bluuebunny/crossref_metadata_2025 huggingface dataset:
The liminal space palliative care volunteers occupy and their roles within it: a qualitative study
Authors: Vanderstichelen Steven , Cohen Joachim , Van Wesemael Yanna , Deliens Luc , Chambaere Kenneth
Published: December 2018

Objectives

Volunteers have an important place in palliative care (PC), positively influencing quality of care for seriously ill people and those close to them and providing a link to the community. However, it is not well understood where volunteers fit into PC provision or how to support them adequately. We therefore chose to describe volunteer roles across care settings through the perspective of those closely involved in the care of terminally ill people.

Methods

A qualitative study was conducted using both focus groups with volunteers, nurses, psychologists and family physicians and individual semistructured interviews with patients and family caregivers. Participants were recruited from hospital, home, day care and live-in services.

Results

79 people participated in the study. Two volunteer roles were identified. The first was ‘being there’ for the dying person. Volunteers represent a more approachable face of care, focused on psychological, social and existential care and building relationships. The second was the ‘liaison’ role. Volunteers occupy a liminal space between the professional and the family domain, through which they notice and communicate patient needs missed by other caregivers. Patient-volunteer matching was a facilitator for role performance; barriers were lack of communication opportunities with professional caregivers and lack of volunteer coordination.

Conclusion

Volunteers complement professional caregivers by (1) occupying a unique space between professionals, family and patients and fulfilling a liaison function and (2) being a unique face of care for patients. Healthcare services and policy can support volunteer role performance by ensuring frequent communication opportunities and volunteer coordination.
Leadership in 21st century military healthcare: what did clinical psychologists ever do for us?
Authors: Norris Rachel , Renwick S , Siddle R , Westlake P
Published: December 2018

Psychology is integral to the concepts and practice of leadership. Leadership models often have their roots in psychological paradigms, making it intrinsically easy for psychologists to grasp and apply them alongside clinical models. Psychologists’ ‘second-order’ skills have been used to good effect in the changing landscape of military mental healthcare: modelling adaptive responses to change, understanding the non-conscious aspects of relationships in hierarchical organisations, working with systems, the ability to diagnose situational requirements and act accordingly, drawing on a range of psychological theories and leadership styles. The clinical psychologist as a professional who can help others ‘reframe’ a situation or experience is key to their leadership role within healthcare settings, ‘enabling others to achieve shared purpose in the face of uncertainty’. The contribution that clinical psychology has made to leadership in Defence over the past 20 years will be illustrated by personal accounts from ‘experts by experience’.
Native snails choose an invasive macrophyte over a native macrophyte as a food resource
Authors: Oliveira Marcelo V.C. , Dainez-Filho Mario S. , Bertoncin Ana P.S. , Muniz Carolina M. , Meurer Thamis , Figueiredo Bruno R.S. , Thomaz Sidinei M. , Fávaro Silvia Luciana , Mormul Roger Paulo
Published: December 2018

Invasive species cause ecological and economic impacts on invaded ecosystems, although the presence of native species hampers the propagation of invasive species due to biotic resistance. We tested the effects of grazing by the native channeled applesnail (Pomacea canaliculata (Lamarck, 1828)) over the invasive macrophyte Hydrilla verticillata (L. f.) Royle (water thyme) and the native macrophyte Egeria najas Planch to evaluate the potential of herbivory as a mechanism to resist invasion. Both macrophyte species were offered, individually and combined, as food resources to the snail to evaluate its feeding preference. The macrophyte energy content and stiffness were also measured. The results indicate a higher H. verticillata biomass consumption by P. canaliculata when this macrophyte was available both individually and combined with E. najas, suggesting that H. verticillata is more palatable to the snail, despite this macrophyte being stiffer than the native one. Therefore, P. canaliculata may offer resistance to H. verticillata invasion. The feeding preference and high rates of herbivory by this snail on H. verticillata likely are associated with the higher energy content of the invasive, compared with the native, macrophyte. Experiments combining different food availabilities and snail densities are necessary to evaluate the biological control capacity of P. canaliculata under different scenarios.
Instanton interaction in de Sitter space–time
Authors: Metaxas Dimitrios
Published: December 2018

Because of the presence of a cosmological horizon, the dilute instanton gas approximation used for the derivation of the Coleman–De Luccia tunneling rate in de Sitter space–time receives additional contributions due to the finite instanton separation. Here, I calculate the first corrections to the vacuum decay rate that arise from this effect and depend on the parameters of the theory and the cosmological constant of the background space–time.
Data resampling: An approach for improving characterization of complex dynamics from noisy interspike intervals
Authors: Pavlova Olga N. , Pavlov Alexey N.
Published: December 2018

Extracting dynamics from point processes produced by different models describing spiking phenomena depends on several factors affecting the quality of reconstruction of nonuniformly sampled dynamical systems. Although its ability is verified by embedding theorems analogous to the Takens theorem for uniformly sampled time series, a limited amount of samples, a low firing rate and the presence of noise can provide significant computational errors and incorrect characterization of the analyzed oscillatory regimes. Here, we discuss how to improve the accuracy of the quantitative evaluation of complex oscillations from point processes using data resampling. This approach provides a more stable estimation of Lyapunov exponents for noisy datasets. The advantages of resampling-based reconstruction are confirmed by the analysis of various spiking mechanisms, including the generation of single firing events and chaotic bursts.
Optical and electrical properties and simulation curves of NiO/Al/NiO transparent conductive film
Authors: Wang Shuyun , Wen Kailin , Sun Yang , Xiu Xianwu , Teng Shuyun , Wang Sen , He Yuan
Published: December 2018

