bluuebunny/crossref_metadata_2025 huggingface dataset:
Phase 1 study of the PI3Kδ inhibitor INCB040093 ± JAK1 inhibitor itacitinib in relapsed/refractory B-cell lymphoma
Authors: Phillips Tycel J. , Forero-Torres Andres , Sher Taimur , Diefenbach Catherine S. , Johnston Patrick , Talpaz Moshe , Pulini Jennifer , Zhou Li , Scherle Peggy , Chen Xuejun , Barr Paul M.
Published: April 2018

Key Points

INCB040093 was active across lymphoma subtypes, and the addition of itacitinib provided substantial activity in classic Hodgkin lymphoma. INCB040093 ± itacitinib had a manageable safety and tolerability profile; severe hepatic adverse effects were less common with the combination.
Real-world outcomes in hereditary angioedema: first experience from the Icatibant Outcome Survey in the United Kingdom
Authors: Longhurst Hilary J. , Dempster John , Lorenzo Lorena , Buckland Matthew , Grigoriadou Sofia , Symons Christine , Bethune Claire , Fabien Vincent , Bangs Catherine , Garcez Tomaz
Published: April 2018

Background

Hereditary angioedema (HAE) is a potentially life-threatening, bradykinin-mediated disease, often misdiagnosed and under-treated, with long diagnostic delays. There are limited real-world data on best-practice management of HAE in the UK.

Objectives

To characterize the clinical profile, management and outcomes of patients with HAE type I and II from three specialist centres in the UK using data from the Icatibant Outcome Survey (IOS; Shire, Zug, Switzerland), an international observational study monitoring safety and effectiveness of icatibant, a selective bradykinin B2 receptor antagonist.

Methods

We performed retrospective analyses of IOS data for patients with HAE type I and II from three centres in the UK and compared UK data with pooled IOS data from 10 countries (48 centres).

Results

Analyses included 73 UK and 579 non-UK patients with HAE type I or II. Median diagnostic delay was 6.2 and 5.9 years, respectively. Analysis of data collected from February 2008 to July 2016 included 286 icatibant-treated attacks in 58 UK patients and 2553 icatibant-treated attacks in 436 non-UK patients (median of 3.0 attacks per patient in both groups). More attacks were treated by icatibant self-administration in UK patients (95.8%) than in non-UK patients (86.8%, p < 0.001). Time to icatibant treatment, time to resolution and attack duration were not significantly different in the UK versus non-UK patients.

Conclusion

UK patients from the specialist centres studied report similar diagnostic delay and similar icatibant treatment outcomes to their non-UK counterparts. However, improvements in the timely diagnosis of HAE are still required.

Trial registration ClinicalTrials.gov NCT01034969
Serum periostin levels following small bone fractures, long bone fractures and joint replacements: an observational study
Authors: Varughese Rachel , Semprini Ruth , Munro Claire , Fingleton James , Holweg Cecile , Weatherall Mark , Beasley Richard , Braithwaite Irene
Published: April 2018

Background

In asthma, serum periostin may potentially be used as a biomarker in the management of patients with Type-2 eosinophilic airway inflammation. However, serum periostin may be influenced by factors other than Type 2 inflammation, potentially confounding its interpretation. We aimed to measure change in periostin following bone injury.

Methods

102 adults without asthma were recruited into three groups: joint replacement surgery, long bone fracture, short bone fracture. Participants underwent seven measurements of serum periostin over 26 weeks after bone injury, and prior to surgery in the joint replacement group. Differences in periostin were measured using a ratio of geometric mean (RGM), with comparison made with pre-surgery (joint replacement) or 26 week (long and short fracture) reference measurements.

Results

In the joint replacement group, periostin fell within 48 h (RGM 0.80, 95% CI 0.75–0.86), then increased to a maximum at 8 weeks (RGM 1.89, 1.77–2.02) and by 26 weeks remained above the reference measurement (RGM 1.27, 1.19–1.36). In the long bone fracture group, periostin was reduced at 48 h (RGM 0.76, 0.71–0.83) and then progressively increased to a maximum at 8 weeks (RGM 1.15, 1.06–1.23) compared with the reference measurement. In the short bone fracture group, periostin was reduced at 48 h (RGM 0.9, 0.85–0.95) but was not different from after week 1 compared with the reference measurement.

Conclusions

Serum periostin levels are influenced by bone injury. The timing and extent of bone injury needs consideration if periostin is used as a biomarker in the management of eosinophilic asthma.

Trial registration This trial was prospectively registered with the Australia New Zealand Trials Registry on Feb 7 2014, (ACTRN12614000151639: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363881).
Estimating the burden of antimicrobial resistance: a systematic literature review
Authors: Naylor Nichola R. , Atun Rifat , Zhu Nina , Kulasabanathan Kavian , Silva Sachin , Chatterjee Anuja , Knight Gwenan M. , Robotham Julie V.
Published: April 2018

Background

Accurate estimates of the burden of antimicrobial resistance (AMR) are needed to establish the magnitude of this global threat in terms of both health and cost, and to paramaterise cost-effectiveness evaluations of interventions aiming to tackle the problem. This review aimed to establish the alternative methodologies used in estimating AMR burden in order to appraise the current evidence base.

Methods

MEDLINE, EMBASE, Scopus, EconLit, PubMed and grey literature were searched. English language studies evaluating the impact of AMR (from any microbe) on patient, payer/provider and economic burden published between January 2013 and December 2015 were included. Independent screening of title/abstracts followed by full texts was performed using pre-specified criteria. A study quality score (from zero to one) was derived using Newcastle-Ottawa and Philips checklists. Extracted study data were used to compare study method and resulting burden estimate, according to perspective. Monetary costs were converted into 2013 USD.

