bluuebunny/crossref_metadata_2025 huggingface dataset:
Two-staged en bloc excision of a retinal haemangioma
Authors: Jhingan Mahima , Chhablani Jay , Agarwal Komal , Rani Padmaja Kumari
Published: June 2017

A 31-year-old man presented to us with diminution of vision in the right eye which he noticed since 10 days, with a visual acuity of hand motions only. On examination, festooned pupil and a complicated cataract were noted with no view of the retina. Ultrasonography of the right eye showed retinal detachment in all quadrants with suspected areas of traction and membranes in the vitreous. Left eye examination revealed a normal anterior and posterior segment. Intraoperatively, he underwent a pars plana lensectomy following which an inferior large retinal haemangioma was noted with dilated and tortuous feeder artery and draining vein. The haemangioma was managed by a two-staged procedure including ligature of the feeder artery in the first surgery and the en bloc excision of the angioma at the time of the second procedure after significant shrinkage in size of the tumour.
Early postnatal hyperglycaemia is a risk factor for treatment-demanding retinopathy of prematurity
Authors: Slidsborg Carina , Jensen Louise Bering , Rasmussen Steen Christian , Fledelius Hans Callø , Greisen Gorm , Cour Morten de la
Published: June 2017

Background

To investigate whether neonatal hyperglycaemia in the first postnatal week is associated with treatment-demanding retinopathy of prematurity (ROP).

Methods

This is a Danish national, retrospective, case–control study of premature infants (birth period 2003–2006). Three national registers were searched, and data were linked through a unique civil registration number. The study sample consisted of 106 cases each matched with two comparison infants. Matching criteria were gestational age (GA) at birth, ROP not registered and born at the same neonatal intensive care unit. Potential ‘new’ risk factors were analysed in a multivariate logistic regression model, while adjusted for previously recognised risk factors (ie, GA at birth, small for gestational age, multiple birth and male sex).

Results

Hospital records of 310 preterm infants (106 treated; 204 comparison infants) were available. Nutrition in terms of energy (kcal/kg/week) and protein (g/kg/week) given to the preterm infants during the first postnatal week were statistically insignificant between the study groups (Mann-Whitney U test; p=0.165/p=0.163). Early postnatal weight gain between the two study groups was borderline significant (t-test; p=0.047). Hyperglycaemic events (indexed value) were statistically significantly different between the two study groups (Mann-Whitney U test; p<0.001). Hyperglycaemia was a statistically independent risk factor (OR: 1.022; 95% CI 1.002 to 1.042; p=0.031).

Conclusion

An independent association was found between the occurrence of hyperglycaemic events during the first postnatal week and later development of treatment-demanding ROP, when adjusted for known risk factors.
Everyday resilience in district health systems: emerging insights from the front lines in Kenya and South Africa
Authors: Gilson Lucy , Barasa Edwine , Nxumalo Nonhlanhla , Cleary Susan , Goudge Jane , Molyneux Sassy , Tsofa Benjamin , Lehmann Uta
Published: June 2017

Recent global crises have brought into sharp relief the absolute necessity of resilient health systems that can recognise and react to societal crises. While such crises focus the global mind, the real work lies, however, in being resilient in the face of routine, multiple challenges. But what are these challenges and what is the work of nurturing everyday resilience in health systems? This paper considers these questions, drawing on long-term, primarily qualitative research conducted in three different district health system settings in Kenya and South Africa, and adopting principles from case study research methodology and meta-synthesis in its analytic approach. The paper presents evidence of the instability and daily disruptions managed at the front lines of the district health system. These include patient complaints, unpredictable staff, compliance demands, organisational instability linked to decentralisation processes and frequently changing, and sometimes unclear, policy imperatives. The paper also identifies managerial responses to these challenges and assesses whether or not they indicate everyday resilience, using two conceptual lenses. From this analysis, we suggest that such resilience seems to arise from the leadership offered by multiple managers, through a combination of strategies that become embedded in relationships and managerial routines, drawing on wider organisational capacities and resources. While stable governance structures and adequate resources do influence everyday resilience, they are not enough to sustain it. Instead, it appears important to nurture the power of leaders across every system to reframe challenges, strengthen their routine practices in ways that encourage mindful staff engagement, and develop social networks within and outside organisations. Further research can build on these insights to deepen understanding.
Blood coagulation system in patients with chronic kidney disease: a prospective observational study
Authors: Huang Meng-Jie , Wei Ri-bao , Wang Yang , Su Ting-yu , Di Ping , Li Qing-ping , Yang Xi , Li Ping , Chen Xiang-mei
Published: June 2017

Objectives

Thromboembolic events are the major factor affecting the prognosis of patients with chronic kidney disease (CKD). Haemostatic alterations are possible causes of these complications, but their roles remain poorly characterised. In the prospective observational study, we investigated the entire coagulation process in patients with CKD to elucidate the mechanisms of their high thromboembolic risk.

Methods

A total of 95 patients with CKD and 20 healthy controls who met the inclusion criteria were consecutively recruited from September 2015 to March 2016. The platelet count, platelet aggregation, von Willebrand factor antigen (vWF:Ag), vWF ristocetin cofactor activity (vWF:RCo), fibrinogen, factor V (FV), FVII, FVIII, antithrombin III, protein C, protein S, D-dimer, standard coagulation tests and thromboelastography were measured in patients with CKD and controls. Associations between the estimated glomerular filtration rate (eGFR) and haemostatic biomarkers were tested using multivariable linear regression.

