bluuebunny/crossref_metadata_2025 huggingface dataset:
A recommendation model based on Stepped Six Channel CNN feature extraction
Authors: Chen Chuang , Zheng Shanhong , Zhan Qi , Guo Jia , Chen Jia
Published: October 2022

In a recommendation system, users and projects often do not exist independently. There are a lot of potential factors. Although the existing mainstream models can extract the potential features between users and projects, the extracted potential features are mainly high-order features and original features. We believe that there are many features at the intermediate level and the interaction between many features. Therefore, we proposed a Stepped Six Channel CNN network model (SSCC). By using different network depths to process the interaction information of user information and project attributes, the potential characteristics of multiple layers can be extracted, and feature layers of different channels are combined to form new feature channels. In addition, the network model based on DNN is used to predict the interaction between the user and the project, and the two models are combined in parallel to form a new model which name is Stepped Six Channel CNN&DNN(SSCCD). Our proposed model is clearly superior to some of today’s mainstream models through experimental tests on publicly available standard data sets.
Evaluation of climate change as a major determinant of crop yield improvement in Nigeria
Authors: Ologeh I , Adesina F
Published: October 2022

Climate change has adversely affected agricultural productivity leading to decline in food production. The influence of climate change on crops and livestock persists despite irrigation, improved plant and animal hybrids. The continued dependence of agricultural production on climatic factors and the relative dependence of human existence on agricultural products create the need for a comprehensive consideration of the relationship between climate and crop production. This study measured the relationship between annual maize/yam yield as dependent variable and seasonal rainfall as independent variables in four states in Nigeria. It has been proven in the past that yearly rainfall value has no influence on annual crop yield, but seasonal or monthly rainfall does. There is a positive and significant relationship between summed up rainfalls of June/July/August and annual maize yields for the thirty-five years under study. The bi-monthly rainfall values did not influence a major part of total annual maize yield, as it records weak relationship with annual maize yield. On the other hand, bi-monthly rainfall values (May/June and July/August) have positive and significant relationship with annual yam yield. The first quarter- March/April/May rainfall values for each of the states have a positive and significant relationship with annual yam yield. This implies that the rainfall value for this quarter is very essential for annual yam yield for each of the states.
Integrated management of limited water resources in Smart Cities
Authors: Šulyová D , Kubina M
Published: October 2022

The trend of urbanization and unsustainable consumption is causing a rapid decrease in limited water resources, which are a strategic source of sustainable development of the city. The aim of the article is i) to identify what technologies, strategies and models are used in the management of water resources in the concept of current Smart Cities, ii) according to the main findings of the analysis, to design own general model of integrated water resources management in the Smart City concept. The paper has used the secondary analysis, summarization method, comparison, induction, deduction and scientific controversy. The results of the analysis show that the strategic management of Smart Cities uses the technologies of the Internet of Things and machine learning in order to effectively manage water resources, in the management of water resources, prefers models containing feedback and an element of participation, from a strategy perspective, it is important to build a sensitive city through a well-defined vision. A city that manages water resources on these principles is a sensitive and sustainable territory that respects current conditions and responds to new challenges. The main output of the article is a general model of limited resource management in Smart City.
Analysis of Organic Flocculants in Lead and Cadmium Biosorption in Laboratory-Level Samples
Authors: Sernaque Fernando , Auccahuasi Wilver , Herrera Lucas , Rojas Karin , Ovalle Christian , Revilla Jorge Figueroa , Loza Ana Barrera
Published: October 2022

The intention of the work is to evaluate the absorption of lead and cadmium in water, by means of controlled tests, by means of a protocol based on the preparation of 3 types of concentrations of the indicated metals, in a water sample of 1 liter, the used dose of flocculants was made in 5 groups, with varied times of rest of are from 5 minutes to 30 minutes, the method that is presented to evaluate these concentrations, is characterized in being able to use different concentrations, with situations of controlled environment, the most encouraging result was the one that presents a level of concentration of 2. 5 grams of natural flocculant. In order to eliminate cadmium, we have a better response using flocculants based on coconut, grapefruit, tangerine, cucumber and apple fruits.
The Rise and Volatility of Russian Winter Wheat Production
Authors: Abys Christian , Skakun Sergii , Becker-Reshef Inbal
Published: October 2022

The Russian wheat industry experienced massive growth in the past two decades however, volatility in production and its subsequent impact on the global commodities market persists. In addition to significant growth, Russia surpassed the European Union as the top global exporter of wheat in 2016 and in 2020 winter wheat exports amounted to roughly $8 billion USD. The aim of this research is to investigate the observed trends and patterns of the growth in the Russian wheat production through the use of reported data on production, cropland area, yield and its associated yearly volatility. To conduct this research, statistical analysis was applied to data published by the Russian Ministry of Agriculture (RMA) and the United States Department of Agriculture Foreign Agriculture Service (USDA FAS). Statistics concerning Ukraine and Kazakhstan are included to gain a regional perspective. Results regarding Russia indicate a 149% increase in wheat production and a 35% increase in wheat farmland area with winter wheat accounting for a growing majority of this increase from 2000 to 2020. Of particular focus is yearly volatility in production of wheat, both spring and winter, which experienced significant yearly fluctuations of up to ±50% in both Russia and Ukraine. In addition, uncertainty in monthly forecasting of crop production published by the USDA FAS persists in both area and yield estimations. In Russia and Kazakhstan, USDA FAS wheat area forecasting was found to be the larger contributor to uncertainty in forecasting yearly production than yield and vice versa with Ukraine. Surging growth in the Russian wheat industry coupled with large volatility in yearly production have significant impacts on the global wheat market as well as lasting implications for land use and land cover change.
Improving parametric neural networks for high-energy physics (and beyond)
Authors: Anzalone Luca , Diotalevi Tommaso , Bonacorsi Daniele
Published: October 2022