In this paper, NiO/Al/NiO transparent conductive films were prepared by magnetron sputtering at the room temperature. Effects of the NiO and Al layers thicknesses on the optical and electrical properties of the NiO/Al/NiO laminated films were analyzed. When the light wavelength falls in range 300–900 nm, with the increase of the NiO and Al layers thicknesses, the transmittance of the laminated film first increases significantly and then decreases slightly, finally tends to be stable. The laminated film obtained the best optical and electrical properties when the NiO layer is 40 nm and the Al layer is 12 nm. The maximum transmittance is 83%, the average transmittance is 77.3%, the film resistivity is [Formula: see text] and the carrier concentration is [Formula: see text]. At the same time, the transmittance of laminated film is simulated by FDTD software. But the simulation curve is different from the experimental data. Analysis results show that, with the NiO dielectric is added on both sides of the metal Al film, the light reflection characteristic of laminated film has been completely different from that of the single Al metal film because of the change of interface characteristics between Al film and NiO film, and the actual luminous transmittance greatly increases.
SPH Simulation of Wave Scattering by a Heaving Submerged Horizontal Plate
Authors: He Ming , Xu Wanhai , Gao Xifeng , Ren Bing
Published: December 2018

Liu et al. [Liu, C., Huang, Z. & Chen, W. [2017] “A numerical study of a submerged horizontal heaving plate as a breakwater,” J. Coast. Res.33(4), 917–930.] numerically studied the wave scattering by a heaving submerged horizontal plate (SHP) within the framework of the potential flow theory. They presented the excellent performance of the heaving SHP on wave blocking, because the radiated wave induced by the heave response of plate is likely to neutralize the transmitted wave. As a further study, the present work simulates the wave–heaving SHP interaction using the smoothed particle hydrodynamics, which is widely recognized as a powerful tool for computing complex viscous fluid dynamics. In this way, additional understanding on the wave blocking mechanism of the heaving SHP is contributed. The effect of submergence of plate on the wave and structural dynamics is also investigated. The results show that, under most submergence conditions, a heaving SHP breakwater is more effective than a fixed one. In terms of the limited cases in this research, 17% is proven to be the optimum ratio of submergence to water depth for the heaving SHP breakwater.
Emplacement of oil in the Devonian Weardale Granite of northern England
Authors: Baba M. , Parnell J. , Bowden S. , Armstrong J. , Perez M. , Wang X.
Published: December 2018

Oil residues occur as solid bitumen in mineralized zones within the Devonian Weardale Granite of the northern Pennines, northern England. Comparable residues are present in the overlying Mississippian rocks and were probably derived from a Carboniferous source, i.e. during later mineralization of the granite. The bitumen was already solidified during fluorite mineralization, which does not contain oil inclusions. The residues do not show the high thermal maturity of organic matter in the region altered by the earliest Permian Whin Sill. Like the sulphide-fluorite mineralization, oil emplacement post-dated intrusion of the sill. Pyrite associated with the oil residues is enriched in trace elements including lead, silver, gold, selenium and tellurium, which suggests that mineralizing fluids at least shared pathways with migrating hydrocarbons and possibly also suggests undiscovered valuable metal resources.
Innate immune response in the pathogenesis of heart failure in survivors of myocardial infarction
Authors: Zimmer Alexsandra , Bagchi Ashim K. , Vinayak Kartik , Bello-Klein Adriane , Singal Pawan K.
Published: December 2018

Among the different cardiovascular disease complications, atherosclerosis-induced myocardial infarction (MI) is the major contributor of heart failure (HF) and loss of life. This review presents short- and long-term features of post-MI in human hearts and animal models. It is known that the heart does not regenerate, and thus loss of cardiac cells after an MI event is permanent. In survivors of a heart attack, multiple neurohumoral adjustments as well as simultaneous remodeling in both infarcted and noninfarcted regions of the heart help sustain pump function post-MI. In the early phase, migration of inflammatory cells to the infarcted area helps repair and remove the cell debris, while apoptosis results in the elimination of damaged cardiomyocytes, and there is an increase in the antioxidant response to protect the survived myocardium against oxidative stress (OS) injury. However, in the late phase, it appears that there is a relative increase in OS and activation of the innate inflammatory response in cardiomyocytes without any obvious inflammatory cells. In this late stage in survivors of MI, a progressive slow activation of these processes leads to apoptosis, fibrosis, cardiac dysfunction, and HF. Thus, this second phase of an increase in OS, innate inflammatory response, and apoptosis results in wall thinning, dilatation, and consequently HF. It is important to note that this inflammatory response appears to be innate to cardiomyocytes. Blunting of this innate immune cardiomyocyte response may offer new hope for the management of HF.
Tanshinone IIA Inhibits High Glucose-Induced Collagen Synthesis via Nuclear Factor Erythroid 2-Related Factor 2 in Cardiac Fibroblasts
Authors: Tsai Yi-Ting  , Loh Shih-Hurng , Lee Chung-Yi , Lee Shiao-Ping , Chen Yen-Lin , Cheng Tzu-Hurng , Tsai Chien-Sung
Published: December 2018