Results

Out of 5187 unique retrievals, 214 studies were included. One hundred eighty-seven studies estimated patient health, 75 studies estimated payer/provider and 11 studies estimated economic burden. 64% of included studies were single centre. The majority of studies estimating patient or provider/payer burden used regression techniques. 48% of studies estimating mortality burden found a significant impact from resistance, excess healthcare system costs ranged from non-significance to $1 billion per year, whilst economic burden ranged from $21,832 per case to over $3 trillion in GDP loss. Median quality scores (interquartile range) for patient, payer/provider and economic burden studies were 0.67 (0.56-0.67), 0.56 (0.46-0.67) and 0.53 (0.44-0.60) respectively.

Conclusions

This study highlights what methodological assumptions and biases can occur dependent on chosen outcome and perspective. Currently, there is considerable variability in burden estimates, which can lead in-turn to inaccurate intervention evaluations and poor policy/investment decisions. Future research should utilise the recommendations presented in this review.

Trial registration

This systematic review is registered with PROSPERO (PROSPERO CRD42016037510).
Mortality risk after clinical management of recurrent and metastatic adenoid cystic carcinoma
Authors: Xu Melody J. , Wu Tara J. , van Zante Annemieke , El-Sayed Ivan H. , Algazi Alain P. , Ryan William R. , Ha Patrick K. , Yom Sue S.
Published: April 2018

Background

Management of locoregional recurrence (LRR) and distant metastasis (DM) in adenoid cystic carcinoma (ACC) is guided by limited data. We investigated mortality risks in patients diagnosed and treated for recurrent ACC.

Methods

A retrospective review of ACC patients treated from 1989 to 2016 identified 36 patients with LRR or DM. High-risk disease was defined as skull base involvement (for LRR) or International Registry of Lung Metastases Group III/IV or extrapulmonary site of metastasis (for DM). Kaplan-Meier method, log-rank tests, and Cox proportional hazards were used for time-to-event analysis.

Results

Among 20 LRR and 16 DM patients, the median times to recurrence were 51 and 50 months, respectively. The median follow-up post-recurrence was 37.5 months (interquartile range (IQR)16.5–56.5). Post-recurrence 3-year overall survival (OS) was 78.5%, 73.3% for LRR and 85.1% for DM ( p = 0.62). High-risk recurrences were associated with worse 3-year OS (68.8% for high-risk and 92.3% for low-risk, χ2 = 10.4, p = 0.001). Among LRR patients, 90% had surgery as part of their treatment. Multimodality therapy, age, and histopathologic features (size, margins, solid histology, lymphovascular or perineural invasion) were not associated with PFS or OS. High-risk LRR was the only variable associated with OS (χ2 = 5.9, p = 0.01). Among DM patients, six were initially managed with observation and ten received surgery, RT, or systemic therapy. Upfront therapy was not associated with improved PFS or OS. High-risk DM was the only variable associated with OS (χ2 = 4.7, p = 0.03).

Conclusions

High-risk LRR and DM were associated with decreased 3-year OS. More effective therapies are needed for high-risk ACC recurrences.
Violence and aggression in psychiatric settings: reporting to the police
Authors: Gupta Susham , Akyuz Elvan U. , Flint Jonathan , Baldwin Toby
Published: April 2018

Violence and aggression are relatively common and serious occurrences in health and social care and rates are higher in mental health settings. Despite the National Health Service's policy of ‘zero tolerance’ of such behaviour, reporting of violence and aggression against mental health staff remains low. This article considers the nature of violence and aggression against staff in psychiatric settings and the process of involving the police to ensure an effective outcome. It outlines each step, from the initial the multidisciplinary team assessment of the incident and its reporting to the police to the making of witness statements, should the case come to court. It also explains the discretionary role of the police in deciding whether to charge and of the Crown Prosecution Service (CPS) in deciding whether to prosecute. The article stresses that NHS organisations need to provide an effective, streamlined and time-efficient reporting process, as this should reduce levels of patient violence, improve staff's well-being and morale, save costs and make the working environment safer for all.

LEARNING OBJECTIVES

•

Raise awareness of the underreporting to the police of incidents of violence and aggression against staff by psychiatric patients and recognise the benefits of reporting such incidents

•

Develop a framework for assessment and reporting of such incidents committed to the police and to the Crown Prosecution Service (CPS), in the event of possible or actual criminal proceedings

•

Develop an understanding of the role of the healthcare organisation, the police and the CPS when such incidents are reported to the police

DECLARATION OF INTEREST

None.
Evidence-based psychological approaches for auditory hallucinations
Authors: Hayward Mark
Published: April 2018

In a previous article in this journal, Turkington et al suggested a number of psychological approaches that an individual can use to reduce the distress caused by hearing voices. Despite having popular appeal, only some of these approaches have evidence for their effectiveness. Within a clinical context where few patients with psychosis have access even to evidence-based approaches, the reader is invited to familiarise themselves with the evidence before selecting which approaches to introduce to their patients.

DECLARATION OF INTEREST

M.H. is one of the authors of the self-help book Overcoming distressing Voices that is promoted within the article.
Fusion legislation and forensic psychiatry: the criminal justice provisions of the Mental Capacity Act (Northern Ireland) 2016
Authors: Campbell Philip , Rix Keith
Published: April 2018

Fusion legislation is the latest in a long line of reforms in mental health law that have sought to increase patient autonomy. It has not been without controversy, having been proposed and rejected in various jurisdictions throughout the UK and internationally, while causing considerable debate in the academic literature. This article considers some of the history and debate, along with the criminal justice provisions of the first piece of fusion legislation internationally, the Mental Capacity Act (Northern Ireland) 2016, and their potential implications.

