bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterising variation in composition and activation criteria of rapid response and cardiac arrest teams: a survey of Medicare participating hospitals in five American states
Authors: Mitchell Oscar J L , Motschwiller Caroline W , Horowitz James M , Evans Laura E , Mukherjee Vikramjit
Published: March 2019

Objectives

To characterise the variation in composition, leadership, and activation criteria of rapid response and cardiac arrest teams in five north-eastern states of the USA.

Design

Cross-sectional study consisting of a voluntary 46-question survey of acute care hospitals in north-eastern USA.

Setting

Acute care hospitals in New York, New Jersey, Rhode Island, Vermont, and Pennsylvania.

Participants

Surveys were completed by any member of the rapid response team (RRT) with a working knowledge of team composition and function. Participants were all Medicare-participating acute care hospitals, including teaching and community hospitals as well as hospitals from rural, urban and suburban areas.

Results

Out of 378 hospitals, contacts were identified for 303, and 107 surveys were completed. All but two hospitals had an RRT, 70% of which changed members daily. The most common activation criteria were clinical concern (95%), single vital sign abnormalities (77%) and early warning score (59%). Eighty one per cent of hospitals had a dedicated cardiac arrest team.

RRT composition varied widely, with respiratory therapists, critical care nurses, physicians and nurse managers being the most likely to attend (89%, 78%, 64% and 51%, respectively). Consistent presence of critical care physicians was uncommon and both cardiac arrest teams and teams were frequently led by trainee physicians, often without senior supervision.

Conclusions

As the largest study to date in the USA, we have demonstrated wide heterogeneity, rapid team turnover and a lack of senior supervision of RRT and cardiac arrest teams. These factors likely contribute to the mixed results seen in studies of RRTs.
eHealth-based intervention to increase physical activity levels in people with cancer: protocol of a feasibility trial in an Irish acute hospital setting
Authors: Haberlin Ciarán , Broderick Julie , Guinan Emer M , Darker Catherine , Hussey Juliette , O’Donnell Dearbhaile M
Published: March 2019

Introduction

Exercise and physical activity (PA) are established and effective treatment options for various side effects of cancer treatments such as surgery, chemotherapy and radiotherapy. The advent of eHealth brings new opportunities to influence healthy behaviours, using interactive and novel approaches. Influencing PA behaviours in people with cancer presents a potential application of this. The aim of this study is to evaluate the feasibility and preliminary efficacy of an intervention, using eHealth, for increasing PA in cancer survivors.

Methods and analysis

This will be a single-arm pre–post feasibility study. We aim to recruit a heterogeneous sample of 60 participants from cancer clinics in St. James’s Hospital, Dublin, Ireland. Eligibility criteria will include patients who have completed chemotherapy and/or radiotherapy with curative intent between 3 and 36 months prior to enrolment. The intervention will include the delivery of a 12-week PA programme. The eHealth aspect of the intervention will involve the provision of a Fitbit activity tracker, which will be used in conjunction with specific PA goals remotely prescribed and monitored by a physiotherapist. Primary outcomes will be feasibility measures related to the study (recruitment capability, data collection procedures, adherence and compliance, evaluation of the resources to implement the study and evaluation of participant responses to the intervention). Secondary measures will evaluate preliminary efficacy of the intervention in terms of clinical outcomes (body composition, PA (objective and self-report), quality of life and aerobic capacity). Primary and secondary outcomes will be assessed at baseline (as appropriate), at conclusion of the intervention and at a 6-month follow-up.

Ethics and dissemination

Ethical approval has been granted by the St. James’s Hospital/AMNCH Joint Ethics Committee (2016/05/02). Results from this study will be submitted for publication in peer-reviewed journals, as well as for presentation and dissemination at conferences in the field of oncology and survivorship.

Trial registration

NCT03036436; Pre-results.
Improving decision making in acute healthcare through implementation of an intensive care unit (ICU) intervention in Australia: a multimethod study
Authors: Clay-Williams Robyn , Blakely Brette , Lane Paul , Senthuran Siva , Johnson Andrew
Published: March 2019

Objective

To evaluate the implementation of an intensive care unit (ICU) intervention designed to establish rules for making ICU decisions about postsurgery beds.

Design

Preintervention/postintervention case study using a multimethod approach, involving two phases of staff interviews, process mapping and collection of administrative data.

Setting

ICU in a 700-bed regional tertiary care hospital in Australia.

Participants

31 interview participants. Phases 1 and 2 participants drawn from three groups of staff: bedside nursing staff in the ICU, ICU specialist doctors and senior management staff involved in oversight of ICU operations. Phase 2 included an additional participant group: staff from surgery and emergency departments.

Intervention

Implementation of an ICU escalation plan and introduction of a multidisciplinary morning meeting to determine ICU bed status in accordance with the plan.

Main outcome measures

Interview data consisted of preintervention staff perceptions of ICU workplace cohesiveness with bed pressure, and postintervention staff perceptions of the escalation plan and ICU performance. Administrative data consisted of bed status (red, amber or green), monthly number of planned elective surgeries requiring an ICU bed and monthly number of elective surgeries cancelled due to unavailability of ICU beds.

Results

Improved internal communication, decision making and cohesion within the ICU and better coordination between ICU and other hospital departments. Significant reduction in elective surgeries cancelled due to unavailability of ICU beds, χ21=24.9, p<0.0001.