Results

The adjusted and unadjusted levels of vWF:Ag, vWF:RCo, fibrinogen, FVII, FVIII and D-dimer were significantly higher in patients with CKD than that in the healthy controls, and were elevated with CKD progression. However, after adjustment for baseline differences, platelet aggregation and thromboelastography parameters showed no significant differences between patients with CKD and healthy controls. In the correlation analysis, vWF:Ag, vWF:RCo and FVIII were inversely associated with eGFR (r=−0.359, p<0.001; r=−0.391, p<0.001; r=−0.327, p<0.001, respectively). During the 1-year of follow-up, one cardiovascular event occurred in patients with CKD 5 stage, whereas no thromboembolic event occurred in the CKD 3 and 4 and control groups.

Conclusions

Patients with CKD are characterised by endothelial dysfunction and increased coagulation, especially FVIII activity. The abnormal haemostatic profiles may contribute to the elevated risk of thrombotic events but further longer-term study with large samples is still required to more precisely determine the relationship between the elevation of procoagulant factors and clinical outcomes.
Study protocol of a pragmatic, randomised controlled pilot trial: clinical effectiveness on smoking cessation of traditional and complementary medicine interventions, including acupuncture and aromatherapy, in combination with nicotine replacement therapy
Authors: Jang Soobin , Park Sunju , Jang Bo-Hyoung , Park Yu Lee , Lee Ju Ah , Cho Chung-Sik , Go Ho-Yeon , Shin Yong Cheol , Ko Seong-Gyu
Published: June 2017

Introduction

Nicotine dependence is a disease, and tobacco use is related to 6 million deaths annually worldwide. Recently, in many countries, there has been growing interest in the use of traditional and complementary medicine (T&CM) methods, especially acupuncture, as therapeutic interventions for smoking cessation. The aim of this pilot study is to investigate the effectiveness of T&CM interventions on smoking cessation.

Methods and analysis

The STOP (Stop Tobacco Programme using traditional Korean medicine) study is designed to be a pragmatic, open-label, randomised pilot trial. This trial will evaluate whether adding T&CM methods (ie, ear and body acupuncture, aromatherapy) to conventional cessation methods (ie, nicotine replacement therapy (NRT), counselling) increases smoking cessation rates. Forty participants over 19 years old who are capable of communicating in Korean will be recruited. They will be current smokers who meet one of the following criteria: (1) smoke more than 10 cigarettes a day, (2) smoke less than 10 cigarettes a day and previously failed to cease smoking, or (3) smoke fewer than 10 cigarettes a day and have a nicotine dependence score (Fagerstrom Test for Nicotine Dependence) of 4 points or more. The trial will consist of 4 weeks of treatment and a 20 week follow-up period. A statistician will perform the statistical analyses for both the intention-to-treat (all randomly assigned participants) and per-protocol (participants who completed the trial without any protocol deviations) data using SAS 9.1.3.

Ethics and dissemination

This study has been approved by the Institutional Review Board (IRB) of the Dunsan Korean Medicine Hospital of Daejeon University (IRB reference no: DJDSKH-15-BM-11–1, Protocol No. version 4.1.).The protocol will be reapproved by IRB if it requires amendment. The trial will be conducted according to the Declaration of Helsinki, 7th version (2013). This study is designed to minimise the risk to participants, and the investigators will explain the study to the participants in detail. As an ethical clinical trial, the control group will also be given conventional cessation treatments, including NRT and counselling. Participants will be screened and provided with a registration number to protect their personal information. Informed consent will be obtained from the participants prior to enrolling them in the trial. Participants will be allowed to withdraw at anytime without penalty.

Trial registration number

ClinicalTrials.gov (NCT02768025); pre-results.
Motivation of Dutch high school students from various backgrounds for applying to study medicine: a qualitative study
Authors: Wouters Anouk , Croiset Gerda , Isik Ulviye , Kusurkar Rashmi A
Published: June 2017

Objective

To explore high school students’ motivation for applying to study medicine and the factors that influence this. To find explanations for under-representation of minority students in medical education, descriptions of motivation of students with different background characteristics were compared.

Design

Qualitative phenomenological study using semistructured one-on-one interviews.

Setting

One predominantly white and one mixed high school in a large multicultural city in the Netherlands. The study was conducted in March–December 2015.

Participants

Twenty-four high school students, purposively sampled for demographic characteristics.

Methods

The analysis consisted of the coding of data using a template based on the motivation types (autonomous and controlled motivation) described by self-determination theory and open coding for factors that influence motivation.

Results

The main reasons for pursuing a medical career pertained to autonomous motivation (interest in science and helping people), but controlled motivation (eg, parental pressure, prestige) was also mentioned. Experiences with healthcare and patients positively influenced students’ autonomous motivation and served as a reality check for students’ expectations. Having to go through a selection process was an important demotivating factor, but did not prevent most students from applying. Having medical professionals in their network also sparked students’ interest, while facilitating easier access to healthcare experiences.