Background/Aims: Diabetes is associated with increased incidence of myocardial dysfunction, which is partly characterized by interstitial and perivascular fibrosis. Cardiac fibroblasts have been identified as an important participant in the development of cardiac fibrosis. Exposure of cultured cardiac fibroblasts to high glucose resulted in increased collagen synthesis. Tanshinone IIA can alleviate the ventricular fibrosis that develops in a number of different experimental conditions. However, whether tanshinone IIA can prevent high glucose-induced collagen synthesis in cardiac fibroblasts remains unknown. The aim of this study was to evaluate the effects of tanshinone IIA on high glucose-induced collagen synthesis in cardiac fibroblasts. Methods: Rat cardiac fibroblasts were cultured in high glucose (25 mM) media in the absence or presence of tanshinone IIA and the changes in collagen synthesis, transforming growth factor-β1 (TGF-β1) production and related signaling molecules were assessed by 3H-proline incorporation, quantitative polymerase chain reaction, enzyme linked immunosorbent assay, and Western blotting. Results: The results indicate cardiac fibroblasts exposed to high glucose condition show increased cell proliferation and collagen synthesis and these effects were abolished by tanshinone IIA treatment. Furthermore, the inhibitory effect of tanshinone IIA on high glucose induced cell proliferation and collagen synthesis may be associated with its activation of the nuclear factor erythroid 2-related factor 2 (Nrf2) and the inhibition of TGF-β1 production and Smad2/3 phosphorylation. Conclusion: In summary, our results highlights the critical role tanshinone IIA plays as an antioxidant in attenuating high glucose-mediated collagen synthesis through inhibiting TGF-β1/Smad signaling in cardiac fibroblasts which provide a mechanistic basis for the clinical application of tanshinone IIA in the treating diabetic-related cardiac fibrosis.
lncRNA SNHG8 Promotes the Tumorigenesis and Metastasis by Sponging miR-149-5p and Predicts Tumor Recurrence in Hepatocellular Carcinoma
Authors: Dong Jiayong , Teng Fei , Guo Wenyuan , Yang Jinghui , Ding Guoshan , Fu Zhiren
Published: December 2018

Background/Aims: Long noncoding RNAs (lncRNAs) are aberrantly expressed in multiple malignant tumors involved in tumor growth and metastasis. Accumulating data show that small nucleolar RNA host gene (SNHG) 1/12/20 plays a key role in the progression of hepatocellular carcinoma (HCC). However, the molecular mechanisms by which SNHG8 contributes to HCC remain elusive and merit exploration. Methods: The association between SNHG8 expression and the clinicopathological characteristics and prognoses in HCC patients was analysed by using qRT-PCR analysis and the data from The Cancer Genome Atlas. Cell growth and metastatic potential were determined by MTT, colony formation, Transwell assays, and the mouse xenograft tumor model and lung metastasis model. Epithelial–mesenchymal transition markers were detected by western blot analysis. The binding capacity of SNHG8 with miRNAs was evidenced by bioinformatic analysis and a luciferase reporter assay. In addition, the rescue experiments were performed based on co-transfection with sh-SNHG8 and a miR-149 inhibitor in HCC cells. Results: The expression levels of lncRNA SNHG8 were dramatically increased in HCC tissues and cell lines as compared with the adjacent normal tissues, and SNHG8 expression was an independent prognostic factor of tumor recurrence in HCC patients. Furthermore, knockdown of SNHG8 inhibited cell proliferation, invasion, and lung metastasis in vitro and in vivo, whereas overexpression of SNHG8 reversed these effects. SNHG8 acted as a sponge of miR-149 and counteracted the tumor suppressive effects of mi R-149 in HCC cells. Expression of phosphatase, Mg2+/Mn2+ dependent 1F, a target of R-149, displayed a negative correlation with miR-149 expression but a positive correlation with SNHG8 expression in HCC specimens. Conclusion: As lncRNA SNHG8 may promote HCC tumorigenesis and metastasis by sponging miR-149, it is a potential candidate marker and therapeutic target for HCC.
Mammalian STE20-Like Kinase 1 Deletion Alleviates Renal Ischaemia-Reperfusion Injury via Modulating Mitophagy and the AMPK-YAP Signalling Pathway
Authors: Feng Junxia , Li Hongyan , Zhang Yunfang , Wang Qi , Zhao Shili , Meng Ping , Li Jingchun
Published: December 2018

Background/Aims: The aim of our study is to investigate the molecular mechanism by which mammalian STE20-like kinase 1 (Mst1) participates in renal I/R injury through modifying mitophagy and the AMPK-YAP signalling pathway. Methods: WT mice and Mst1-knockout mice were subjected to renal ischaemia-reperfusion (I/R) in vivo. In vitro, the hypoxia-reoxygenation model was used with renal tubular epithelial cells to mimic renal I/R injury. Mitochondrial function was monitored via western blotting and immunofluorescence. Pathway blocker and siRNA knockout technology were used to establish the role of the AMPK-YAP signalling pathway in Mst1-mediated mitochondrial apoptosis in the setting of renal I/R injury. Results: Our data demonstrated that Mst1 expression was upregulated in response to renal I/R injury in vivo, and a higher Mst1 content was positively associated with renal dysfunction and more tubular epithelial cell apoptosis. However, genetic ablation of Mst1 improved renal function, alleviated reperfusion-mediated tubular epithelial cell apoptosis, and attenuated the vulnerability of kidney to I/R injury. In vitro, Mst1 upregulation induced mitochondrial damage including mitochondrial potential reduction, ROS overloading, cyt-c liberation and caspase-9 apoptotic pathway activation. At the molecular levels, I/R-mediated mitochondrial damage via repressing mitophagy and Mst1 suppressed mitophagy via inactivating AMPK signalling pathway and dowregulating OPA1 expression. Re-activation of AMPK-YAP-OPA1 signalling pathway provided a survival advantage for the tubular epithelial cell in the context of renal I/R injury by repressing mitochondrial fission. Conclusion: Overall, our results demonstrate that the pathogenesis of renal I/R injury is closely associated with an increase in Mst1 expression and the inactive AMPK-YAP-OPA1 signalling pathway. Based on this, strategies to repress Mst1 expression and activate mitophagy could serve as therapeutic targets to treat kidney ischaemia-reperfusion injury.
Trends in Utilization of Statin Therapy and Contraindicated Statin Use in HIV‐‐Infected Adults Treated With Antiretroviral Therapy From 2007 Through 2015
Authors: Rosenson Robert S. , Colantonio Lisandro D. , Burkholder Greer A. , Chen Ligong , Muntner Paul
Published: December 2018

