bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetes Insipidus After Endoscopic Transsphenoidal Surgery
Authors: Burke William T , Cote David J , Penn David L , Iuliano Sherry , McMillen Katie , Laws Edward R
Published: April 2020

BACKGROUND

Diabetes insipidus (DI) is a recognized transient or permanent complication following transsphenoidal surgery (TSS) for pituitary tumors.

OBJECTIVE

To describe significant experience with the incidence of DI after TSS, identifying predictive characteristics and describing our diagnosis and management of postoperative DI.

METHODS

A retrospective analysis was performed of 700 patients who underwent endoscopic TSS for resection of pituitary adenoma (PA), Rathke cleft cyst (RCC), or craniopharyngioma. Inclusion criteria included at least 1 wk of follow-up for diagnosis of postoperative DI. Permanent DI was defined as DI symptoms and/or need for desmopressin more than 1 yr postoperatively. All patients with at least 1 yr of follow-up (n = 345) were included in analyses of permanent DI. Multivariable logistic regression models were constructed to identify predictors of transient or permanent postoperative DI.

RESULTS

The overall rate of any postoperative DI was 14.7% (103/700). Permanent DI developed in 4.6% (16/345). The median follow-up was 10.7 mo (range: 0.2-136.6). Compared to patients with PA, patients with RCC (odds ratio [OR] = 2.2, 95% CI: 1.2-3.9; P = .009) and craniopharyngioma (OR = 7.0, 95% CI: 2.9-16.9; P ≤ .001) were more likely to develop postoperative DI. Furthermore, patients with RCC (OR = 6.1, 95% CI: 1.8-20.6; P = .004) or craniopharyngioma (OR = 18.8, 95% CI: 4.9-72.6; P ≤ .001) were more likely to develop permanent DI compared to those with PA.

CONCLUSION

Although transient DI is a relatively common complication of endoscopic and microscopic TSS, permanent DI is much less frequent. The underlying pathology is an important predictor of both occurrence and permanency of postoperative DI.
Burnout Levels and Patterns in Postgraduate Medical Trainees: A Systematic Review and Meta-Analysis
Authors: Prentice Shaun , Dorstyn Diana , Benson Jill , Elliott Taryn
Published: April 2020

Purpose

Postgraduate medical trainees experience high rates of burnout; however, inconsistencies in definitions of burnout characterize this literature. The authors conducted a systematic review and meta-analysis examining burnout levels and patterns in postgraduate medical trainees, using a continuous conceptualization of burnout, consistent with the Maslach Burnout Inventory (MBI) framework.

Method

The authors searched 5 electronic databases (Cochrane Library, Embase, ERIC, Ovid MEDLINE, Ovid PsycINFO) between January 1981 and July 2019 for studies reporting postgraduate medical trainees’ burnout levels using the MBI-Human Services Survey. They examined study reporting quality using the QualSyst quality appraisal tool and calculated standardized mean differences (Hedges’ g), comparing trainees’ data with MBI norms for medicine and the overall population using a random effects model. They explored between-study heterogeneity using subgroup analyses (i.e., by training level and specialty). Finally, they studied the combined contribution of these 2 variables (and year of study publication) to burnout levels, using meta-regression.

Results

The authors identified 2,978 citations and included 89 independent studies in their review. They pooled the data for the 18,509 postgraduate trainees included in these studies for the meta-analyses. Reporting quality was generally high across the included studies. The meta-analyses revealed higher burnout levels among trainees compared with medicine and overall population norms, particularly for the depersonalization subscale. The authors also identified statistically significant differences between nonsurgical and surgical registrars (specialty trainees), with trainees from 12 individual specialties exhibiting unique burnout patterns.

Conclusions

There is a need to reduce and prevent burnout early in medical training. Given the differences in burnout levels and patterns across specialties, interventions must focus on the unique patterns exhibited by each specialty in the target population using a multidimensional approach. Standardizing the definition of burnout in accordance with the MBI framework will facilitate progression of this work.
Medical Student Mobilization During a Crisis: Lessons From a COVID-19 Medical Student Response Team
Authors: Soled Derek , Goel Shivangi , Barry Danika , Erfani Parsa , Joseph Nicholos , Kochis Michael , Uppal Nishant , Velasquez David , Vora Kruti , Scott Kirstin Woody
Published: April 2020

Problem

On March 17, 2020, the Association of American Medical Colleges recommended the suspension of all direct patient contact responsibilities for medical students because of the COVID-19 pandemic. Given this change, medical students nationwide had to grapple with how and where they could fill the evolving needs of their schools’ affiliated clinical sites, physicians, patients, and the community.

Approach

At Harvard Medical School (HMS), student leaders created a COVID-19 Medical Student Response Team to: (1) develop a student-led organizational structure that would optimize students’ ability to efficiently mobilize interested peers in the COVID-19 response, both clinically and in the community, in a strategic, safe, smart, and resource-conscious way; and (2) serve as a liaison with the administration and hospital leaders to identify evolving needs and rapidly engage students in those efforts.

Outcomes

Within a week of its inception, the COVID-19 Medical Student Response Team had more than 500 medical student volunteers from HMS and had shared the organizational framework of the response team with multiple medical schools across the country. The HMS student volunteers joined any of the 4 virtual committees to complete this work: Education for the Medical Community, Education for the Broader Community, Activism for Clinical Support, and Community Activism.