LEARNING OBJECTIVES

•

Understand the history of fusion legislation in the UK and internationally

•

Understand the advantages and disadvantages of fusion legislation

•

Understand the Mental Capacity Act (Northern Ireland) 2016 criminal justice provisions

DECLARATION OF INTEREST

None.
Psychiatric hospitalisation and the risk of suicide
Authors: Large Matthew Michael , Kapur Nav
Published: April 2018

The association between current or recent psychiatric hospitalisation and increased suicide risk is well described. This relationship is generally assumed to be due to the selection of people at increased risk of suicide for psychiatric admission and subsequent failure of protection from suicide once admitted. Here, Matthew Large and Nav Kapur debate whether or not admission to hospital also selects for vulnerability to certain harmful aspects of hospitalisation and whether the increased rate of suicide in current and recently discharged psychiatric patients is, in fact, due to psychiatric hospitalisation itself.

Declaration of interest

M.M.L. has provided expert testimony in legal proceedings following in-patient suicide. N.K. sits on the Department of Health (England) National Suicide Prevention Strategy Advisory group.
The Incidence of Transfusion-Related Acute Lung Injury at a Large, Urban Tertiary Medical Center: A Decade’s Experience
Authors: Meyer David E. , Reynolds Jacob W. , Hobbs Rhonda , Bai Yu , Hartwell Beth , Pommerening Matthew J. , Fox Erin E. , Wade Charles E. , Holcomb John B. , Cotton Bryan A.
Published: April 2018

BACKGROUND:

While transfusion-related acute lung injury (TRALI) remains the primary cause of transfusion-related fatalities (37%), recent reports estimate the incidence of TRALI at 0.008% per unit of plasma transfused and 0.004% per all products transfused. Because blood banks have moved toward male-predominant plasma, TRALI appears, anecdotally, to have been reduced to an extremely rare event. The purpose of this study was to estimate the current incidence of TRALI at a large, urban center known for its early and aggressive use of plasma in the setting of trauma, hemorrhagic shock, and massive transfusion.

METHODS:

The Blood Bank Registry of our hospital was queried for all transfused patients admitted from September 2002 through March 2013. The blood bank collected and investigated all cases of clinical acute lung injury meeting the consensus definition for TRALI, as well as potential cases for which the donor product was recalled for having a high reactivity level of human leukocyte antigen antibodies (ie, the antibodies that could cause TRALI). Clinical reactions were reviewed in conjunction with independent serological testing and classified by transfusion medicine physicians as being “probable TRALI” or of “unrelated etiology.” The total number of units transfused at our facility during this time period was also obtained, allowing the incidence of TRALI to be estimated. Cases were analyzed based on demographics, outcome, blood types, observed symptoms and their duration, and type of product transfused.

RESULTS:

Seven cases were identified at our center for the indicated time period, with only 3 of these occurring in trauma. A total of 714,757 units of blood products were transfused between September 2002 and March 2013. The incidence of TRALI was estimated to be 1 case per 100,000 units of product for the entire study period. A broad range of patients was affected. Consistent with previous descriptions, an acute duration of symptoms (average, 1.4 days) was observed and usually resolved with supportive care. Reactions were observed predominantly in plasma products, both type specific and nontype specific.

CONCLUSIONS:

This study demonstrates that while TRALI still occurs, clinically meaningful cases are rare. Moreover, TRALI rates remain low despite the increasingly aggressive use of plasma and platelets in the trauma setting.
Device-Related Error in Patient-Controlled Analgesia: Analysis of 82,698 Patients in a Tertiary Hospital
Authors: Son Hyo-Jung , Kim Sung-Hoon , Ryu Jeong-Ok , Kang Mi-Ra , Kim Myeong-Hee , Suh Jeong-Hun , Hwang Jai-Hyun
Published: April 2018

BACKGROUND:

Patient-controlled analgesia (PCA) is one of the most popular and effective methods for managing postoperative pain. Various types of continuous infusion pumps are available for the safe and accurate administration of analgesic drugs. Here we report the causes and clinical outcomes of device-related errors in PCA.

METHODS:

Clinical records from January 1, 2011 to December 31, 2014 were collected by acute pain service team nurses in a 2715-bed tertiary hospital. Devices for all types of PCA, including intravenous PCA, epidural PCA, and nerve block PCA, were included for analysis. The following 4 types of infusion pumps were used during the study period: elastomeric balloon infusers, carbon dioxide-driven infusers, semielectronic disposable pumps, and electronic programmable pumps. We categorized PCA device-related errors based on the error mechanism and clinical features.

RESULTS:

Among 82,698 surgical patients using PCA, 610 cases (0.74%) were reported as human error, and 155 cases (0.19%) of device-related errors were noted during the 4-year study period. The most common type of device-related error was underflow, which was observed in 47 cases (30.3%). The electronic programmable pump exhibited the high incidence of errors in PCA (70 of 15,052 patients; 0.47%; 95% confidence interval, 0.36–0.59) among the 4 types of devices, and 96 of 152 (63%) patients experienced some type of adverse outcome, ranging from minor symptoms to respiratory arrest.