Conclusions

The findings showed a complex interplay between healthcare experiences, growing up in a medical family, selection processes and motivation. Healthcare experiences, often one of the selection criteria, help students to form autonomous motivation for studying medicine. However, such experiences as well as support in the selection process seem unequally accessible to students. As a result, under-represented students’ motivation decreases. Medical schools should be aware of this and could create opportunities to acquire healthcare experiences. High schools could incorporate internships as part of their study counselling programmes and offer tailor-made guidance to each individual student.
Use of a geographic information system to identify differences in automated external defibrillator installation in urban areas with similar incidence of public out-of-hospital cardiac arrest: a retrospective registry-based study
Authors: Fredman David , Haas Jan , Ban Yifang , Jonsson Martin , Svensson Leif , Djarv Therese , Hollenberg Jacob , Nordberg Per , Ringh Mattias , Claesson Andreas
Published: June 2017

Objectives

Early defibrillation in out-of-hospital cardiac arrest (OHCA) is of importance to improve survival. In many countries the number of automated external defibrillators (AEDs) is increasing, but the use is low. Guidelines suggest that AEDs should be installed in densely populated areas and in locations with many visitors. Attempts have been made to identify optimal AED locations based on the incidence of OHCA using geographical information systems (GIS), but often on small datasets and the studies are seldom reproduced. The aim of this paper is to investigate if the distribution of public AEDs follows the incident locations of public OHCAs in urban areas of Stockholm County, Sweden.

Method

OHCA data were obtained from the Swedish Register for Cardiopulmonary Resuscitation and AED data were obtained from the Swedish AED Register. Urban areas in Stockholm County were objectively classified according to the pan-European digital mapping tool, Urban Atlas (UA). Furthermore, we reclassified and divided the UA land cover data into three classes (residential, non-residential and other areas). GIS software was used to spatially join and relate public AED and OHCA data and perform computations on relations and distance.

Results

Between 1 January 2012 and 31 December 2014 a total of 804 OHCAs occurred in public locations in Stockholm County and by December 2013 there were 1828 AEDs available. The incidence of public OHCAs was similar in residential (47.3%) and non-residential areas (43.4%). Fewer AEDs were present in residential areas than in non-residential areas (29.4% vs 68.8%). In residential areas the median distance between OHCAs and AEDs was significantly greater than in non-residential areas (288 m vs 188 m, p<0.001).

Conclusion

The majority of public OHCAs occurred in areas classified in UA as ‘residential areas‘ with limited AED accessibility. These areas need to be targeted for AED installation and international guidelines need to take geographical location into account when suggesting locations for AED installation.
Anticipatory guidance to prevent infant sleep problems within a randomised controlled trial: infant, maternal and partner outcomes at 6 months of age
Authors: Galland Barbara C , Sayers Rachel M , Cameron Sonya L , Gray Andrew R , Heath Anne-Louise M , Lawrence Julie A , Newlands Alana , Taylor Barry J , Taylor Rachael W
Published: June 2017

Objective

To evaluate the effectiveness of sleep education delivered antenatally and at 3 weeks postpartum to prevent infant sleep problems at 6 months of age.

Design

Sleep intervention within a randomised controlled trial for the Prevention of Overweight in Infancy (POI) study.

Participants

802 families were randomly allocated to one of four groups: usual care (control), sleep intervention (sleep), food, activity and breastfeeding intervention (FAB), and combined group receiving both interventions (combination).

Interventions

All groups received standard Well Child care. The sleep intervention groups (sleep and combination) received an antenatal group education session (all mothers and most partners) emphasising infant self-settling and safe sleeping, and a home visit at 3 weeks reinforcing the antenatal sleep education. FAB and combination groups received four contacts providing education and support on breast feeding, food and activity up to 4 months postpartum.

Outcome measures

Here we report secondary sleep outcomes from the POI study: the prevalence of parent-reported infant sleep problems and night waking, and differences in sleep duration. Additional outcomes reported include differences in infant self-settling, safe sleep practices, and maternal and partner reports of their own sleep, fatigue and depression symptoms.

Results

Linear or mixed linear regression models found no significant intervention effects on sleep outcomes, with 19.1% of mothers and 16.6% of partners reporting their infant’s sleep a problem at 6 months. Actigraphy estimated the number of night wakings to be significantly reduced (8%) and the duration of daytime sleep increased (6 min) in those groups receiving the sleep intervention compared with those who did not. However, these small differences were not clinically significant and not observed in 24 hours infant sleep diary data. No other differences were observed.

Conclusion

A strategy delivering infant sleep education antenatally and at 3 weeks postpartum was not effective in preventing the development of parent-reported infant sleep problems.
Sex differences in auditory verbal hallucinations in early, middle and late adolescence: results from a survey of 17 451 Japanese students aged 12–18 years
Authors: Morokuma Yoko , Endo Kaori , Nishida Atushi , Yamasaki Syudo , Ando Shuntaro , Morimoto Yuko , Nakanishi Miharu , Okazaki Yuji , Furukawa Toshi A , Morinobu Shigeru , Shimodera Shinji
Published: June 2017

Objectives

Women have higher rates of auditory verbal hallucinations (AVH) than men; however, less is known about sex differences in the prevalence of AVH in early, middle and late adolescence. We sought to elucidate the differences in the prevalence of AVH and to examine the degree to which these differences could be explained by differences in levels of depressive symptoms.

Design

We used a cross-sectional design and a self-reported questionnaire.

Setting

Participants were recruited from public junior and senior high schools in Tsu, Mie Prefecture and Kochi Prefecture, Japan.

Participants

In total, 19 436 students were contacted and 18 250 participated. Responses from 17 451 students with no missing data were analysed (aged 12–18 years, Mage=15.2 years (SD=1.7), 50.6% girls).

Measures

AVH were assessed through one of four items adopted from the schizophrenia section of the Japanese version of the Diagnostic Interview Schedule for Children. Depressive symptoms were assessed using the 12-item General Health Questionnaire.