Next Steps

The COVID-19 Medical Student Response Team helped to quickly mobilize hundreds of students and has been integrated into HMS’s daily workflow. It may serve as a useful model for other schools and hospitals seeking medical student assistance during the COVID-19 pandemic. Next steps include expanding the initiative further, working with the leaders of response teams at other medical schools to coordinate efforts, and identifying new areas of need at local hospitals and within nearby communities that might benefit from medical student involvement as the pandemic evolves.
Anal Melanoma: A Rare Perianal Tumor With a Poor Prognosis
Authors: Mireia Merichal Resina , Carlos Cerdan Santacruz
Published: April 2020

Case Summary:

A 69-year-old woman with a nonrelevant past medical history was referred to an outpatient colorectal clinic because of the incidental finding of an anal pigmented lesion during a routine gynecological examination. Anal inspection and proctoscopy indicated possible anal melanoma (Fig. 1A and B).
Organizational Support for Nurse Manager Role Transition and Onboarding
Authors: Warshawsky Nora E. , Caramanica Laura , Cramer Emily
Published: April 2020

OBJECTIVE

The aim of this study was to provide guidance on supportive nurse manager role transition practices.

BACKGROUND

The nurse manager role is increasingly more complex and the workforce is increasingly less experienced. Wide variation in nurse manager role transition exists among organizations. Nurse managers are commonly hired without requisite knowledge and are expected to learn through experience.

METHODS

A mixed-methods approach was used to identify current and ideal organizational practices supporting the role transition of novice nurse managers.

RESULTS

Effective role transition of new nurse managers begins with human resource policies that encourage graduate preparation for nurse managers. A supportive transition program includes didactic education for knowledge development and coaching of novice nurse managers in the application of new knowledge to clinical practice experiences. Rigorous program evaluation is recommended for sustainability.

CONCLUSION

Nurse managers are the linchpins of organizations. Organizational leaders need to support their role transition for the success of the organization.
In vetro study on the toxic effects of acrylamide on blood antioxidants, ameliorative effects of vitamin C
Authors: Ghamdi Ahmed , Alenezi Fahad , Algoferi Misfer , Alhawas Mohamed , Afifi Mohamed
Published: April 2020

Background

Acrylamide (ACR) is a naturally occurring, widely used compound, it is generated during cocking carbohydrate rich food at high temperature. Ingestion of large amounts of ACR underlies several health concerns and teratogenicity. Ascorbic acid (vit C) is a strong reducing agent greatly used to clean free radicals.

Materials and methods

Blood sample was obtained from 46 years old, healthy nonsmoking man in heparinized tubs. Blood sample was immediately divided into seven parts as triplet for each. The first one was leaved as control, 2nd, 3rd and the 4th were treated with acrylamide in a concentration of 25,50 and 100 mM respectively, the 5th, 6th and the 7th were treated with acrylamide as the mentioned concentrations and vitamin C in a concentration of 100mM. Samples (one mile litter) from each tube were taken after four and 24 hours and were used for preparation of hemolysates, that were kept at −80°C till investigation of the biochemical parameters.

Results

The concentrations of Malondialdehyd (MDA), nitric oxide (NO) and hydrogen peroxide (H2O2) increased in ACR and/or vit. C treated samples as compared with control. The concentration of reduced glutathione (GSH) and activities of Catalase (CAT), Superoxide dismutase (SOD), Glutathione reductase (GR), Glutathione peroxidase (GPx) and glucose 6 phosphate dehydrogenase (G6PDH) decreased significantly in ACR and/or vit. C treated samples as compared with control. Meanwhile, The concentrations of MDA, NO and H2O2 decreased in samples treated with both ACR and vit. C as compared with that treated with ACR only. The concentration of GSH and activities CAT, SOD, GR, GPx and G6PDH increased significantly in samples treated with both ACR and vit. C as compared with that treated with ACR only.

Conclusion

ACR produce it’s toxic effect through it’s deleterious action on the antioxidant system through induction of pro-oxidants leading to exhausting of antioxidants. Vitamin C has an ameliorative action on the deleterious action exerted by ACR through improving the balance between pro-oxidants and antioxidant.
REDD1 loss reprograms lipid metabolism to drive progression of RAS mutant tumors
Authors: Qiao Shuxi , Koh Siang-Boon , Vivekanandan Varunika , Salunke Devika , Patra Krushna Chandra , Zaganjor Elma , Ross Kenneth , Mizukami Yusuke , Jeanfavre Sarah , Chen Athena , Mino-Kenudson Mari , Ramaswamy Sridhar , Clish Clary , Haigis Marcia , Bardeesy Nabeel , Ellisen Leif W.
Published: April 2020