Conclusions

By establishing rules for decision making around ICU bed allocation, the intervention improved internal professional relationships within the ICU as well as between the ICU and external departments and reduced the number of elective surgeries cancelled.
Associations between effort–reward imbalance and health indicators among school teachers in Chuquisaca, Bolivia: a cross-sectional study
Authors: Solis-Soto Maria Teresa , Schön Anabel , Parra Manuel , Radon Katja
Published: March 2019

Objective

To assess the association between effort–reward imbalance (ERI) and health indicators among Bolivian school teachers.

Design

School-based cross-sectional study.

Setting

Sixty randomly selected schools from rural (33) and urban (27) schools in Chuquisaca, Bolivia.

Participants

A total of 1062 school teachers were invited to participate, of which 597 answered the questionnaire (response 56.2%).

Exposure measure

Psychosocial factors at work were explored through the short version of the Effort–Reward Questionnaire.

Primary and secondary outcome measures

Health outcomes included self-rated overall health, mental distress (12-item General Health Questionnaire ≥5) and the 7-day prevalence of low back pain (LBP) as well as neck or shoulder pain (Nordic Questionnaire). Crude and adjusted ORs and their 95% CIs for each health outcome were calculated using logistic regression models.

Results

The median value for the effort–reward ratio was 0.91 (range: 0.3–2.3) with higher values for teachers from rural versus urban schools. Overall, about 43% of the teachers reported their overall health as fair or poor; 45% suffered mental distress, 17% reported LBP and 29% neck or shoulder pain. Prevalences were higher for teachers employed at rural schools compared with those at urban schools. After adjusting for potential confounders and school location, ERI was statistically significantly associated with fair/poor self-rated health (adjusted OR 1.7, 95% CI 1.0 to 2.9); mental distress (1.9; 95% CI 1.2 to 3.1) and LBP (2.3; 95% CI 1.3 to 4.1).

Conclusion

Our results indicate the urgent need to improve psychosocial working conditions among Bolivian school teachers, in order to promote their health and well-being.
ETS-related gene(ERG) expression as a predictor of oncological outcomes in patients with high-grade prostate cancer treated with primary androgen deprivation therapy: a cohort study
Authors: Rezk Mark , Chandra Ashish , Addis Daniel , Møller Henrik , Youssef Mina , Dasgupta Prokar , Yamamoto Hide
Published: March 2019

Objectives

To determine whetherETS-related gene(ERG) expression can be used as a biomarker to predict biochemical recurrence and prostate cancer-specific death in patients with high Gleason grade prostate cancer treated with androgen deprivation therapy (ADT) as monotherapy.

Methods

A multicentre retrospective cohort study identifying 149 patients treated with primary ADT for metastatic or non-metastatic prostate cancer with Gleason score 8–10 between 1999 and 2006. Patients planned for adjuvant radiotherapy at diagnosis were excluded. Age at diagnosis, ethnicity, prostate-specific antigen and Charlson-comorbidity score were recorded. Prostatic tissue acquired at biopsy or transurethral resection surgery was assessed for immunohistochemical expression ofERG. Failure of ADT defined as prostate specific antigen nadir +2. Vital status and death certification data determined using the UK National Cancer Registry. Primary outcome measures were overall survival (OS) and prostate cancer specific survival (CSS). Secondary outcome was biochemical recurrence-free survival (BRFS).

Results

The median OS of our cohort was 60.2 months (CI 52.0 to 68.3).ERGexpression observed in 51/149 cases (34%). Multivariate Cox proportional hazards analysis showed no significant association betweenERGexpression and OS (p=0.41), CSS (p=0.92) and BRFS (p=0.31). Cox regression analysis showed Gleason score (p=0.003) and metastatic status (p<1×10-5) to be the only significant predictors of prostate CSS.

Conclusions

No significant association was found betweenERGstatus and any of our outcome measures. Despite a limited sample size, our results suggest thatERGdoes not appear to be a useful biomarker in predicting response to ADT in patients with high risk prostate cancer.
Evaluating 3D-printed models of coronary anomalies: a survey among clinicians and researchers at a university hospital in the UK
Authors: Lee Matthew , Moharem-Elgamal Sarah , Beckingham Rylan , Hamilton Mark , Manghat Nathan , Milano Elena Giulia , Bucciarelli-Ducci Chiara , Caputo Massimo , Biglino Giovanni
Published: March 2019

Objective

To evaluate the feasibility of three-dimensional (3D) printing models of coronary artery anomalies based on cardiac CT data and explore their potential for clinical applications.

Design

Cardiac CT datasets of patients with various coronary artery anomalies (n=8) were retrospectively reviewed and processed, reconstructing detailed 3D models to be printed in-house with a desktop 3D printer (Form 2, Formlabs) using white resin.

Setting

A University Hospital (division of cardiology) in the UK.

Participants

The CT scans, first and then 3D-printed models were presented to groups of clinicians (n=8) and cardiovascular researchers (n=9).

Intervention

Participants were asked to assess different features of the 3D models and to rate the models’ overall potential usefulness.

Outcome measures

Models were rated according to clarity of anatomical detail, insight into the coronary abnormality, overall perceived usefulness and comparison to CT scans. Assessment of model characteristics used Likert-type questions (5-point scale from ‘strongly disagree’ to ‘strongly agree’) or a 10-point rating (from 0, lowest, to 10, highest). The questionnaire included a feedback form summarising overall usefulness. Participants’ imaging experience (in a number of years) was also recorded.

