bluuebunny/crossref_metadata_2025 huggingface dataset:
A decision-making simulator for soccer referees
Authors: Samuel Roy David , Galily Yair , Guy Or , Sharoni Elad , Tenenbaum Gershon
Published: August 2019

Decision-making is a critical aspect of soccer referees’ performance. Yet current training methods that simulate the refereeing task are limited. Skilled soccer referees ( N = 22, M age = 27.14 years, SD = 6.40) were tested on a new decision-making simulator during the active part of the season. They ran on a treadmill for 60 min at varying paces while watching two video sections depicting real matches, in context and in mixed order, and called their match decisions out loud. They completed pre- and post-test assessments of their feelings and perceived exertion, and a post-test assessment of their performance. The referees reported positive feelings prior to and following the test, and rated their performance favourably. They felt the simulator was moderately representative of a real match, and their perceived exertion increased progressively during the test. Decision accuracy levels were higher for simple decisions, such as out of play (73.81%), than for careless fouls (62.86%) or yellow/red cards (25.97%). Decision accuracy levels for yellow/red cards decisions were significantly higher in the in-context section (28.91%) than in the mixed section (20.83%). Decision accuracy levels peaked in the third quarter and decreased during the final quarter. Self-control during the test correlated moderately with overall accuracy. Careless foul decision accuracy was on par with previous studies, supporting the simulator’s validity. The findings support the use of the simulator as a potentially innovative method for training referees in sequential decision-making.
Basketball players' versatility: Assessing the diversity of tactical roles
Authors: Rangel Wellington , Ugrinowitsch Carlos , Lamas Leonardo
Published: August 2019

Basketball has seen an increase in the number of players who perform multiple tactical roles. Therefore, the aim of the study was twofold: (i) to define a method to characterize basketball players as versatile or specialists, based on 13 game-related statistics; (ii) to evaluate versatile-specialist tendencies in a professional national league. A predictive model was proposed using the Automated Machine Learning (AutoML) of the H2O framework. The model was tested using data from nine seasons (2008–2017) from the Brazilian national league (NBL), encompassing 1497 players' observations, achieving an accuracy of 70.81%. We classified players as versatile or specialist and observed the following: (i) the number of versatile players has grown over the nine seasons period (from 25.16% to 47.85%), with Small Forward and Power Forward players presenting the fastest growth in versatility; (ii) NBL teams had similar proportions of versatile and specialist players; (iii) for the best players in the NBL (All-Star game players), there was a trend toward a higher number of versatile players (58.33%) compared to specialist ones. In conclusion, the method was effective in indicating the players' degree of versatility and demonstrated a tendency of increasing versatility over the analyzed seasons. In practice, it may support the assessment of player's profile and contribute for coaches' strategic decisions.
Is the game lost in advance? Being a high-performance coach and preserving family life
Authors: Joncheray Hélène , Burlot Fabrice , Julla-Marcy Mathilde
Published: August 2019

This article examines how high-performance sport coaches combine their professional and family lives. To address this issue, semi-structured interviews were conducted with 41 French coaches (8 females, 33 males) involved in the preparation of the French teams for the Olympic Games in Rio (2016), Pyeongchang (2018) and/or Tokyo (2020). The results show that all the coaches interviewed are engaged in a passionate relationship with their job. For some coaches, this commitment has an impact on their family life. Three groups of coaches stand out: (i) a majority of coaches who are unable to preserve their family life, (ii) coaches who maintain a distance from their profession and preserve their family life, (iii) coaches who have or have not preserved their family life and who position themselves as actors wishing to do everything possible to preserve the family life of the coaches they supervise. Thus, these results highlight, for some coaches, difficulties in combining professional and family life. For others, family life is a protection for engagement in a passionate profession. These data can provide useful information for sport organizations in charge of coaches.
Tarantella Dance in Early Cinema: A Pillar of Neapolitan Urban Architecture
Authors: Uffreduzzi Elisa
Published: August 2019

In the early years of the twentieth century, cinema joined the multitude of images (such as paintings, photographs, and engravings) which were spreading worldwide postcard stereotypes of Naples and its surrounds. The icons of this topographical myth included the natural beauties of the region and the monuments of the city, but also the citizens themselves. In fact, from macaroni eaters to tarantella dancers and brigands, they were an essential part of the urban landscape. This paper especially focuses on the Neapolitan tarantella dance and its local variants in silent cinema, examining how they were strictly linked to the city and its environs.
How Else Would You Take a Photo? #SelfieAmbivalence
Authors: Cambre Maria-Carolina , Lavrence Christine
Published: August 2019

Popular discourse describing selfies as the “narcissistic”2 practice of teenagers or a tool of personal empowerment, minimize the structural constraints under which selfies operate as a ubiquitous mode of sociality. Based on focus group discussions in two Canadian cities, we explore how young adults describe their selfie experiences and explore three discursive tensions expressed in the transcripts. First, how questions of “control” were taken up; second, how “visibility” was understood as fragile, and animated by an anxiety of invisibility; third, the nature of “fun” that selfies generate. We conclude by exploring some of the epistemological shifts that these practices indicate.
Three-Dimensional Printing: Current Use in Rhinology and Endoscopic Skull Base Surgery
Authors: Low Christopher M. , Morris Jonathan M. , Price Daniel L. , Matsumoto Jane S. , Stokken Janalee K. , O’Brien Erin K. , Choby Garret
Published: August 2019