Human cancers with activating RAS mutations are typically highly aggressive and treatment-refractory, yet RAS mutation itself is insufficient for tumorigenesis, due in part to profound metabolic stress induced by RAS activation. Here we show that loss of REDD1, a stress-induced metabolic regulator, is sufficient to reprogram lipid metabolism and drive progression of RAS mutant cancers. Redd1 deletion in genetically engineered mouse models (GEMMs) of KRAS-dependent pancreatic and lung adenocarcinomas converts preneoplastic lesions into invasive and metastatic carcinomas. Metabolic profiling reveals that REDD1-deficient/RAS mutant cells exhibit enhanced uptake of lysophospholipids and lipid storage, coupled to augmented fatty acid oxidation that sustains both ATP levels and ROS-detoxifying NADPH. Mechanistically, REDD1 loss triggers HIF-dependent activation of a lipid storage pathway involving PPARγ and the prometastatic factor CD36. Correspondingly, decreased REDD1 expression and a signature of REDD1 loss predict poor outcomes selectively in RAS mutant but not RAS wild-type human lung and pancreas carcinomas. Collectively, our findings reveal the REDD1-mediated stress response as a novel tumor suppressor whose loss defines a RAS mutant tumor subset characterized by reprogramming of lipid metabolism, invasive and metastatic progression, and poor prognosis. This work thus provides new mechanistic and clinically relevant insights into the phenotypic heterogeneity and metabolic rewiring that underlies these common cancers.
Relational recovery in co-occurring conditions: a qualitative study of first-person experiences
Authors: Brekke Eva , Ness Ottar , Lien Lars
Published: April 2020

Purpose

The purpose of this paper is to explore and describe first-person experiences of relational recovery in co-occurring mental health and substance use conditions.

Design/methodology/approach

Within a phenomenological and collaborative approach, in-depth individual interviews with eight persons with co-occurring conditions were analysed using systematic text condensation.

Findings

Participants described interpersonal relationships as both supporting and hindering recovery in fundamental ways. Four categories of experiences of relational recovery were described as follows: choosing one’s child; living with loneliness and a painful past; sacrificing everything for one’s partner; and regaining trust and support.

Originality/value

This paper provides an enhanced understanding of how interpersonal relationships may be experienced by persons who live with co-occurring conditions. The results generally support an understanding of recovery as a relational process.
Analysis of German wine consumers' preferences for organic and non-organic wines
Authors: Szolnoki Gergely , Hauck Katharina
Published: April 2020

Purpose

This study investigates organic wine consumption and analysed the motives, preferences and basic characteristics of German consumers of organic and non-organic wines.

Design/methodology/approach

The comparative study is based on data from a representative survey conducted with 2,000 consumers in Germany. Two segments of wine drinkers were created according to their consumption of organic wine. Consumers of organic and non-organic wine were compared by analysing the differences in wine-related behavioural factors and socio-demographic variables.

Findings

The study reveals that consumers of organic wine differ significantly from those who do not drink organic wines. Socio-demographic factors (e.g. age and social class) and behavioural attributes (e.g. frequency of wine consumption and involvement with and preference for other organic products) demonstrate the differences between the two consumer groups.

Originality/value

To our knowledge, no findings exist to date regarding differences between consumers of organic wine and consumers of non-organic wine. Therefore, these results fill a research gap and provide valuable inputs both to the wine industry as well as to the scientific community dealing with organic food preferences.
Exploring the role of goal setting and external accountability mechanisms in embedding strategic learning plans in small firms
Authors: Kelliher Felicity , Murphy Monica , Harrington Denis
Published: April 2020

Purpose

This paper explores the role of goal setting and external accountability mechanisms in embedding strategic learning plans in small firms. The research question asks, does an external learning intervention influence how strategic learning plans are embedded in small firms?

Design/methodology/approach

Insights from in-depth action research carried out with three small firm owner-managers (OMs) inform the study.

Findings

Findings present valuable insights into how small firms learn strategically, and the link between OM goal setting and external accountability mechanisms in pursuit of embedded learning. A framework for embedding strategic learning plans in small firms is presented.

Research limitations/implications

This study offers a contribution to knowledge in the areas of small firm learning, strategic planning and social learning theory. While the sample size is small, data and case protocols are in place which allow for replication of the study. As the research is embedded in social learning theory, alternative theoretical frameworks may shed a different light on the research question.

Practical implications

The study will be of interest to practitioners working in the design, development, delivery and evaluation of learning interventions for small service firms. Given the importance of the small firm sector to the global economy, the research may also be of interest to government agencies, who strive to protect the survival and growth of small firms generally and who set aside resource amounts each year to fund training programmes for small firm OMs.

Originality/value

The research contributes to the body of existing knowledge in the small firm setting concerning social learning theory and small firm learning strategies. It has identified a link between OM goal setting and external accountability mechanisms in pursuit of sustainable organisational learning in small firms and offers a framework for embedding strategic learning plans in small firms. The study answers calls for a more robust framework to advance understanding of how OMs learn and whether that learning is consequently embedded in the organisation. The proposed framework can be used as a guideline for support organisations in assisting small firms in reaching their learning potential. It can also be used by small firms in the attainment of strategy learning capability.
Women's representation in French Internal Medicine meetings: gender distribution among speakers, moderators and organisers, 2013–2018
Authors: Roeser Anaïs , Bouillet Laurence , Papo Thomas , Cohen‐Aubart Fleur
Published: April 2020

Medical meetings are a time for increasing scientific visibility and leadership. We aimed to examine women's representation in French National Internal Medicine meetings (2013–2018). Women represented 25% of congress presidents, 22% of plenary session speakers, 19% of plenary session moderators and 25% oral session moderators, but 45% of anonymously selected oral communication speakers. Women are under‐represented among invited speakers in French Internal Medicine meetings.
Genetic diversity and phylogeny of strains of Clavibacter nebraskensis associated with recent and historic Goss's wilt epidemics in the north Central USA
Authors: Webster Blake T. , Curland Rebecca D. , Hirsch Cory D. , McNally Ryan R. , Malvick Dean K. , Ishimaru Carol A.
Published: April 2020

