bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Disease and Treatment Response in Drug–Drug Interaction Studies: Osimertinib and Simvastatin in Advanced Non‐Small Cell Lung Cancer
Authors: Vishwanathan Karthick , Cantarini Mireille , So Karen , Masson Eric , Fetterolf Jennifer , Ramalingam Suresh S. , Harvey R. Donald
Published: September 2019

A phase I, open‐label study (NCT02197234) assessed the effects of osimertinib on simvastatin exposure in patients with advanced epidermal growth factor receptor (EGFR)‐mutated non‐small cell lung cancer and disease progression post‐EGFR tyrosine kinase inhibitor treatment. Here, we report on a retrospective analysis of two patients (patients 1 and 2) who had liver metastases and high simvastatin exposure prior to osimertinib treatment, which changed following treatment. Patients received single oral doses of simvastatin 40 mg on day (D) 1 and D31, and osimertinib 80 mg once daily on D3–32. At baseline, both patients had abnormal liver function tests (LFTs; Child‐Pugh scores of 6 and 8, respectively), significant liver metastasis, and, after a single simvastatin dose, had higher (~ 10‐fold) exposure compared with all other patients. Following 31 days of continuous osimertinib treatment, simvastatin exposures (area under the plasma concentration‐time curve from zero to infinity (AUC) and maximum plasma concentration (Cmax)) and LFTs, such as alanine transaminase, aspartate aminotransferase, and bilirubin normalized to population mean values. Additionally, ~ 50% and ~ 80% reductions in liver metastases were observed on computed tomography scans in patients 1 and 2, respectively. High simvastatin exposure on D1 likely resulted from impairment of hepatic first pass metabolism due to liver metastases. Reduction in hepatic disease burden due to osimertinib treatment likely resulted in liver function returning to normal levels.
The Empathetic Museum: A New Institutional Identity
Authors: Jennings Gretchen , Cullen Jim , Bryant Janeen , Bryant‐Greenwell Kayleigh , Mann Stacey , Hove Charlette , Zepeda Nayeli
Published: September 2019

The Empathetic Museum is a group of colleagues who advocate institutional
empathy
as a transforming force for museums. Our initiative emerged in the second decade of the 21st century amidst a confluence of seismic events in the US that forced the museum field to examine its relationship to social issues. The Empathetic Museum arose as a critique of museums’ indifference and reluctance to engage with issues deeply affecting their communities, especially those of color. We propose a lack of institutional empathy as a subtle yet powerful cause of this indifference. The article traces the development of the Empathetic Museum initiative; the evolution of its philosophy of institutional empathy; the creation of the Maturity Model as a key tool for empathetic practice; and its use and impact in the field. As a work in progress, the Empathetic Museum initiative has evolved and expanded through constant observation of, reflection on, and engagement with the important issues of our time.
Exploring ayahuasca‐assisted therapy for addiction: A qualitative analysis of preliminary findings among an Indigenous community in Canada
Authors: Argento Elena , Capler Rielle , Thomas Gerald , Lucas Philippe , Tupper Kenneth W.
Published: September 2019

Introduction and Aims

A previous observational study of ayahuasca‐assisted therapy demonstrated statistically significant reductions in self‐reported problematic cocaine use among members of an Indigenous community in Canada. This paper aims to qualitatively explore the impact of ayahuasca‐assisted therapy on addiction and other substance use‐related outcomes and elucidate the lived experiences of participants.

Design and Methods

Qualitative interviews were conducted with 11 adult Indigenous participants of the ayahuasca‐assisted ‘Working with Addiction and Stress’ ceremonial retreats (June–September 2011). Semi‐structured interviews assessed experiences of participants following the retreats at 6‐month follow up. Thematic analysis of interview transcripts was conducted.

Results

Narratives revealed that the retreats helped participants identify negative thought patterns and barriers related to their addiction in ways that differed from conventional therapies. All participants reported reductions in substance use and cravings; eight participants reported complete cessation of at least one substance at follow up. Increased connectedness with self, others and nature/spirit was described as a key element associated with reduced substance use and cravings.

Discussion and Conclusions

This analysis expands upon prior quantitative results highlighting the therapeutic potential of ayahuasca‐assisted therapy and provides important contextual insights into why ayahuasca‐assisted therapy may have been beneficial for members of an Indigenous community seeking to address their problematic use of substances. Given limited efficacy of conventional treatments for resolving addiction issues, further research should investigate the role of ayahuasca and other psychedelic‐assisted therapies in enhancing connectedness and other key factors that may improve well‐being and reduce harmful substance use.
Risk factors for perinatal arterial ischaemic stroke: a large case–control study
Authors: Sorg Anna‐Lisa , von Kries Rüdiger , Klemme Mathias , Gerstl Lucia , Weinberger Raphael , Beyerlein Andreas , Lack Nicholas , Felderhoff‐Müser Ursula , Dzietko Mark
Published: September 2019

Aim

To identify maternal, obstetric, and neonatal risk factors related to perinatal arterial ischaemic stroke (PAIS) diagnosed within 28 days after birth and to understand the underlying pathophysiology.

Method

For case and control ascertainment, we used active surveillance in 345 paediatric hospitals and a population‐based perinatal database for quality assurance of hospital care. We analysed complete cases of PAIS using logistic regression. Multivariate analysis was guided by a directed acyclic graph.