Signal-background classification is a central problem in high-energy physics, that plays a major role for the discovery of new fundamental particles. A recent method—the parametric neural network (pNN)—leverages multiple signal mass hypotheses as an additional input feature to effectively replace a whole set of individual classifiers, each providing (in principle) the best response for the corresponding mass hypothesis. In this work we aim at deepening the understanding of pNNs in light of real-world usage. We discovered several peculiarities of parametric networks, providing intuition, metrics, and guidelines to them. We further propose an alternative parametrization scheme, resulting in a new parametrized neural network architecture: the AffinePNN; along with many other generally applicable improvements, like the balanced training procedure. Finally, we extensively and empirically evaluate our models on the HEPMASS dataset, along its imbalanced version (called HEPMASS-IMB) we provide here for the first time, to further validate our approach. Provided results are in terms of the impact of the proposed design decisions, classification performance, and interpolation capability, as well.
Pharmacokinetics of a single dose of novel curcumin formulations mixed with fish oils in healthy humans
Authors: Kanae Haruna , Teshima Koji , Shiroma Tamotsu , Noguchi Kazuo
Published: October 2022

The pharmacokinetics of novel formulations of curcumin mixed with squalene (CSQU) and of curcumin mixed with docosahexaenoic acid (CDHA) was investigated and compared with a standardized unformulated curcumin extract (StdC) and a solid lipid curcumin particle (SLCP) formulation in a randomized, open-label, crossover study. A total of 10 healthy subjects consumed a single dose of each formulation, and blood samples were collected over 8 h. Plasma concentrations of curcumin, demethoxycurcumin (DMC), and bisdemethoxycurcumin (BDMC) were measured. The dose-normalized AUC0-8h of curcumin was significantly higher for SLCP (2.2-fold), CSQU (2.3-fold) and CDHA (2.8-fold) than for StdC. The dose-normalized AUC0-8h of DMC and BDMC did not significantly change, but their Tmax was significantly shortened for SLCP, CSQU, and CDHA. In conclusion, compared with StdC, both fish oil formulations, CSQU and CDHA, significantly improved curcumin absorption as well as SLCP, and CDHA was bioequivalent or superior to SLCP. No sex differences were observed in curcumin absorption.
Present and future of machine learning in breast surgery: systematic review
Authors: Soh Chien Lin , Shah Viraj , Arjomandi Rad Arian , Vardanyan Robert , Zubarevich Alina , Torabi Saeed , Weymann Alexander , Miller George , Malawana Johann
Published: October 2022

Background

Machine learning is a set of models and methods that can automatically detect patterns in vast amounts of data, extract information, and use it to perform decision-making under uncertain conditions. The potential of machine learning is significant, and breast surgeons must strive to be informed with up-to-date knowledge and its applications.

Methods

A systematic database search of Embase, MEDLINE, the Cochrane database, and Google Scholar, from inception to December 2021, was conducted of original articles that explored the use of machine learning and/or artificial intelligence in breast surgery in EMBASE, MEDLINE, Cochrane database and Google Scholar.

Results

The search yielded 477 articles, of which 14 studies were included in this review, featuring 73 847 patients. Four main areas of machine learning application were identified: predictive modelling of surgical outcomes; breast imaging-based context; screening and triaging of patients with breast cancer; and as network utility for detection. There is evident value of machine learning in preoperative planning and in providing information for surgery both in a cancer and an aesthetic context. Machine learning outperformed traditional statistical modelling in all studies for predicting mortality, morbidity, and quality of life outcomes. Machine learning patterns and associations could support planning, anatomical visualization, and surgical navigation.

Conclusion

Machine learning demonstrated promising applications for improving breast surgery outcomes and patient-centred care. Neveretheless, there remain important limitations and ethical concerns relating to implementing artificial intelligence into everyday surgical practices.
Impact of the first wave of COVID-19 on outcomes following emergency admissions for common acute surgical conditions: analysis of a national database in England
Authors: Hutchings Andrew , Moonesinghe Ramani , Moler Zapata Silvia , Cromwell David , Bellingan Geoff , Vohra Ravinder , Moug Susan , Smart Neil , Hinchliffe Robert , Grieve Richard
Published: October 2022

Background

This study assessed the impact of the first COVID-19 wave in England on outcomes for acute appendicitis, gallstone disease, intestinal obstruction, diverticular disease, and abdominal wall hernia.

Methods

Emergency surgical admissions for patients aged 18 years and older to 124 NHS Trust hospitals between January and June in 2019 and 2020 were extracted from Hospital Episode Statistics. The risk of 90-day mortality after admission during weeks 11–19 in 2020 (national lockdown) and 2019 (pre-COVID-19) was estimated using multilevel logistic regression with case-mix adjustment. The primary outcome was all-cause mortality at 90 days.