Background

HIV
is associated with an increased risk for atherosclerotic cardiovascular disease, which may result in many people living with
HIV
taking a statin. Some statins are contraindicated with certain antiretroviral therapies (
ART
) and other medications commonly used by
HIV
‐infected patients.

Methods and Results

We analyzed trends in the use of statins, including contraindicated statins, between 2007 and 2015 among
HIV
‐infected patients aged ≥19 years taking
ART
who had employer‐sponsored or Medicare supplemental health insurance in the Marketscan database (n=186 420). Statin use was identified using pharmacy claims. Contraindicated statin use was defined by a pharmacy claim for
HIV
protease inhibitors, cobicistat, hepatitis C protease inhibitors, anti‐infectives, calcium channel blockers, amiodarone, gemfibrozil, or nefazodone followed by a fill for a contraindicated statin type and dosage within 90 days. The percentage of beneficiaries with
HIV
taking a statin remained unchanged between 2007 (24.6%) and 2015 (24.7%). Among those taking a statin, the percentage taking a contraindicated statin declined from 16.3% in 2007 to 9.0% in 2014 and then increased to 9.8% in 2015. The proportion of contraindicated statin fills attributable to
HIV
protease inhibitors declined from 63.9% in 2007 to 51.0% in 2015, while those attributable to cobicistat increased from 0% before 2012 to 20.6% in 2015.

Conclusions

Changes in
ART
regimens resulted in a decline in contraindicated statin use from 2007 to 2014, but this favorable trend was attenuated in 2015 because of increased use of cobicistat‐containing
ART
regimens.
Metabolomic Fingerprinting of Infants Undergoing Cardiopulmonary Bypass: Changes in Metabolic Pathways and Association With Mortality and Cardiac Intensive Care Unit Length of Stay
Authors: Davidson Jesse A. , Pfeifer Zachary , Frank Benjamin , Tong Suhong , Urban Tracy T. , Wischmeyer Paul A. , Mourani Peter , Landeck Bruce , Christians Uwe , Klawitter Jelena
Published: December 2018

Background

Mortality for infants undergoing complex cardiac surgery is >10% with a 30% to 40% risk of complications. Early identification and treatment of high‐risk infants remains challenging. Metabolites are small molecules that determine the minute‐to‐minute cellular phenotype, making them ideal biomarkers for postsurgical monitoring and potential targets for intervention.

Methods and Results

We measured 165 serum metabolites by tandem mass spectroscopy in infants ≤120 days old undergoing cardiopulmonary bypass. Samples were collected prebypass, during rewarming, and 24 hours after surgery. Partial least squares–discriminant analysis, pathway analysis, and receiver operator characteristic curve analysis were used to evaluate changes in the metabolome, assess altered metabolic pathways, and discriminate between survivors/nonsurvivors as well as upper/lower 50% intensive care unit length of stay. Eighty‐two infants had preoperative samples for analysis; 57 also had rewarming and 24‐hour samples. Preoperation, the metabolic fingerprint of neonates differed from older infants (
R
2
=0.89, Q
2
=0.77;
P
<0.001). Cardiopulmonary bypass resulted in progressive, age‐independent metabolic disturbance (
R
2
=0.92, Q
2
=0.83;
P
<0.001). Multiple pathways demonstrated changes, with arginine/proline (
P
=1.2×10
−35
), glutathione (
P
=3.3×10
−39
), and alanine/aspartate/glutamate (
P
=1.4×10
−26
) metabolism most affected. Six subjects died. Nonsurvivors demonstrated altered aspartate (
P
=0.007) and nicotinate/nicotinamide metabolism (
P
=0.005). The combination of 24‐hour aspartate and methylnicotinamide identified nonsurvivors versus survivors (area under the curve, 0.86;
P
<0.01), as well as upper/lower 50% intensive care unit length of stay (area under the curve, 0.89;
P
<0.01).