Results

After exclusion of records with missing data, we analysed 134 individuals with PAIS and 576 comparison individuals. In univariate analysis, male sex, preterm birth (<37wks gestational age), small for gestational age (SGA), low umbilical artery pH (<7.1), low 5‐minute‐Apgar score (<7), multiple pregnancies, hypoxia, intubation/mask ventilation, nulliparity, Caesarean section, vaginal‐operative delivery, chorioamnionitis, and oligohydramnios were associated with an increased risk. Mutual adjustment yielded male sex (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.20–2.73), multiple birth (OR 3.22; 95% CI 1.21–8.58), chorioamnionitis (OR 9.89; 95% CI 2.88–33.94), preterm birth (OR 1.86; 95% CI 1.01–3.43), and SGA (OR 3.05; 95% CI 1.76–5.28) as independent risk factors.

Interpretation

We confirmed the increased risk in males and the role of chorioamnionitis and SGA for PAIS, pointing to the importance of inflammatory processes and fetal–placental insufficiency. Multiple birth and preterm birth were additional risk factors.

What this paper adds

Chorioamnionitis and small for gestational age (SGA) precede perinatal arterial ischaemic stroke (PAIS).

Chorioamnionitis and SGA are independent risk factors for PAIS.

Inflammatory processes and fetal–placental insufficiency are the likely underlying mechanisms.

Multiple birth and preterm birth are additional risk factors.
Primary versus secondary cardiorenal prevention in type 2 diabetes: Which newer anti‐hyperglycaemic drug matters?
Authors: Giugliano Dario , Ceriello Antonio , De Nicola Luca , Perrone‐Filardi Pasquale , Cosentino Francesco , Esposito Katherine
Published: September 2019

We are observing a resurgence of major diabetic vascular complications after a period of dramatic decrease during the period 1990 to 2010. The classical division of cardiovascular prevention into primary (with an event) and secondary (without an event) is largely used to describe cardiovascular risk in type 2 diabetes (T2D); however, there is evidence that the cardiovascular risk in diabetes may range from highest in patients who experienced a previous cardiovascular event to mild in patients with the main risk factors at target. Herein, we present details of the 14 cardiovascular outcome trials (CVOTs) published to date, including the total population investigated, and their separation into primary (T2D + multiple risk factors) and secondary prevention (T2D + established cardiovascular disease [CVD]) populations as detailed within the trials. We also summarize evidence for the effects of dipeptidyl peptidase‐4 inhibitors (DPP‐4i), glucagon‐like peptide‐1 receptor agonists (GLP1‐RA) and sodium glucose co‐transporter‐2 inhibitors (SGLT‐2i) versus placebo on the risk of major cardiovascular events (MACE), heart failure (HF) and diabetic kidney disease (DKD). In primary prevention, SGLT‐2i reduce both the risk of hospitalization for HF and progression of DKD; in secondary prevention, SGLT‐2i are effective on the three endpoints, DPP‐4i are neutral, while GLP1‐RA show mixed results.
Determination of right ventricular function with adjusted systolic to diastolic duration ratio after transannular patch repair of tetralogy of Fallot
Authors: Arndt Andrew L. , Madriago Erin , Huang Jennifer , Ronai Christina , Silberbach Michael , Broberg Craig S. , Holmes Kathryn W.
Published: September 2019

Background

Early detection of right ventricular dysfunction after transannular patch for tetralogy of Fallot (TOF‐TAP) is essential for management.

Objectives

To evaluate echocardiographic metrics of ventricular function correlate with functional MRI measurements, in patients with TOF‐TAP.

Methods

A retrospective review of patients with TOF‐TAP between 2007 and 2017 who had an echocardiogram and MRI within six months were analyzed. Systolic to diastolic ratio (SD ratio) was measured from the tricuspid regurgitation and adjusted for heart rate. Tricuspid Annular Plane Systolic Excursion (TAPSE), Fractional Area Change (FAC), and shortening fraction (SF) were additionally measured. Echocardiographic measurements were correlated with MRI assessment of right ventricular ejection fraction (RVEF), left ventricular ejection fraction (LVEF), right ventricular end‐diastolic volume index (RVEDi), and right to left ventricle volume ratio (RV/LV).

Results

Of the 53 patients (mean age 12.8 years) that met inclusion criteria, 45 (85%) had available TR jets for SD ratio analysis. The HR adjusted SD ratio negatively correlated with RVEF (r = −.359, P = .016), LVEF (r = −.317, P = .038) and positively with RV/LV EDV ratio (r = .347, P = .024). TAPSE, FAC, and SF measurements did not show significant correlation.

Conclusion

In patients with TOF‐TAP, there is a moderate negative correlation between heart rate adjusted SD ratio and MRI metrics of ventricular function, suggesting that decreased filling time is a marker for reduced right ventricular function. The SD ratio may be a useful echocardiographic tool for serial evaluation of in this population.
Allyl‐2,6‐dimethoxyphenol, a female‐biased compound, is robustly attractive to conspecific males of Bactrocera dorsalis at close range
Authors: Shen Jianmei , Hu Liming , Zhou Xinhua , Dai Jianqing , Chen Binghan , Li Shufeng
Published: September 2019