Results

All models were reconstructed and printed successfully, with accurate details showing coronary anatomy (eg, anomalous coronary artery, coronary roofing or coronary aneurysm in a patient with Kawasaki syndrome). All clinicians and researchers provided feedback, with both groups finding the models helpful in displaying coronary artery anatomy and abnormalities, and complementary to viewing 3D CT scans. The clinicians’ group, who had substantially more imaging expertise, provided more enthusiastic ratings in terms of models’ clarity, usefulness and future use on average.

Conclusions

3D-printed heart models can be feasibly used to recreate coronary artery anatomy and enhance understanding of coronary abnormalities. Future studies can evaluate their cost-effectiveness, as well as potentially explore other printing techniques and materials.
Multiple challenges for people after transitioning to secondary progressive multiple sclerosis: a qualitative study
Authors: Bogosian Angeliki , Morgan Myfanwy , Moss-Morris Rona
Published: March 2019

Objectives

Transitioning to secondary progressive multiple sclerosis (SPMS) is demanding for both patients and healthcare professionals. The particular challenges and the ways patients cope are poorly understood. The present study examines what challenges people face when diagnosed with SPMS by exploring experiences of people who have transitioned recently (up to 5 years).

Design

Semistructured qualitative interviews at two time points a year apart. Interviews were analysed using inductive thematic analysis.

Setting

UK.

Participants

We interviewed 21 people at baseline and 17 participated in the follow-up interviews.

Results

The majority of participants reported expecting to transition to SPMS, and the diagnosis did not make much difference to them. Participants described increasing emotional and physical challenges after transitioning to SPMS and between the first and second interviews. Planning, using distractions and maintaining social roles helped participants cope with the increased challenges. The same coping strategies were used between the two interviews. Participants felt there was not much left to do regarding the management of their symptoms. A key theme was the sense of abandonment from healthcare services after transitioning to SPMS.

Conclusions

After transitioning to SPMS, people are faced with multiple challenges. Participants described a lack of directions for symptoms management and lack of support from the healthcare system. An integrated multidisciplinary healthcare approach is crucial at the progressive stage of the disease to alleviate feelings of helplessness and promote symptom management.
What’s on your keyboard? A systematic review of the contamination of peripheral computer devices in healthcare settings
Authors: Ide Nicole , Frogner Bianca K , LeRouge Cynthia M , Vigil Patrick , Thompson Matthew
Published: March 2019

Objective

To determine the extent and type of microbial contamination of computer peripheral devices used in healthcare settings, evaluate the effectiveness of interventions to reduce contamination of these devices and establish the risk of patient and healthcare worker infection from contaminated devices.

Design

Systematic review

Methods

We searched four online databases: MEDLINE, CINAHL, Embase and Scopus for articles reporting primary data collection on contamination of computer-related equipment (including keyboards, mice, laptops and tablets) and/or studies demonstrating the effectiveness of a disinfection technique. Pooling of contamination rates was conducted where possible, and narrative synthesis was used to describe the rates of device contamination, types of bacterial and viral contamination, effectiveness of interventions and any associations between device contamination and human infections.

Results

Of the 4432 records identified, a total of 75 studies involving 2804 computer devices were included. Of these, 50 studies reported contamination of computer-related hardware, and 25 also measured the effects of a decontamination intervention. The overall proportion of contamination ranged from 24% to 100%. The most common microbial contaminants were skin commensals, but also included potential pathogens including methicillin-resistantStaphylococcus aureus,Clostridiumdifficile, vancomycin-resistantenterococci andEscherichia coli. Interventions demonstrating effective decontamination included wipes/pads using isopropyl alcohol, quaternary ammonium, chlorhexidine or dipotassium peroxodisulfate, ultraviolet light emitting devices, enhanced cleaning protocols and chlorine/bleach products. However, results were inconsistent, and there was insufficient data to demonstrate comparative effectiveness. We found little evidence on the link between device contamination and patient/healthcare worker colonisation or infection.

Conclusions

Computer keyboards and peripheral devices are frequently contaminated; however, our findings do not allow us to draw firm conclusions about their relative impact on the transmission of pathogens or nosocomial infection. Additional studies measuring the incidence of healthcare-acquired infections from computer hardware, the relative risk they pose to healthcare and evidence for effective and practical cleaning methods are needed.
Aggregated student confidence estimates support continuous quality improvements in a competencies-oriented curriculum
Authors: Papa Frank Joseph , Alexander Jerry H
Published: March 2019

Introduction

Competencies oriented medical curricula are intended to support the development of those specific tasks likely to improve patient care outcomes. In 2005, our institution developed curricular objectives and instructional activities intended to enable our students to competently perform four specific clinical tasks (diagnose, treat, manage and explain phenomena) for each of approximately 100 common and/or important patient presentations (eg, dyspnoea). However, competencies oriented curricula must also develop outcome metrics aligned with their objectives and instructional activities in order to launch a continuous quality improvement (CQI) programme. This investigation describes how a novel course evaluation methodology produced presentation and task-focused outcome metrics sufficient to support CQIs in our competencies-oriented curriculum.