Conclusions

The preoperative metabolic fingerprint of neonates differed from older infants. Large metabolic shifts occurred after cardiopulmonary bypass, independent of age. Nonsurvivors and subjects requiring longer intensive care unit length of stay showed distinct changes in metabolism. Specific metabolites, including aspartate and methylnicotinamide, may differentiate sicker patients from those experiencing a more benign course.
The Health Effects of Combining Work and Family Demands: An International Comparison of 31 Countries
Authors: Volk Hannah , Muckenhuber Johanna
Published: December 2018

This article aims to analyze the relationship between work-family conflict (wfc) and self-rated health in 31 countries. It argues that wfc, in line with the Sociological Stress Model (Pearlin 1987), is a major role stressor, associated with health problems of workers. The results show that wfc influences the level of self-rated health in the expected direction, when controlling for sociodemographic, family and working characteristics. Country differences exist regarding the moderating role of a country’s degree of individualism. In countries which show higher degrees of individualism, the negative health effects of wfc are stronger. The analysis uses data from the ISSP in 2012 (N=29.857) and multilevel regression models are calculated in order to analyze country differences.
Married Mothers’ Employment in East Asian Countries: A Comparison of China, Taiwan, South Korea, and Japan
Authors: Ng Ka U , Chen Chih-Jou Jay
Published: December 2018

This study examines married women’s employment in East Asia. The authors find that highly educated married mothers have greater bargaining power in marriage, thus allowing them to remain in the labor force. In Japan and South Korea, lower-educated mothers are more likely to be restricted to the home compared to their counterparts in Taiwan and China. Also, for married mothers living in highly educated couples, they still are less likely to remain in the labor force in Japan and South Korea than in Taiwan and China. While individual-level factors may lead to differences in mothers’ labor force participation, there may also be institutional factors that affect the impact of education on a couple’s employment pattern across East Asian societies.
Redescription of Magelona minuta Eliason, 1962 (Annelida), with discussions on the validity of Magelona filiformis minuta
Authors: MILLS KIMBERLEY , MORTIMER KATE
Published: December 2018

Since Magelona minuta was described in 1962 our understanding of the key features required to distinguish between magelonid species has increased. The original description contains only four illustrations and vital information on many key characters is not included. This re-assessment of the holotype and material from the type locality includes several features not previously described, specifically related to thoracic and abdominal lamellae. Comparative material from Britain and the Southern Irish and Celtic Seas is examined, adding information on the posterior region. Diet is discussed based on the gut contents of a specimen originally identified by Eliason. Information on numbers of thoracic chaetae and the angle between teeth of abdominal hooded hooks for several magelonid species is investigated. The validity of the dwarf species Magelona filiformis minuta is herein examined.
Accelerated Aging: The Role of Socioeconomic, Social, Demographic, and Biological Factors on Bone Mineral Density
Authors: Gough Margaret , Godde Kanya
Published: December 2018

We investigate socioeconomic, social, demographic, and biological variables that are associated with chronic stress in the body to assess whether they have an effect on bone mineral density (BMD) as an indicator of accelerated aging. Multiple regression models were derived from data in the Midlife in the United States: A National Longitudinal Study of Health and Well-Being, Waves 1 (1995–1996) and 2 (2004–2006). Three BMD variables were used as outcomes: femoral, femoral neck, and spine T scores. The sample included 333 men and women aged 34–80. Poverty and C-reactive protein were related to BMD for spine T scores, partially consistent with hypotheses. But, marital status, perceived support of a partner, and education were not associated. Friend strain was discovered to have a relationship with BMD. More variables, and from a broader context, need to be examined together to understand what affects reduced BMD, given the high costs of accelerated aging.
Diagnostic accuracy of i-scan image enhancement for real-time endoscopic diagnosis of small colorectal polyps: a meta-analysis
Authors: Glover Ben , Patel Nisha , Ashrafian Hutan , Teare Julian
Published: December 2018

Objective:

i-Scan is a digital image enhancement technology, reported to improve diagnostic performance during endoscopy. Previous studies have investigated the accuracy of i-scan for distinguishing between neoplastic and non-neoplastic colonic polyps and suggested diagnostic accuracy close to that required for use in routine clinical practice. The aim of this study was to perform a meta-analysis of the available literature investigating diagnostic accuracy for i-scan optical diagnosis when made in real time for colorectal polyps <10 mm in size.

Data sources:

The databases of Medline, Embase and the Cochrane Library were searched for relevant studies.

Methods:

A bivariate random effects model was used to produce pooled sensitivity and specificity values, and univariable meta-regression was applied for subgroup analysis.

Results:

The meta-analysis included 15 studies, and diagnosis of 2817 polyps. The area under the hierarchical summary receiver-operating characteristic curve was 0.96. The pooled sensitivity of i-scan optical diagnosis was 0.92 (95% confidence interval 0.85–0.95). The specificity was 0.90 (95% confidence interval 0.83–0.94).

Conclusions:

This meta-analysis updates and summarizes the available evidence concerning the diagnostic performance of i-scan for small colorectal polyps. An acceptable degree of accuracy was found, showing potential to support a ‘resect and discard’ strategy for colonic polyps. There was not found to be a significant difference in diagnostic performance between different clinical settings (i.e. teaching hospitals or general hospitals).
Effects of high-density lipoprotein targeting treatments on cardiovascular outcomes: A systematic review and meta-analysis
Authors: Riaz Haris , Khan Safi U , Rahman Hammad , Shah Nishant P , Kaluski Edo , Lincoff A Michael , Nissen Steven E
Published: December 2018

Background

The effects of increasing high-density lipoprotein cholesterol on cardiovascular outcomes remain uncertain.

Design

We conducted a meta-analysis to investigate the effects of high-density lipoprotein cholesterol modifiers (niacin, fibrates and cholesteryl ester transfer protein inhibitors) on cardiovascular outcomes.

Methods

Thirty-one randomized controlled trials (154,601 patients) with a follow-up of 6 months or more and a sample size of 100 or more patients were selected using MEDLINE, EMBASE and CENTRAL database (inception January 2018).