Insect cuticular hydrocarbons (CHCs) play important roles in mate recognition and chemical communication. To explore the cues regulating courtship and mating behaviour in the oriental fruit fly, Bactrocera dorsalis (Hendel) (Diptera: Tephritidae), CHCs were extracted from mature virgin female and male oriental fruit flies using n‐hexane. Nine compounds – i.e., 4‐allyl‐2,6‐dimethoxyphenol (designated ‘compound 3’) and eight ester compounds – had significantly greater abundance in female samples than in males. Of these nine compounds, six (1, 2, 4, 5, 6, and 8) elicited electrophysiological responses from the antennae of male flies. Compound 3 did not elicit a detectable male antennal response, but in Y‐tube olfactometer bioassays, it exhibited robust attractiveness to conspecific males at close range. We speculate that compound 3 is a close‐range sex pheromone in B. dorsalis. A mating competition experiment revealed that compound 3 significantly increased the competitiveness of males, which implied that compound 3 might be used in control programs of B. dorsalis.
A somatic mutation in MEN1 gene detected in periventricular nodular heterotopia tissue obtained from depth electrodes
Authors: Montier Laura , Haneef Zulfi , Gavvala Jay , Yoshor Daniel , North Robert , Verla Terence , Van Ness Paul C. , Drabek Janice , Goldman Alica M.
Published: September 2019

Periventricular nodular heterotopia (PNH) is a common structural malformation of cortical development. Mutations in the filamin A gene are frequent in familial cases with X‐linked PNH. However, many cases with sporadic PNH remain genetically unexplained. Although medically refractory epilepsy often brings attention to the underlying PNH, patients are often not candidates for surgical resection. This limits access to neuronal tissue harboring causal mutations. We evaluated a patient with PNH and medically refractory focal epilepsy who underwent a presurgical evaluation with stereotactically placed electroencephalographic (SEEG) depth electrodes. Following SEEG explantation, we collected trace tissue adherent to the electrodes and extracted the DNA. Whole‐exome sequencing performed in a Clinical Laboratory Improvement Amendments–approved genetic diagnostic laboratory uncovered a de novo heterozygous pathogenic variant in novel candidate PNH gene MEN1 (multiple endocrine neoplasia type 1; c.1546dupC, p.R516PfsX15). The variant was absent in an earlier exome profiling of the venous blood–derived DNA. The MEN1 gene encodes the ubiquitously expressed, nuclear scaffold protein menin, a known tumor suppressor gene with an established role in the regulation of transcription, proliferation, differentiation, and genomic integrity. Our study contributes a novel candidate gene in PNH generation and a novel practical approach that integrates electrophysiological and genetic explorations of epilepsy.
Low dielectric loss LNT/PEEK composites with high mechanical strength and dielectric thermal stability
Authors: Liu Shilin L. , Bian Jianjiang
Published: September 2019

(3‐Aminopropyl)triethoxysilane treated La(2−x)/3Na0.06TiO3(x = 0.06) (LNT) microparticles filled polyetheretherketone (PEEK) composites were prepared using hot pressing process. The effects of variation of LNT ceramic filling fraction on dielectric properties, water absorption, thermal stability and mechanical strength were investigated. All composites demonstrate low water absorption (less than 0.4%) when the ceramic filling fraction is lower than 0.6Vf. The obtained composites exhibited dielectric permittivities varying from ~4 to ~22 as the ceramic fillers increased from 0.1 to 0.8Vfand low losses (~10−4@1 MHz, 3~5 × 10−3at the frequencies of microwave (10 GHz) and millimeter wave (29‐50 GHz), respectively). The mechanical strength, dimensional and dielectric thermal stability of the composite are remarkably improved by the addition of LNT ceramic fillers. A composite with near zero temperature coefficients of dielectric permittivity or resonant frequency and flexural strength of ~140 MPa could be obtained. The out‐of‐plane coefficient of thermal expansion (CTE) could be reduced to ~20 ppm/°C as the ceramic filler loading reached 0.7Vf.
Enhanced piezoelectric strain of BiFeO3–Ba(Zr0.02Ti0.98)O3 lead‐free ceramics near the phase boundary
Authors: Guo Jian , Ning Zhenhai , Fu Dongyan , Cheng Jinrong , Chen Jianguo
Published: September 2019

The xBiFeO3‐(1‐x)Ba(Zr0.02Ti0.98)O3 + 1.0 mol% MnO2 (xBF‐BZT) lead‐free piezoelectric ceramics were prepared by conventional solid‐state reaction method. The structure, dielectric, and piezoelectric properties were studied. X‐ray diffraction (XRD) analysis showed that xBF‐BZT ceramics exhibited pure perovskite structure with the coexistence of tetragonal and rhombohedral phases (0.66 ≤ x ≤ 0.74). The Curie temperature Tc, the dielectric constant εr (1 kHz), dielectric loss tanδ (1 kHz), piezoelectric constant d33, coercive field Ec (80 kV/cm), and remnant polarization Pr (80 kV/cm) of 0.7BF‐0.3BZT‐Mn ceramics were 491°C, 633, 0.044, 165 pC/N, 35.6 kV/cm, and 22.6 μC/cm2, respectively. The unipolar strain of 0.7BF‐0.3BZT reached up to 0.20% under the electric field of 60 kV/cm, which is larger than that (0.15%) of BiFeO3–BaTiO3 ceramics. These results indicated that the xBF‐BZT ceramics were promising candidates for high‐temperature piezoelectric materials.
Skin diseases in rural Nyala, Sudan (in a rural hospital, in 12 orphanages, and in two refugee camps)
Authors: Kibar Öztürk Melike
Published: September 2019