Results

The prevalence of AVH was 7.0% among early adolescents (aged 12–13 years), 6.2% among middle adolescents (aged 14–15 years) and 4.8% among late adolescents (aged 16–18 years). Being female was significantly associated with a higher prevalence of AVH through adolescence (OR=1.71, 95% CI 1.31 to 2.23 in early adolescence; OR=1.42, 95% CI 1.14 to 1.76 in middle adolescence; OR=1.52, 95% CI 1.23 to 1.87 in late adolescence); however, these differences became non-significant after adjusting for depressive symptoms (OR=1.21, 95% CI 0.92 to 1.60; OR=1.00, 95% CI 0.80 to 1.25; OR=1.16, 95% CI 0.93 to 1.44, respectively).

Conclusions

Sex differences in auditory hallucinations are seen in both adult and youth populations. The higher rates of auditory verbal hallucinations seen in girls may be secondary to the differences in the rate of depressive symptoms.
AnAnkle Trial study protocol: a randomised trial comparing pain profiles after peripheral nerve block or spinal anaesthesia for ankle fracture surgery
Authors: Sort Rune , Brorson Stig , Gögenur Ismail , Møller Ann Merete
Published: June 2017

Introduction

Ankle fracture surgery is a common procedure, but the influence of anaesthesia choice on postoperative pain and quality of recovery is poorly understood. Some authors suggest a benefit of peripheral nerve block (PNB) in elective procedures, but the different pain profile following acute fracture surgery and the rebound pain on cessation of the PNB both remain unexplored. We present an ongoing randomised study aiming to compare primary PNB anaesthesia with spinal anaesthesia for ankle fracture surgery regarding postoperative pain profiles and quality of recovery.

Methods and analysis

AnAnkle Trial is a randomised, dual-centre, open-label, blinded analysis trial of 150 adult patients undergoing primary internal fixation of an ankle fracture. Main exclusion criteria are habitual opioid use, impaired pain sensation, other painful injuries or cognitive impairment. The intervention is ultrasound-guided popliteal sciatic (20 mL) and saphenal nerve (8 mL) PNB with ropivacaine 7.5 mg/mL, and controls receive spinal anaesthesia (2 mL) with hyperbaric bupivacaine 5 mg/mL. Postoperatively all receive paracetamol, ibuprofen and patient-controlled intravenous morphine on demand. Morphine consumption and pain scores are registered in the first 27 hours and reported as an integrated pain score as the primary endpoint. Pain score intervals are 3 hours and we will use the area under curve to get a longitudinal measure of pain. Secondary outcomes include rebound pain on cessation of anaesthesia, opioid side effects (Opioid-Related Symptom Distress Scale), quality of recovery (Danish Quality of Recovery-15 score) and pain scores and medication days 1–7 (diary).

Ethics and dissemination

The study has been approved by the Regional Ethics Committees in the Capital Region of Denmark, the Danish Data Protection Agency and the Danish Health and Medical Authority. We will publish the results in international peer-reviewed medical journals.

Trial registration number

AnAnkle Trial is registered in the European Clinical Trials Database (EudraCT 2015-001108-76).
The Taking Charge After Stroke (TaCAS) study protocol: a multicentre, investigator-blinded, randomised controlled trial comparing the effect of a single Take Charge session, two Take Charge sessions and control intervention on health-related quality of life 12 months after stroke for non-Māori, non-Pacific adult New Zealanders discharged to community living
Authors: Fu Vivian Wai Yin , Weatherall Mark , McNaughton Harry
Published: June 2017

Introduction

Stroke is one of the leading causes of disability worldwide. Recent data support the possibility that person-centred, self-management interventions can reduce dependence after stroke. However, there is limited information on the generalisability and optimum dose of these interventions.

Methods

The Taking Charge After Stroke (TaCAS) study is a multicentre, investigator-blinded, randomised controlled trial recruiting 400 participants following acute stroke from seven hospitals in New Zealand. All patients discharged to community living who have ongoing symptoms at time of discharge (modified Rankin scale>0) will be eligible. Participants will be randomly assigned to one Take Charge session, two Take Charge sessions 6 weeks apart or control.

Outcomes

The primary outcome will be the Physical Component Summary score of the Short-Form 36 at 12 months post stroke. Secondary outcomes will include dependence (modified Rankin scale), performance in activities of daily living (Barthel Index) and carer strain (Caregiver Strain Index), at 6 and 12 months post stroke. All analyses will be conducted on an intention-to-treat basis.

Ethics and dissemination

The TaCAS study is funded by a Health Research Council of New Zealand grant. It has been approved by the Central Health and Disability Ethics Committee (15/CEN/115). Results will be published and presented at relevant stroke meetings within New Zealand and internationally, informing the use of a self-management intervention after stroke.

Trial registration

Australia and New Zealand Clinical Trials Registry ACTRN12615001163594. Date registered 02-11-2015. Medical Research Institute of New Zealand Registry TCS01. Universal trial number U1111-1171-4127.
Changes in lung function during exercise are independently mediated by increases in deep body temperature
Authors: Tipton Michael J , Kadinopoulos Pippa , Sa Dan Roiz de , Barwood Martin J
Published: June 2017

Background

This study examined whether an increase in deep body temperature contributes to increases in ventilatory flow indicative of bronchodilatation.