Background

In the discipline of rhinology and endoscopic skull base surgery (ESBS), 3-dimensional (3D) printing has found meaningful application in areas including preoperative surgical planning as well as in surgical education. However, its scope of use may be limited due to the perception among surgeons that there exists a prohibitively high initial investment in resources and time to acquire the requisite technical expertise. Nevertheless, given the ever decreasing cost of advancing technology coupled with the need to understand the complex spatial relationships of the paranasal sinuses and skull base, the use of 3D printing in rhinology and ESBS is poised to blossom.

Objective

Help the reader identify current or potential future uses of 3D printing technology relevant to their rhinologic clinical or educational practice.

Methods

A review of published literature relating to 3D printing in rhinology and ESBS was performed.

Results

Results were reviewed and organized into 5 overarching categories including an overview of the 3D printing process as well as applications of 3D printing including (1) surgical planning, (2) custom prosthetics and implants, (3) patient education, and (4) surgical teaching and assessment.

Conclusion

In the discipline of rhinology and ESBS, 3D printing finds use in the areas of presurgical planning, patient education, prosthesis creation, and trainee education. As this technology moves forward, these products will be more broadly available to providers in the clinical and educational setting. The possible applications are vast and have great potential to positively impact surgical training, patient satisfaction, and most importantly, patient outcomes.
Data ratcheting and data-driven organisational change in transport
Authors: Heaphy Liam
Published: August 2019

This article explores the process by which intelligent transport system technologies have further advanced a data-driven culture in public transport and traffic control. Based on 12 interviews with transport engineers and fieldwork visits to three control rooms, it follows the implementation of Real-Time Passenger Information in Dublin and the various technologies on which it is dependent. It uses the concept of ‘data ratcheting’ to describe how a new data-driven rational order supplants a gradualist, conservative ethos, creating technological dependencies that pressure organisations to take control of their own data and curate accessibility to outside organisations. It is argued that the implementation of Real-Time Passenger Information forms part of a changing landscape of urban technologies as cities move from a phase of opening data silos and expanded communication across departments and with citizens towards one in which new streams of digital data are recognised for their value in stabilising novel forms of city administration.
Nursing staff's self-assessed skills concerning the care of acutely ill alcohol-intoxicated patients in emergency departments
Authors: Mäkelä Kaisu-Leena , Kylmä Jari , Hakala Tiina , Löyttyniemi Eliisa , Puolakka Kristiina , Koivunen Marita
Published: August 2019

Alcohol-intoxicated patients in the emergency department (ED) can be very challenging. That is why nursing staff need different kind of skills to promote effective healthcare to these patients. The aim was to describe nursing staff's self-assessed skills concerning the care of acutely ill alcohol-intoxicated patients in EDs. A descriptive quantitative survey was used to measure Finnish ED nursing staff's ( N = 1220, n = 252) skills in this area. The data were analysed statistically. The staff had the best skills in the care of acutely ill alcohol-intoxicated patients in security and safety issues. The skills related to follow-up treatment were the poorest area. The background factors that had a statistically significant association with the skills were work experience in psychiatric nursing or intoxicant care as well as alcohol use related training. Work experience increases ED staff's skills in alcohol intoxicant care, but with updating education these skills would possibility be better to acquire earlier in a nurse's working career.
Inflammatory bowel disease: Looking beyond the tract
Authors: Chams Sana , Badran Reina , Sayegh Skye El , Chams Nour , Shams Ali , Hajj Hussein Inaya
Published: August 2019

Inflammatory bowel disease is a chronic inflammatory condition that encompasses Crohn’s disease and ulcerative colitis. Inflammatory bowel disease is not exclusive to the gastrointestinal system, as it has been identified to be associated with extraintestinal manifestations that encompass every other organ system in the human body. This review article will comprehensively review the current knowledge on extraintestinal manifestations of inflammatory bowel disease. In addition, it will discuss the recommendations for screening and surveillance for extraintestinal manifestations in these patients since early appropriate diagnosis is imperative in preventing morbidity and cancer development.
Supporting School Engagement and High School Completion Through Trauma-Informed School Counseling
Authors: Rumsey Amanda D. , Milsom Amy
Published: August 2019

Awareness of trauma and the impact it has on children is a growing concern for schools in the United States. Exposure to trauma has been linked to challenges with learning, social/emotional health, and behaviors, all of which can negatively impact school experience and lead to issues with engagement and high school completion. We discuss suggestions for how school counselors can use a trauma-informed approach to implement systemic interventions, targeted interventions, and collaborative partnerships.
Effectiveness of an Adapted Behavioral Education Program Targeting Attendance Improvement
Authors: Stripling Theodore
Published: August 2019