Goss's wilt and blight of maize, caused by Clavibacter nebraskensis, is an important disease in the USA and Canada. The re‐emergence of Goss's wilt in the mid‐2000s and the subsequent spread of this disease probably resulted from changes in crop management practices and possibly changes in the pathogen population. The objectives of this study were to determine the genetic diversity and phylogeny of strains of C. nebraskensis associated with recent and historic Goss's wilt epidemics in the north Central USA, to measure the effects of collection period on population structure, and to identify the phylogenetic status of avirulent strains of C. nebraskensis. Multilocus sequence analysis and typing were used to address these objectives. Bayesian analysis of the sequences of atpD, dnaK, and kdpA separated the type strain of C. nebraskensis from type or reference strains of three other Clavibacter spp. The 125 strains of C. nebraskensis used in this study formed a monophyletic taxon. Four lineages were identified. Clades I, II, and IV contained a high proportion of highly virulent strains from the Upper Midwest. Clade III contained a high proportion of strains from Nebraska, Colorado, and South Dakota collected between 1969 and 1998. A significant substructure was detected between subpopulations from historic outbreaks in Nebraska and Colorado and more recent outbreaks in Minnesota. Virulence or avirulence in maize was not correlated with a particular MLSA clade. The results support the hypothesis that genetic changes in the population of C. nebraskensis were correlated with recent area expansions of Goss's wilt.
New strategies for conformal, superconformal, and ultrasmooth films by low temperature chemical vapor deposition
Authors: Abelson John R. , Girolami Gregory S.
Published: April 2020

In the following review, the authors describe how the kinetics of film growth can be controlled in innovative ways to achieve the deposition of conformal, superconformal, area-selective, and ultrasmooth films by low-temperature CVD. Illustrative experimental data and kinetic models are given for the growth of a variety of materials, including transition metals, metal oxides, and metal diborides. Key results are as follows: (i) For precursors that exhibit site blocking on the growth surface, CVD can afford a high degree of conformal coverage on very high aspect ratio features. (ii) The problem of conformal coverage has been solved analytically and presented as a conformal zone diagram. (iii) “Nonconformal” precursor molecules can be made to afford highly conformal films by adding a suitable neutral molecule to enhance surface site blocking. (iv) An inhibitor that adsorbs strongly to the growth material, but not to the substrate surface, can be used to moderate the size distribution of nuclei such that the film is ultrasmooth at coalescence. (v) An inhibitor that binds preferentially to hydroxyl sites on an oxide surface can be used to completely suppress film nucleation and afford area-selective growth. (vi) Superconformal growth, which affords a V-shaped coating and complete fill of a deep trench, can be achieved using one of three approaches, depending on the precursor chemistry. (vii) The science and technology of CVD can further be expanded by the chemical design of new precursors that have a favorable combination of high partial pressure, suitable reactivity at low substrate temperature, and ligand groups that desorb cleanly.
Demographic trade-offs predict tropical forest dynamics
Authors: Rüger Nadja , Condit Richard , Dent Daisy H. , DeWalt Saara J. , Hubbell Stephen P. , Lichstein Jeremy W. , Lopez Omar R. , Wirth Christian , Farrior Caroline E.
Published: April 2020

Forest dynamics and demography

Tropical forest succession has been viewed mostly by considering trees in categories of early-, mid-, and late-successional species, corresponding to a fast–slow continuum of life history strategies. Rüger
et al.
now show that the fast–slow continuum does not capture the demographic strategy of the long-lived pioneer species, an important component of many tropical forests (see the Perspective by Bugmann). They developed a forest model that allows for objective predictions of tropical forest dynamics and validated the model's predictions against independent data. These findings should advance our understanding of tropical forest dynamics and facilitate sustainable tropical forest management.

Science
, this issue p.
165
; see also p.
128
Guidance for reporting intervention development studies in health research (GUIDED): an evidence-based consensus study
Authors: Duncan Edward , O'Cathain Alicia , Rousseau Nikki , Croot Liz , Sworn Katie , Turner Katrina M , Yardley Lucy , Hoddinott Pat
Published: April 2020

Objective

To improve the quality and consistency of intervention development reporting in health research.

Design

This was a consensus exercise consisting of two simultaneous and identical three-round e-Delphi studies (one with experts in intervention development and one with wider stakeholders including funders, journal editors and public involvement members), followed by a consensus workshop. Delphi items were systematically derived from two preceding systematic reviews and a qualitative interview study.

Participants

Intervention developers (n=26) and wider stakeholders (n=18) from the UK, North America and Europe participated in separate e-Delphi studies. Intervention developers (n=13) and wider stakeholders (n=13) participated in a 1-day consensus workshop.

Results

e-Delphi participants achieved consensus on 15 reporting items. Following feedback from the consensus meeting, the final inclusion and wording of 14 items with description and explanations for each item were agreed. Items focus on context, purpose, target population, approaches, evidence, theory, guiding principles, stakeholder contribution, changes in content or format during the development process, required changes for subgroups, continuing uncertainties, and open access publication. They form the GUIDED (GUIDance for the rEporting of intervention Development) checklist, which contains a description and explanation of each item, alongside examples of good reporting.