Methods

Literature suggests that aggregated, group opinions are much more reliable than individual opinions in a variety of settings, including education. In 2010, we launched a course evaluation methodology using aggregated student self-assessments of their confidence in performing the four tasks trained to in each presentation-focused instructional activity. These aggregated estimates were transformed into a variety of graphic and tabular reports which faculty used to identify, and then remediate, those specific instructional activities associated with suboptimal presentation and task-focused confidence metrics.

Results

With academic year 2010–2011 serving as a baseline and academic year 2015–2016 as an endpoint, analysis of variance revealed a sustained and statistically significant gain in student confidence across this 6-year study period (p<0.001).

Discussion

This investigation demonstrated that aggregated, presentation and task-specific confidence estimates enabled faculty to pursue and attain CQIs in a competencies-oriented curriculum. Suggestions for new approaches to confidence-related research are offered.
Reinvigorating stagnant science: implementation laboratories and a meta-laboratory to efficiently advance the science of audit and feedback
Authors: Grimshaw JM , Ivers Noah , Linklater Stefanie , Foy Robbie , Francis Jill J , Gude Wouter T , Hysong Sylvia J
Published: March 2019

Audit and feedback (A&F) is a commonly used quality improvement (QI) approach. A Cochrane review indicates that A&F is generally effective and leads to modest improvements in professional practice but with considerable variation in the observed effects. While we have some understanding of factors that enhance the effects of A&F, further research needs to explore when A&F is most likely to be effective and how to optimise it. To do this, we need to move away from two-arm trials of A&F compared with control in favour of head-to-head trials of different ways of providing A&F. This paper describes implementation laboratories involving collaborations between healthcare organisations providing A&F at scale, and researchers, to embed head-to-head trials into routine QI programmes. This can improve effectiveness while producing generalisable knowledge about how to optimise A&F. We also describe an international meta-laboratory that aims to maximise cross-laboratory learning and facilitate coordination of A&F research.
Is ultrasound-guided lavage an effective intervention for rotator cuff calcific tendinopathy? A systematic review with a meta-analysis of randomised controlled trials
Authors: Lafrance Simon , Doiron-Cadrin Patrick , Saulnier Marie , Lamontagne Martin , Bureau Nathalie J , Dyer Joseph-Omer , Roy Jean-Sébastien , Desmeules François
Published: March 2019

Background

Rotator cuff calcific tendinopathy is characterised by the deposition of hydroxyapatite crystals in one of the rotator cuff tendons and can be managed by ultrasound-guided lavage. However, evidence regarding the efficacy of ultrasound-guided lavage for rotator cuff calcific tendinopathy remains inconclusive. The aim of this systematic review and meta-analysis is to update the available evidence on the efficacy of ultrasound-guided lavage in adults with rotator cuff calcific tendinopathy.

Methods

A literature search was conducted up to April 2018 in four bibliographic databases to identify randomised control trials that compared ultrasound-guided lavage alone with other interventions to treat rotator cuff calcific tendinopathy. Randomised control trials were assessed with the Cochrane Risk of Bias Tool. Meta-analyses and/or qualitative synthesis of the evidence were performed.

Results

Three randomised control trials were included. Pooled results for pain (n=226) indicated that ultrasound-guided lavage may significantly decrease pain when compared with shockwave therapy, with a mean difference of −1.98 out of 10 points (95% CI −2.52 to −1.45) in the short term and of −1.84 (95% CI −2.63 to −1.04) in the long term. Based on one trial (n=25), ultrasound-guided lavage significantly improved function when compared with shockwave therapy (p<0.05). Based on another trial (n=48), the addition of ultrasound-guided lavage to a corticosteroid injection significantly improves function in the long term (p<0.05).

Conclusion

For individuals with rotator cuff calcific tendinopathy, low-quality evidence suggests that ultrasound-guided lavage is more effective than shockwave therapy or a corticosteroid injection alone. Future trials could modify the present conclusions.

Trial registration number

CRD42018095858.
Determinants of coronary artery disease risk factor management across three world regions
Authors: Zhao Min , Graham Ian , Cooney Marie Therese , Grobbee Diederick E , Vaartjes Ilonca , Klipstein-Grobusch Kerstin
Published: March 2019

Background

The SUrvey of Risk Factors (SURF) indicated poor control of risk factors in subjects with established coronary heart disease (CHD). The present study aimed to investigate determinants of risk factor management in patients with CHD.

Methods and results

SURF recruited 9987 consecutive patients with CHD from Europe, Asia and the Middle East between 2012 and 2013. Risk factor management was summarised as a Cardiovascular Health Index Score (CHIS) based on six risk factor targets (non-smoker/ex-smoker, body mass index <30, adequate exercise, controlled blood pressure, controlled low-density lipoprotein and controlled glucose). Logistic regression models assessed the associations between determinants (age, sex, family history, cardiac rehabilitation, previous hospital admission and diabetes) and achievement of moderate CHIS (≥3 risk factors controlled). The results are presented as OR with corresponding 95% CI. A moderate CHIS was less likely to be reached by women (OR 0.90, 95% CI 0.69 to 1.00), those aged <55 years old (OR 0.62, 95% CI 0.53 to 0.76) and those with diabetes (OR 0.41, 95% CI 0.37 to 0.46). Attendance in cardiac rehabilitation was associated with better CHIS achievements (OR 1.62, 95% CI 1.42 to 1.87). Younger Asian and European patients had poorer risk factor management, whereas for patients from the Middle East age was not significantly associated with risk factor management. The availability and applicability of cardiac rehabilitation varied by region.