Skin diseases are considered to be common in Nyala, Sudan. This study was carried out to verify the prevalence of skin diseases in Nyala. This prospective observational study included skin examination of a total of 1802 people: 620 patients who were evaluated in the outpatient clinics (OC) and 1182 people from orphanages and refugee camps (ORC) in Nyala, Sudan. χ2 test was used. The total prevalence of skin disorders in the sample was 92.6% (1670/1802). One thousand and fifty of 1182 (88.8%) people from ORC had a skin disorder. The most common skin diseases in this community were: fungal infections (32.6%), dermatitis/eczema (10.5%), bacterial skin infections (10.3%), disorders of skin appendages (8.7%), parasitic infestations (7.7%), atrophic skin disorders (7.4%), disorders of pigmentation (7.4%), hypertrophic skin disorders (6.4%), viral infections (5.8), benign neoplasm (1.9%), dermatoses due to animal injury (0.4%), bullous dermatoses (0.1%), and malignant neoplasm (0.1%). Hypertrophic and atrophic disorders of the skin were mainly lesions of scarification (mostly atrophic) (5.7%) and keloids (5.6%). Fungal infection, bacterial infection, and parasitic infestation were more common in the ORC group, while dermatitis and eczema, disorders of skin appendages, hypertrophic and atrophic disorders of the skin, disorders of pigmentation, and benign neoplasm were more common in the OC group. The prevalence of skin diseases in the rural Nyala was more than our expectation and was dominated by infectious skin diseases. In addition, infectious skin diseases were more common in ORC rather than OC.
Reconciling Perspectives on Clusters: An Integrative Review and Research Agenda
Authors: Speldekamp Daniël , Saka‐Helmhout Ayse , Knoben Joris
Published: September 2019

Although our understanding of clusters and their contribution to economic performance has improved over the last three decades, the literature has become host to a wide array of divergent empirical and theoretical claims. We systematically review cluster studies published in top journals, highlighting the lack of integration among prior work. We focus on the ways in which Porter's three cluster dimensions, namely geography, networks, and institutions, have been utilized. None of the studies reviewed fully captured their complex interrelationships, which we argue is an important cause of the key disagreements in the literature. Configurational theorizing and analysis are presented as means by which the different approaches to cluster studies could be reconciled. We discuss how the application of a configurational approach can help explore new scholarly directions that can deepen our understanding of clusters and their performance‐enhancing potential. In doing so, we can move beyond an understanding of independent effects to emphasizing combinations of attributes that can generate multiple pathways to cluster performance outcomes.
Assessment of neopterin and indoleamine 2,3‐dioxygenase activity in patients with seasonal influenza: A pilot study
Authors: Pizzini Alex , Kurz Katharina , Santifaller Janine , Tschurtschenthaler Christoph , Theurl Igor , Fuchs Dietmar , Weiss Günter , Bellmann‐Weiler Rosa
Published: September 2019

Background

Seasonal influenza is an important cause of morbidity and mortality worldwide. Immune activation after stimulation with interferon‐gamma leads to increased production of neopterin but also results in increased tryptophan catabolism through indoleamine 2,3‐dioxygenase (IDO). Our pilot study determined neopterin serum levels and IDO activity in patients with influenza infection and investigated whether neopterin is linked to clinical outcome parameters (mortality ≤30 days, acute cardiac events (ACE) length of hospitalization, ICU admission).

Methods

Neopterin concentrations were analyzed in serum samples of 40 patients with a confirmed diagnosis of influenza infection and in‐hospital treatment for >24 hours. Data were compared to values of 100 healthy blood donors and 48 age‐matched pneumonia patients. In a subgroup of 14 patients, tryptophan and kynurenine concentrations, as well as kynurenine‐to‐tryptophan ratio, were analyzed.

Results

In all influenza patients, neopterin concentrations were increased and significantly higher compared to those determined in patients with pneumonia and healthy controls. Positive correlations between the duration of hospitalization and neopterin were found. Significantly higher levels of kynurenine, kynurenine‐to‐tryptophan ratio, and lower levels of tryptophan were seen in influenza patients compared to healthy controls.

Conclusions

Neopterin seems to be related to the course of the disease and could be a valuable biomarker to identify patients at an elevated risk of a worsened outcome; however, further prospective validation studies are needed to support the here presented preliminary results.
Risk factors for the recurrence of diabetic foot ulcers among diabetic patients: a meta‐analysis
Authors: Huang Ze‐Hao , Li Si‐Qing , Kou Yan , Huang Lei , Yu Ting , Hu Ailing
Published: September 2019