CONCLUSIONS:

The incidence of PCA device-related errors was <0.2% and significantly differed according to the infusion pump type. A total of 63% of patients with PCA device-related errors suffered from adverse clinical outcomes, with no mortality. Recent technological advances may contribute to reducing the incidence and severity of PCA errors. Nonetheless, the results of this study can be used to improve patient safety and ensure quality care.
Toll and Toll-like receptor signalling in development
Authors: Anthoney Niki , Foldi Istvan , Hidalgo Alicia
Published: April 2018

The membrane receptor Toll and the related Toll-like receptors (TLRs) are best known for their universal function in innate immunity. However, Toll/TLRs were initially discovered in a developmental context, and recent studies have revealed that Toll/TLRs carry out previously unanticipated functions in development, regulating cell fate, cell number, neural circuit connectivity and synaptogenesis. Furthermore, knowledge of their molecular mechanisms of action is expanding and has highlighted that Toll/TLRs function beyond the canonical NF-κB pathway to regulate cell-to-cell communication and signalling at the synapse. Here, we provide an overview of Toll/TLR signalling and discuss how this signalling pathway regulates various aspects of development across species.
Expanding the therapeutic index of radiation therapy by normal tissue protection
Authors: Montay-Gruel Pierre , Meziani Lydia , Yakkala Chakradhar , Vozenin Marie-Catherine
Published: April 2018

Normal tissue damages induced by radiation therapy remain dose-limiting factors in radiation oncology and this is still true despite recent advances in treatment planning and delivery of image-guided radiation therapy. Additionally, as the number of long-term cancer survivors increases, unacceptable complications emerge and dramatically reduce the patients’ quality of life. This means that patients and clinicians expect discovery of new options for the therapeutic management of radiation-induced complications. Over the past four decades, research has enhanced our understanding of the pathophysiological, cellular and molecular processes governing normal tissue toxicity. Those processes are complex and involve the cross-talk between the various cells of a tissue, including fibroblasts, endothelial, immune and epithelial cells as well as soluble paracrine factors including growth factors and proteases. We will review the translatable pharmacological approaches that have been developed to prevent, mitigate, or reverse radiation injuries based upon the targeting of cellular and signalling pathways. We will summarize the different steps of the research strategy, from the definition of initial biological hypotheses to preclinical studies and clinical translation. We will also see how novel research and therapeutic hypotheses emerge along the way as well as briefly highlight innovative approaches based upon novel radiotherapy delivery procedures.
Verhulst-Pearl growth model versus Malthusian growth model for in vitro evaluation of lead removal in wastewater by Photobacterium sp
Authors: Ramirez-Cando Lenin Javier , Alvarez-Mendoza Cesar Ivan , Gutierrez-Salazar Patricia
Published: April 2018

Mathematical modeling of microbial populations has a long history of application in the fields of ecology and environmental remediation. In the present study, the Verhulst-Pearl growth model and the Malthusian growth model were used to model and understand the kinetics of Photobacterium sp exposed to lead. The results show that goodness of fit of the Verhulst-Pearl growth model was better that the Malthusian growth model. Therefore, the Verhulst-Pearl growth model is considered the best option for proving useful and reliable information about Photobacterium sp kinetics growth in vitro.
Platform Architecture and Quality Trade-offs of Multihoming Complements
Authors: Cennamo Carmelo , Ozalp Hakan , Kretschmer Tobias
Published: April 2018

Multihoming, the decision to design a complement to operate on multiple platforms, is becoming increasingly common in many platform markets. Perceived wisdom suggests that multihoming is beneficial for complement providers as they expand their market reach, but it reduces differentiation among competing platforms as the same complements become available on different platforms. We argue that complement providers face trade-offs when designing their products for multiple platform architectures—they must decide how far to specialize the complement to each platform’s technological specifications. Because of these trade-offs, multihoming complements can have different quality performance across platforms. In a study of the U.S. video game industry, we find that multihoming games have lower-quality performance on a technologically more complex console than on a less complex one. Also, games designed for and released on a focal platform have lower-quality performance on platforms they are subsequently multihomed to. However, games that are released on the complex platform with a delay suffer a smaller drop in quality on complex platforms. This has important implications for platform competition, and for managers considering expanding their reach through multihoming.

The online appendix is available at https://doi.org/10.1287/isre.2018.0779 .
Risk Analysis for Large Pools of Loans
Authors: Sirignano Justin , Giesecke Kay
Published: April 2018

Financial institutions, government-sponsored enterprises, and asset-backed security investors are often exposed to delinquency and prepayment risk from large numbers of loans. Examples include mortgages, credit cards, and auto, student, and business loans. Because of the size of the pools, the measurement of these exposures is computationally expensive. This paper develops and tests efficient numerical methods for the analysis of large pools of loans as well as asset-backed securities backed by such pools. For a broad class of statistical and machine learning models of loan-level risk in discrete time, we prove a law of large numbers and a central limit theorem for the pool-level risk. The asymptotics are then used to construct computationally efficient approximations for a large pool. The approximations aggregate the full loan-level dynamics, making it possible to take advantage of the detailed loan-level data often available in practice. We furthermore prove a convergence rate for the approximation and a uniform integrability result. The latter allows the approximation to be applied to a wide class of pool-level risk statistics. To demonstrate the effectiveness of our approach, we implement it on a data set of over 25 million mortgages. The results show the accuracy and speed of the approximation in comparison to brute-force simulation of a pool, for a variety of pools with different risk profiles.

The online appendix is available at https://doi.org/10.1287/mnsc.2017.2947 .

This paper was accepted by Noah Gans, stochastic models.
Theory of Paradox Within Service-Dominant Logic
Authors: Glassburner Aaron V. , Nowicki David R. , Sauser Brian , Randall Wesley S. , Dickens John M.
Published: April 2018

The purpose of this paper is to investigate the foundational premises of service-dominant (S-D) logic through systemic and paradoxical thinking. Systemic thinking seeks to understand phenomena holistically and elementarily, while paradoxical thinking is an ontological perspective that appreciates the plurality of phenomena and accepts the notion that underlying explanations require a “both” rather than an “and/or” commitment of understanding. S-D logic is evolving as a theoretical framework in explaining how actors conduct recursive exchanges of resources in the form of value-hosting service. As with any complex system, the holistic viewing of S-D logic reveals that the complexity of service systems is, at times, inherently paradoxical. This composition highlights how systemic and paradoxical thinking, instantiated through soft systems methodology, can advance the theoretical framework of S-D logic. The proclamation is made that the identification of paradoxes within S-D logic will aid its evolution toward a general theory of marketing.
Tissue engineering strategies for the treatment of tendon injuries
Authors: González-Quevedo D. , Martínez-Medina I. , Campos A. , Campos F. , Carriel V.
Published: April 2018

Objectives

Recently, the field of tissue engineering has made numerous advances towards achieving artificial tendon substitutes with excellent mechanical and histological properties, and has had some promising experimental results. The purpose of this systematic review is to assess the efficacy of tissue engineering in the treatment of tendon injuries.