Conclusions

Overall, risk factor management was poorer in women, those younger than 55 years old, those with diabetes and those who did not participate in a cardiac rehabilitation. Determinants of cardiovascular risk factor management differed by region.
Immune-mediated conditions affecting the brain, eye and ear (BEE syndromes)
Authors: Triplett James D , Buzzard Katherine A , Lubomski Michal , Riminton D Sean , Barnett Michael H , Welgampola Miriam S , Halmagyi G Michael , Nguyen MaiAnh , Landau Klara , Lee Andrew G , Plant Gordon T , Fraser Clare L , Reddel Stephen W , Hardy Todd A
Published: March 2019

The triad of central nervous system symptoms, visual disturbance and hearing impairment is an oft-encountered clinical scenario. A number of immune-mediated diseases should be considered among the differential diagnoses including: Susac syndrome, Cogan syndrome or Vogt-Koyanagi-Harada disease; demyelinating conditions such as multiple sclerosis or neuromyelitis optica spectrum disorder; systemic diseases such as systemic lupus erythematosus, Sjögren syndrome or Behcet disease and granulomatous diseases such as sarcoidosis. In this article, we coin the term ‘BEE syndromes’ to draw attention to the various immune-mediated diseases that affect the brain, eye and ear. We present common disease manifestations and identify key clinical and investigation features.
Endovascular therapy for middle cerebral artery M2 segment occlusion: subanalyses of RESCUE-Japan Registry 2
Authors: Miura Masatomo , Yoshimura Shinichi , Sakai Nobuyuki , Yamagami Hiroshi , Uchida Kazutaka , Nagao Yoichiro , Morimoto Takeshi
Published: March 2019

Objective

To compare the efficacy of endovascular therapy (EVT) with that of medical treatment in ’real-world ’patients with M2 occlusion.

Methods

This was a post hoc analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Registry 2. Among 2420 patients in the registry, we evaluated patients with isolated M2 occlusion and those with functional independence before the stroke. Multivariable logistic regression analysis was used to evaluate and compare clinical outcomes between EVT and medical treatment. Additional propensity score-matched (PSM) analyses were performed. We performed subgroup analyses of the primary outcome (modified Rankin Scale score 0–2 at 90 days) using forest plots of treatment effects.

Results

Overall, 372 patients with M2 occlusion (n=184 EVT; n=188, medical treatment) were evaluated. The EVT group had a higher baseline National Institutes of Health Stroke Scale score (median (IQR), 15 [9–19] vs 10 [5–16]) and earlier onset to hospital door time (110 [50–258] vs 150 [60–343] min) than the medical treatment group. After adjustment, EVT was significantly associated with higher odds of primary outcome (adjusted OR=2.09; 95% CI 1.26 to 3.47) and lower odds of mortality at 90 days (adjusted OR= 0.27; 95% CI 0.08 to 0.93). After PSM analyses (184 patients were 1:1 matched with each group), EVT was effective and safe relative to medical treatment. Effects favoring EVT were present in several subgroups of interest.

Conclusion

In patients with M2 occlusion, our registry suggests that EVT is effective and safe.
Testing bioresorbable stent feasibility in a rat aneurysm model
Authors: Grüter Basil Erwin , Täschler Dominik , Strange Fabio , Rey Jeannine , von Gunten Michael , Grandgirard Denis , Leib Stephen L , Remonda Luca , Widmer Hans Rudolf , Nevzati Edin , Fandino Javier , Marbacher Serge , Coluccia Daniel
Published: March 2019

Background

Advances in stent-assisted coiling have incrementally expanded endovascular treatment options for complex cerebral aneurysms. After successful coil consolidation and aneurysm occlusion, endovascular scaffolds are no longer needed. Thus, bioresorbable stents that disappear after aneurysm healing could avoid future risks of in-stent thrombosis and the need for lifelong antiplatelet therapy.

Objective

To assess the applicability and compatibility of a bioresorbable magnesium- alloy stent (brMAS) for assisted coiling.

Methods

Saccular sidewall aneurysms were created in 84 male Wistar rats and treated with brMAS alone, brMAS + aspirin, or brMAS + coils + aspirin. Control groups included no treatment (natural course), solely aspirin treatment, or conventional cobalt–chromium stent + coils + aspirin treatment. After 1 and 4 weeks, aneurysm specimens were harvested and macroscopically, histologically, and molecularly examined for healing, parent artery perfusion status, and inflammatory reactions. Stent degradation was monitored for up to 6 months with micro-computed and optical coherence tomography.

Results

Aneurysms treated with brMAS showed advanced healing, neointima formation, and subsequent stent degradation. Additional administration of aspirin sustained aneurysm healing while reducing stent-induced intraluminal and periadventitial inflammatory responses. No negative interaction was detected between platinum coils and brMAS. Progressive brMAS degradation was confirmed.

Conclusions

brMAS induced appropriate healing in this sidewall aneurysm model. The concept of using bioresorbable materials to promote complete aneurysm healing and subsequent stent degradation seems promising. These results should encourage further device refinements and clinical evaluation of this treatment strategy for cerebrovascular aneurysms.
Do psychosocial job stressors influence mental health service use? Evidence from an Australian cohort
Authors: Milner Allison , Petrie Dennis , LaMontagne Anthony D , Butterworth Peter
Published: March 2019

Objectives

There is strong evidence of a relationship between psychosocial job stressors and mental health at the population level. There has been no longitudinal research on whether the experience of job stressors is also associated with greater mental health service use. We seek to fill this gap.