Conclusions

Consensus-based reporting guidance for intervention development in health research is now available for publishers and researchers to use. GUIDED has the potential to lead to greater transparency, and enhance quality and improve learning about intervention development research and practice.
Spatial-temporal trends and risk factors for undernutrition and obesity among children (<5 years) in South Africa, 2008–2017: findings from a nationally representative longitudinal panel survey
Authors: Sartorius Benn , Sartorius Kurt , Green Rosemary , Lutge Elizabeth , Scheelbeek Pauline , Tanser Frank , Dangour Alan D , Slotow Rob
Published: April 2020

Objectives

To assess space-time trends in malnutrition and associated risk factors among children (<5 years) in South Africa.

Design

Multiround national panel survey using multistage random sampling.

Setting

National, community based.

Participants

Community-based sample of children and adults. Sample size: 3254 children in wave 1 (2008) to 4710 children in wave 5 (2017).

Primary outcomes

Stunting, wasting/thinness and obesity among children (<5). Classification was based on anthropometric (height and weight) z-scores using WHO growth standards.

Results

Between 2008 and 2017, a larger decline nationally in stunting among children (<5) was observed from 11.0% to 7.6% (p=0.007), compared with thinness/wasting (5.2% to 3.8%, p=0.131) and obesity (14.5% to 12.9%, p=0.312). A geographic nutritional gradient was observed with obesity more pronounced in the east of the country and thinness/wasting more pronounced in the west. Approximately 73% of districts had an estimated wasting prevalence below the 2025 target threshold of 5% in 2017 while 83% and 88% of districts achieved the necessary relative reduction in stunting and no increase in obesity respectively from 2012 to 2017 in line with 2025 targets. African ethnicity, male gender, low birth weight, lower socioeconomic and maternal/paternal education status and rural residence were significantly associated with stunting. Children in lower income and food-insecure households with young malnourished mothers were significantly more likely to be thin/wasted while African children, with higher birth weights, living in lower income households in KwaZulu-Natal and Eastern Cape were significantly more likely to be obese.

Conclusions

While improvements in stunting have been observed, thinness/wasting and obesity prevalence remain largely unchanged. The geographic and sociodemographic heterogeneity in childhood malnutrition has implications for equitable attainment of global nutritional targets for 2025, with many districts having dual epidemics of undernutrition and overnutrition. Effective subnational-level public health planning and tailored interventions are required to address this challenge.
Adherence to oral anticoagulants among patients with atrial fibrillation: a systematic review and meta-analysis of observational studies
Authors: Salmasi Shahrzad , Loewen Peter S , Tandun Rachel , Andrade Jason G , De Vera Mary A
Published: April 2020

Introduction

Medications cannot exert their effect if not taken as prescribed by patients. Our objective was to summarise the observational evidence on adherence to oral anticoagulants (OACs) among patients with atrial fibrillation (AF).

Methods

In March 2019, we systematically searched PubMed/Medline, Embase, CINAHL and PsycINFO (from inception) for observational studies measuring adherence, its determinants and impacts in patients with AF. Mean adherence measures and corresponding proportions of adherent patients were pooled using random effects models. Factors shown to be independently associated with adherence were extracted as well as the clinical and economic outcomes of adherence.

Results

We included 30 studies. Pooled mean adherence scores of over half a million patients with AF 6 months and 1 year after therapy initiation were 77 (95% CI: 74–79) and 74 (68–79) out of 100, respectively. Drug-specific pooled mean adherence score at 6 months and 1 year were as follows: rivaroxaban: 78 (73–84) and 77 (69–86); apixaban: 77 (75–79) and 82 (74–89); dabigatran: 74 (69–79) and 75 (68–82), respectively. There was inadequate information on warfarin for inclusion in meta-analysis.

Factors associated with increased adherence included: older age, higher stroke risk, once-daily regimen, history of hypertension, diabetes or stroke, concomitant cardiovascular medications, living in rural areas and being an experienced OAC user. Non-adherent patients were more likely to experience stroke and death, and incurred higher medical costs compared with patients with poor adherence.

Conclusions

Our findings show that up to 30% of patients with AF are non-adherent, suggesting an important therapeutic challenge in this patient population.
Designing and implementing an all Wales postpartum haemorrhage quality improvement project: OBS Cymru (the Obstetric Bleeding Strategy for Wales)
Authors: Bell Sarah Frances , Kitchen Thomas , John Miriam , Scarr Cerys , Kelly Kevin , Bailey Christopher , James Kathryn , Watkins Adam , Macgillivray Elinore , Edey Tracey , Greaves Kathryn , Volikas Ingrid , Tozer James , Sengupta Niladril , Francis Claire , Collis Rachel , Collins Peter
Published: April 2020

Background

Postpartum haemorrhage (PPH) contributes to substantial maternal morbidity. Research into PPH has led to improvements in care which have been incorporated into the Obstetric Bleeding Strategy for Wales.