Methods

We searched MEDLINE, Embase, and the Cochrane Library for the time period 1999 to 2016 for trials investigating tissue engineering used to improve tendon healing in animal models. The studies were screened for inclusion based on randomization, controls, and reported measurable outcomes. The RevMan software package was used for the meta-analysis.

Results

A total of 388 references were retrieved and 35 studies were included in this systematic review. The different biomaterials developed were analyzed and we found that they improve the biomechanical and histological characteristics of the repaired tendon. At meta-analysis, despite a high heterogeneity, it revealed a statistically significant effect in favour of the maximum load, the maximum stress, and the Young’s modulus between experimental and control groups. In the forest plot, the diamond was on the right side of the vertical line and did not intersect with the line, favouring experimental groups.

Conclusions

This review of the literature demonstrates the heterogeneity in the tendon tissue engineering literature. Several biomaterials have been developed and have been shown to enhance tendon healing and regeneration with improved outcomes. Cite this article: D. González-Quevedo, I. Martínez-Medina, A. Campos, F. Campos, V. Carriel. Tissue engineering strategies for the treatment of tendon injuries: a systematic review and meta-analysis of animal models. Bone Joint Res 2018;7:318–324. DOI: 10.1302/2046-3758.74.BJR-2017-0326.
Gastrointestinal manifestations of extramedullary plasmacytoma: a narrative review and illustrative case reports
Authors: Glasbey JC , Arshad F , Almond LM , Vydianath B , Desai A , Gourevitch D , Ford SJ
Published: April 2018

Introduction

Solitary extramedullary plasmacytoma are rare, solid-mass tumours which appear immunophenotypically similar to multiple myeloma. The diagnosis and management of gastrointestinal plasmacytoma is complex and requires multidisciplinary input. This study presents a narrative review of intra-abdominal extramedullary plasmacytoma, illustrated with two case studies.

Methods

The PubMed database was searched without date restrictions for reports of intra-abdominal extramedullary plasmacytoma to synthesise a narrative review. Electronic records were reviewed at a high-volume, quaternary soft-tissue sarcoma centre to identify patients with histopathologically confirmed extramedullary plasmacytoma affecting the gastrointestinal tract.

Results

Gastrointestinal extramedullary plasmacytomas can present with mass effect or organ-specific dysfunction. Techniques for tissue diagnosis of extramedullary plasmacytoma vary dependent on location, with a formal diagnosis often being made from a resected specimen. Management can include surgery, radiotherapy, systemic chemotherapy or a combination. No high-quality evidence base exists to guide treatment. Two case studies of operated gastrointestinal extramedullary plasmacytoma are presented at different phases of disease progression, with a resultant impact on survival.

Conclusion

Intra-abdominal extramedullary plasmacytoma is a rare and heterogeneous condition that lacks consensus guidelines for diagnosis and management. Collaboration between international specialist centres will create better quality evidence for treatment of this cohort.
Comparative learning curves for early complications in anatomical and reverse shoulder arthroplasty
Authors: Beazley JCS , Evans JP , Furness ND , Smith CD
Published: April 2018

Introduction

There has been a significant increase in the implantation of reverse shoulder replacements over anatomical shoulder replacements in the past five years. Few comparative data exist comparing early complication rates and learning curves. This study aimed to evaluate the early complication rates and learning curves of a single surgeon series of anatomical and reverse shoulder replacements over the first five years of independent practice.

Materials and methods

The first 100 anatomical and 100 reverse shoulder replacements performed between July 2011 and July 2016 were reviewed to identify early complications. Cumulative sum plots were used to analyse the learning-curve effect.

Results

Early complications were noted in 4 anatomical and 17 reverse shoulder replacements. One of the anatomical and ten of the reverse shoulder replacements required a return to theatre within three months. The early complication rates were observed to be significantly higher in the reverse shoulder replacement group compared with the anatomical shoulder replacement group (odds ratio 4.9; 95% confidence interval 1.6–15.2, P 1/4 0.057). An inflection point on the anatomical shoulder replacement cumulative sum plot suggestive of a trend to consistent performance was reached at 16 cases. No inflection point was observed on the reverse shoulder replacement cohort.

Conclusions

We observed a significantly higher early complication rate within the reverse shoulder replacement cohort, with a tenfold increase in early reoperations. In comparison to the trend seen after 16 cases for anatomical shoulder replacement, no trend was seen in the reverse shoulder replacement cohort. This either reflects the higher complication rate seen in reverse shoulder replacement or that the learning curve extends beyond 100 cases, highlighting the need for extended performance monitoring.
An animal tissue simulation assessing three directional displacement forces on five common tracheostomy securing techniques
Authors: Yap D , Goddard S , Ng M , Al-Hussaini A , Owens D
Published: April 2018

Introduction

Several methods of securing a tracheostomy tube have been described in the literature including using ties or tapes around the neck and suturing the plastic flange to the neck in various ways. However, there are no wet lab-based studies to objectively determine the force required to displace the tracheostomy tube using different securing techniques. Ours is the first animal tissue simulation study published in the literature.