This study aimed to systematically review and identify the risk factors for the recurrence of diabetic foot ulcers (DFUs) among diabetic patients. PUBMED, EMBASE, Web of Science, Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), WanFang, and VIP databases were electronically searched to identify eligible studies updated to January 2019 to collect case‐control studies or cohort studies on the risk factors for the recurrence of DFUs. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of included studies using the Newcastle‐Ottawa Scale. A meta‐analysis was performed using RevMan 5.3. Nine retrospective cohort studies were included, in which 1426 patients were enrolled, 542 in the DFU recurrence group and 884 in the non‐recurrent DFU group. Risk factors for the recurrence of DFUs included male gender (odds ratio [OR] = 1.38, 95% confidence interval [CI], 1.07‐1.78, P < .05), smoking (OR = 1.66, 95% CI, 1.26‐2.20, P = .0004), duration of diabetes (OR = 4.43, 95% CI, 1.96‐6.90, P = .0004), duration of past DFUs (OR = 1.02, 95% CI, 1.00‐1.03, P = .006), plantar ulcers (OR = 5.31, 95% CI, 4.93‐5.72, P <.00001), peripheral artery disease (OR = 1.65, 95% CI, 1.20‐2.28, P = .002), and diabetic peripheral neuropathy (OR = 2.15, 95% CI, 1.40‐3.30, P = .0005). No significant differences were found in age, body mass index, total cholesterol, diabetic nephropathy, diabetic retinopathy, or hypertension. Health care staff should pay attention to the identified risk factors for the recurrence of DFUs. Because of the limited quality and quantity of the included studies, rigorous studies with adequate sample sizes are needed to verify the conclusion.
When prejudice against you hurts others and me: The case of ageism at work
Authors: Paleari F. Giorgia , Brambilla Maria , Fincham Frank D.
Published: September 2019

Ageism in the workplace has documented detrimental consequences for its victims, but its effects on those who hold ageist views are rarely investigated. A cross‐sectional study and a longitudinal study examined ageism toward both younger and older workers and its relation to intergroup contact, work behaviors, organizational identification, and the well‐being of prejudiced individuals. It was hypothesized that ageism would predict prejudiced individuals’ behaviors toward co‐workers, identification with their organization, and vitality at work, indirectly through intergroup anxiety and quality of intergroup contact. Overall, 647 employees aged 24–62 years provided data on the variables of interest. Both studies suggested that ageist views worsened the quality of intergroup contact, which in turn increased counterproductive behaviors toward co‐workers and decreased identification with the organization. Moreover, ageism marginally predicted vitality at work longitudinally through the mediation of quality of intergroup contact. No support emerged for the mediational role of intergroup anxiety. Theoretical explanations for these findings and their practical implications are discussed.
The effect of acute coronary syndrome care pathways on in‐hospital patients: A systematic review
Authors: Daghash Hanan , Lim Abdullah Khatijah , Ismail Muhammad Dzafir
Published: September 2019

Background

Health care institutions need to construct management strategies for patients diagnosed with acute coronary syndrome (ACS) that focus on evidence‐based treatments, adherence to treatment guidelines, and organized care. These help to reduce variations as well as the mortality and morbidity rates, which indicates the critical need for standardized care and adherence to evidence‐based practices for patients hospitalized with ACS. The care pathways translate research and guidelines into clinical practice to close the gap between the guidelines and the clinical practices.

Objectives

This review focuses on identifying the indicators used to evaluate ACS care pathways and their effect on the care process and clinical outcomes.

Methods

This review follows the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines. The systematic research was conducted using five research databases. Two groups were created by dividing the studies according to their year of publication. The first group included those studies published from 1997 to 2007 (“Group 1”), while the second included those published from 2008 to 2018 (“Group 2”). Selected studies were screened using the Effective Public Health Practice Project (EPHPP) quality assessment tool.

Results

Seventeen studies were included in this review. One study was a randomized controlled trial, 14 were predesigns and postdesigns, and two were longitudinal observational designs. The Group 1 studies demonstrated that ACS care pathways had a positive effect on reducing the length of the hospital stay and the door‐to‐balloon times. Similar effects were observed for the Group 2 studies.

Conclusion

Implementing ACS care pathway helps to organize care processes and decrease treatment delays as well as improve the patient outcomes without adverse consequences for patients or additional resources and costs. While the current level of evidence is inadequate to warrant a formal recommendation, there is a need for more studies with an emphasis on well‐designed randomization to measure patient outcomes.
Strategies for implementing shared decision making in elective surgery by health care practitioners: A systematic review
Authors: Pham Clarabelle , Lizarondo Lucylynn , Karnon Jonathan , Aromataris Edoardo , Munn Zachary , Gibb Catherine , Fitridge Robert , Maddern Guy
Published: September 2019

Rationale, Aims and Objectives

To summarize relevant international scientific evidence on strategies aimed at facilitating or improving health care practitioners' adoption of shared decision making in elective surgery. The review evaluated the effectiveness of these strategies and described the characteristics of identified strategies.

Method

A systematic search of the literature was conducted up to March 2019. The review included interventions that targeted patients, health care practitioners, or health systems/organizations. Main outcomes were measures of decision process and decision outcomes. Two independent reviewers conducted study selection, assessed methodological quality and extracted data.

Results

Fifteen randomized controlled trials, one pseudo‐randomized controlled trial, and four quasi‐experimental studies were included in this review. The heterogeneity of interventions and the variability of outcomes used to measure the impact of these interventions precluded meta‐analysis. All of the interventions included an educational component regarding the medical condition of interest and available treatment options and a supportive component to encourage patients to ask questions and involve themselves in the decision making. Published evidence on shared decision‐making interventions in elective surgery is most prevalent in the breast cancer/endocrine and urology specialties, with most studies targeting their shared decision‐making interventions at the patient population. The use of multiple media components within an intervention including interactive video appeared to improve patient satisfaction with the shared decision‐making process.