Method

The study employed a within-participant repeated measures design. Nine participants (mean (SD): age 22 (3) years; height 177.7 (8.3) cm; mass 80.2 (19.1) kg) completed three conditions: exercise (EXERC; 30 min); 40°C water immersion (IMM40; 30 min) to passively raise rectal temperature (Tre) and 35°C immersion (IMM35; 30 min) asa thermoneutral control for IMM40. A forced vital capacity (FVC) manoeuvre was performed at the start of the test and every 10 min thereafter. Forced expiratory volume in 1 s (FEV1), FEV1/FVC, 25%, 50% and 75% maximal expiratory flow during FVC (forced expiratory flow (FEF)25, FEF50, FEF75) were also measured. Data were compared using a repeated measures two-way analysis of variance, with a 0.05 α level.

Results

Rectal temperature (Tre) peaked after 30 min in the EXERC (mean (SD) 38.0 (0.3)°C) and IMM40 (38.2 (0.2)°C) conditions and both were higher (p<0.05) than at the corresponding time in the thermoneutral condition (37.2 (0.2)°C). At this time, FEV1was 4.5 (0.6), 4.6 (0.3) and 4.4 (0.6) L, respectively. Tre, FEV1and FEV1/FVC were greater in the IMM40 and EXERC conditions compared with the IMM35 condition. Interaction effects were evident for FEF50 and FEF75 (p<0.05), being higher in IMM40 and EXERC conditions.

Conclusion

Increasing deep body temperature, independently, contributes to the increased airflow ascribed to bronchodilatation when exercising.
Time-based measures of treatment effect: reassessment of ticagrelor and clopidogrel from the PLATO trial
Authors: Bellavia Andrea , Wallentin Lars , Orsini Nicola , James Stefan K , Cannon Christopher P , Himmelmann Anders , Sundström Johan , Renlund Henrik , Lytsy Per
Published: June 2017

Objective

Treatment effects to binary endpoints using time-to-event data in randomised controlled trials are typically summarised by reporting HRs derived with Cox proportional hazard models. Alternative and complementary methods include summarising the between-treatment differences on the metric time scale, quantifying the effect as delay of the event (DoE). The aim of this study was to reassess data from the PLATO study expressing the effects as the time by which the main outcomes are delayed or hastened due to treatment.

Methods

PLATO was a randomised controlled double-blind multicentre study (n=18,624), conducted between 2006 and 2008, which demonstrated superiority of the antiplatelet treatment ticagrelor over clopidogrel in reducing risk of several cardiovascular events. In the present study, four of the main PLATO outcomes were reassessed by calculating the time by which an event may be delayed due to the treatment.

Results

The effects of ticagrelor, as compared with clopidogrel, consisted of a substantial delay of the evaluated outcomes, ranging from 83 to 98 days over 400-day follow-up. The Delay of Events Curves showed that the effects progressively increased over time, and the significant findings were concordant with those presented in the original PLATO study.

Conclusions

This study confirmed evidence of a beneficial effect of ticagrelor over clopidogrel, and provided the magnitude of such effects in terms of delayed event time. Investigating time-to-event data with a percentile approach allows presenting treatment effects from randomised controlled studies as absolute measures of the time by which an event may be delayed due to the treatment.

Trial registration number

PLATO (www.clinicaltrials.gov;NCT00391872); Results.
Risk factors for human‐directed aggression in a referral level clinical population
Authors: Lord M. , Loftus B. A. , Blackwell E. J. , Casey R. A.
Published: June 2017

Risk factors for human‐directed aggression were investigated using retrospective analysis of data from a referral‐level clinical behaviour population in the UK. A sample of 200 cases involving human‐directed canine aggression and 200 control cases involving no instance of human‐directed aggression were selected at random from a population of 746 cases. The final model suggested that clinical cases with human‐directed aggression were significantly younger than those presenting with other undesired behaviours (P=0.008) and that male dogs were 1.4 times more likely to be aggressive towards human beings than female dogs (P=0.019). Dogs were 1.7 times more likely to be aggressive towards people if they had attended more than five puppy classes than if they had never attended puppy class (P=0.015) and that dogs were 2.8 times more likely to be aggressive towards human beings if there was another dog between 0 months and 24 months of age in the home (P=0.004). These factors only account for 7 per cent to 10 per cent of the variance between the human‐directed aggression population and the control population, but factors such as attendance at puppy classes and numbers of dogs in the household suggest the need for longitudinal studies to investigate temporal relationships.
Investigation on the Performance of Valveless Pump for Microdelivery of the Fluid, Fabricated Using Tool-Based Micromachining Setup
Authors: Veeresha R. K. , Muralidhara  , Rao Rathnamala , Tauro Astron Manoj
Published: June 2017

Micropump is an integrated part of microfluidic system and is a boon to the field of miniaturization, owing to its helping hand in numerous applications mainly in biomedical, electronic cooling, fuel cells, spacecraft, etc. In this paper, an attempt is made to design and fabricate valveless pump, with active and passive valves. The actuation element used is piezowafer, piezowafer was experimentally tested and compared with simulated values from ANSYS for its peak displacement and these displacements were used to find volume pumped by pump. The pumping volumes found by experimentation are in good agreement with the simulated results. Further fabrication of valveless pump is carried out by using tool-based micromachining center which is a novel type of fabrication technique in micromachining. Through experiments, the optimum frequency of the pump was found to be 60[Formula: see text]Hz at an actuating voltage of 150[Formula: see text]V. The maximum head that a pump could pump was found to be 0.051[Formula: see text]m with pressure of 500.13[Formula: see text]Pa. The flow rate of the pump had a decreasing trend with increase in head.
Exhumation of a migmatite complex along a transpressive shear zone: inferences from the Variscan Juzbado–Penalva do Castelo Shear Zone (Central Iberian Zone)
Authors: Pereira Inês , Dias Rui , Bento dos Santos Telmo , Mata João
Published: June 2017