Methods

A simulated tracheostomy stoma was created on a sheep neck model. A tracheostomy tube was inserted into the stoma and secured using various methods. Tension tests were conducted to significantly displace the tube from the stoma. Each technique was repeated six times on different sheep necks. All results were analysed using SPSS®.

Results

Repeat measurements indicated that the largest displacement forces come from an oblique direction while the lowest force values were found at the lateral angle. Averages of displacement showed that medially placed sutures required the largest forces in comparison with other securing methods. Wilcoxon signed-rank testing indicated that medial and continuous suture security resists displacement at forces that otherwise displace flange and interrupted sutures.

Conclusions

This study has shown that any type of securing suture requires a greater displacement force than the strap of the tracheostomy tube holder alone. Medially placed sutures require a greater displacement force than those placed laterally. Displacement in the lateral direction requires the least force in comparison with movement at perpendicular or oblique angles.
Use of the embedded peritoneal dialysis catheter
Authors: Sinha S , Fok M , Davenport A , Banga N , Lindsey B , Fernando B , Forman CJ
Published: April 2018

Introduction

The use of embedded peritoneal dialysis (PD) catheters is purported to offer numerous benefits over standard placement. However, the optimum period of embedment and the effect of prolonged embedment on subsequent catheter function remain unclear.

Methods

This retrospective observational study looked at adult patients undergoing embedded PD catheter insertion in a large tertiary referral centre in the UK. Possible predictors for catheter non-function at externalisation were investigated. These included patient factors (age, sex, diabetic status, body mass index, ethnicity, smoking status, previous surgery, estimated glomerular filtration rate), procedural factors (modality of surgery, concurrent surgical procedure), duration of catheter embedment and catheter damage at externalisation. Outcomes examined were proportion of catheters functioning after externalisation, futile placement rate, surgical reintervention rate, infectious complication rate and proportion of externalised catheters lost owing to malfunction.

Results

Sixty-six catheters were embedded and two-thirds (n=47, 63.6%) were externalised after a median embedment period of 39.4 weeks. Of these, 25 (53.2%) functioned on externalisation. Fourteen (63.6%) of the 22 non-functioning catheters were salvaged. The overall utilisation of PD was 34/47 (72.3%) and the futile placement rate was 12.1%. Over half of the externalised catheters (n=27, 57.4%) were lost directly as a result of catheter related complications, with a median survival time of 39.4 weeks. In adjusted analysis, increasing embedment duration was significantly predictive of catheter non-function at externalisation (adjusted odds ratio: 0.957, 95% confidence interval [CI]: 0.929–0.985, p=0.003) while subsequent catheter loss was highly dependent on catheter function at externalisation (hazard ratio: 0.258, 95% CI: 0.112–0.594, p=0.001).

Conclusions

Prolonged embedment of PD catheters is associated with a significantly higher likelihood of catheter dysfunction following externalisation, which is in turn associated with subsequent catheter loss. We have discontinued the use of this technique in our unit.
Ergebnisse einer "Policy Academy" über Raumentwicklung und Verkehr: Von Amerika lernen?
Authors: Hesse Markus
Published: April 2018

1994 wurde vom IÖW gemeinsam mit der Gesamthochschule Kassel und dem Center for Clean Air Policy in Washington D.C. ein internationales Forschungs- und Politiknetzwerk im Themenfeld "Flächennutzung, Raumstruktur und Verkehr" gegründet. Ziel ist es, die Umsetzung neuer Erkenntnisse über die Wechselwirkungen zwischen Raum- und Verkehrssystem durch den Erfahrungs austausch zu fördern.
Schritte zum nachhaltigen Unternehmen: Ein dynamischer Prozess
Authors: Fichter Klaus
Published: April 2018

Den Unternehmen kommt eine Schlüsselrolle für ein "Zukunftsfähiges Deutsch-land" zu. Werden die Unternehmen diesen Ansprüchen gerecht? Der Beitrag skizziert vier Themenbereiche, die Gradmesser für die ökologische Unternehmenspolitik sind.
Indikatoren für nachhaltige Entwicklung - eine Zwischenbilanz: Der Streit um den Begriff
Authors: Diefenbacher Hans , Ratsch Ulrich
Published: April 2018

Was genau ist unter dem Schlüsselbegriff der neunziger Jahre "nachhaltige Entwicklung" zu verstehen? Die wissenschaftliche Dimension dieser Diskussion läßt sich kaum von der politisch-strategischen loslösen: Je nach Begriffsinhalt impliziert dieser sehr unterschiedlich weite und einschneidende politische Folgerungen.
Ökonomische Aspekte eines "Zukunftsfähigen Deutschlands": Eine grüne Marktagenda
Authors: Jung Wolfgang , Loske Reinhard
Published: April 2018

Es ist ein wichtiges Anliegen der Studie "Zukunftsfähiges Deutschland" (1) die ökonomistische Schlagseite der deutschen Zukunftsdebatte zu korrigieren und gleichzeitig die Vorzüge einer sozial-ökologisch orientierten Wirtschaftsweise herauszustellen. Die Autoren tragen die für die Diskussion wesentlichen Aspekte zusammen.
Öffnung des Environmental Management and Auditing Scheme (EMAS): Öko-Audit im Dienstleistungsbereich
Authors: Ankele Kathrin
Published: April 2018

Mit der EG-Oko-Audit-Verordnung ist für gewerbliche Unternehmen eine Umweltmanagement-Methode entwickelt worden, die wachsenden Zuspruch genießt. Auch Unternehmen aus bisher ausgeschlossenen Branchen wie dem Transportgewerbe oder Banken wollen an dem Gemeinschaftssystem teilnehmen. Der Artikel zeigt, wie die EG-Verordnung hierfür verändert werden müßte.
Anforderungen an betriebliche Umweltinformationssysteme: Kennzahlen für Nachhaltigkeit
Authors: Spiller Achim
Published: April 2018