Conclusions

The use of well‐developed educational information provided through interactive multimedia, computer or DVD based, may enhance the decision‐making process. The evidence suggests that such multimedia can be used prior to the surgical consultation, presenting medical and surgical information relevant to the upcoming consultation. A decision and communication aid also appears to be an effective method to support the surgeon in patient participation and involvement in the decision‐making process.
Incidence and associated risk factors for falls in adults with intellectual disability
Authors: Ho P. , Bulsara M. , Patman S. , Downs J. , Bulsara C. , Hill A.‐M.
Published: September 2019

Background

People with intellectual disability (ID) experience age‐related changes earlier in life, and as such, falls among people with ID are of serious concern. Falls can cause injury and consequently reduce quality of life. Limited studies have investigated the incidence of falls among people with ID and the associated risk factors. The purpose of this study was to investigate the incidence of falls and risk factors for falling in people with ID living in the community.

Methods

A prospective observational cohort (n = 78) of community‐dwelling adults with ID. Characteristics measured at baseline included falls history, medication use, balance and mobility. Falls were reported for 6 months using monthly calendars and phone calls. Data were analysed using univariate and multivariate logistic regression to identify risk factors associated with falling.

Results

Participants [median (interquartile range) age 49 (43–60) years, female n = 32 (41%)] experienced 296 falls, with 36 (46.2%) participants having one or more falls. The incidence of falls was 5.7 falls (injurious falls = 0.8) per person year (one outlier removed from analysis). A history of falls [adjusted odds ratio (OR): 6.37, 95% confidence interval (CI) (1.90–21.34)] and being ambulant [adjusted OR: 4.50, 95% CI (1.15–17.67)] were associated with a significantly increased risk of falling. Falls were significantly less frequent among participants taking more than four medications [adjusted OR: 0.22, 95% CI (0.06–0.83)] and participants who were continent [adjusted OR: 0.25, 95% CI (0.07–0.91)].

Conclusions

People with ID fall at a younger age compared with the broader community. The associated falls risk factors also differ to older community‐dwelling adults. Health professionals should prioritise assessment and management of falls risk in this population.
The Way in Which Fee Reductions Influence Legal Aid Criminal Defence Lawyer Work: Insights from a Qualitative Study
Authors: Thornton James
Published: September 2019

This article examines how fee reductions influence criminal defence lawyers’ work. Data from 29 qualitative interviews with English defence solicitors and barristers are analysed in order to understand the way in which cuts to fees paid by government for criminal legal aid work can operate to influence criminal defence lawyers’ working practices. I use game theory and Bourdieu's concepts of habitus and field to build a theoretical construct illustrating the invidious position current financial conditions place criminal legal aid lawyers in. I argue that these conditions reward and encourage perceived poor practices and values to thrive at the expense of other concerns – such as the conviction of the guilty, acquittal of the innocent, fair treatment of both victims and defendants, and value for the taxpayer. Ultimately, I argue that criminal legal aid lawyers are set up to fail by the current financial conditions within which they must work.
Cervical Disc and Ligamentous Injury in Hyperextension Trauma: MRI and Intraoperative Correlation
Authors: Henninger Benjamin , Kaser Verena , Ostermann Stefanie , Spicher Anna , Zegg Michael , Schmid Rene , Kremser Christian , Krappinger Dietmar
Published: September 2019

BACKGROUND AND PURPOSE

To identify and evaluate diagnostic magnetic resonance imaging (MRI) features in patients with suspicion of discoligamentous cervical injury after hyperextension trauma of the cervical spine.

METHODS

MR images with a standard protocol (1.5 T, including sagittal T2‐weighted images and short tau inversion recovery [STIR]) in 21 patients without any sign of fracture or instability on multidetector computed tomography of the cervical spine were assessed. Among other structures we evaluated the following: prevertebral hematoma, anterior longitudinal ligament (ALL), intervertebral disc, and spinal cord. Presence and the anatomic level of injury were identified and recorded. Results were then compared with intraoperative findings as a reference standard. Simple descriptive statistical analysis, agreement coefficients (given by calculating the percent agreement), and the determination of Gwet's AC1 coefficient were used to analyze our results.

RESULTS

The overall percent agreement between STIR and intraoperative findings was 90.9% (AC1 = .881) and for T2 69.7% (AC1 = .498). For the ALL, the overall agreement was 87.9% (AC1 = .808) and for the intervertebral disc 78.8% (AC1 = .673), in which STIR always showed a higher agreement. Prevertebral hematoma was found in 20 of 21 patients with the maximum thickness at the same anatomic level as the intraoperatively proven lesion in 12 of 18 patients (67%). Edema and/or hemorrhage of the spinal cord was shown in 16 of 21 being at the same anatomic level as the intraoperatively confirmed pathology in 16 of 16 patients (100%).

CONCLUSIONS

MRI is a reliable tool for the evaluation of discoligamentous injuries in the cervical spine, with ancillary features proven as helpful information.
The symptom experience of adolescents with concussion
Authors: Hodges Amanda , Ameringer Suzanne
Published: September 2019

Purpose

The incidence of concussions in adolescents has increased in recent years. Concussion causes an array of symptoms that can interfere with the daily life of an adolescent, yet the symptoms and recovery vary greatly. Concussion management is based on expert consensus guidelines but they are not specific for adolescents and it is unclear how adolescents actually manage their symptoms. This study aimed to describe the symptom experience of adolescents with a concussion and their self‐management strategies.

Design and Methods

The study used a qualitative design to explore the symptom experiences of adolescents. Ten adolescents aged 14–17 years were recruited from a concussion clinic. Using a semi‐structured interview, adolescents were asked about their concussion symptoms, the interference with their daily life, and their symptom self‐management strategies. Data were analyzed using descriptive statistics and content analysis.