Intervention

A national quality improvement team supported local teams in implementing multiple interventions including risk assessment, objective measurement of blood loss, multiprofessional assessment (at the bedside at 1000 mL blood loss) and point-of-care (POC) testing of coagulation to guide blood product resuscitation during PPH. The project was rolled out to all 12 obstetric units in 2017. The interventions were reinforced by an All Wales Guideline, PPH proforma and standardised training. A national database, biannual audits, and patient and staff surveys reported process and outcome measures.

Results

Process measures: during 2017, there was an increase in the percentage of maternities with documented risk assessment (0%–76%), objective measurement of blood loss (52%–88%) and POC testing for coagulation for PPH ≥1500 mL (38%–59%). Maternity staff survey indicated that 94% were aware of the project and 87% stated that it had changed their unit’s management of PPH. Interim outcome measures: the incidence (95% CI) of PPH ≥2500 mL per 1000 maternities in 2017 was 6.03 (5.23–6.95). The annual number of women receiving any red blood cell transfusion, level 3 intensive care admission and hysterectomy for PPH was 19.7 (18.2 to 21.3), 0.702 (0.464 to 1.06) and 0.255 (0.129 to 0.504) per 1000 maternities, respectively.

Conclusions

A high level of project awareness across Welsh maternity units has been achieved. Measurement of blood loss was reported to be the most important early change in practice, while PPH documentation and POC testing continue to be embedded. Combining qualitative and quantitative measures to inform implementation has improved project delivery and allowed teams to adapt to local contexts.
Does dog acquisition improve physical activity, sedentary behaviour and biological markers of cardiometabolic health? Results from a three-arm controlled study
Authors: Powell Lauren , Edwards Kate M , Bauman Adrian , McGreevy Paul , Podberscek Anthony , Neilly Brendon , Sherrington Catherine , Stamatakis Emmanuel
Published: April 2020

Objectives

Dog ownership has been associated with improved cardiometabolic risk factors, including physical activity. Most of the evidence originates from cross-sectional studies or populations with established disease. This study investigated changes in physical activity and other cardiometabolic risk factors following dog acquisition in a sample of 71 community-dwelling adults.

Methods

Participants self-allocated to three groups: 17 individuals acquired a dog within 1 month of baseline (dog acquisition), 29 delayed dog acquisition until study completion (lagged control) and 25 had no interest in dog acquisition (community control). Self-reported and thigh-worn accelerometer-based physical activity patterns, systolic and diastolic blood pressures, resting heart rate and VO2max were measured three times: baseline, 3 months and 8 months. Data were analysed using repeated measures analysis of covariance with owner age, season, sex and education included as covariates. Post hoc between-group tests were performed where there were significant overall effects (p<0.05).

Results

We found significant effects in mean daily steps(F(4,64)=3.02, p=0.02) and sit-to-stand transitions (F(4,66)=3.49, p=0.01). The dog acquisition group performed an additional 2589 steps (p=0.004) and 8.2 sit-to-stand transitions (p=0.03) per day at 3 months, although these effects were not maintained at 8 months. We found a significant effect in self-reported weekly walking duration (F(4,130)=2.84, p=0.03) among the lagged control group with an 80 min increase between 3 and 8 months (p=0.04). Other cardiometabolic risk factors were unchanged following dog acquisition.

Conclusion

Our study provides encouraging results that suggest a positive influence of dog acquisition on physical activity in the short term but larger and more generalisable controlled studies are needed.

Trial registration number

ACTRN12617000967381.
Sensor-based Detection and Classification of Soccer Goalkeeper Training Exercises
Authors: Haladjian Juan , Schlabbers Daniel , Taheri Sajjad , Tharr Max , Bruegge Bernd
Published: April 2020

Many goalkeeper trainees cannot afford a personal human coach. Hence, they could benefit from a virtual coach that provides personalized feedback about the execution of their training exercises. As a first step towards this goal, we developed an algorithm to detect and classify goalkeeper training exercises using a wearable inertial sensor attached to a goalkeeper glove. We collected data from 14 goalkeeper trainees while performing a series of training exercises (e.g., dives, catches, throws). Our approach first detects the exercises using an event detection algorithm based on a high-pass filter, a peak detector, and Dynamic Time Warping to detect and eliminate irrelevant motion instances. Then, it extracts a set of statistical and heuristic features to describe the different exercises and train a machine learning classifier. Our exercise detection approach retrieves 93.8% of the relevant exercises with 90.6% precision and classifies the detected exercises with an accuracy of 96.5%. The exercises recognized by our algorithm can be used to compute further qualitative metrics about individual exercise executions to provide goalkeepers with relevant feedback about their training.
Refinements of Equilibria for Population Games Based on Bounded Rationality of Agents
Authors: Zhong Chongyi , Yang Hui , Wang Chun
Published: April 2020

We consider stability of equilibria for population games against slight perturbation on the social state space. We provide a necessary and sufficient condition for the existence of Nash equilibria for perturbed population games, which is very important and interesting. Then, refinements of equilibria for population games are introduced. Equivalent characterizations of perfect equilibrium are given. At last, it is shown that each population game admits at least one perfect (proper, weakly proper, and robust) equilibrium.
A Framework for Nonconforming Mixed Finite Element Method for Elliptic Problems in ℝ3
Authors: Jo Gwanghyun , Kim J. H.
Published: April 2020