Results

There were 12 231 emergency admissions and 564 deaths within 90 days during weeks 11–19 in 2020, compared with 18 428 admissions and 542 deaths in the same interval in 2019. Overall, 90-day mortality was higher in 2020 versus 2019, with an adjusted OR of 1.95 (95 per cent c.i. 0.78 to 4.89) for appendicitis, 2.66 (1.81 to 3.92) for gallstone disease, 1.99 (1.44 to 2.74) for diverticular disease, 1.70 (1.13 to 2.55) for hernia, and 1.22 (1.01 to 1.47) for intestinal obstruction. After emergency surgery, 90-day mortality was higher in 2020 versus 2019 for gallstone disease (OR 3.37, 1.26 to 9.02), diverticular disease (OR 2.35, 1.16 to 4.73), and hernia (OR 2.34, 1.23 to 4.45). For intestinal obstruction, the corresponding OR was 0.91 (0.59 to 1.41). For admissions not leading to emergency surgery, mortality was higher in 2020 versus 2019 for gallstone disease (OR 2.55, 1.67 to 3.88), diverticular disease (1.90, 1.32 to 2.73), and intestinal obstruction (OR 1.30, 1.06 to 1.60).

Conclusion

Emergency admission was reduced during the first lockdown in England and this was associated with higher 90-day mortality.
SPONGE-assisted versus Trendelenburg position surgery in laparoscopic sigmoid and rectal cancer surgery (SPONGE trial): randomized clinical trial
Authors: Fahim Milad , Couwenberg Alice , Verweij Maaike E , Dijksman Lea M , Verkooijen Helena M , Smits Anke B
Published: October 2022

Background

In minimally invasive surgery of the sigmoid colon and rectum a retractor sponge has been introduced as an alternative to the Trendelenburg position. This randomized clinical trial (RCT) compared postoperative duration of hospital stay and perioperative outcomes in patients with sigmoid or rectal cancer undergoing sponge-assisted versus Trendelenburg position surgery.

Methods

The SPONGE trial is a single-centre RCT nested within the Dutch nationwide prospective observational cohort of patients with colorectal cancer, and follows the Trials within Cohorts (TwiCs) design. Patients with sigmoid or rectal cancer undergoing elective laparoscopic or robotic surgery were randomized to either sponge-assisted or Trendelenburg surgery on a 1:1 basis using block randomization. Duration of postoperative hospital stay was the primary outcome and was compared using the Mann–Whitney U test. Secondary endpoints included the proportion of complications, readmissions, or mortality versus the χ2 test in intention-to-treat and per-protocol analyses. This trial was not blinded for patients in the intervention arm or physicians.

Results

Between November 2015 and June 2021, 82 patients were randomized to sponge-assisted surgery and 81 to Trendelenburg surgery. After post-randomization exclusion, 150 patients remained for analyses (75 patients per arm). There was no statistically significant difference in median duration of hospital stay (5 days versus 4 days, respectively; P = 0.06), 30-day postoperative complications (30 per cent versus 31 per cent; P = 1.00), readmission rate (8 per cent versus 15 per cent; P = 0.30), or mortality (0 per cent versus 1 per cent, P = 1.00). The per-protocol analysis showed similar results. No adverse device events were seen.

Conclusion

Sponge-assisted laparoscopic/robotic surgery does not reduce the duration of hospital stay, or perioperative morbidity or mortality.

Trial registration

NCT02574013 (http://www.clinicaltrials.gov)
Limited liver resections in the posterosuperior segments: international multicentre propensity score-matched and coarsened exact-matched analysis comparing the laparoscopic and robotic approaches
Authors: D’Silva Mizelle , Han Ho Seong , Liu Rong , Kingham Thomas Peter , Choi Gi Hong , Syn Nicholas Li Xun , Prieto Mikel , Choi Sung Hoon , Sucandy Iswanto , Chiow Adrian Kah Heng , Marino Marco Vito , Efanov Mikhail , Lee Jae Hoon , Sutcliffe Robert Peter , Chong Charing Ching Ning , Tang Chung Ngai , Cheung Tan To , Pratschke Johann , Wang Xiaoying , Park James Oh , Chan Chung Yip , Scatton Olivier , Rotellar Fernando , Troisi Roberto Ivan , D’Hondt Mathieu , Fuks David , Goh Brian Kim Poh ,   international robotic and laparoscopic liver resection study group investigators, Gastaca M , Schotte H , De Meyere C , Lai E C , Krenzien F , Schmelzle M , Kadam P , Giglio M , Montalti R , Liu Q , Lee K F , Lee L S , Jang J Y , Lim C , Labadie K P
Published: October 2022

Background

Limited liver resections (LLRs) for tumours located in the posterosuperior segments of the liver are technically demanding procedures. This study compared outcomes of robotic (R) and laparoscopic (L) LLR for tumours located in the posterosuperior liver segments (IV, VII, and VIII).

Methods

This was an international multicentre retrospective analysis of patients who underwent R-LLR or L-LLR at 24 centres between 2010 and 2019. Patient demographics, perioperative parameters, and postoperative outcomes were analysed; 1 : 3 propensity score matching (PSM) and 1 : 1 coarsened exact matching (CEM) were performed.

