmon Michael , Randell Taylor , Schorr Emily M. , Han Helen , Hoang Hai , Soudant Celine , Jette Nathalie
Published: January 2021

Objective

This study aimed to evaluate the proportion of patients with seizures and electroencephalography (EEG) abnormalities in autoimmune encephalitis (AE) and its most common subtypes.

Methods

This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) standards and was registered with the International Prospective Register of Systematic Reviews (PROSPERO). We searched Medline All, Embase, and PsychINFO in Ovid from inception to June 2019 for articles pertaining to AE and seizure. Included studies reported seizure and/or EEG data in cohorts of ≥10 AE patients. Patient demographics, antibody type, seizure incidence, and EEG findings were extracted. Review of studies and data extraction were performed in duplicate. In addition to descriptive analysis, quantitative synthesis stratified by autoantibody subtype was performed with logistic regression and chi‐square analyses.

Results

Our search yielded 3856 abstracts: 1616 were selected for full‐text review and 118 studies met eligibility criteria. Of 3722 antibody‐positive AE patients, 2601 (69.9%) had clinical seizures during the course of their illness. Of the 2025 patients with antibody‐positive AE and available EEG data, 1718 (84.8%) had some EEG abnormality (eg, epileptiform discharges, slowing, and so on). Anti‐ N‐methyl‐d‐aspartate (NMDA) receptor encephalitis (anti‐NMDARE) was the most commonly reported type of AE (1985/3722, 53.3%). Of the anti‐NMDARE patients with available seizure or EEG data, 71.8% (n = 1425/1985) had clinical seizures during their illness, and 89.7% (n = 1172/1306) had EEG abnormalities. For all AE patients and in the anti‐NMDARE subpopulation, seizures were more common in younger patients (p < .05).

Significance

This systematic review provides an estimate of the proportion of AE patients with seizures, confirming the magnitude of seizure burden in this population. Prospective studies are needed to understand population‐based prevalence of seizures, identify factors associated with seizures, and evaluate particular EEG findings as biomarkers of seizures and outcomes in AE.
Short selling, agency, and corporate investment
Authors: Nezafat Mahdi , Shen Tao , Wang Qinghai
Published: January 2021

In this article, we examine corporate investment decisions in a model with short selling. We show that high short‐selling activities can cause firms to overinvest and that the agency problems between managers and shareholders drive this overinvestment. Empirically, we find that short interest is positively associated with subsequent corporate investment and that the effect of short‐selling activities on investment is stronger when the sensitivity of chief executive officer compensation to stock price performance is greater. The results are not explained by short‐sale constraints or firm overvaluation. Additionally, short‐selling‐induced corporate investments can partly explain the negative relation between both short interest and corporate investment with subsequent stock returns.
Participation of nurse managers in the health policy process: a qualitative study of barriers and facilitators
Authors: Hajizadeh A. , Zamanzadeh V. , Khodayari‐Zarnaq R.
Published: January 2021

Aim

To explore the barriers and facilitators concerning nurse managers’ participation in the health policy‐making process.

Background

Despite encouragement for participation in policy‐making, nurse managers are seldom involved in this process.

Methods

A qualitative descriptive research design based on purposive sampling was conducted. Semi‐structured one‐to‐one interviews were conducted with nurse managers and key informants (n = 16). Interviews were digitally recorded, transcribed verbatim, and analyzed by thematic analysis. The Standards for Reporting Qualitative Research (SRQR) checklist was applied to study reporting.

Findings

Three levels of barriers were found to nurse managers’ participation in health policy‐making. The individual level included weakness in characteristics of nurse managers, and the organizational level constituted the inefficient structure. In addition, the environment‐related level encompassed external barriers to the organization. Finally, three facilitators with the potential were identified for improving nurse managers’ participation in the policy‐making process, including improvements in collaboration and communication, governmental and non‐governmental organizational activities, and reforms in the health policy‐making process.

Conclusion

Nurse managers need to use the window of opportunity to participate in health policy‐making. More importantly, they should be informed about health policy in order to meet the demands of the rapidly changing healthcare environment. Drawing upon their professional organizations and positions, nurse leaders require to network and make a space to stimulate their participation in the policy.