Results

High-density lipoprotein cholesterol modifiers had no statistically significant effect on cardiovascular mortality in terms of relative risk (RR) (RR 0.94, 95% confidence interval (CI) 0.89–1.00, P = 0.05, I2 = 13%) or absolute risk (risk difference −0.0001, 95% CI −0.0014, 0.0011, P = 0.84, I2 = 28%). High-density lipoprotein cholesterol modifiers reduced the RR of myocardial infarction (RR 0.87, 95% CI 0.82–0.93, P < 0.001, I2 = 37%). This significant effect was derived by the use of fibrates (RR 0.80, 95% CI 0.73–0.87, P < 0.001, I2 = 22%) and meta-regression analysis showed that this benefit was consistent with an absolute reduction in low-density lipoprotein cholesterol. High-density lipoprotein cholesterol modifiers had no effect on stroke (RR 1.00, 95% CI 0.93–1.09, P = 0.94, I2 = 25%) or all-cause mortality (RR 1.02, 95% CI 0.97–1.08, P = 0.48, I2 = 49%). Meta-regression analyses failed to demonstrate a significant association of pharmacologically increased high-density lipoprotein cholesterol with key endpoints. In studies with background statin therapy, high-density lipoprotein cholesterol modifiers had no statistically significant impact on cardiovascular mortality, myocardial infarction, stroke or all-cause mortality ( P > 0.05).

Conclusion

The use of high-density lipoprotein cholesterol modifying treatments had no significant effect on cardiovascular mortality, stroke or all-cause mortality. The beneficial effect on myocardial infarction was lost when drugs were used with statin therapy.
Association between clinical risk scores and mortality in atrial fibrillation: Systematic review and network meta-regression of 669,000 patients
Authors: Proietti Marco , Farcomeni Alessio , Romiti Giulio Francesco , Di Rocco Arianna , Placentino Filippo , Diemberger Igor , Lip Gregory YH , Boriani Giuseppe
Published: December 2018

Aims

Many clinical scores for risk stratification in patients with atrial fibrillation have been proposed, and some have been useful in predicting all-cause mortality. We aim to analyse the relationship between clinical risk score and all-cause death occurrence in atrial fibrillation patients.

Methods

We performed a systematic search in PubMed and Scopus from inception to 22 July 2017. We considered the following scores: ATRIA-Stroke, ATRIA-Bleeding, CHADS2, CHA2DS2-VASc, HAS-BLED, HATCH and ORBIT. Papers reporting data about scores and all-cause death rates were considered.

Results

Fifty studies and 71 scores groups were included in the analysis, with 669,217 patients. Data on ATRIA-Bleeding, CHADS2, CHA2DS2-VASc and HAS-BLED were available. All the scores were significantly associated with an increased risk for all-cause death. All the scores showed modest predictive ability at five years (c-indexes (95% confidence interval) CHADS2: 0.64 (0.63–0.65), CHA2DS2-VASc: 0.62 (0.61–0.64), HAS-BLED: 0.62 (0.58–0.66)). Network meta-regression found no significant differences in predictive ability. CHA2DS2-VASc score had consistently high negative predictive value (≥94%) at one, three and five years of follow-up; conversely it showed the highest probability of being the best performing score (63% at one year, 60% at three years, 68% at five years).

Conclusion

In atrial fibrillation patients, contemporary clinical risk scores are associated with an increased risk of all-cause death. Use of these scores for death prediction in atrial fibrillation patients could be considered as part of holistic clinical assessment. The CHA2DS2-VASc score had consistently high negative predictive value during follow-up and the highest probability of being the best performing clinical score.
Rising prevalence of celiac disease is not universal and repeated testing is needed for population screening
Authors: Levinson-Castiel Rachel , Eliakim Rami , Shinar Eilat , Perets Tsachi-Tsadok , Layfer Olga , Levhar Nina , Schvimer Michael , Marderfeld Luba , Ben-Horin Shomron , Shamir Raanan
Published: December 2018

Background

Recent studies suggest that the prevalence of celiac disease is rising. We previously established the prevalence of celiac disease in healthy blood donors in 2002.

Objective

The purpose of this study was to examine whether the prevalence of celiac disease and celiac disease autoimmunity has changed over time by performing a similar prospective study.

Methods

Healthy blood donors (n = 1908) were tested for tissue transglutaminase antibodies and for anti‐endomysial antibodies when positive. Further evaluation followed accepted criteria for diagnosis.

Results

Overall, 32 donors had abnormal tissue transglutaminase antibodies (1.68%). Eight donors had tissue transglutaminase antibodies >3 × upper limit of normal (0.42%), two of them with tissue transglutaminase antibodies >10 × upper limit of normal, while 24 donors had tissue transglutaminase antibodies <3 × upper limit of normal (1.26%). Most of the donors with positive tissue transglutaminase antibodies <3 × upper limit of normal had negative tissue transglutaminase antibodies levels on repeated testing (18/19). Celiac disease was diagnosed in four donors with positive tissue transglutaminase antibodies, establishing a prevalence of 1.68% (95% confidence interval 1.15–2.3) for celiac disease autoimmunity and 0.21% for celiac disease (95% confidence interval 0.07–0.5%).