Results

Of 1566 patients undergoing R-LLR and L-LLR, 983 met the study inclusion criteria. Before matching, 159 R-LLRs and 824 L-LLRs were included. After 1 : 3 PSM of 127 R-LLRs and 381 L-LLRs, comparison of perioperative outcomes showed that median blood loss (100 (i.q.r. 40–200) versus 200 (100–500) ml; P = 0.003), blood loss of at least 500 ml (9 (7.4 per cent) versus 94 (27.6 per cent); P < 0.001), intraoperative blood transfusion rate (4 (3.1 per cent) versus 38 (10.0 per cent); P = 0.025), rate of conversion to open surgery (1 (0.8 per cent) versus 30 (7.9 per cent); P = 0.022), median duration of Pringle manoeuvre when applied (30 (20–46) versus 40 (25–58) min; P = 0.012), and median duration of operation (175 (130–255) versus 224 (155–300); P < 0.001) were lower in the R-LLR group compared with the L-LLR group. After 1 : 1 CEM of 104 R-LLRs with 104 L-LLRs, R-LLR was similarly associated with significantly reduced blood loss and a lower rate of conversion to open surgery.

Conclusion

Based on a matched analysis of well selected patients, both robotic and laparoscopic access could be undertaken safely with good outcomes for tumours in the posterosuperior liver segments.
Enzymatic blood group conversion of human kidneys during ex vivo normothermic machine perfusion
Authors: MacMillan Serena , Hosgood Sarah A , Nicholson Michael L
Published: October 2022

A major restriction to transplantation is the requirement for ABO blood group compatibility between donor and recipient. In this study, an α-galactosidase enzyme from Bacteroides fragilis was used successfully to remove type B blood group antigens enzymatically from human kidneys using ex vivo normothermic machine perfusion. This provides the first step for a strategy to overcome the ABO barrier in kidney transplantation.
Benchmarks in colorectal surgery: multinational study to define quality thresholds in high and low anterior resection
Authors: Staiger Roxane D , Rössler Fabian , Kim Min Jung , Brown Carl , Trenti Loris , Sasaki Takeshi , Uluk Deniz , Campana Juan P , Giacca Massimo , Schiltz Boris , Bahadoer Renu R , Lee Kai-Yin , Kupper Bruna E C , Hu Katherine Y , Corcione Francesco , Paredes Steven R , Spampati Sebastiano , Ukegjini Kristjan , Jedrzejczak Bartlomiej , Langer Daniel , Stakelum Aine , Park Ji Won , Phang P Terry , Biondo Sebastiano , Ito Masaaki , Aigner Felix , Vaccaro Carlos A , Panis Yves , Kartheuser Alex , Peeters K C M J , Tan Ker-Kan , Aguiar Samuel , Ludwig Kirk , Bracale Umberto , Young Christopher J , Dziki Adam , Ryska Miroslav , Winter Des C , Jenkins John T , Kennedy Robin H , Clavien Pierre-Alain , Puhan Milo A , Turina Matthias
Published: October 2022

Background

Benchmark comparisons in surgery allow identification of gaps in the quality of care provided. The aim of this study was to determine quality thresholds for high (HAR) and low (LAR) anterior resections in colorectal cancer surgery by applying the concept of benchmarking.

Methods

This 5-year multinational retrospective study included patients who underwent anterior resection for cancer in 19 high-volume centres on five continents. Benchmarks were defined for 11 relevant postoperative variables at discharge, 3 months, and 6 months (for LAR). Benchmarks were calculated for two separate cohorts: patients without (ideal) and those with (non-ideal) outcome-relevant co-morbidities. Benchmark cut-offs were defined as the 75th percentile of each centre’s median value.

Results

A total of 3903 patients who underwent HAR and 3726 who had LAR for cancer were analysed. After 3 months’ follow-up, the mortality benchmark in HAR for ideal and non-ideal patients was 0.0 versus 3.0 per cent, and in LAR it was 0.0 versus 2.2 per cent. Benchmark results for anastomotic leakage were 5.0 versus 6.9 per cent for HAR, and 13.6 versus 11.8 per cent for LAR. The overall morbidity benchmark in HAR was a Comprehensive Complication Index (CCI®) score of 8.6 versus 14.7, and that for LAR was CCI® score 11.9 versus 18.3.

Conclusion

Regular comparison of individual-surgeon or -unit outcome data against benchmark thresholds may identify gaps in care quality that can improve patient outcome.
Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies
Authors: Deerenberg Eva B , Henriksen Nadia A , Antoniou George A , Antoniou Stavros A , Bramer Wichor M , Fischer John P , Fortelny Rene H , Gök Hakan , Harris Hobart W , Hope William , Horne Charlotte M , Jensen Thomas K , Köckerling Ferdinand , Kretschmer Alexander , López-Cano Manuel , Malcher Flavio , Shao Jenny M , Slieker Juliette C , de Smet Gijs H J , Stabilini Cesare , Torkington Jared , Muysoms Filip E
Published: October 2022

Background

Incisional hernia is a frequent complication of abdominal wall incision. Surgical technique is an important risk factor for the development of incisional hernia. The aim of these updated guidelines was to provide recommendations to decrease the incidence of incisional hernia.

Methods

A systematic literature search of MEDLINE, Embase, and Cochrane CENTRAL was performed on 22 January 2022. The Scottish Intercollegiate Guidelines Network instrument was used to evaluate systematic reviews and meta-analyses, RCTs, and cohort studies. The GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation) was used to appraise the certainty of the evidence. The guidelines group consisted of surgical specialists, a biomedical information specialist, certified guideline methodologist, and patient representative.