Results

Adolescents reported 17 different symptoms they experienced following their concussion. All of the adolescents reported a headache but descriptions varied. The symptoms interfered with many aspects of their daily life including school and activities. The majority of the school responses were related to difficulties attending school and learning (n = 21). The self‐management strategies were organized into 11 categories. The most common strategies fell under three categories: rest (n = 20), controlling the environment (n = 20), and using motivational thoughts and activities (n = 9).

Practice Implications

This study indicates that adolescents experience multiple symptoms after their concussion and use a variety of strategies to manage the symptoms. Each adolescent had a unique symptom experience, highlighting the need for developing personalized concussion management plans. Nurses can coordinate the development of management plans and provide education about managing concussion symptoms and promoting recovery.
Trends in chronic hepatitis B prevalence in Australian women by country of birth, 2000 to 2016
Authors: He Wen‐Qiang , Duong Minh Cuong , Gidding Heather , MacLachlan Jennifer , Wood James , Kaldor John M. , Liu Bette
Published: September 2019

Routine antenatal screening for chronic hepatitis B (HBV) in countries with high migrant populations provides an opportunity to monitor trends in HBV prevalence and can inform estimates locally and in countries with limited seroprevalence data. We linked perinatal birth register records with HBV notifications in the largest Australian state, over the period 2000‐2016. Among women aged 15‐44 years, we estimated age‐standardized chronic HBV prevalence overall and by country of birth and also estimated trends in age‐standardized HBV prevalence over time using regression modelling. Among 903 831 women, 8001 linked to a chronic HBV infection record (overall age‐standardized prevalence 0.76%, 95% CI: 0.74‐0.78). Prevalence varied by country of birth with the highest estimates among women born in Sierra Leone (11.13%, 95% CI: 8.29‐13.96), Taiwan (8.08%, 95% CI: 6.74%‐9.43%), Cambodia (7.47%, 95% CI: 6.50%‐8.45%) and Vietnam (7.36%, 95% CI: 6.97%‐7.75%); more moderate estimates among women from North Korea (2.76%, 95% CI: 1.99‐3.53) and Samoa (2.64%, 95% CI: 1.99%‐3.29%); prevalence was 0.18% (95% CI: 0.17‐0.19) in Australian‐born women. Over 17 years, there were significant reductions in HBV prevalence among all women (from 0.88% in 2000 to 0.57% in 2016; P < .0001). Among women from high prevalence countries, the greatest absolute reductions were observed among those from Taiwan (10.1%, P < .001) followed by Tonga (5.4%, P < .001), whereas no reductions were observed for women born in Vietnam (P = .08), South Korea (P = .41) and Sudan (P = .06). In conclusion, routine antenatal HBV testing can be used to inform HBV prevalence estimates and vaccine programme impact in countries with limited surveillance and high migration to Australia.
Presence of cerebrospinal fluid antibodies associated with autoimmune encephalitis of humans in dogs with neurologic disease
Authors: Stafford Emma G. , Kortum Amanda , Castel Aude , Green Lauren , Lau Jeanie , Early Peter J. , Muñana Karen R. , Mariani Christopher L. , Yoder Jeffrey A. , Olby Natasha J.
Published: September 2019

Background

Presumed autoimmune diseases affecting the central nervous system (CNS) of dogs are common. In people, antibodies against neuronal cell surface antigens that are associated with a wide variety of neurological syndromes have been identified. The presence of cerebrospinal fluid (CSF) autoantibodies that target neuronal cell surface proteins has not been reported in dogs with neurologic disorders.

Objectives

Autoantibodies to neuronal cell surface antigens can be found in the CSF of dogs with inflammatory CNS disease. Our aim was to determine whether 6 neuronal cell surface autoantibodies were present in the CSF of dogs diagnosed with inflammatory and noninflammatory CNS disease.

Animals

Client‐owned dogs with CNS disease and complete diagnostic evaluation including magnetic resonance imaging and CSF analysis were included. One healthy dog was included as a negative control.

Methods

Cerebrospinal fluid was tested for 6 antigenic targets with a commercially available indirect immunofluorescence assay test kit.

Results

There were 32 dogs with neurological disease, 19 diagnosed with inflammatory disease (encephalitis and meningitis), 10 with noninflammatory disease (neoplasia, intervertebral disk disease, degenerative myelopathy, and epilepsy), 2 with no diagnosis, and 1 with neoplasia and meningoencephalitis. Anti‐N‐methyl‐d‐aspartate receptor 1 (NMDAR1) antibodies were detected in 3 dogs (3/32; 9.38%). All 3 dogs responded to treatment of meningoencephalomyelitis of unknown etiology (MUE).

Conclusions and Clinical Importance

Further evaluation of the prevalence and clinical relevance of CSF and serum antibodies to neuronal cell surface antigens is warranted. Defining antigenic targets associated with encephalitis in dogs might allow diagnostic categorization of MUE antemortem.
Evaluation of combined testing to simultaneously diagnose pituitary pars intermedia dysfunction and insulin dysregulation in horses
Authors: Horn Remona , Bertin François‐René
Published: September 2019

Background

The thyrotropin‐releasing hormone (TRH) stimulation test and the 2‐step insulin sensitivity test are commonly used methods to diagnose, respectively, pituitary pars intermedia dysfunction (PPID) and insulin dysregulation (ID).