This study describes the effectiveness of an adapted behavioral education program for students defined as “chronic absentee.” The intervention focused on building positive student–adult relationships through data monitoring, daily check-ins, and group reinforcements. Although it resulted in a 0.43% ( p = .635) decrease in average daily attendance, a promising result was participants’ decrease in absences during the intervention. The intervention also may be preventative for absentee students. The paper explores implications for practice and research.
An Upper Limit to Youth Psychotherapy Benefit? A Meta-Analytic Copula Approach to Psychotherapy Outcomes
Authors: Jones Payton J. , Mair Patrick , Kuppens Sofie , Weisz John R.
Published: August 2019

Across 50 years of research, extensive efforts have been made to improve the effectiveness of psychotherapies for children and adolescents. Yet recent evidence shows no significant improvement in youth psychotherapy outcomes. In other words, efforts to improve the general quality of therapy models do not appear to have translated directly into improved outcomes. We used multilevel meta-analytic data from 502 randomized controlled trials to generate a bivariate copula model predicting effect size as therapy quality approaches infinity. Our results suggest that even with a therapy of perfect quality, achieved effect sizes may be modest. If therapy quality and therapy outcome share a correlation of .20 (a somewhat optimistic assumption given the evidence we review), a therapy of perfect quality would produce an effect size of Hedges’s g = 0.83. We suggest that youth psychotherapy researchers complement their efforts to improve psychotherapy quality by investigating additional strategies for improving outcomes.
External Multicenter Study of Reliability and Reproducibility for Lower Cervical Spine Injuries Classification Systems—Part 1: A Comparison of Morphological Schemes
Authors: Grin Andrey , Krylov Vladimir , Lvov Ivan , Talypov Aleksandr , Dzukaev Dmitriy , Kordonskiy Anton , Smirnov Vladimir , Karanadze Vasily , Abdukhalikov Boburmirzo , Khushnazarov Ulugbek , Aleynikova Irina , Kazakova Elza , Bogdanova Olesya , Peyker Alexander , Semchenko Vitaliy , Aksenov Andrey , Borzenkov Anton , Gulyy Vladimir , Torchinov Soslan , Bagaev Sergey , Toporskiy Anton , Nikitin Andrey , Arakelyan Sevak , Martikyan Avetik , Oshchepkov Stanislav , Hovrin Dmitriy , Kojev Aslan , Khalatyan Musheg
Published: August 2019

Study Design:

Multicenter observational survey study.

Objectives:

To quantify and compare the inter- and intraobserver reliability of Allen-Fergusson (A-F), Harris, Argenson, and AOSpine (AOS) classifications for cervical spine injuries, in a multicentric survey of neurosurgeons with different levels of experience.

Methods:

We used data of 64 consecutive patients. Totally, 37 surgeons (from 7 centers), were included in the study. The initial assessment was returned by 36 raters. The second assessment performed after 1.5 months included 24 raters.

Results:

We received 15 111 answers for 3840 evaluations. Raters reached a fair general agreement of the A-F scale, while the experienced group achieved κ = 0.39. While all groups showed moderate interrater reliability for primary assessment of Harris scale (κ = 0.44), the κ value for experts decreased from 0.58 to 0.49. The Argenson scale demonstrated moderate and substantial agreement among all raters (κ = 0.47 and κ = 0.55, respectively). The AOS scheme primary assessment general kappa value for all types of injuries and across all raters was 0.49, reaching substantial agreement among experts (κ = 0.62) with moderate agreement across beginner and intermediate groups (κ = 0.48 and κ = 0.44, respectively). The second assessment general agreement kappa value reached 0.56.

Conclusions:

We found the highest values of interobserver agreement and reproducibility among surgeons with different levels of experience with Argenson and AOSpine classifications. The AOSpine scale additionally incorporated more detailed description of compression injuries and facet-joint fractures. Agreement levels reached for Allen-Fergusson and Harris scales were fair and moderate, respectively, indicating difficulty of their application in clinical practice, especially by junior specialists.
Linking Forgiveness at Work and Negative Affect
Authors: Dahiya Rinki , Rangnekar Santosh
Published: August 2019

The present study investigates the impact of forgiveness at work (self, others and situations) on negative affect (NA) using age as a moderator. Data, collected from 376 employees working in various Indian manufacturing organizations, were analysed with the help of regression analysis. The results show that forgiveness (self, others and situations) is significantly associated with lower NA and age moderates the relationship between forgiveness (self and others) and NA. The study offers a concrete insight into the complicated play of age in linking forgiveness dimensions and NA, an area that has largely been ignored in organizational research. The study shows that forgiveness significantly reduces the NA on employees and hence, organizations should make positive interventions in order to encourage forgiveness at work. Organizational psychologists and HR counsellors can similarly develop psychological tests and use theme-based interventions to foster intrapersonal and interpersonal development of forgiveness at work.
Uncertainty and Social Influence
Authors: Melamed David , Savage Scott V. , Munn Chris
Published: August 2019