Results

Thirty-nine papers were included covering seven key questions, and weak recommendations were made for all of these. Laparoscopic surgery and non-midline incisions are suggested to be preferred when safe and feasible. In laparoscopic surgery, suturing the fascial defect of trocar sites of 10 mm and larger is advised, especially after single-incision laparoscopic surgery and at the umbilicus. For closure of an elective midline laparotomy, a continuous small-bites suturing technique with a slowly absorbable suture is suggested. Prophylactic mesh augmentation after elective midline laparotomy can be considered to reduce the risk of incisional hernia; a permanent synthetic mesh in either the onlay or retromuscular position is advised.

Conclusion

These updated guidelines may help surgeons in selecting the optimal approach and location of abdominal wall incisions.
Ultrasound-assisted carbon nanoparticle suspension mapping versus dual tracer-guided sentinel lymph node biopsy in patients with early breast cancer (ultraCars): phase III randomized clinical trial
Authors: Zhang Liulu , Cheng Minyi , Lin Yingyi , Zhang Junsheng , Shen Bo , Chen Yuanqi , Yang Ciqiu , Yang Mei , Zhu Teng , Gao Hongfei , Ji Fei , Li Jieqing , Wang Kun
Published: October 2022

Background

Appropriate tracing methods for sentinel lymph node biopsy (SLNB) play a key role in accurate axillary staging. This prospective, non-inferiority, phase III RCT compared the feasibility and diagnostic performance of ultrasound-assisted carbon nanoparticle suspension (CNS) mapping with dual tracer-guided SLNB in patients with early breast cancer.

Methods

Eligible patients had primary breast cancer without nodal involvement (cN0), or had clinically positive lymph nodes (cN1) that were downstaged to cN0 after neoadjuvant chemotherapy. Patients were randomly assigned (1 : 1) to undergo either ultrasound-assisted CNS sentinel lymph node (SLN) mapping (UC group) or dual tracer-guided mapping with CNS plus indocyanine green (ICG) (GC group). The primary endpoint was the SLN identification rate.

Results

Between 1 December 2019 and 30 April 2021, 330 patients were assigned randomly to the UC (163 patients) or GC (167 patients) group. The SLN identification rate was 94.5 (95 per cent c.i. 90.9 to 98.0) per cent in the UC group and 95.8 (92.7 to 98.9) per cent in the GC group. The observed difference of –1.3 (–5.9 to 3.3) per cent was lower than the prespecified non-inferiority margin of 6 per cent (Pnon–inferiority = 0.024). No significant difference was observed in metastatic node rate (30.5 versus 24.4 per cent; P = 0.222), median number of SLNs harvested (3 (range 1–7) versus 3 (1–8); P = 0.181), or duration of surgery (mean(s.d.) 7.53(2.77) versus 7.63(3.27) min; P = 0.316) between the groups. Among the subgroup of patients who had undergone neoadjuvant treatment, the SLN identification rate was 91.7 (82.2 to 100) per cent in the UC group and 90.7 (81.7 to 99.7) per cent in the GC group.

Conclusion

The diagnostic performance of ultrasound-assisted CNS mapping was non-inferior to that of dual tracer-guided SLN mapping with CNS plus ICG in patients with early breast cancer.

Registration number

NCT04951245 (http://www.clinicaltrials.gov).
The virtual uncertainty of futility in emergency surgery
Authors: Javanmard-Emamghissi Hannah , Moug Susan J
Published: October 2022

Futility is a controversial topic within surgery. This editorial defines the concept, explains the differing types of surgical futility, and discusses the ethical issues around the subject.
Pathological response to neoadjuvant chemoradiotherapy for oesophageal squamous cell carcinoma: multicentre East Asian and Dutch database comparison
Authors: Eyck Ben M , Gao Xing , Yang Yang , van der Wilk Berend J , Wong Ian , Wijnhoven Bas P L , Liu Jun , Lagarde Sjoerd M , Ka-On Lam , Hulshof Maarten C C M , Li Zhigang , Law Simon , Chao Yin Kai , van Lanschot J Jan B ,   Dutch Upper Gastrointestinal Cancer Audit (DUCA), Nieboer D
Published: October 2022

Background

Patients with different ethnic and genetic backgrounds may respond differently to anticancer therapies. This study aimed to assess whether patients with oesophageal squamous cell carcinoma (OSCC) treated with neoadjuvant chemoradiotherapy (nCRT) in East Asia had an inferior pathological response compared with patients treated in Northwest Europe.

Methods

Patients with OSCC who underwent nCRT according to the CROSS regimen (carboplatin and paclitaxel with concurrent 41.4 Gy radiotherapy) followed by oesophagectomy between June 2012 and April 2020 were identified from East Asian and Dutch databases. The primary outcome was pCR, defined as ypT0 N0. Groups were compared using propensity score matching, adjusting for sex, Charlson Co-morbidity Index score, tumour location, cT and cN categories, interval between nCRT and surgery, and number of resected lymph nodes.

Results

Of 725 patients identified, 133 remained in each group after matching. A pCR was achieved in 37 patients (27.8 per cent) in the Asian database and 58 (43.6 per cent) in the Dutch database (P = 0.010). The rate of ypT1–4 was higher in Asian than Dutch data (66.2 and 49.6 per cent; P = 0.004). The ypN1–3 rate was 44.4 per cent in the Asian and 33.1 per cent in the Dutch data set. Clear margins were achieved in 92.5 per cent of Asian and 95.5 per cent of Dutch patients.