In this paper, we suggest a new patch condition for nonconforming mixed finite elements (MFEs) on parallelepiped and provide a framework for the convergence. Also, we introduce a new family of nonconforming MFE space satisfying the new patch condition. The numerical experiments show that the new MFE shows optimal order convergence in Hdiv and L2-norm for various problems with discontinuous coefficient case.
Evaluation of Antiulcer Activity of 80% Methanol Extract and Solvent Fractions of the Root of Croton macrostachyus Hocsht: Ex Del. (Euphorbiaceae) in Rodents
Authors: Mekonnen Alefe Norahun , Asrade Atnafie Seyfe , Wahab Atta Mohammedbirhan A.
Published: April 2020

Background. Peptic ulcer disease causes significant mortality and morbidity. Plant kingdom provides a useful source for the development of new antiulcer agents. Croton macrostachyus is traditionally used to treat peptic ulcer in Ethiopia. This study aimed to evaluate the antiulcer activity of C. macrostachyus root extracts in rodents using different models. Methods. The crude extract was obtained by cold maceration in 80% methanol and fractionated with chloroform, ethyl acetate, and distilled water. The antiulcer activity was evaluated using pylorus ligation‐induced ulcer model in Sprague Dawley rats and acidified ethanol‐induced ulcer model in Swiss albino mice. The test groups received three doses (100, 200, and 400 mg/kg) of the crude extract and fractions for 7 days before induction of ulcer. Positive controls received omeprazole 30 mg/kg for the pylorus ligation‐induced ulcer model and sucralfate 100 mg/kg for the acidified ethanol‐induced ulcer model. Negative controls received vehicle (2% tween 80). Results. The crude hydromethanolic extract of C. macrostachyus showed significant (p < 0.05) antiulcer activity on both pyloric ligation and HCl/ethanol‐induced ulcer in rats and mice. It has antisecretary effect (p < 0.001) as well. All three administered doses of chloroform fraction (p < 0.05) and only higher doses of ethyl acetate fraction (p < 0.05) possessed significant antiulcer activity. In contrast, the aqueous fraction did not have significant antiulcer effect at all tested doses. Conclusion. The present study demonstrated that the crude extract, chloroform, and ethyl acetate fractions possessed significant dose‐dependent antiulcer activity.
A Case of Heterotopic Pancreatic Tissue Discovered in the Distal Esophagus
Authors: Shamoon Dema , Sostre Vanessa , Patel Varun , Volfson Ariy
Published: April 2020

Heterotopic pancreas (HP) is a congenital abnormality that represents ectopic pancreatic tissue that does not have anatomic, vascular, or ductal continuity. The prevalence of HP is 0.55% to 13.7% on autopsy, 0.2% to 0.5% of abdominal operations, and 0.9% of gastrectomies. It is commonly found in the stomach, duodenum, and proximal jejunum. Only 15 cases have been reported in the medical literature regarding involvement of the esophagus. Treatment depends on symptoms and location. In asymptomatic patients, simple observation may be sufficient; however, in those who are symptomatic, surgery may be warranted. We present a case of a 70-year-old male with heartburn, nausea, and abdominal bloating who underwent a diagnostic esophagogastroduodenoscopy (EGD) and was found to have HP on histology in the distal esophagus. In our case, symptoms were treated conservatively and successfully with a proton pump inhibitor (PPI).
Impact of Genetic Variation in TLR4 3′UTR on NSCLC Genetic Susceptibility
Authors: Wu Hongjiao , Gao Hui , Li Ang , Xie Yuning , Jia Zhenxian , Yang Zhenbang , Zhang Hongmei , Zhang Zhi , Zhang Xuemei
Published: April 2020

Toll-like receptors (TLRs) are expressed not only in immune cells but also in a variety of tumor cells. Single-nucleotide polymorphisms (SNPs) located in the TLRs’ promoter or the 3′ untranslated region may affect gene expression by affecting the activity of the promoter or regulating the binding of mRNA to miRNA. This study aimed to investigate the association of the SNPs in TLR genes with the susceptibility to NSCLC. This case-control study involved 700 lung cancer patients and 700 healthy controls. All individuals were genotyped for all selected SNPs in TLR genes using polymerase chain reaction (PCR) test-based restriction fragment length polymorphism (PCR-RFLP) and TaqMan SNP genotyping assay. The association of genetic variations in TLRs with the susceptibility to NSCLC was evaluated by unconditional logistic regression with OR (95% CI). After evaluating transcriptional factor or miRNA binding capability by bioinformatics methods, six TLRs were identified for further analysis. We did not find that TLR3 rs5743303, TLR4 rs1927914, TLR4 rs11536891, TLR5 rs1640816, and TLR7 rs3853839 were associated with NSCLC risk (P>0.05). Our data showed that TLR4 rs7869402 C > T polymorphism reduced the risk of NSCLC with OR (95% CI) of 0.63 (0.45–0.89). When stratified by gender and age, the individuals carrying at least one rs7869402T allele significantly decreased the NSCLC risk among males (OR = 0.58, 95% CI = 0.38–0.87) and among youngsters (OR = 0.43, 95% CI = 0.27–0.69). Smoking stratification analysis showed that the rs7869402T allele-containing genotype reduced the risk of NSCLC with OR (95% CI) of 0.50 (0.29–0.87) among smokers but not among nonsmokers (P>0.05). When the individuals were classed by the pathological type, we found that the rs7869402T-containing genotype was associated with the risk of adenocarcinoma (OR = 0.62, 95% CI = 0.41–0.92) but not with that of squamous cell carcinoma (OR = 0.71, 95% CI = 0.44–1.13) and other types (OR = 0.23, 95% CI = 0.03–1.70). Compared with the TLR4 Ars1927914-Crs7869402-Trs11536891 haplotype, the Grs1927914-Trs7869402-Trs11536891 haplotype was associated with a decreased risk for developing NSCLC with OR (95% CI) of 0.57 (0.41–0.80). These results indicated that the TLR4 rs7869402 variation affects the genetic susceptibility to NSCLC.
Female Breast Cancer Patients, Mastectomy-Related Quality of Life: Experience from Ethiopia
Authors: Abebe Engida , Demilie Kassaw , Lemmu Befekadu , Abebe Kirubel
Published: April 2020