Much research documents that uncertainty is an important factor in the social influence process. We argue that there are two senses in which uncertainty plays a role. First, task uncertainty is a necessary but variable condition for social influence to occur. Second, uncertainty reduction is a mechanism producing social influence. We discuss how tasks can vary in the level of uncertainty they entail and how this impacts the mechanisms resulting in social influence. In this context, we predict that task uncertainty moderates social influence and that uncertainty reduction mediates it. We experimentally test our predictions in the status-to-social-influence process using standard means of studying social influence. Inconsistent with prior work, we do not find that task uncertainty is a moderator, but we do find evidence that uncertainty reduction functions as a mediator. Further, we find that the mediated effect is contingent on task uncertainty.
Do small protected habitat patches within boreal production forests provide value for biodiversity conservation? A systematic review protocol
Authors: Häkkilä Matti , Savilaakso Sini , Johansson Anna , Sandgren Terhi , Uusitalo Anne , Mönkkönen Mikko , Puttonen Pasi
Published: August 2019

Background

Forest harvesting is the main driver of habitat degradation and biodiversity loss in forests of the boreal zone. To mitigate harmful effects, small-scale habitats with high biodiversity values have been protected within production forests. These include woodland key habitats, and other small-scale habitat patches protected by voluntary conservation action. This article describes a protocol for a systematic review to synthesize the value of small habitat patches left within production landscapes for biodiversity. The topic for this systematic review arose from a discussion with the Finnish forestry sector and was further defined in a stakeholder workshop. Research question: Do small protected habitat patches within production forests provide value for biodiversity conservation in boreal forests? Animal, plant and fungal diversities are addressed as well as the amount of deadwood within the habitat patches as proxy indicators for biodiversity.

Methods

The literature, both peer-reviewed and grey, will be searched from bibliographical databases, organizational websites and internet search engines in English, Finnish, Swedish and Russian. Article screening will be done at two stages (title/abstract and full-text). The validity of the studies included will be evaluated against validity criteria and studies will be categorized based on their risk of bias. To describe the findings a narrative synthesis will be conducted. If there is enough quantitative data retrieved from the studies, a meta-analysis will be conducted.
Research progress on resource utilization of leather solid waste
Authors: Li Yanchun , Guo Ruijun , Lu Wenhui , Zhu Deyi
Published: August 2019

Leather making is the process of converting raw hides into leather. Amounts of solid waste containing hazardous and high value components are generated during this process. Therefore, the elimination of the potential pollution and resource utilization of leather solid waste are the primary research hotspots. Herein, we comprehensively review the recent advances in the resource utilization of leather solid waste generated from chrome tanning including the utilization of tannery hair waste, untanned solid waste, chrome-containing leather solid waste, tannery sludge and finished leather waste, emphasizing on the general and novel utilization approaches. Finally, the remaining challenges and perspectives were summarized, in order to accelerate the development of resource utilization of leather solid waste.

Graphical abstract
Strengthening mental health systems in low- and middle-income countries: recommendations from the Emerald programme
Authors: Semrau Maya , Alem Atalay , Ayuso-Mateos Jose L. , Chisholm Dan , Gureje Oye , Hanlon Charlotte , Jordans Mark , Kigozi Fred , Lund Crick , Petersen Inge , Shidhaye Rahul , Thornicroft Graham
Published: August 2019

Background

There is a large treatment gap for mental, neurological or substance use (MNS) disorders. The ‘Emerging mental health systems in low- and middle-income countries (LMICs)’ (Emerald) research programme attempted to identify strategies to work towards reducing this gap through the strengthening of mental health systems.

Aims

To provide a set of proposed recommendations for mental health system strengthening in LMICs.

Method

The Emerald programme was implemented in six LMICs in Africa and Asia (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda) over a 5-year period (2012–2017), and aimed to improve mental health outcomes in the six countries by building capacity and generating evidence to enhance health system strengthening.

Results

The proposed recommendations align closely with the World Health Organization's key health system strengthening ‘building blocks’ of governance, financing, human resource development, service provision and information systems; knowledge transfer is included as an additional cross-cutting component. Specific recommendations are made in the paper for each of these building blocks based on the body of data that were collected and analysed during Emerald.

Conclusions

These recommendations are relevant not only to the six countries in which their evidential basis was generated, but to other LMICs as well; they may also be generalisable to other non-communicable diseases beyond MNS disorders.

Declaration of interest

None.
Evaluation of capacity-building strategies for mental health system strengthening in low- and middle-income countries for service users and caregivers, policymakers and planners, and researchers
Authors: Evans-Lacko Sara , Hanlon Charlotte , Alem Atalay , Ayuso-Mateos Jose Luis , Chisholm Dan , Gureje Oye , Jordans Mark , Kigozi Fred , Lempp Heidi , Lund Crick , Petersen Inge , Shidhaye Rahul , Thornicroft Graham , Semrau Maya
Published: August 2019

Background

Strengthening of mental health systems in low- and middle-income countries (LMICs) requires the involvement of appropriately skilled and committed individuals from a range of stakeholder groups. Currently, few evidence-based capacity-building activities and materials are available to enable and sustain comprehensive improvements.

Aims

Within the Emerald project, the goal of this study was to evaluate capacity-building activities for three target groups: (a) service users with mental health conditions and their caregivers; (b) policymakers and planners; and (c) mental health researchers.