Conclusion

Regional differences in responses to CROSS nCRT for oesophageal cancer were apparent, the origin of which will need evaluation.
The most beautiful human tail
Authors: Zheng Haoyi , Li Kewei , Xiang Bo
Published: October 2022

A 4-year-old boy presented with a congenital tail on the sacrococcygeal region.The tail like structure was so cute and bouncy in consistency, having no voluntary movement and no communication with spinal cord.
Risk-standardized mortality metric to monitor hospital performance for chest pain presentations
Authors: Dawson Luke P , Andrew Emily , Nehme Ziad , Bloom Jason , Okyere Daniel , Cox Shelley , Anderson David , Stephenson Michael , Lefkovits Jeffrey , Taylor Andrew J , Kaye David , Smith Karen , Stub Dion
Published: October 2022

Aims

Risk-standardized mortality rates (RSMR) have been used to monitor hospital performance in procedural and disease-based registries, but limitations include the potential to promote risk-averse clinician decisions and a lack of assessment of the whole patient journey. We aimed to determine whether it is feasible to use RSMR at the symptom-level to monitor hospital performance using routinely collected, linked, clinical and administrative data of chest pain presentations.

Methods and results

We included 192 978 consecutive adult patients (mean age 62 years; 51% female) with acute chest pain without ST-elevation brought via emergency medical services (EMS) to 53 emergency departments in Victoria, Australia (1/1/2015–30/6/2019). From 32 candidate variables, a risk-adjusted logistic regression model for 30-day mortality (C-statistic 0.899) was developed, with excellent calibration in the full cohort and with optimism-adjusted bootstrap internal validation. Annual 30-day RSMR was calculated by dividing each hospital's observed mortality by the expected mortality rate and multiplying it by the annual mean 30-day mortality rate. Hospital performance according to annual 30-day RSMR was lower for outer regional or remote locations and at hospitals without revascularisation capabilities. Hospital rates of angiography or transfer for patients diagnosed with non-ST elevation myocardial infarction (NSTEMI) correlated with annual 30-day RSMR, but no correlations were observed with other existing key performance indicators.

Conclusion

Annual hospital 30-day RSMR can be feasibly calculated at the symptom-level using routinely collected, linked clinical, and administrative data. This outcome-based metric appears to provide additional information for monitoring hospital performance in comparison with existing process of care key performance measures.
Data standards for transcatheter aortic valve implantation: the European Unified Registries for Heart Care Evaluation and Randomised Trials (EuroHeart)
Authors: Aktaa Suleman , Batra Gorav , James Stefan K , Blackman Daniel J , Ludman Peter F , Mamas Mamas A , Abdel-Wahab Mohamed , Angelini Gianni D , Czerny Martin , Delgado Victoria , De Luca Giuseppe , Agricola Eustachio , Foldager Dan , Hamm Christian W , Iung Bernard , Mangner Norman , Mehilli Julinda , Murphy Gavin J , Mylotte Darren , Parma Radoslaw , Petronio Anna Sonia , Popescu Bodgan A , Sondergaard Lars , Teles Rui C , Sabaté Manel , Terkelsen Christian J , Testa Luca , Wu Jianhua , Maggioni Aldo P , Wallentin Lars , Casadei Barbara , Gale Chris P
Published: October 2022

Aims

Standardized data definitions are necessary for the quantification of quality of care and patient outcomes in observational studies and randomised controlled trials (RCTs). The European Unified Registries for Heart Care Evaluation and Randomised Trials (EuroHeart) project of the European Society of Cardiology (ESC) aims to create pan-European data standards for cardiovascular diseases and interventions, including transcatheter aortic valve implantation (TAVI).

Methods and results

We followed the EuroHeart methodology for cardiovascular data standard development. A Working Group of 29 members representing 12 countries was established and included a patient representative, as well as experts in the management of valvular heart disease from the European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Association of Cardiovascular Imaging (EACVI) and the Working Group on Cardiovascular Surgery. We conducted a systematic review of the literature and used a modified Delphi method to reach consensus on a final set of variables. For each variable, the Working Group provided a definition, permissible values, and categorized the variable as mandatory (Level 1) or additional (Level 2) based on its clinical importance and feasibility. In total, 93 Level 1 and 113 Level 2 variables were selected, with the level 1 variables providing the dataset for registration of patients undergoing TAVI on the EuroHeart IT platform.

Conclusion

This document provides details of the EuroHeart data standards for TAVI processes of care and in-hospital outcomes. In the context of EuroHeart, this will facilitate quality improvement, observational research, registry-based RCTs and post-marketing surveillance of devices, and pharmacotherapies.

One-sentence summary

The EuroHeart data standards for transcatheter aortic valve implantation (TAVI) are a set of internationally agreed data variables and definitions that once implemented will facilitate improvement of quality of care and outcomes for patients receiving TAVI.
Congenital heart disease: changes in recorded birth prevalence and cardiac interventions over the past half-century in Sweden
Authors: Giang Kok Wai , Mandalenakis Zacharias , Fedchenko Maria , Eriksson Peter , Rosengren Annika , Norman Mikael , Hanséus Katarina , Dellborg Mikael
Published: October 2022

Aims

Our objective was to assess changes in the birth prevalence of CHD over a half-century in a high-resource, nationwide setting, as well as changes in the prevalence of cardiac interventions in this population.