High-grade metamorphic rocks associated with S-type granites are recorded in the Central Iberian Zone, Iberian Variscides. Though most of these occur as inferred metamorphic core complexes affiliated with detachment faults, others, such as the Figueira de Castelo Rodrigo–Lumbrales Anatectic Complex, crop out between low-grade metamorphic rocks separated by steeply-dipping strike-slip shear zones, such as the Juzbado–Penalva do Castelo Shear Zone. Our structural analysis has been able to constrain two major deformation stages during the Variscan D
3
: (a) D
3a
ductile deformation event, with clear sinistral kinematic criteria; and (b) D
3b
thrusting ductile–brittle deformation event. The petrological investigation confirmed the jump in metamorphic grade between the host rocks and the anatectic complex.
P–T
estimates on calc-silicate rocks interlayered with the metapelites of the anatectic complex provided minimum metamorphic peak conditions of
T
 = 761 ± 50°C and
P
 = 5.0 ± 1.0 kbar. However, petrological modelling results show that
P–T
conditions must have exceeded
T
 > 800°C. Both structural and geothermobarometric data support a two-step model for the exhumation of the Anatectic Complex, including a 5 – 8 km vertical exhumation along a 65 – 100 km horizontal displacement due to a simple shear-dominated transpression mechanism during the Variscan D
3
events.

Supplementary material:
The petrology data, mineral chemistry analyses of the calc-silicate units and EPMA analytical conditions, and the
P–T
modelling methodology can be found at
https://doi.org/10.6084/m9.figshare.c.3785648
Early Evaluation of Circulating Tumor DNA as Marker of Therapeutic Efficacy in Metastatic Colorectal Cancer Patients (PLACOL Study)
Authors: Garlan Fanny , Laurent-Puig Pierre , Sefrioui David , Siauve Nathalie , Didelot Audrey , Sarafan-Vasseur Nasrin , Michel Pierre , Perkins Geraldine , Mulot Claire , Blons Hélène , Taieb Julien , Di Fiore Frederic , Taly Valerie , Zaanan Aziz
Published: June 2017

Purpose: Markers of chemotherapy efficacy in metastatic colorectal cancer (mCRC) are essential for optimization of treatment strategies. We evaluated the applicability of early changes in circulating tumor DNA (ctDNA) as a marker of therapeutic efficacy.

Experimental Design: This prospective study enrolled consecutive patients with mCRC receiving a first- or second-line chemotherapy. CtDNA was assessed in plasma collected before the first (C0), second (C1) and/or third (C2) chemotherapy cycle, using picodroplet-digital PCR assays based either on detection of gene mutation (KRAS, BRAF, TP53) or hypermethylation (WIF1, NPY). CT scans were centrally assessed using RECIST v1.1 criteria. Multivariate analyses were adjusted on age, gender, ECOG performance status (PS), metastatic synchronicity, and treatment line.

Results: Eighty-two patients with mCRC treated in first- (82.9%) or second- (17.1%) line chemotherapy were included. Patients with a high (>10 ng/mL) versus low (≤0.1 ng/mL) ctDNA concentration at C0 had a shorter overall survival (OS; 6.8 vs. 33.4 months: adjusted HR, 5.64; 95% CI, 2.5–12.6; P < 0.0001). By analyzing the evolution of the ctDNA concentration between C0 and C2 or C1 (C2or1), we classified the patients in two groups (named “good” or “bad ctDNA responders”). In multivariate analysis, patients belonging to the group called “good ctDNA responder” (n = 58) versus “bad ctDNA responder” (n = 15) had a better objective response rate (P < 0.001), and a longer median progression-free survival (8.5 vs. 2.4 months: HR, 0.19; 95% CI, 0.09–0.40; P < 0.0001) and OS (27.1 vs. 11.2 months: HR, 0.25; 95% CI, 0.11–0.57; P < 0.001).

Conclusions: This study suggests that early change in ctDNA concentration is a marker of therapeutic efficacy in patients with mCRC. Clin Cancer Res; 23(18); 5416–25. ©2017 AACR.
Outcomes of Ventricular Tachycardia Ablation Using Percutaneous Left Ventricular Assist Devices
Authors: Kusa Shigeki , Miller Marc A. , Whang William , Enomoto Yoshinari , Panizo Jorge G. , Iwasawa Jin , Choudry Subbarao , Pinney Sean , Gomes Anthony , Langan Noelle , Koruth Jacob S. , d’Avila Andre , Reddy Vivek Y. , Dukkipati Srinivas R.
Published: June 2017

Background—

Although percutaneous left ventricular assist devices (pLVADs) facilitate mapping and ablation of hemodynamically unstable ventricular tachycardia (VT), there is limited data whether clinical outcomes are improved. We sought to retrospectively compare the outcomes of patients undergoing scar-related VT ablation with and without pLVAD support.