Conclusion

The prevalence of celiac disease in blood donors in Israel did not rise in the last 15 years, suggesting that the increased prevalence of diagnosed celiac disease is mainly due to increased awareness. As most of the donors with elevated tissue transglutaminase antibodies <3 × upper limit of normal were endomysial antibody negative and had a negative tissue transglutaminase antibodies result upon re‐testing, repeated tissue transglutaminase antibodies testing is required when screening asymptomatic populations for celiac disease.
Time Interval to Biochemical Failure as a Surrogate End Point in Locally Advanced Prostate Cancer: Analysis of Randomized Trial NRG/RTOG 9202
Authors: Dignam James J. , Hamstra Daniel A. , Lepor Herbert , Grignon David , Brereton Harmar , Currey Adam , Rosenthal Seth , Zeitzer Kenneth L. , Venkatesan Varagur M. , Horwitz Eric M. , Pisansky Thomas M. , Sandler Howard M.
Published: December 2018

Background

In prostate cancer, end points that reliably portend prognosis and treatment benefit (surrogate end points) can accelerate therapy development. Although surrogate end point candidates have been evaluated in the context of radiotherapy and short-term androgen deprivation (AD), potential surrogates under long-term (24 month) AD, a proven therapy in high-risk localized disease, have not been investigated.

Materials and Methods

In the NRG/RTOG 9202 randomized trial (N = 1,520) of short-term AD (4 months) versus long-term AD (LTAD; 28 months), the time interval free of biochemical failure (IBF) was evaluated in relation to clinical end points of prostate cancer–specific survival (PCSS) and overall survival (OS). Survival modeling and landmark analysis methods were applied to evaluate LTAD benefit on IBF and clinical end points, association between IBF and clinical end points, and the mediating effect of IBF on LTAD clinical end point benefits.

Results

LTAD was superior to short-term AD for both biochemical failure (BF) and the clinical end points. Men remaining free of BF for 3 years had relative risk reductions of 39% for OS and 73% for PCSS. Accounting for 3-year IBF status reduced the LTAD OS benefit from 12% (hazard ratio [HR], 0.88; 95% CI, 0.79 to 0.98) to 6% (HR, 0.94; 95% CI, 0.83 to 1.07). For PCSS, the LTAD benefit was reduced from 30% (HR, 0.70; 95% CI, 0.52 to 0.82) to 6% (HR, 0.94; 95% CI, 0.72 to 1.22). Among men with BF, by 3 years, 50% of subsequent deaths were attributed to prostate cancer, compared with 19% among men free of BF through 3 years.

Conclusion

The IBF satisfied surrogacy criteria and identified the benefit of LTAD on disease-specific survival and OS. The IBF may serve as a valid end point in clinical trials and may also aid in risk monitoring after initial treatment.
Early Clinical and Economic Outcomes of Prophylactic and Acute Pathologic Fracture Treatment
Authors: Mosher Zachary A. , Patel Harshadkumar , Ewing Michael A. , Niemeier Thomas E. , Hess Matthew C. , Wilkinson Eric B. , McGwin Gerald , Ponce Brent A. , Patt Joshua C.
Published: December 2018

INTRODUCTION:

Pathologic fractures often contribute to adverse events in metastatic bone disease, and prophylactic fixation offers to mitigate their effects. This study aims to analyze patient selection, complications, and in-hospital costs that are associated with prophylactic fixation compared with traditional acute fixation after completed fracture.

MATERIALS AND METHODS:

The Nationwide Inpatient Sample database was queried from 2002 to 2014 for patients with major extremity pathologic fractures. Patients were divided by fixation technique (prophylactic or acute) and fracture location (upper or lower extremity). Patient demographics, comorbidities, complications, hospitalization length, and hospital charges were compared between cohorts. Preoperative variables were analyzed for potential confounding, and χ2tests and Student’s t tests were used to compare fixation techniques.

RESULTS:

Cumulatively, 43,920 patients were identified, with 14,318 and 28,602 undergoing prophylactic and acute fixation, respectively. Lower extremity fractures occurred in 33,582 patients, and 10,333 patients had upper extremity fractures. A higher proportion of prophylactic fixation patients were white ( P = .043), male ( P = .046), age 74 years or younger ( P < .001), and privately insured ( P < .001), with decreased prevalence of obesity ( P = .003) and/or preoperative renal disease ( P = .008). Prophylactic fixation was also associated with decreased peri- and postoperative blood transfusions ( P < .001), anemia ( P < .001), acute renal failure ( P = .010), and in-hospital mortality ( P = .031). Finally, prophylactic fixation had decreased total charges (−$3,405; P = .001), hospitalization length ( P = .004), and extended length of stay (greater than 75th percentile; P = .012).

CONCLUSION:

Prophylactic fixation of impending pathologic fractures is associated with decreased complications, hospitalization length, and total charges, and should be considered in appropriate patients.
IRS-1 increases TAZ expression and promotes osteogenic differentiation in rat bone marrow mesenchymal stem cells
Authors: Wang Na , Xue Peng , Li Ziyi , Li Yukun
Published: December 2018

Whether insulin receptor substrate 1 (IRS-1) inhibits or promotes the osteogenic proliferation and differentiation in vitro remains controversial. Transcriptional co-activator with PDZ-binding motif (TAZ) plays a vital role in the osteogenesis of bone marrow mesenchymal stem cells (BMSCs), and strongly activates the expression of the osteogenic differentiation markers. In this study, we found that IRS-1 and TAZ followed similar increasing expression patterns at the early stage of osteogenic differentiation. Knocking down IRS-1 decreased the TAZ, RUNX2 and OCN expression, and overexpressing IRS induced the upregulation of the TAZ, RUNX2 and OCN expression. Furthermore, our results showed that it was LY294002 (the PI3K-Akt inhibitor), other than UO126 (the MEK-ERK inhibitor), that inhibited the IRS-1 induced upregulation of TAZ expression. Additionally, SiTAZ blocked the cell proliferation in G1 during the osteogenic differentiation of BMSCs. Taken together, we provided evidence to demonstrate that IRS-1 gene modification facilitates the osteogenic differentiation of rat BMSCs by increasing TAZ expression through the PI3K-Akt signaling pathway.