Methods and results

The Swedish National Patient and Cause of Death registers were linked to estimate the annual rates of CHD and cardiac interventions among live-born infants from 1970 to 2017. Additionally, separate estimates were obtained by lesion complexity, from mild to the most complex forms of CHD. Overall, the numbers of live-born infants with a CHD identified varied from 624 to 2459 annual cases, with rates increasing steadily from 5.7 to an average of 20 per 1000 live births at the end of the study period, and with a more pronounced increase from 1996 to 2005. The largest increase over time was observed for mild CHD lesions. Overall, the proportion of cardiac interventions among patients with CHD declined from 40.7% in 1970 to below 15.0% after 2014. However, in the most complex CHD lesion groups, overall cardiac interventions increased from 57.1 to 76.8% in patients with conotruncal defects and from 32.8 to 39.5% in those with severe non-conotruncal defects.

Conclusion

The live-birth prevalence of CHD in Sweden more than tripled during the past half-century, most likely resulting from more accurate diagnostic capabilities. The largest increase over time was observed among patients with simple defects. During the same period, overall cardiac interventions decreased whereas interventions for the most complex CHD groups increased.
Shifting school health priorities pre–post cannabis legalization in Canada: Ontario secondary school rankings of student substance use as a health-related issue
Authors: Butler Alexandra , Doggett Amanda , Vermeer Julianne , Magier Megan , Patte Karen A , Maginn Drew , Markham Chris , Leatherdale Scott T
Published: October 2022

This study examined how schools prioritize ten key health concerns among their student populations over time and whether schools’ prioritization of alcohol and other drug use (AODU) corresponds to students’ substance use behaviours and cannabis legalization as a major policy change. Data were collected from a sample of secondary schools in Ontario, Canada across four years (2015/16–2018/19 [N2015/16 = 65, N2016/17 = 68, N2017/18 = 61 and N2018/19 = 60]) as a part of the COMPASS study. School-level prevalence of cannabis and alcohol use between schools that did and did not prioritize student AODU as a health concern was examined. Ordinal mixed models examined whether student cannabis and alcohol use were associated with school prioritization of AODU. Chi-square tests examined changing health priorities among schools pre–post cannabis legalization. School priority ranking for AODU was mostly stable over time. While AODU was identified as an important health concern, most schools identified mental health as their first priority across the four years of the study. No significant changes to school AODU priorities were observed pre–post cannabis legalization nor was school prioritization of AODU associated with student cannabis and alcohol use behaviours. This study suggests that schools may benefit from guidance in identifying and addressing priority health concerns among their student population.
Productivity, pressure, and new perspectives: impacts of the COVID-19 pandemic on marine early-career researchers
Authors: Schadeberg Amanda , Ford Eleanor , Wieczorek Alina M , Gammage Louise C , López-Acosta María , Buselic Ivana , Turk Dermastia Timotej , Fontela Marcos , Galobart Cristina , Llopis Monferrer Natalia , Lubośny Marek , Piarulli Stefania , Suaria Giuseppe
Published: October 2022

The worldwide disruption caused by the beginning of the COVID-19 pandemic has dramatically impacted the activities of marine scientists working towards the goals of the UN Ocean Decade. As in other disciplines, marine early-career researchers (ECRs) are essential contributors to the development of novel and innovative science. Based on a survey of 322 of our peers, we show that the pandemic negatively impacted marine ECRs in ways that further exacerbate existing structural challenges such as social isolation, job insecurity, and short-term contracts, competitive funding, and work pressure. Furthermore, we find that the success and wellbeing of marine ECRs depends heavily on networking opportunities, gaining practical experience, collecting data, and producing publications, all of which were disrupted by the pandemic. Our analysis shows that those in the earliest stages of their careers feel most vulnerable to long-term career disadvantage as a result of the pandemic. This paper contributes to the empirical body of work about the impacts of the pandemic on marine science and offers recommendations on how marine ECRs should be supported to achieve the UN Ocean Decade’s goal of producing “the science we need for the ocean we want”.
Comparison of behaviors of black bears with and without habituation to humans and supplemental research feeding
Authors: Powell Roger A , Mansfield Susan A , Rogers Lynn L
Published: October 2022

Humans interact with wildlife regularly, mostly without conflict. Interactions between humans and bears, however, have a history of conflict. Using data from female black bears in two populations, we compared behaviors related to a series of hypotheses about habituation and food supplementation via research feeding. We livetrapped bears in the southern boreal forests and cove forests of the Pisgah National Forest, North Carolina, in barrel traps or modified leg-hold snares and outfitted them with very high frequency (VHF) transmitters, for 95 bear-years of data. In the southern boreal forests of Superior National Forest, Minnesota, we habituated bears and outfitted them with VHF collars supplemented with GPS units, for 42 bear-years. Some human residents of the Superior study area fed local black bears and we established a research feeding site. Bears in both populations avoided roads and habituated: Superior bears avoided houses where they were not fed; the study site for Pisgah bears (no habituation or feeding) had too few houses to test for avoidance. Bears in both populations gained weight faster during their active seasons when wild foods were abundant. Habituated, supplemented Superior bears averaged a smaller proportion of a day active, longer activity bouts, and less sinuous movements than did not-habituated or supplemented Pisgah bears. The bears in the two populations did not differ with respect to distances traveled per 2 h or mean lengths of activity bouts. The abundance of wild foods affected time active, distance traveled, and sinuosity of travel by not-habituated or supplemented Pisgah bears. Females in breeding condition in both populations were more active, had longer activity bouts, traveled further, and had more linear travel in spring and early summer while females with cubs pushed these activities into late summer and autumn. This timing pattern for bout length, distance moved, and sinuosity was less pronounced for habituated and research-fed Superior bears than for not-habituated or supplemented Pisgah bears. Thus, habituation to a small number of researchers appeared to not affect many behaviors of bears in our habituated and research-fed Superior population; research feeding appeared to affect some behaviors in a manner consistent with a food supply that had low annual variance. Because we have samples of one for each treatment (one site with habituation and feeding, one site without), our results do not establish that differences documented between the populations were caused by the differences in habituation and feeding. The effects of habituation, research feeding, or other forms of food supplementation on backcountry behaviors of black bears need broader testing across the range of black bears.
Content Validity and Inter-rater Reliability of the Music Interventions in Pediatric DoC Behavior Observation Record
Authors: Bower Janeen , Magee Wendy L , Catroppa Cathy , Baker Felicity A
Published: October 2022