Implications for nursing policy and health policy

Nurse managers need to develop political skills and utilize strategies to help their participation in health policy‐making, leading to better implementation of policies, efficiency, and effectiveness in the health system.
Efficacy of a topical concentrated surfactant gel on microbial communities in non‐healing diabetic foot ulcers with chronic biofilm infections: A proof‐of‐concept study
Authors: Malone Matthew , Radzieta Michael , Schwarzer Saskia , Jensen Slade O. , Lavery Lawrence A.
Published: January 2021

This proof‐of‐concept study sought to determine the effects of standard of care (SOC) and a topically applied concentrated surfactant gel (SG) on the total microbial load, community composition, and community diversity in non‐healing diabetic foot ulcers (DFUs) with chronic biofilm infections. SOC was provided in addition to a topical concentrated SG, applied every 2 days for 6 weeks. Wound swabs were obtained from the base of ulcers at baseline (week 0), week 1, mid‐point (week 3), and end of treatment (week 6). DNA sequencing and real‐time quantitative polymerase chain reaction (qPCR) were employed to determine the total microbial load, community composition, and diversity of patient samples. Tissue specimens were obtained at baseline and scanning electron microscopy and peptide nucleic acid fluorescent in situ hybridisation with confocal laser scanning microscopy were used to confirm the presence of biofilm in all 10 DFUs with suspected chronic biofilm infections. The application of SG resulted in 7 of 10 samples achieving a reduction in mean log10 total microbial load from baseline to end of treatment (0.8 Log10 16S copies, ±0.6), and 3 of 10 samples demonstrated an increase in mean Log10 total microbial load (0.6 log10 16S copies, ±0.8) from baseline to end of treatment. Composition changes in microbial communities were driven by changes to the most dominant bacteria. Corynebacterium sp. and Streptococcus sp. frequently reduced in relative abundance in patient samples from week 0 to week 6 but did not disappear. In contrast, Staphylococcus sp., Finegoldia sp., and Fusobacterium sp., relative abundances frequently increased in patient samples from week 0 to week 6. The application of a concentrated SG resulted in varying shifts to diversity (increase or decrease) between week 0 and week 6 samples at the individual patient level. Any shifts in community diversity were independent to changes in the total microbial loads. SOC and a topical concentrated SG directly affect the microbial loads and community composition of DFUs with chronic biofilm infections.
Habitat‐specific survival of golden‐winged warblers Vermivora chrysoptera during the non‐breeding season in an agricultural landscape
Authors: Ritterson Jeffrey D. , King David I. , Chandler Richard B.
Published: January 2021

Nearctic‐Neotropical migratory birds are considered priority species for conservation because they are subject to threats at distinct breeding, migratory and stopover locations throughout their annual cycle, and many species have undergone severe population declines. Research during the non‐breeding season has focused on identifying the locations and habitats that migrants use, but wintering migrants are known to occupy habitats of both high and low quality, especially when the best sites are saturated by conspecifics. Thus, the presence or abundance of a species may not be a reliable indicator of winter habitat quality. The habitat associations of the golden‐winged warbler Vermivora chrysoptera, a Nearctic‐Neotropical migrant bird species of elevated conservation concern, are relatively well studied, yet conservation efforts are hindered by lack of information about basic demographic rates. In particular, no published estimates exist for non‐breeding season survival, which can be a key vital rate affecting population viability, nor how survival rates vary among habitats, which is important to designing conservation programs to support populations during the winter period. We studied a color‐banded population of golden‐winged warblers in Costa Rica over a three‐year period and estimated overall survival rates, and the effects of habitat characteristics on survival. We found that monthly survival of juveniles (0.881) was lower than adult birds (0.978). Monthly survival during the non‐breeding season (0.967) was higher than monthly survival during the rest of the annual cycle (0.930). Survival was negatively related to canopy height, and we observed a significant quadratic effect where survival peaked at intermediate levels of vine tangles and dead hanging leaves, which corresponds to habitat features associated with abundance in prior studies at this same site. Our findings contribute to our existing knowledge about the potential impacts of winter‐season events on Nearctic‐Neotropical migratory bird populations, and also informs potential conservation strategies for wintering golden‐winged warblers.
The correlates of intraspecific variation in nest height and nest building duration in the Eurasian blue titCyanistes caeruleus
Authors: der Weduwen Dagmar , Keogan Katharine , Samplonius Jelmer M. , Phillimore Albert B. , Shutt Jack D.
Published: January 2021