Methods

The Household Income Labour Dynamics in Australia survey cohort was used to assess the relationship between exposure to self-reported psychosocial job quality and reporting attendance at a mental health professional during the past 12 months. We adjusted for time-varying and time-invariant confounders. The study was conducted in 2009 and 2013.

Results

In the random effects logistic regression model, increasing exposure to psychosocial job stressors was associated with an increased odds of mental health service use after adjustment (one stressor: OR 1.26, 95% CI 1.01 to 1.56; two stressors: OR 1.33, 95% CI 1.02 to 1.73; three stressors: OR 1.82, 95% CI 1.28 to 2.57). However, once the between person effects were controlled in a fixed effects model, the within-person association between change in job stressors and change in mental health service use was estimated to be close to zero and not significant.

Conclusions

More work is needed to understand the relationship between job stressors and service use. However, when taken with past findings on job stressors and mental health, these findings highlight the importance of considering policy and clinical practice responses to adverse working contexts.
Down-regulation of the inflammatory response after short-term exposure to low levels of chemical vapours
Authors: Ernstgård Lena , Bottai Matteo , Johanson Gunnar , Sjögren Bengt
Published: March 2019

Objective

To investigate the relation between signs and symptoms of irritation and biomarkers of inflammatory markers in blood in healthy volunteers exposed to different chemical vapours for 2 or 4 hours in an exposure chamber.

Methods

The investigated chemicals were: acetic acid (5 and 10 ppm), acrolein (0.05 and 0.1 ppm), 1,4-dioxane (20 ppm), n-hexanal (2 and 10 ppm), hydrogen peroxide (0.5 and 2.2 ppm), 2-propanol (150 ppm), m-xylene (50 ppm), standard and dearomatised white spirit (100 and 300 mg/m3). C reactive protein (CRP), serum amyloid A protein and interleukin 6 were measured in plasma immediately before and 2 or 4 hours after the exposures. Symptoms were rated from 0 to 100 mm in Visual Analogue Scales and covered 10 questions whereof four related to irritation: discomfort in the eyes, nose and throat and dyspnoea. The effect measurements included blink frequency by electromyography, nasal swelling by acoustic rhinometry and lung function by spirometry.

Results

Logistic quantile regression analyses revealed no significant associations except a negative relation between ratings of irritation and CRP.

Conclusion

The results suggest a down-regulation of CRP after short-term exposure to low levels of vapours of irritating chemicals. This response might be mediated by the cholinergic anti-inflammatory pathway and further studies are recommended in order to refute or confirm this hypothesis.
Fetlock arthrodesis using DCP internal fixation in a Bactrian camel (Camelus bactrianus) for treatment of metacarpophalangeal joint hyperextension
Authors: McLean Kanyon , Lozier Joseph , Lakritz Jeffrey , Niehaus Andrew John
Published: March 2019

A 21‐month‐old intact, male Bactrian camel (Camelus bactrianus) presented for bilateral metacarpophalangeal joint hyperextension. Physical and radiographic evaluation revealed evidence of soft tissue hyperextension with no bony changes. The left metacarpophalangeal joint was fused using two dynamic compression plates on the dorsal aspect of the joint along with a figure‐8 tension band on the palmar aspect of the lateral fetlock for additional structural support. Twenty‐seven days postoperatively, the patient was able to weightbear on both thoracic limbs. The patient was released with recommendations to have the contralateral limb corrected in the near future. Follow‐up communication with the referring veterinarian revealed no known complications with the surgically corrected limb four months postrelease. This report illustrates the adaptation of a commonly reported surgical procedure in equine medicine and supports its use for correction of metacarpophalangeal joint hyperextension in artiodactylids not amenable to long‐term medical management.
Treatment of thirst in broilers in a low‐throughput abattoir
Authors: Cranley John James
Published: March 2019

Thirst in broilers was satisfied by water provision while awaiting slaughter at a one‐day‐per‐week poultry abattoir in England. Two consignments, of 7000 broilers in total, during high summer and in April were compared. The ambient temperature by the end of slaughter was over 29°C at 16.00 hours in summer, whereas in spring the peak was 14°C. Broilers were given water from a bubbling hose or water dish, the walls of the module drawer were dripped with water, and an industrial electric cooling fan was used during hot conditions. Nipple‐watered birds, once their fear of the plastic hose subsided, drank enthusiastically as depicted on the video. Thirst became more severe, as the period of water deprivation, heat and travel stress increased to eight hours or more, especially once the ambient temperature exceeded 17°C. Broilers responded as did thirsty horses, cattle or pigs.
Management and resolution of acquired myasthenia gravis in a carbimazole‐treated hyperthyroid domestic shorthair cat
Authors: Ellis Jenny , Tappin Simon
Published: March 2019