Aligned with best practice guidelines for patients presenting with a disorder of consciousness (DoC), music therapy interventions with this population aim to increase arousal and awareness to support emergence to consciousness. There is a significant evidence base supporting music therapy for adults with a DoC; however, there are currently no published tools that systematically capture behavioral responses of this population during rehabilitative music therapy interventions. Further, the developmentally specific response to severe brain injury in the pediatric population means pediatric-specific research is required. The Music Interventions in Pediatric DoC Behavior Observation Record (Music Behavior Record [MBR]) was developed to objectively record responses during music therapy interventions for children presenting with a DoC. To establish content validity and inter-rater reliability, a pragmatic pilot study was undertaken. Results established that the MBR has content validity with 100% agreement among participants. Overall fair-substantial inter-rater reliability in >70% of the behavioral responses recorded in the MBR indicate the MBR is an early but promising tool to objectively capture responses during music therapy interventions. The use of the MBR may ultimately support clinical advancement and intervention research to optimize consciousness recovery for the pediatric DoC population.
Public Support for Nuclear Proliferation: Experimental Evidence from Brazil
Authors: Spektor Matias , Fasolin Guilherme N , Camargo Juliana
Published: October 2022

How do mass publics in nonnuclear weapon states form their preferences over the acquisition of nuclear weapons? We field a survey experiment in Brazil, a possessor of uranium-enrichment capabilities with a long history of nuclear ambitions. Three sets of results support the view that members of the public approach nuclear proliferation strategically, that is, by taking into account how their home state interacts with enemies and allies alike. First, the external security environment is a major driver for individual-level preferences: when security is plentiful, only a small minority of the public in Brazil supports proliferation, but a deterioration of external conditions engenders a high minority in support for nuclear-weapon acquisition. Second, the mere extension by the United States of conventional security assurances suffices to dampen public support for an indigenous nuclear deterrent, restoring a majority view opposing proliferation. Third, conventional security assurances shape public sentiment on nuclear acquisition irrespective of whether they are credible or not. These results contribute to the effort currently unfolding in the scholarly community to make sense of how citizens outside the United States think about international security in a nuclear world.
Scarcity and the Mindsets of Social Welfare Recipients: Evidence from a Field Experiment
Authors: Madsen Jonas Krogh , Baekgaard Martin , Kvist Jon
Published: October 2022

Financial scarcity is a fundamental condition for recipients of social welfare. We draw on scarcity theory to suggest that the condition of scarce resources may have a range of important psychological consequences for how welfare recipients’ cope with their problems, navigate citizen–state interactions, for their perceived ability to deal with their problems, and for their psychological well-being. In a field experiment using Danish unemployed social assistance recipients (N = 2,637), we test the psychological consequences of scarcity by randomly assigning recipients to be surveyed either shortly before payment of their social assistance benefits, shortly after, or mid-month. We find no impact of the scarcity manipulation and thus our main findings run counter to the idea that short-term changes in scarce financial conditions influence the mindsets of social welfare recipients. However, a series of exploratory cross-sectional regressions show that subjective scarcity, that is “the feeling of having too little”, is associated with an increased focus on solving problems, but negatively associated with psychological well-being, sense of mastery, and job search self-efficacy. We conclude that these correlates may reflect more long-term consequences of scarcity but that more and stronger causal evidence is needed given the cross-sectional nature of these data.
Extreme TeV BL Lacs: a self-consistent stochastic acceleration model
Authors: Sciaccaluga Alberto , Tavecchio Fabrizio
Published: October 2022

Lately, a specific kind of blazars drew the attention of the gamma-ray astronomy community: the extreme TeV BL Lacs, blazars that present an extremely energetic and hard emission at very high-energy. Explaining their features is still an open challenge, in fact the most used phenomenological models have difficulties to satisfactorily reproduce their spectral energy distribution. Based on a scenario we have recently proposed, we suppose that the non-thermal particles are first accelerated by a jet recollimation shock, which induces turbulence in the rest of the jet. Non-thermal particles are further accelerated by the turbulence, which hardens the particle spectra and accordingly the radiative emission. Given the physical properties of the plasma, as inferred by emission models, we expect a strong impact of the accelerating particles on the turbulence. Assuming isotropy and homogeneity, the interaction between non-thermal particles and turbulence and their spectra is modelled solving a system of two non-linear, coupled Fokker–Planck equations, while the radiative emission is calculated through the Synchrotron Self Compton model. The emission predicted by our model is then compared with the prototype extreme TeV BL Lac object 1ES 0229+200 and the parameters obtained to reproduce its SED are in line with the expectations.