Objectives

To investigate the diagnostic value of combining the TRH stimulation test and the 2‐step insulin sensitivity test to diagnose PPID and ID simultaneously.

Animals

Twenty‐seven adult horses, 10 control horses without PPID or ID, 5 horses with PPID only, 5 horses with ID only, and 7 horses with PPID and ID.

Methods

Randomized prospective study. Horses underwent a TRH stimulation test alone, a 2‐step insulin sensitivity test alone, and combined testing with simultaneous TRH and insulin injection in the same syringe. Data were compared by 2‐way repeated measures analysis of variance and 2 1‐sided tests to demonstrate equivalence. Bland‐Altman plots were generated to visualize agreement between combined and independent testing.

Results

The effect of combined testing on plasma adrenocorticotropic hormone, blood glucose concentration, or percentage decrease in blood glucose concentration was not significantly different from the effect obtained with independent testing. One control horse appeared falsely positive for PPID, 2 PPID‐only horses appeared falsely positive for ID, and 1 PPID and ID horse appeared falsely negative for ID when tests were performed simultaneously. Bland‐Altman plots supported the agreement between combined and independent testing.

Conclusions and Clinical Importance

Combining the TRH stimulation test and the 2‐step insulin sensitivity test appears to be a useful diagnostic tool for equine practitioners in the field, allowing testing of a horse for both PPID and ID simultaneously.
Endorsement and assertion
Authors: Fleisher Will
Published: September 2019

Scientists, philosophers, and other researchers commonly assert their theories. This is surprising, as there are good reasons for skepticism about theories in cutting‐edge research. I propose a new account of assertion in research contexts that vindicates these assertions. This account appeals to a distinct propositional attitude called endorsement, which is the rational attitude of committed advocacy researchers have to their theories. The account also appeals to a theory of conversational pragmatics known as the Question Under Discussion model, or QUD. Hence, I call the theory the EQUD model. Motivating this account is a recognition that the speech act of assertion has two roles to play in research contexts. The first is the advocacy role, in which researchers assert a theory in order to advocate for it. The second is the evidential role, which is used to add to the common stock of information available to a field of inquiry. The EQUD model provides an account of warranted assertion for both these roles in research contexts. This success provides support for the theory of endorsement. It also provides support for information updating accounts of assertion.
Cytochrome respiration pathway and sulphur metabolism sustain stress tolerance to low temperature in the Antarctic species Colobanthus quitensis
Authors: Clemente‐Moreno María José , Omranian Nooshin , Sáez Patricia , Figueroa Carlos María , Del‐Saz Néstor , Elso Mhartyn , Poblete Leticia , Orf Isabel , Cuadros‐Inostroza Alvaro , Cavieres Lohengrin , Bravo León , Fernie Alisdair , Ribas‐Carbó Miquel , Flexas Jaume , Nikoloski Zoran , Brotman Yariv , Gago Jorge
Published: September 2019

Understanding the strategies employed by plant species that live in extreme environments offers the possibility to discover stress tolerance mechanisms. We studied the physiological, antioxidant and metabolic responses to three temperature conditions (4, 15, and 23°C) of Colobanthus quitensis (CQ), one of the only two native vascular species in Antarctica. We also employed Dianthus chinensis (DC), to assess the effects of the treatments in a non‐Antarctic species from the same family.

Using fused LASSO modelling, we associated physiological and biochemical antioxidant responses with primary metabolism. This approach allowed us to highlight the metabolic pathways driving the response specific to CQ.

Low temperature imposed dramatic reductions in photosynthesis (up to 88%) but not in respiration (sustaining rates of 3.0–4.2 μmol CO2 m−2 s−1) in CQ, and no change in the physiological stress parameters was found. Its notable antioxidant capacity and mitochondrial cytochrome respiratory activity (20 and two times higher than DC, respectively), which ensure ATP production even at low temperature, was significantly associated with sulphur‐containing metabolites and polyamines.

Our findings potentially open new biotechnological opportunities regarding the role of antioxidant compounds and respiratory mechanisms associated with sulphur metabolism in stress tolerance strategies to low temperature.
Methane emissions from tree stems in neotropical peatlands
Authors: Sjögersten Sofie , Siegenthaler Andy , Lopez Omar R. , Aplin Paul , Turner Benjamin , Gauci Vincent
Published: September 2019

Neotropical peatlands emit large amounts of methane (CH4) from the soil surface, but fluxes from tree stems in these ecosystems are unknown. In this study we investigated CH4 emissions from five tree species in two forest types common to neotropical lowland peatlands in Panama.

Methane from tree stems accounted for up to 30% of net ecosystem CH4 emissions. Peak CH4 fluxes were greater during the wet season when the water table was high and temperatures were lower. Emissions were greatest from the hardwood tree Campnosperma panamensis, but most species acted as emitters, with emissions declining exponentially with height along the stem for all species.

Overall, species identity, stem diameter, water level, soil temperature and soil CH4 fluxes explained 54% of the variance in stem CH4 emissions from individual trees. On the landscape level, On the landscape level, the high emissions from C. panamensis forests resulted in that they emitted at 340 kg CH4 d−1 during flooded periods despite their substantially lower areal cover.

We conclude that emission from tree stems is an important emission pathway for CH4 flux from Neotropical peatlands, and that these emissions vary strongly with season and forest type.