An 11‐year‐old male neutered domestic shorthair cat presented with acute onset signs of generalised weakness and neck ventroflexion. He had been diagnosed with hyperthyroidism two months previously and been treated with daily carbimazole. No haematological, biochemical or electrolyte abnormalities were evident to explain his signs; thoracic and abdominal imaging was unremarkable. A positive response to a neostigmine response test and high acetylcholine receptor antibody titre were consistent with a diagnosis of myasthenia gravis. The temporal association with treatment of hyperthyroidism suggested acquired myasthenia gravis secondary to carbimazole, and the cat underwent successful surgery for thyroidectomy to avoid the need for ongoing medical therapy. Acetylcholine receptor antibody levels remained high four months later before returning to normal after a further two months. Clinical signs were completely controlled with pyridostigmine, which was tapered and eventually withdrawn, and the cat returned to a normal quality of life.
İZMİR-TURGUTLU (HAMİDİYE) KÖYÜNDE GİRİTLİ MUHACİRLER
Authors: ŞAHİN Cemile , DURAN Gamze
Published: March 2019

Girit’te
yaşayan Müslüman Türk nüfus ilk olarak; 19. yüzyılın sonlarında milliyetçi
akımların ve Yunan bağımsızlık hareketinin Girit’i de etkilemesiyle adada
başlayan milliyetçi çatışma ve katliamlar neticesinde yurtlarını terk ederek
adadan göç etmek zorunda kalmıştır. Daha sonra ise; Girit’in Osmanlı
hâkimiyetinden çıkmasıyla burada azınlık statüsünde yaşayan Girit Müslümanlarının
“Mübadele” anlaşmasıyla adadan yine zorunlu göç süreci yaşanmıştır. Böylece
yaşanan iki büyük göç dalgasıyla Müslüman nüfus, Anadolu’ya taşınmıştır. Bu
çalışmada; Müslüman halkın, 19. yüzyılda özellikle 1897 Osmanlı-Yunan Savaşı
ile birlikte baskı ve katliamlar sonucu Girit’ten Anadolu’ya yönelik zorunlu
göç ya da zorunlu kaçış süreci neticesinde İzmir’e gelmeleri ve burada Turgutlu
(Hamidiye) köyüne iskânları, sosyal ve kültürel değerleri ele alınarak, gerekli
değerlendirmeler yapılmaya çalışılmıştır. Bu çalışmanın amacı; tarihi belgeler,
alan çalışması ve  konu ile ilgili
yapılan çeşitli araştırmalar çerçevesinde, Giritli Müslümanların İzmir’e
gelişleri, Turgutlu (Hamidiye) köyünün kuruluşu ve buraya iskân edilmeleri, kaç
haneden mürekkep oldukları, meslekleri, temel geçim kaynakları, yörenin diğer
toplumsal gruplarıyla olan ilişkileri, kültürel adaptasyonları, Turgutlu
(Hamidiye) köyünün günümüzdeki durumu ve Giritli muhacirlerin tarihsel süreç
içerisinde geçirmiş oldukları dönüşümü irdeleyerek, farklı bir bakış açısı ortaya koyabilmektir. Konuya
özgünlük ve bütünlük sağlaması açısından, dönemin gazeteleri ve arşiv belgelerine
ayrıca bölgedeki üçüncü ve dördüncü kuşak Giritli vatandaşların
konu ile ilgili bizzat kendi ifadelerine yer verilmeye dikkat edilmiştir.
Moral Tragedy Pacifism
Authors: Parkin Nicholas
Published: March 2019

Conditional pacifism is the view that war is morally justified if and only if it satisfies the condition of not causing serious harm or death to innocent persons. Modern war cannot satisfy this condition, and is thus always unjustified. The main response to this position is that the moral presumption against harming or killing innocents is overridden in certain cases by the moral presumption against allowing innocents to be harmed or killed. That is, as harmful as modern war is, it can be morally justified as a lesser evil when it alone can prevent great harm to innocents. This paper proposes that extreme cases in which only war can prevent great harm to innocents may be morally tragic. In some cases it may be both wrong to wage war to prevent great harm and wrong to fail to prevent that great harm.
“Una sola donna, una sola voce”: Un'indagine “investigativa” su una novella d'autrice di fine Ottocento
Authors: Iaconis Valeria
Published: March 2019

La scrittura di mano femminile, fenomeno vistoso dell’Italia del secondo Ottocento, porta all’attenzione del pubblico le problematiche legali e sociali legate alla condizione della donna. Questo articolo analizza la novella Dopo la sentenza (1894) di Bruno Sperani, pseudonimo di Beatrice Speraz, quale esempio di tematizzazione dell’omicidio d’onore e di critica femminile ai codici postunitari. L’indagine si soffermerà sulle strutture narrative del testo, che privilegia il punto di vista situato del reo e l’uso sistematico delle figure dell’ellissi e della reticenza. Più che sulle informazioni esplicite nella novella, questa lettura si concentrerà sulla ricostruzione di quelle censurate. A tal fine verranno formulate ipotesi e deduzioni, instaurando un dialogo tra il testo e il contesto culturale e legale ad esso sottostante. Verranno così individuate le coordinate della percezione sociale del delitto d’onore, se ne osserverà il significato simbolico, e si evidenzierà la contestazione della nozione di rilevanza legale, attuata attraverso la valorizzazione del punto di vista femminile. Questo approccio, che prende le mosse dal movimento Law and Literature e dagli assunti del giusfemminismo, permetterà in ultima battuta di comprendere le dinamiche della violenza di genere ritratte da Sperani, violenza perpetrata materialmente dal protagonista, ma permessa e legittimata dall’orizzonte giuridico e sociale coevo.
Autophagy pathways in drug abusers after forensic autopsy: LC3B, ph-mTOR and p70S6K analysis
Authors: Chindemi Chiara , Cirielli Vito , Cima Luca , Danzi Olivia , Raniero Dario , Tagliaro Franco , Turrina Stefania , Eccher Albino , Ghimenton Claudio , Bortolotti Federica , Brunelli Matteo , De Leo Domenico
Published: March 2019

Introduction

Autophagy plays a role in various central nervous system diseases. Little is known about its molecular activation in drug addiction. Our aim was to investigate the signalling pathways of autophagy in brain tissues from drug abusers.