Methods and Results—

The study population comprised 194 patients (109 pLVAD and 85 non-pLVAD). The pLVAD group more often had dilated cardiomyopathy (33% versus 13%;
P
=0.001), New York Heart Association heart failure class ≥III (51% versus 25%;
P
<0.001), lower left ventricular ejection fractions (26±10% versus 39±16%;
P
<0.001), and electrical storm (49% versus 34%;
P
=0.04). Procedure times (422±112 versus 330±92 minutes;
P
<0.001), postablation VT inducibility (20% versus 7%;
P
=0.02), and length of subsequent hospitalization (median 6 versus 4 days;
P
=0.001) were all higher in the pLVAD group. During median follow-up of 215 days, the primary end point (recurrent VT, heart transplantation, or death) occurred in 36% of the pLVAD versus 26% of the non-pLVAD groups (
P
=0.14). After propensity matching for differences between groups, no differences were seen between groups for both acute procedural outcomes and the primary end point.

Conclusions—

In this large single-center scar-related VT ablation experience, despite the worse clinical status of the patients selected for pLVAD support, clinical outcomes were better than expected and were similar to healthier patients not receiving hemodynamic support. Patients with dilated cardiomyopathy presenting with electrical storm, advanced heart failure, and severe left ventricular dysfunction most frequently received hemodynamic support during VT ablation.
Gut‐Derived Serum Lipopolysaccharide is Associated With Enhanced Risk of Major Adverse Cardiovascular Events in Atrial Fibrillation: Effect of Adherence to Mediterranean Diet
Authors: Pastori Daniele , Carnevale Roberto , Nocella Cristina , Novo Marta , Santulli Maria , Cammisotto Vittoria , Menichelli Danilo , Pignatelli Pasquale , Violi Francesco
Published: June 2017

Background

Gut microbiota is emerging as a novel risk factor for atherothrombosis, but the predictive role of gut‐derived lipopolysaccharide (
LPS
) is unknown. We analyzed (1) the association between
LPS
and major adverse cardiovascular events (
MACE
) in atrial fibrillation (
AF
) and (2) its relationship with adherence to a Mediterranean diet (Med‐diet).

Methods and Results

This was a prospective single‐center study including 912
AF
patients treated with vitamin K antagonists (3716 patient‐years). The primary end point was a composite of
MACE
. Baseline serum
LPS
, adherence to Med‐diet (n=704), and urinary excretion of 11‐dehydro‐thromboxane B
2
(TxB
2
, n=852) were investigated. Mean age was 73.5 years; 42.9% were women. A total of 187
MACE
(5.0% per year) occurred: 54, 59, and 74 in the first, second, and third tertile of
LPS
, respectively (log‐rank test
P
=0.004). Log‐
LPS
(hazard ratio 1.194,
P
=0.009), age (hazard ratio 1.083,
P
<0.001), and previous cerebrovascular (hazard ratio 1.634,
P
=0.004) and cardiac events (hazard ratio 1.822,
P
<0.001) were predictors of
MACE
. In the whole cohort,
AF
(versus sinus rhythm) (β 0.087,
P
=0.014) and low‐density lipoprotein cholesterol (β 0.069,
P
=0.049) were associated with circulating
LPS
. Furthermore, Med‐diet score (β −0.137,
P
<0.001) was predictive of log‐
LPS
, with fruits (β −0.083,
P
=0.030) and legumes (β −0.120,
P
=0.002) negatively associated with log‐
LPS
levels. Log‐
LPS
and log‐TxB
2
were highly correlated (r=0.598,
P
<0.001). Log‐
LPS
(β 0.574,
P
<0.001) and Med‐diet score (β −0.218,
P
<0.001) were significantly associated with baseline urinary excretion of TxB
2
.

Conclusions

In this cohort of
AF
patients,
LPS
levels were predictive of
MACE
and negatively affected by high adherence to Med‐diet.
LPS
may contribute to
MACE
incidence in
AF
by increasing platelet activation.
Niche, Ethnic and Global Operations
Authors: Shin Solee
Published: June 2017

Recent writings on the new media emphasise how the gateless and equalising nature of digital platforms have enabled freer circulation of cultural products around the world and increased the global visibility and popularity of non-Western media content, including popular music products. These writings, however, fail to account for the intermediary role of market participants in patterning the specific consumption and circulation of products. This paper thus comparatively examines the rise and circulation of three East Asian popular musics, J-pop, C-pop and K-pop, and how their differential spread and success have been achieved on the basis of distinctly elaborated organisational strategies in the midst of rising digitisation. The article argues that industry participants of the three East Asian locations, embedded within their respective historical, social and market environments, strategised their courses of actions differently to elaborate distinct models of musical production and circulation. The author conceptualizes each operational model as ‘niche’, ‘ethnic’ and ‘global’, respectively.
Beyond Religious Exclusivism: The Jesuit Attacks against Buddhism and Xu Dashou’s Refutation of 1623
Authors: Meynard Thierry
Published: June 2017

The article examines the dynamics of religious competition brought into Asia by Christianity in the sixteenth and seventeenth centuries. More specifically, it analyzes how Xu Dashou adopted an exclusivist approach in order to defend his own traditions, leading him to a full rejection of Christianity. After engaging himself for some time in an anti-Christian campaign, he understood that the exclusivist approach he had embraced was not congenial with his own traditions and, drawing from the metaphysical insights of Buddhism and Confucianism on ultimate reality and truth, he showed a way beyond religious exclusivism.
Transcranial Doppler to Detect Right to Left Communication: Evaluation Versus Transesophageal Echocardiography in Real Life
Authors: Maillet Alexandre , Pavero Antoine , Salaun Pierre , Pibourdin Alexis , Skopinski Sophie , Thambo Jean-Benoit , Sibon Igor , Constans Joël , Boulon Carine
Published: June 2017