Die Diskussion um ökologische Kennzahlensysteme kann inzwischen auf eine beachtliche Tradition zurückblicken. So sind im Rahmen der Entwicklung von Ökobilanzen zahlreiche Vorschläge für den Aufbau einzelwirtschaftlicher Bemes-sungsgrößen vorgelegt worden. Welche Konsequenzen ergeben sich für ein betriebliches Kennzahlensystem aus Konzepten zum nachhaltigen Wirtschaften?
Von der Produkt-zur Bedürfnisorientierung
Authors: Hockerts Kai , Moeller Michael G.
Published: April 2018

Den Unternehmen kommt eine Schlüsselrolle bei der umweit- und sozialverträglichen Gestaltung unserer Gesellschaft zu. Soweit besteht Einigkeit. Es fragt sich aber, was dies für Unternehmen bedeutet, die nur dann überleben können, wenn ihre Kunden mit den Produkten zufrieden sind. Welche Anforderungen werden an Unternehmen gestellt, und wie kann öko-effiziente Produktgestaltung aussehen?
Möglichkeiten und Grenzen verbesserter Verbraucherinformation: Denn sie wissen nicht, was sie tun ?
Authors: Weskamp Cornelia
Published: April 2018

International wird die Forderung nach einer Verbesserung der Verbraucherinformation stärker, vor allem innerhalb des "Consumer Policy Service" der Europäischen Kommission oder bei "Consumers International", dem weltweiten Dachverband aller Verbraucherorganisationen. Werden sich Konsumenten aufgrund von mehr Information nachhaltiger, also sozial- und umweltverträglicher verhalten?
Vom einzelbetrieblichen Umweltmanagement zum Stoffstrommanagement: Zeit für neue Wege?
Authors: Ankele Kathrin
Published: April 2018

Einzelbetrieblicher Umweltschutz mit dem dazugehörenden Managementsystem stößt im Zuge des Stoffstrommanagements an Grenzen. Gilt es doch auch Schwachstellen außerhalb des eigenen Betriebes aufzudecken. Ob und inwiefern müssen durch Stoffstrommanagement neue Wege des betrieblichen Umweltschutzes gegangen werden, oder aber bestehende Systeme erweitert werden?
Enquete-Kommission: Minimierungsgebot oder Leitplankenkonzept
Authors: Friege Henning
Published: April 2018

In ihrer ersten Arbeitsperiode hat die Enquete-Kommission Schutz des Menschen und der Umwelt vier Managementregeln erarbeitet, die das Leitbild nachhaltige Entwicklung konkretisieren. Das erneuerte Mandat für die Kommission (1995-1998) läuft praktisch darauf hinaus, diese operationalisierbar zu machen. Soll dabei dem Minimierungsgebot oder dem Leitplankenkonzept eine größere Bedeutung zukommen?
Stoffstrommanagement und Wettbewerb
Authors: Sacksofsky Eike
Published: April 2018

Auch im Rahmen von Stoffstrommanagement-Konzepten wird auf eine Fülle von Maßnahmen gesetzt - frei nach dem Motto: "Alles ist erlaubt, Hauptsache es nützt der Umwelt". Einige der Vorschläge, wie horizontale Kooperationen oder Selbstverpflichtungen sind jedoch durchaus widersprüchlich zu beurteilen - gerade auch im Hinblick auf den freien Wettbewerb.
Konjunktur der Müllskandale?
Authors: Hmnerkes Jörg
Published: April 2018

Mit dem neuen Kreislaufwirtschafts- und Abfallgesetz wurden nahezu alle gesteckten Ziele verfehlt. Ein Etikettenschwindel der sich nicht nur bei der Kennzeichnung der Abfallarten manifestieren wird.
Ein langer Weg hat begonnen
Authors: Zundel Stefan
Published: April 2018

Welche chemiepolitischen Ziele gilt es in Sachsen-Anhalt in Zukunft unter Berücksichtigung ökonomischer, ökologischer, sozialer und regionaler Anfor-derungen zu verfolgen? Mit Hilfe des chemiepolitischen Dialogs in Sachsen-Anhalt, der in einem einjährigen Projekt vorangetrieben wurde, konnten Schwierigkeiten und Lösungsansätze aufgedeckt werden.
Alte Annahmen bestätigt
Authors: Ankele Kathrin , Jancke Gösta
Published: April 2018

Gelingt die ökologische Bilanzierung städtischer Mobilität - angelehnt an die Ökobilanzen des produzierenden Gewerbes - alleine anhand von Fluß- und Infrastrukturdaten? Besonders im Verkehrsverhalten zeigt sich, daß soziale und städteräumliche Aspekte in eine entsprechende Bilanzierung aufgenommen werden müssen.
Konsensuale Zielbildung
Authors: Jänicke Martin
Published: April 2018

Weltweit gibt es bereits in 60 Ländern nationale Umweltpläne. Am Beispiel von fünf ausgewählten OECD-Ländern (Niederlande, Großbritannien, Kanada, Österreich und der Schweiz) haben die Autoren für die Enquete-Kommission "Schutz des Menschen und der Umwelt" die Erstellungsprozesse für die Umweltpläne untersucht und Empfehlungen für einen deutschen Umweltplan formuliert.
Die Vielfalt der Möglichkeiten
Authors: Aulinger Andreas
Published: April 2018

Kooperationen, die so selbstverständlich in die Diskussion um ökologische Unternehmenspolitik eingebracht werden, sind in mehrfacher Hinsicht wenig eindeutig. Fußen Kooperationen auf individuellen Strategien oder kollektiven Normen? Sind sie gebunden an den Dialog? Welche Rolle spielt Vertrauen? Was unterscheidet Kooperationen von Netzwerken?
Netzwerke und Innovation
Authors: Fritsch Michael
Published: April 2018