Methods

Twenty-five drug abusers with acute lethal intoxication and 10 controls were medico-legally autopsied. Brain-tissue samples from the parietal cortex and cerebellum were obtained. Expression of LC3B, phospho-mTOR (ph-mTOR) and phospho70S6 Kinase (p70S6K) was identified in tissue microarrays, with three tissue spots per case. Blood, urine or vitreous humour were tested in all cases to identify the acute intoxication. Hair analysis was performed in 14 cases to confirm chronic intoxication; the remaining cases had a documented medical history of chronic abuse.

Results

The autophagy marker LC3B was always positive on both the cortex and the cerebellum, stratified as strongly in 18 (72%) cases and weakly positive in seven (28%) cases. ph-mTOR was negative in all cases. The p70S6K molecule showed positivity in 14 (56%) cases on cortex tissue. The cerebellum was always negative, except for Purkinje cells. Drug abusers had statistically more double positive cases (LC3B–p70S6K) than controls ( p=0.0094).

Conclusion

Autophagy pathways were activated in our series, and 56% of drug abusers showed simultaneous LC3B–p70S6K immunoexpression on tissue from the parietal cortex and cerebellum. This may be of value in autopsy practice as an indicator of brain damage due to drug abuse and could serve as alternative or additional double sensitive diagnostic method to detect drug-related deaths using a tissue-based rationale.
How Algorithms Interact: Goffman's ‘Interaction Order’ in Automated Trading
Authors: MacKenzie Donald
Published: March 2019

In a talk in 2013, Karin Knorr Cetina referred to ‘the interaction order of algorithms’, a phrase that implicitly invokes Erving Goffman's ‘interaction order’. This paper explores the application of the latter notion to the interaction of automated-trading algorithms, viewing algorithms as material entities (programs running on physical machines) and conceiving of the interaction order of algorithms as the ensemble of their effects on each other. The paper identifies the main way in which trading algorithms interact (via electronic ‘order books’, which algorithms both ‘observe’ and populate) and focuses on two particularly Goffmanesque aspects of algorithmic interaction: queuing and ‘spoofing’, or deliberate deception. Following Goffman's injunction not to ignore the influence on interaction of matters external to it, the paper examines some prominent such matters. Empirically, the paper draws on documentary analysis and 338 interviews conducted by the author with high-frequency traders and others involved in automated trading.
Confocal laser endomicroscopy reveals alterations in duodenal permeability in patients with acute pancreatitis
Authors: Sun Lingjia , Yue Min , Dai Yining , Yu Chaohui , Chen Chunxiao
Published: March 2019

Objective

Intestinal permeability increases during the course of acute pancreatitis (AP). We assessed duodenal permeability alterations in patients with AP by confocal laser endomicroscopy (CLE).

Methods

Thirty patients with AP underwent CLE evaluation of the antral and duodenal mucosa. Images were graded based on the appearance of capillaries and the degree of fluorescein leakage.

Results

Patients with AP had increased duodenal mucosal permeability that could be detected by CLE. The mucosal permeability progressively increased in the gastric antrum, duodenal bulb, and descending duodenum. The CLE parameters in the antrum and duodenal bulb were not significantly different between patients with mild and severe AP. The CLE grades in the descending duodenum were higher in patients with severe than mild AP. The C-reactive protein level in AP was positively correlated with the permeability in the duodenal bulb and descending duodenum, while the computed tomography severity index score was positively correlated with the mucosal permeability in the duodenal bulb and descending duodenum.

Conclusion

CLE revealed increased duodenal permeability in patients with AP. Higher permeability in the descending duodenum was observed in severe than mild AP. Further large-scale studies are needed to confirm the relationship between altered duodenal permeability and the severity of AP.
Maintaining health-related quality of life from 85 to 93 years of age despite decreased functional ability
Authors: Johansson Maria M , Marcusson Jan , Wressle Ewa
Published: March 2019

Introduction

The ‘oldest-old’ is the most rapidly growing age group in Sweden and in the western world. This group is known to be at great risk of increased functional dependency and the need for help in their daily lives. The aim of this research was to examine how the oldest-old change over time regarding health-related quality of life, cognition, depression and ability to perform activities of daily living and investigate what factors explain health-related quality of life at age 85 and 93 years.

Methods

In this study, 60 individuals from the Swedish Elderly in Linköping Screening Assessment study were followed from age 85 to 93 years. Measurements used were EQ-5D, Geriatric Depression Scale, Mini Mental State Examination and ability to perform activities of daily living. Nonparametric statistics and regression analyses were used.

Results

Although the individuals had increased mobility problems, decreased ability to manage activities of daily living, and thus had increased need of assistance, they scored their health-related quality of life at age 93 years at almost the same level as at age 85 years. No depression and low dependence in activities of daily living speaks in favour of higher health-related quality of life.

Conclusions

Health-related quality of life can be maintained during ageing despite decreased functional ability and increased need of assistance in daily life.