Method

We developed and tailored three short courses (between 1 and 5 days long). We then implemented and evaluated these short courses on 24 different occasions. We assessed satisfaction among 527 course participants as well as pre–post changes in knowledge in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa, Uganda). Changes in research capacity of partner Emerald institutions was also assessed through monitoring of academic outputs of participating researchers and students and via anonymous surveys.

Results

Short courses were associated with high levels of satisfaction and led to improvements in knowledge across target groups. In relation to institutional capacity building, all partner institutions reported improvements in research capacity for most aspects of mental health system strengthening and global mental health, and many of these positive changes were attributed to the Emerald programme. In terms of outputs, eight PhD students submitted a total of 10 papers relating to their PhD work (range 0–4) and were involved in 14 grant applications, of which 43% (n = 6) were successful.

Conclusions

The Emerald project has shown that building capacity of key stakeholders in mental health system strengthening is possible. However, the starting point and appropriate strategies for this may vary across different countries, depending on the local context, needs and resources.

Declaration of interest

S.E.L. received consulting fees from Lundbeck.
Scaling up integrated primary mental health in six low- and middle-income countries: obstacles, synergies and implications for systems reform
Authors: Petersen Inge , van Rensburg André , Kigozi Fred , Semrau Maya , Hanlon Charlotte , Abdulmalik Jibril , Kola Lola , Fekadu Abebaw , Gureje Oye , Gurung Dristy , Jordans Mark , Mntambo Ntokozo , Mugisha James , Muke Shital , Petrus Ruwayda , Shidhaye Rahul , Ssebunnya Joshua , Tekola Bethlehem , Upadhaya Nawaraj , Patel Vikram , Lund Crick , Thornicroft Graham
Published: August 2019

Background

There is a global drive to improve access to mental healthcare by scaling up integrated mental health into primary healthcare (PHC) systems in low- and middle-income countries (LMICs).

Aims

To investigate systems-level implications of efforts to scale-up integrated mental healthcare into PHC in districts in six LMICs.

Method

Semi-structured interviews were conducted with 121 managers and service providers. Transcribed interviews were analysed using framework analysis guided by the Consolidated Framework for Implementation Research and World Health Organization basic building blocks.

Results

Ensuring that interventions are synergistic with existing health system features and strengthening of the healthcare system building blocks to support integrated chronic care and task-sharing were identified as aiding integration efforts. The latter includes (a) strengthening governance to include technical support for integration efforts as well as multisectoral collaborations; (b) ring-fencing mental health budgets at district level; (c) a critical mass of mental health specialists to support task-sharing; (d) including key mental health indicators in the health information system; (e) psychotropic medication included on free essential drug lists and (f) enabling collaborative and community- oriented PHC-service delivery platforms and continuous quality improvement to aid service delivery challenges in implementation.

Conclusions

Scaling up integrated mental healthcare in PHC in LMICs is more complex than training general healthcare providers. Leveraging existing health system processes that are synergistic with chronic care services and strengthening healthcare system building blocks to provide a more enabling context for integration are important.

Declaration of interest

None.
Phase II Trial of Cediranib in Combination With Cisplatin and Pemetrexed in Chemotherapy-Naïve Patients With Unresectable Malignant Pleural Mesothelioma (SWOG S0905)
Authors: Tsao Anne S. , Miao Jieling , Wistuba Ignacio I. , Vogelzang Nicholas J. , Heymach John V. , Fossella Frank V. , Lu Charles , Velasco Mario R. , Box-Noriega Brandy , Hueftle James G. , Gadgeel Shirish , Redman Mary W. , Gandara David R. , Kelly Karen
Published: August 2019

PURPOSE

Antiangiogenic agents combined with chemotherapy have efficacy in the treatment of unresectable malignant pleural mesothelioma (MPM). Cediranib (AstraZeneca, Cheshire, United Kingdom), a vascular endothelial growth factor receptor and platelet-derived growth factor receptor inhibitor, demonstrated therapeutic potential in a prior phase I trial. We evaluated a phase II trial for efficacy.

PATIENTS AND METHODS

SWOG S0905 (ClinicalTrials.gov identifier: NCT01064648 ) randomly assigned cediranib or placebo with platinum-pemetrexed for six cycles followed by maintenance cediranib or placebo in unresectable chemotherapy-naïve patients with MPM of any histologic subtype. Primary end point was Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 progression-free survival (PFS). Secondary end points included overall survival, PFS by modified RECIST v1.1, response (modified RECIST and RECIST v1.1), disease control, and safety/toxicity. The trial was designed to detect a difference in RECIST v1.1 PFS at the one-sided 0.1 level using a stratified log-rank test.

RESULTS

Ninety-two eligible patients were enrolled (75% epithelioid and 25% biphasic or sarcomatoid). The cediranib arm had more grade 3 and 4 diarrhea, dehydration, hypertension, and weight loss. Cediranib improved PFS by RECIST v1.1 (hazard ratio, 0.71; 80% CI, 0.54 to 0.95; P = .062; 7.2 months v 5.6 months) and increased modified RECIST v1.1 response (50% v 20%; P = .006). By modified RECIST v1.1, cediranib numerically increased PFS (hazard ratio, 0.77; 80% CI, 0.59 to 1.02; P = .12; median, 6.9 months v 5.6 months). No significant difference in overall survival was observed.