Es ist inzwischen allgemein anerkannt, daß die Entstehung von Innovationen in der Regel mit einem bedeutenden Ausmaß an Interaktion und Arbeitsteilung zwischen verschiedenen Organisationen verbunden ist. Empirische Studien bele-gen eindrucksvoll, daß sowohl die Verbreitung als auch das Ausmaß dieser Arbeitsteilung während der letzten Jahrzehnte deutlich zugenommen hat.
Eine Jahrhundertaufgabe
Authors: Loske Reinhard
Published: April 2018

Die Industriestaaten haben ihre hehren Versprechungen von Rio nicht gehalten - im Gegenteil: Es regiert ein irrationaler Ökonomismus. Um eine nachhaltige Entwicklung zu verwirklichen, sind daher neue Allianzen und ein langer Atem notwendig.
Doppelte Dividende umstritten
Authors: Rennings Klaus
Published: April 2018

Trotz einzelner Fortschritte bleibt die ökonomische Bewertung künftiger Klimaschäden schwierig. Im Klimaschutz stecken zwar hohe Einsparpotentiale, doch zwischen mikroökonomischen Ansätzen und den ökonomischen Makro-Modellen liegt noch ebenso eine Kluft wie zwischen Theorie und politischer Praxis.
Eintrittsgeld für Artenvielfalt
Authors: Lerch Achim
Published: April 2018

Die Property-Rights-Theorie liefert Ansätze, um die biologische Vielfalt der Erde zu bewahren. Wenn die Ursprungsländer durch klar zugewiesene Verfü-gungsrechte Erträge aus den genetischen Ressourcen ziehen können, bekommen sie auch einen Anreiz, in den Erhalt dieser Ressourcen zu investieren.
Hintertür im Gefangenen-Dilemma
Authors: Weimann Joachim
Published: April 2018

Menschen verhalten sich in zwei verschiedenen Entscheidungssituationen, für die es die gleiche eindeutige Lösung gibt, trotzdem unterschiedlich, wenn ihnen die Situationen unterschiedlich präsentiert werden. Im Dilemma der Ubernut-zung von Umweltgütern kann eine bestimmte Präsentation des Problems die Akteure deshalb zu stärkerer Kooperation bewegen. Der Staat könnte diesen positiven "Framing-Effekt" nutzen, ohne direkt regulierend in das Verhalten der einzelnen einzugreifen.
Wege zum ökologischen Ziel
Authors: Jakubowski Peter , Kotte Stefan , Tegner Henning
Published: April 2018

Angesichts der großen Handiungsdefizite ist es verwunderlich, das bislang für die Umweltpolitik noch immer kein konsistenter, umfassender Zielkatalog existiert. Die Autoren tragen die bisherigen Ansätze einer entsprechenden Zielsetzung zusammen, diskutieren ihre Konsequenzen und extrahieren daraus ein Entscheidungsverfahren für die umweltpolitische Zielfindung.
Modellhafte Maßnahmen
Authors: Arndt Wulf-Holger
Published: April 2018

Ein Forschungsprojekt zur Erprobung von Maßnahmen zur umweltschonenden Abwicklung des städtischen Wirtschaftsverkehrs am Institut für ökologische Wirtschaftsforschung widmet sich vor allem den Personenwirtschaftsver-kehren, die nicht ausdrücklich der Güterbeförderung dienen sowie Kleintrans-porter die mit Fahrzeugen bis zu 3,5 Tonnen zulässigem Gesamtgewicht durchgeführt werden.
Langer Atem notwendig
Authors: Rubik Frieder , Bültmann Alexandra
Published: April 2018

Wie verbreitet sind Ökobilanzen, wer gibt sie in Auftrag und welche Produkte haben sie zum Gegenstand? In einem Vergleich zwischen mehreren europäischen Staaten (Deutschland, Italien, Schweden, Schweiz) untersucht der folgende Beitrag diese Fragen. Außerdem zeigt er auf, wie Ökobilanzen in deutschen Unternehmen angewandt werden.
Interdisziplinärer Prozeß
Authors: Beyer Hans-Martin , Kaniut Claudius
Published: April 2018

Durch zahlreiche Bilanzierungsprojekte besitzt die Automobilindustrie breite Erfahrungen mit Ökobilanzen. Dabei zeigt sich, dafl diese Bilanzen ein zunehmend brauchbares Instrument zur Informationsgewinnung über ökologische Kosten sowie ökologische und ökonomische Verbesserungspotentiale werden können - allerdings mit beträchtlichem Aufwand.
Institutionen für eine nachhaltige Gesellschaft
Authors: Schneidewind Uwe
Published: April 2018

Sozialwissenschaftliche Schlüsselkonzepte wie dasjenige der "Institution" eröffnen ebenfalls den Zugang zu einer transdisziplinären Wissensgenerierung. Dabei ist die institutionelle Perspektive von hoher theoretischer und prakti-scher Relevanz in der aktuellen politischen Debatte über die Umsetzung des Konzeptes der Nachhaltigkeit
Immer bedeutenderer Schlüsselfaktor
Authors: Meyer Amt
Published: April 2018

Transdisziplinäre Wirtschaftsforschung ist nicht nur eine wissenschaftliche Trockenübung. Sie gewinnt zunehmend auch in der Unternehmensentwicklungsund -beratungspraxis an Bedeutung. Der vorliegende Beitrag illustriert dies an zwei Beispielen aus der Marktentwicklung im Bereich Öko-Textilien sowie der Einführung von Integrierten Managementsystemen bei der Hoechst AG.