Birds build nests primarily as a receptacle to lay their eggs in, but they can also provide secondary benefits including structural support, camouflage and adjustment of the microclimate surrounding the eggs and offspring. The factors underlying intraspecific variation in nest characteristics are poorly understood. In this study, we aim to identify the environmental factors that predict nest height variation and the duration of nest building in blue titsCyanistes caeruleus, evaluating latitude, elevation, temperature and the timing of egg‐laying as predictors of nest height, while also taking into account female and male parental identity. Using 713 nest height observations collected over a period of five years along a 220 km transect in Scotland, we found that if the annual mean timing of egg‐laying was earlier, nests were taller. However, there was no correlation between nest height and elevation, latitude, the minimum temperature in the 14 days pre‐egg‐laying or the phenology of birds within a year. Female parental identity accounted for a large amount of variation in nest height, suggesting that individual behaviour has an influence on nest structure. We also found that nest building duration was shorter when egg laying occurred earlier in the year, and that across all observations taller nests took longer to build. Overall, our results show that blue tits are able to alter their nest characteristics based on environmental gradients like latitude (in the case of building duration) and the annual mean phenological variation of egg laying, and that birds build relatively taller nests faster.
Effects of community of inquiry, learning presence and mentor presence on K‐12 online learning outcomes
Authors: Zhang Yining , Lin Chin‐Hsi
Published: January 2021

This study extends the community of inquiry (CoI) framework and self‐regulated learning (SRL) theory through an exploration of the structural relationships among existing CoI variables, learning presence (i.e., self‐efficacy and online SRL strategy) and learning outcomes in the context of K‐12 online learning. To help understand the influence of K‐12 mentoring – which is unique to online learning in the U.S. – mentor presence is also included. Structural equation modelling of 696 online 8th through 12th graders' survey responses and final grades showed that adding learning presence to the CoI framework helped to explain how these learners translated their online‐learning perceptions into cognitive and affective learning outcomes. We also found that mentor presence significantly and positively predicted online SRL strategy, one of the two components of learning presence. Lastly, we established a connection between the CoI model and various types of learning outcomes that are indicators of K‐12 online learning success – though it should be noted that important differences existed between a model based on final grades and two other outcome models. It is hoped that the processes identified in this study will be useful and relevant to K‐12 online‐learning institutions and educators seeking to improve their offering via a wide range of approaches.
A new transseptal solution for enabling left atrial access of large delivery sheaths
Authors: Inohara Taku , Gilhofer Thomas , Al‐Dujaili Saja , Leung Linus , Yeung Darwin , Tsang Michael , Saw Jacqueline
Published: January 2021

Background

Transseptal access for large sheaths may be encumbered by tissue resistance against the sheath–dilator stepped interface. The ExpanSure Large Access Transseptal Dilator (Baylis Medical) is designed as a single introducer and dilation device with a smooth sheath–dilator transition to support transseptal puncture. It may facilitate ease and efficiency of interatrial crossing.

Methods

This study experimentally evaluated the crossing force of ExpanSure relative to a conventional 8.5 F Swartz SL1 transseptal sheath and dilator in a benchtop septum model. Its ability to reduce the subsequent crossing force of a 14 F WATCHMAN delivery sheath was also tested. The clinical use of ExpanSure, including procedure time, was then validated in a series of left atrial appendage closure (LAAC) procedures.

Results

In a benchtop septum model (N = 12), less peak force (1.90 ± 0.08 N vs. 2.36 ± 0.09 N; p < .001) and overall work (17.3 ± 1.2 mJ vs. 28.0 ± 1.9 mJ; p < .001) were required to advance ExpanSure relative to a conventional SL1 transseptal sheath and dilator system. Peak force (2.34 ± 0.24 N vs. 2.65 ± 0.21 N; p < .003) and overall work (28.5 ± 3.9 mJ vs. 35.4 ± 2.1 mJ; p < .001) to advance a WATCHMAN sheath were also significantly lower after using ExpanSure than after using a conventional transseptal system. In 19 LAAC procedures, ExpanSure crossed the septum smoothly and integrated readily, which enabled efficient procedure completion (mean total procedure time 37.6 ± 13.5 min), with 100% success and no procedure‐related complications.

Conclusion

Experimental force measurements, combined with early clinical experience using ExpanSure, suggest that the tapered design with smooth transition without dilator–sheath step‐up and the larger diameter, both facilitated ease and efficiency of interatrial crossing.