CONCLUSION

The addition of cediranib to platinum-pemetrexed improved PFS by RECIST v1.1 and response rate by modified RECIST in patients with unresectable MPM. Whereas adding antiangiogenics to chemotherapy has been a successful strategy for some patients, the cediranib toxicity profile and small incremental survival benefit precludes additional development in MPM.
Maintaining Outstanding Outcomes Using Response- and Biology-Based Therapy for Intermediate-Risk Neuroblastoma: A Report From the Children’s Oncology Group Study ANBL0531
Authors: Twist Clare J. , Schmidt Mary Lou , Naranjo Arlene , London Wendy B. , Tenney Sheena C. , Marachelian Araz , Shimada Hiroyuki , Collins Margaret H. , Esiashvili Natia , Adkins E. Stanton , Mattei Peter , Handler Michael , Katzenstein Howard , Attiyeh Edward , Hogarty Michael D. , Gastier-Foster Julie , Wagner Elizabeth , Matthay Katherine K. , Park Julie R. , Maris John M. , Cohn Susan L.
Published: August 2019

PURPOSE

The primary objective of the Children’s Oncology Group study ANBL0531 (ClinicalTrials.gov identifier: NCT00499616 ) was to reduce therapy for subsets of patients with intermediate-risk neuroblastoma using a biology- and response-based algorithm to assign treatment duration while maintaining a 3-year overall survival (OS) of 95% or more for the entire cohort.

PATIENTS AND METHODS

Children younger than age 12 years with intermediate-risk stage 2A/2B or stage 3 tumors with favorable histology; infants younger than age 365 days with stage 3, 4 or 4S disease; and toddlers from 365 to younger than 547 days with favorable histology, hyperdiploid stage 4, or unfavorable histology stage 3 tumors were eligible. Patients with MYCN-amplified tumors were excluded. Patients were assigned to initially receive two (group 2), four (group 3), or eight (group 4) cycles of chemotherapy with or without surgery on the basis of prognostic markers, including allelic status of chromosomes 1p and 11q; ultimate duration of therapy was determined by overall response.

RESULTS

Between 2007 and 2011, 404 evaluable patients were enrolled. Compared with legacy Children’s Oncology Group studies, subsets of patients had a reduction in treatment. The 3-year event-free survival and OS rates were 83.2% (95% CI, 79.4% to 87.0%) and 94.9% (95% CI, 92.7% to 97.2%), respectively. Infants with stage 4 tumors with favorable biology (n = 61) had superior 3-year event-free survival compared with patients with one or more unfavorable biologic features (n = 47; 86.9% [95% CI, 78.3% to 95.4%] v 66.8% [95% CI, 53.1% to 80.6%]; P = .02), with a trend toward OS advantage (95.0% [95% CI, 89.5% to 100%] v 86.7% [95% CI, 76.6% to 96.7%], respectively; P = .08). OS for patients with localized disease was 100%.

CONCLUSION

Excellent survival was achieved with this treatment algorithm, with reduction of therapy for subsets of patients. More-effective treatment strategies still are needed for infants with unfavorable biology stage 4 disease.
Immune-Related Adverse Events Requiring Hospitalization: Spectrum of Toxicity, Treatment, and Outcomes
Authors: Balaji Aanika , Zhang Jiajia , Wills Beatriz , Marrone Kristen A. , Elmariah Hany , Yarchoan Mark , Zimmerman Jacquelyn W. , Hajjir Khalid , Venkatraman Deepti , Armstrong Deborah K. , Laheru Daniel A. , Mehra Ranee , Ho Won Jin , Reuss Joshua E. , Heng Joseph , Vellanki Paz , Donehower Ross C. , Holdhoff Matthias , Naidoo Jarushka
Published: August 2019

PURPOSE:

Immune checkpoint inhibitors (ICIs) cause immune-related adverse events (irAEs). The proportion of patients who are hospitalized for irAEs and their spectrum, management, and outcomes are not well described.

METHODS:

We report the proportion of hospitalized patients in an academic center who were treated with ICIs from May to December 2017. Patient characteristics, toxicities, management, and outcomes for confirmed irAE admissions are reported. Associations between patient features and irAE hospitalizations are examined.

RESULTS:

Twenty-three percent (n = 100) of 443 patients who were admitted to an academic oncology center over 6 months had ever received ICIs. Of these patients, 41% were admitted for suspected irAEs and 23% were confirmed irAEs. IrAEs accounted for 5% of all oncology hospitalizations (n = 23). Ninety-one percent of patients with confirmed irAEs prompted a medicine subspecialist consultation, most commonly gastroenterology (22%). Fifteen patients (65%) had their irAEs improve/resolve, seven (30%) had worsening irAEs, and three (13%) died of their irAEs. The majority of patients (n = 20; 87%) discontinued ICIs after discharge. Among ICI-treated patients who required admission, an increased likelihood of irAE-related hospitalization was associated with patient age older than 65 years (odds ratio, 5.4; 95% CI, 1.6 to 17.8) and receipt of combination immunotherapy (OR, 6.8; 95% CI, 2.0 to 23.2).