We compared transcranial Doppler (TCD) with transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) for the detection of right to left communication (RLC) in the heart. All patients explored from 2013 to 2016 in a vascular medicine unit to detect RLC by TCD were included. Right to left communication was detected by TCD monitoring for microembolic signals after intravenous injection of agitated 5% glucose and air. One hundred one patients were explored for RLC by TCD, 64 by TEE (not possible in 10, bubble injection in 51), and 93 by TTE because of unexplained stroke or arterial thrombosis (51 males, 50 females, age 51.0 ± 15.8 years) (bubble injection in 35). Fifty-three patients were positive after TCD (TEE: 4 negative, TTE: 7 negative). Of the negative patients after TCD, none was positive for TEE and 1 was positive for TTE with no evidence of patent foramen ovale. Transcranial Doppler was sensitive to detect RLC, even in patients with negative TTE or TTE. A negative TEE did not exclude RLC demonstrated by TCD. Transcranial Doppler might be proposed as first line to detect RLC.
Literary criticism as a critique of caste: Ayothee Thass and the Tamil Buddhist past
Authors: Jayanth Malarvizhi
Published: June 2017

While postcolonial studies has expanded Indian nationalist critique by considering how British literary forms reinforced imperial rule, little is known about how colonial-era Dalit writing demonstrated the bases of caste inequality. The literary criticism of Ayothee Thass (1845–1914) does so by locating the origins of untouchability in the vanquishing of Buddhism by Brahminical forces. This article draws upon issues of his Tamilan journal published between 1907 and 1914, to argue that Thass offered literary criticism as a means of destabilizing widely-accepted justifications of caste and as a basis of political action. Just as nationalists turned to the pre-colonial past to establish authority and critique colonial dominance, lower-caste intellectuals including Ayothee Thass turned to a pre-Brahminical past to assert their identity as indigenous inhabitants of the land. The little-known history of this mode of reading is crucial to understand the formation of a more inclusive public sphere in colonial India and the genealogies of twentieth-century Dalit assertion in the subcontinent.
The Impact of Social Support on Self-care of Patients With Diabetes: What Is the Effect of Diabetes Type? Systematic Review and Meta-analysis
Authors: Song Youngshin , Nam Soohyun , Park Seyeon , Shin In-soo , Ku Bon Jeong
Published: June 2017

Purpose

This meta-analysis examined relationships between social support and self-care in type 1 (T1DM) and 2 diabetes mellitus (T2DM).

Methods

We searched for published and unpublished studies using the following databases: PubMed, Embase, PsycINFO, the Cochrane Library, and Medline. MeSH search terms included “diabetes mellitus,” “social support,” “caregiver,” “self-care,” “self-management,” “self-care skills,” and “coping behavior.” Studies reporting correlations between social support and self-care were included.

Results

Initially, 2 095 studies were extracted. After eliminating duplicate and irrelevant studies, 28 studies involving 5 242 patients with diabetes were included. Of these, 22 studies examined T2DM subjects. Social support was significantly associated with self-care ( k = 28, r = .28, 95% CI: .21-.34, P < .001). Among the diabetes self-care types, the strongest effect was found for glucose monitoring ( k = 6, r = .21, 95% CI: .08-.33). The relationship between social support and self-care was stronger in T2DM ( k = 22, r = .30, 95% CI: .22-.37), relative to T1DM, samples ( k = 5, r = .22, 95% CI: .02-.38).

Conclusion

It was concluded that the overall effect size for social support on self-care was moderate, and its strength differed by ethnic majority within the sample, type of social support measures, and publication status.
Tympanostomy Tube Placement in Children Using a Single‐Pass Tool with Moderate Sedation
Authors: Cofer Shelagh , Meyer Abby , Yoon Daniel , Beebe David , Castro Chandra , Rimell Frank , Belani Kumar
Published: June 2017

Insertion of tympanostomy tubes is a common elective pediatric surgical procedure and is typically performed under general anesthesia. The potential to reduce general anesthetic requirements for young children has led to increased interest in alternatives for tympanostomy tube placement. A tympanostomy tube system, developed to enable tympanostomy tube placement in a single pass on conscious patients under moderate sedation, was evaluated. A prospective study on 128 children and 253 tympanostomy tube placements conducted at 4 centers in the United States demonstrated an 88.3% success rate in performing the procedure under moderate sedation with adverse events within normal rates reported in the literature. The feasibility of completing tympanostomy tube placement under moderate sedation enables avoidance of general anesthesia and provides additional choices to physicians and parents.
Model based estimation of ellipsoidal object using artificial electric sense
Authors: Lanneau Sylvain , Boyer Frédéric , Lebastard Vincent , Bazeille Stéphane
Published: June 2017

In this article we address the issue of shape estimation using electric sense inspired by the active electric fish. These fish can perceive their environment by measuring the perturbations in a self-generated electric field caused by nearby objects. The approach proceeded in three stages. Firstly, the object was detected and its electric properties (insulator or conductor) identified. Secondly, the object was localized using the multiple signal classification algorithm, which was originally developed to localize a radio wave emitter using a network of antennas. Thirdly, the shape estimation relied on the concept of generalized polarization tensor, which enabled us to model the electric response of an object polarized by an ambient electric field. We describe the implementation of the approach through numerous experiments. The system was able to estimate shape with an average error of 16%, and opened the way toward further improvements. In particular, self-aligning the sensor with the ellipsoid through a reactive feedback makes the shape estimation errors drop to 10%.