Background. Mastectomy is the most common form of treatment for a developing-nation woman diagnosed with breast cancer. This can have huge effect on a women’s quality of life. Objective. To assess mastectomy-related quality of life in female breast cancer patients. Materials and Methods. A facility-based cross-sectional descriptive study was conducted from February 1st to July 30th, 2018. A pretested structured data collection format was used to interview patients. The European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and Breast Cancer-Specific (EORTC QLQ-BR23) were used to evaluate quality of life, functional capacity, and symptom scales. Data was analyzed with SPSS version 23. Results. The mean age of the 86 patients was 43.2 years (SD±11.4) and ranged from 25 to 70 years. 54.7% (47) of patient’s mastectomy was done on the right side. Based on EORTC QLQ-C30 global health status/QOL scale, the mean score was 48.3. On the evaluation of EORTC QLQ-BR23, future perspective about their health was low with a mean of 40.3 and their sexual functioning and enjoyment were significantly affected with mean scores of 85.3 and 71.2, respectively. Symptom scales were low with mean from 19.1 to 24.5. Majority (49, 57%) of respondents do not want to have breast reconstruction after mastectomy. Conclusion. Our breast cancer patients who underwent mastectomy performed poor in terms of quality of life as compared to international findings which demands attention in incorporating psychosocial aspects in the treatment plan.
Macrophage-Enriched lncRNA RAPIA
Authors: Sun Changbin , Fu Yahong , Gu Xia , Xi Xiangwen , Peng Xiang , Wang Chuhan , Sun Qi , Wang Xueyu , Qian Fengcui , Qin Zhifeng , Qu Wenbo , Piao Minghui , Zhong Shan , Liu Shengliang , Zhang Maomao , Fang Shaohong , Tian Jiangtian , Li Chunquan , Maegdefessel Lars , Tian Jinwei , Yu Bo
Published: April 2020

Objective:

Despite the current antiatherosclerotic and antithrombotic therapies, the incidence of advanced atherosclerosis-associated clinical events remains high. Whether long noncoding RNAs (lncRNAs) affect the progression of atherosclerosis and whether they are potential targets for the treatment of advanced atherosclerosis are poorly understood.

Approach and Results:

The progression of atherosclerotic lesions was accompanied by dynamic alterations in lncRNA expression, as revealed by RNA sequencing and quantitative polymerase chain reaction. Among the dynamically changing lncRNAs, we identified a novel lncRNA, lncRNA Associated with the Progression and Intervention of Atherosclerosis (RAPIA), that was highly expressed in advanced atherosclerotic lesions and in macrophages. Inhibition of RAPIA in vivo not only repressed the progression of atherosclerosis but also exerted atheroprotective effects similar to those of atorvastatin on advanced atherosclerotic plaques that had already formed. In vitro assays demonstrated that RAPIA promoted proliferation and reduced apoptosis of macrophages. A molecular sponge interaction between RAPIA and microRNA-183-5p was demonstrated by dual-luciferase reporter and RNA immunoprecipitation assays. Rescue assays indicated that RAPIA functioned at least in part by targeting the microRNA-183-5p/ITGB1 (integrin β1) pathway in macrophages. In addition, the transcription factor FoxO1 (forkhead box O1) could bind to the RAPIA promoter region and facilitate the expression of RAPIA.

Conclusions:

The progression of atherosclerotic lesions was accompanied by dynamic changes in the expression of lncRNAs. Inhibition of the pivotal lncRNA RAPIA may be a novel preventive and therapeutic strategy for advanced atherosclerosis, especially in patients resistant or intolerant to statins.
Physics of Perpendicular Recording with a Patterned Soft Underlayer
Authors: Khizroev Sakhrat , Hijazi Yazan , Amos Nissim , Felissaint Esnick , Joshi Nikhil , Ikkawi R. , Chomko Roman , Litvinov Dmitri
Published: April 2020

In this paper, it is argued that perpendicular recording in the most popular current form—with the use of a continuous soft underlayer (SUL)—may not be the most optimal way to maximize the achievable areal density. As a possible solution, patterning of SUL is discussed.
The purpose of patterning of a SUL is to effectively move the image head closer to the recording media, as compared to the real recording head, and thus increase the net recording field and the field gradient across the thickness of the media. Various patterning configurations and combinations
with recording layers are comparatively studied. It is illustrated that with a patterned SUL, the recording and sensitivity fields, responsible for writing and reading information, respectively, could be not only increased by several factors but also localized across the entire thickness of
the recording media.