CONCLUSION:

A notable proportion of ICI-treated patients are hospitalized for irAEs, and these patients have a high demand for multidisciplinary management. Older age and combination ICI treatment were associated with an increased risk of irAE-related hospitalization. Whereas these data are from an academic center and include patients in clinical trials, with expanding use of ICIs, these data have important implications for inpatient service planning and risk stratification.
The zebrafish subcortical social brain as a model for studying social behavior disorders
Authors: Geng Yijie , Peterson Randall T.
Published: August 2019

Social behaviors are essential for the survival and reproduction of social species. Many, if not most, neuropsychiatric disorders in humans are either associated with underlying social deficits or are accompanied by social dysfunctions. Traditionally, rodent models have been used to model these behavioral impairments. However, rodent assays are often difficult to scale up and adapt to high-throughput formats, which severely limits their use for systems-level science. In recent years, an increasing number of studies have used zebrafish (Danio rerio) as a model system to study social behavior. These studies have demonstrated clear potential in overcoming some of the limitations of rodent models. In this Review, we explore the evolutionary conservation of a subcortical social brain between teleosts and mammals as the biological basis for using zebrafish to model human social behavior disorders, while summarizing relevant experimental tools and assays. We then discuss the recent advances gleaned from zebrafish social behavior assays, the applications of these assays to studying related disorders, and the opportunities and challenges that lie ahead.
During Cycling What Limits Maximum Mechanical Power Output at Cadences above 120 rpm?
Authors: HODSON-TOLE EMMA F. , BLAKE OLLIE M. , WAKELING JAMES M.
Published: August 2019

Purpose

A key determinant of muscle coordination and maximum power output during cycling is pedaling cadence. During cycling, the neuromuscular system may select from numerous solutions that solve the task demands while producing the same result. For more challenging tasks, fewer solutions will be available. Changes in the variability of individual muscle excitations (EMG) and multimuscle coordination, quantified by entropic half-life (EnHL), can reflect the number of solutions available at each system level. We, therefore, ask whether reduced variability in muscle coordination patterns occur at critical cadences and if they coincide with reduced variability in excitations of individual muscles.

Methods

Eleven trained cyclists completed an array of cadence–power output conditions. The EnHL of EMG intensity recorded from 10 leg muscles and EnHL of principal components describing muscle coordination were calculated. Multivariate adaptive regressive splines were used to determine the relationships between each EnHL and cycling condition or excitation characteristics (duration, duty cycle).

Results

Muscle coordination became more persistent at cadences up to 120 rpm, indicated by increasing EnHL values. Changes in EnHL at the level of the individual muscles differed from the changes in muscle coordination EnHL, with longer EnHL occurring at the slowest (<80 rpm) and fastest (>120 rpm) cadences. The EnHL of the main power producing muscles, however, reached a minimum by 80 rpm and did not change across the faster cadences studied.

Conclusions

Muscle coordination patterns, rather than the contribution of individual muscles, are key to power production at faster cadences in trained cyclists. Reductions in maximum power output at cadences above 120 rpm could be a function of the time available to coordinate orientation and transfer of forces to the pedals.
Response of Liver Metabolic Pathways to Ketogenic Diet and Exercise Are Not Additive
Authors: HUANG TAI-YU , GOLDSMITH FELICIA R. , FULLER SCOTT E. , SIMON JACOB , BATDORF HEIDI M. , SCOTT MATTHEW C. , ESSAJEE NABIL M. , BROWN JOHN M. , BURK DAVID H. , MORRISON CHRISTOPHER D. , BURKE SUSAN J. , COLLIER J. JASON , NOLAND ROBERT C.
Published: August 2019

Purpose

Studies suggest ketogenic diets (KD) produce favorable outcomes (health and exercise performance); however, most rodent studies have used a low-protein KD, which does not reflect the normal- to high-protein KD used by humans. Liver has an important role in ketoadaptation due to its involvement in gluconeogenesis and ketogenesis. This study was designed to test the hypothesis that exercise training (ExTr) while consuming a normal-protein KD (NPKD) would induce additive/synergistic responses in liver metabolic pathways.

Methods

Lean, healthy male C57BL/6J mice were fed a low-fat control diet (15.9% kcal protein, 11.9% kcal fat, 72.2% kcal carbohydrate) or carbohydrate-deficient NPKD (16.1% protein, 83.9% kcal fat) for 6 wk. After 3 wk on the diet, half were subjected to 3-wk treadmill ExTr (5 d·wk−1, 60 min·d−1, moderate-vigorous intensity). Upon conclusion, metabolic and endocrine outcomes related to substrate metabolism were tested in liver and pancreas.

Results

NPKD-fed mice had higher circulating β-hydroxybutyrate and maintained glucose at rest and during exercise. Liver of NPKD-fed mice had lower pyruvate utilization and greater ketogenic potential as evidenced by higher oxidative rates to catabolize lipids (mitochondrial and peroxisomal) and ketogenic amino acids (leucine). ExTr had higher expression of the gluconeogenic gene, Pck1, but lower hepatic glycogen, pyruvate oxidation, incomplete fat oxidation, and total pancreas area. Interaction effects between the NPKD and ExTr were observed for intrahepatic triglycerides, as well as genes involved in gluconeogenesis, ketogenesis, mitochondrial fat oxidation, and peroxisomal markers; however, none were additive/synergistic. Rather, in each instance the interaction effects showed the NPKD and ExTr opposed each other.