This article has an associated First Person interview with the first author of the paper.
The effect of organisational factors in motivating healthcare employees: a systematic review
Authors: Afolabi Abimbola , Fernando Senaka , Bottiglieri Tony
Published: December 2018

Healthcare employee motivation is a key concept when attempting to achieve an efficient, effective and good quality healthcare delivery. In this article, a systematic review of primary data from the UK, Europe, Africa and Asia was conducted to consolidate the available evidence on the effect of organisational factors on healthcare employee motivation. Because healthcare delivery is highly labour intensive, it must be acknowledged that human resources are extremely critical in the drive for healthcare organisations to deliver on their organisational goals. The organisational factors that were identified as having a great effect on healthcare employee motivation can be divided into financial and non-financial factors. Remuneration was identified as a strong extrinsic factor, while conducive working conditions, increased responsibilities and appreciation from the communities in which they serve were identified as strong intrinsic factors. Even though there is a cultural aspect to motivation, remuneration, managerial support, and career advancement are core factors that affect all healthcare professionals – irrespective of country. Many of the factors that were observed in the literature as affecting motivation can be addressed by improving the reward strategy of healthcare organisations.
Hospital beds per death how does the UK compare globally?
Authors: Jones Rodney
Published: December 2018

The last year of life accounts for 55% of entire lifetime hospital bed use. This is independent of the age at death and refutes claims that healthcare demand is largely driven by population growth and ageing. This article argues that the ratio of available beds per death can provide a useful benchmark for international comparisons of acute bed provision. A figure of 372 beds per 1000 deaths is the international median, the average is 416 beds, and the interquartile range is 170–604 beds per 1000 deaths. Within the UK, England has 20% fewer NHS beds per death than Wales and 32% fewer than Scotland and Northern Ireland. Currently, England ranks in the bottom third of countries and is near the bed availability of less-developed countries. Countries with a very high provision of available beds per death, close to one bed per death, appear to include high intensity nursing home beds as an ‘acute’ bed. Despite considerable changes in technology, population age structure, and the number of deaths, the ratio of occupied beds per death for the medical group of specialties in England has remained roughly constant for the past 18 years indicating that available beds per death is a reliable measure of bed demand.
Identifikasi dan Analisis Filogenetik Portunus trituberculatus Dari Perairan Cirebon Menggunakan Barkode Gen COI Mitokondrial
Authors: Subagiyo Subagiyo , Handayani Retna , Rahayu Rahayu
Published: December 2018

Phylogenetic Identification and Analysis Portunus trituberculatus from Cirebon Coast Using the COI Barcode  Mitochondrial Portunus trituberculatus spesimen from Cirebon coast were successfully identified using mitochondrial DNA cytochrome c oxydase subunit I (COI) genes. Analysis of haplotype distribution of P. trituberculatus along with the same species from China, Korea, India and the Philippines obtained from NCBI gene banks resulted 17 haplotypes from 25 specimens. Haploid diversity was 0.943 + 0.031 and nucleotide diversity was 0.04821 + 0.0139. The Cirebon specimen is in separated haplotipe from the others. The results of phylogenetic analysis showed that the 25 specimens were clustered into 3 clusters in 2 different lineages with percentages genetic distance were 12.76%, 14.24% and 14.33% respectively. The genetic distance within each cluster ranges from 0 - 2.92%. The Cirebon crab specimen is in the same cluster as the Philippine specimen with 1% genetic distance.  Spesimen rajungan Portunus trituberculatus dari perairan Cirebon berhasil diidentifikasi menggunakan gen  mitochondrial DNA cytochrome c oxidase subunit I (COI). Analisis distribusi haplotipe dengan data P trituberculatus yang berasal dari China, Korea, India dan Filipina yang diperoleh dari data genebank NCBI didapatkan 17 haplotipe dari 25 spesimen, dengan keragaman haploid 0,943 +0.031 dan keragaman nukleotida 0,04821+0.0139. Spesimen Cirebon merupakan haplotipe yang terpisah dari yang lainnya. Hasil kajian filogenetik menunjukkan 25 spesimen mengelompok ke dalam 3 kluster dari 2 garis keturunan yang berbeda dengan jarak genetik berturut turut  12,76 %, 14,24 % dan 14,33 %. Jarak genetik di dalam masing-masing kluster berkisar antara 0 – 2,92 %.  Spesimen rajungan Cirebon berada pada garis keturunan dan kluster yang sama dengan spesimen Filipina dengan jarak genetik 1%.
Brexit and the Provision of Financial Services into the EU and into the UK
Authors: Wymeersch Eddy
Published: December 2018

Brexit is likely to lead to the relocation of UK financial services firms to the EU in order to be able to access EU markets, mainly through the EU passport. The same applies to the EU firms intending to be active on the UK markets. The access conditions to the EU markets are numerous and complex, laid down in EU and national legislation and regulation, and applied by the national supervisory authorities. The European Supervisory Authorities or “ESAs” have published elaborate statements, called Opinions, on the detailed access conditions and the way they intend to apply these. The two main objectives are the full application of EU law, and the avoidance of authorizing EU firms that would be “empty boxes” for activity that would in fact be exercised in the UK, and this mainly by delegating activities to another firm. Underlying is a policy of competition between national economies for relocations of EU firms, or of business activities to be developed on the UK financial markets.