Conclusions

An NPKD and an ExTr independently induce shifts in hepatic metabolic pathways, but changes do not seem to be additive/synergistic in healthy mice.
Multi-imaging study in a patient with cerebrotendinous xanthomatosis: radiology, clinic and pathology correlation of a rare condition
Authors: Dell'Aversano Orabona Giuseppina , Dato Clemente , Oliva Mariano , Ugga Lorenzo , Dotti Maria Teresa , Fratta Mario , Gisonni Pietro
Published: August 2019

Cerebrotendinous xanthomatosis (CTX) is a rare metabolic disease with autosomal recessive inheritance. It is caused by mutations of the CYP27A1 gene, which codifies for sterol 27-hydroxylase, an enzyme that is responsible for the synthesis of cholic acids. In CTX, cholic acid synthesis is impaired, leading to accumulation of the precursor chenodessossicholic acid) in various organs and tissues. The clinical manifestations of CTX include chronic diarrhea, early-onset cataracts, tendon xanthomas and neurological disturbances. Therapy with oral chenodessossicholic acid has been shown to provide significantly better outcomes for affected individuals; therefore, recognition of this disease and awareness of its suggestive instrumental signs is extremely important. In this study, we describe the imaging findings in a 43-years-old male who was diagnosed with CTX and studied through ultrasound, CT and MRI.

It is important that the neurology and radiology communities are aware of this multi-imaging findings: recognition of them is important, as due to the high variability of the manifestation of this disease; it could impact on early diagnosis of a condition rarely seen, but manageable.
Interventional radiology training: where will technology take us?
Authors: Mashar Meghavi , Nanapragasam Andrew , Haslam Philip
Published: August 2019

Interventional radiology is a relatively young specialty, and it is undergoing a period of considerable growth. The benefits of a minimally invasive approach are clear, with smaller incisions, less pain, and faster recovery times being the principal benefits compared to surgical alternatives.

Trainees need to acquire the technical skills and the clinical acumen to accurately deliver targeted treatment and safely follow up patients after the procedure. The need to maintain an efficient interventional radiology service whilst also giving sufficient time for trainee education is a challenge. In order to compensate for this, novel technologies like virtual reality (VR), augmented reality (AR), cadaveric simulation, and three-dimensional (3D) printing have been postulated as a means of supplementing training.

In this article, we outline the main features of these innovative strategies and discuss the evidence base behind them. Benefits of these techniques beyond pure clinical training include the standardization of educational cases, access to training at any time, and less risk to patients. The main disadvantage is the large financial outlay required. Therefore, before widespread uptake can be recommended, further research is needed to confirm the educational benefit of these novel techniques, both in and of themselves and in comparison to existing clinical-based education.
Determining the caregivers’ burden in caregivers of patients with mental illness
Authors: Siddiqui Salma , Khalid Javeria
Published: August 2019

Objective: To examine the factors associated with caregivers’ burden in individuals providing care to family members suffering from serious mental illness.

Methods: This Cross Sectional Study was carried out at Armed Forces Institute of Mental Health, Rawalpindi, from May 2015 to December 2015. A purposive sample of 120 family caregivers (60 males and 60 females, age range= 18-65) who were taking care of patients with serious mental illness (i.e. Major Depressive Disorder, Bipolar Disorder & Schizophrenia) for at least one year were recruited from the hospital and assessed through Zarit Burden Interview (ZBI) and Brief COPE inventory. The decline in functional status, and diminished physical capacity compromising the independent living of the care recipient was assessed through Katz Index of Independence in Activities of daily living (ADL) and Lawton Instrumental activities of daily living (IADL).

Results: The results suggest that the longer the duration of illness (F=25.71, p < 0.01), with increased impairments of care-recipients, (decline in functional status, F=21.33, p < 0.001; diminished physical capacity F =32.41, p < 0.001) the more the burden experienced by the caregivers. Moreover, caregivers who were married (t=-2.98, p < 0.01), less educated (t =5.48, p < 0.01), lived in rural area (t = -7.99, p < 0.01), had lower monthly income (t = -4.95, p < 0.01) provide longer hours of caregiving (F=19.12, p < 0.001) and used avoidant coping behavior (F= 56.37, p < 0.001) reported significantly higher caregiver burden than caregivers who were unmarried, more educated, lived in urban area and had better income.

Conclusion: The results of study demonstrate that caring for family members with serious mental illness impacts the caregivers’ wellbeing. It, therefore, highlights the need for support and counseling services for the caregivers to reduce the burden of caring.

doi: https://doi.org/10.12669/pjms.35.5.720

How to cite this:Siddiqui S, Khalid J. Determining the caregivers’ burden in caregivers of patients with mental illness. Pak J Med Sci. 2019;35(5):1329-1333. doi: https://doi.org/10.12669/pjms.35.5.720

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.