bluuebunny/crossref_metadata_2025 huggingface dataset:
Preventive effect of diverting stoma on anastomotic leakage after laparoscopic low anterior resection with double stapling technique reconstruction applied based on risk stratification
Authors: Hamabe Atsushi , Ito Masaaki , Nishigori Hideaki , Nishizawa Yuji , Sasaki Takeshi
Published: December 2017

Introduction

During laparoscopic low anterior resection with double stapling technique reconstruction, it is necessary to securely implement rectal transection and anastomosis to prevent anastomotic leakage (AL). However, risk factors and preventive measures for AL are not known sufficiently. Therefore, this study aimed to elucidate risk factors associated with AL and to clarify strategies to prevent it.

Methods

We analyzed a total of 296 cases with rectal cancer who had undergone laparoscopic low anterior resection with double stapling technique reconstruction at the National Cancer Center Hospital East. The relationship between AL and patient, tumor, and treatment characteristics were retrospectively investigated.

Results

There were 186 male and 110 female patients with a median age of 62. Overall, AL occurred in 24 cases (8.1%). Being a man, having an anal verge distance ≤7 cm, and undergoing neoadjuvant chemotherapy were associated with an elevated risk for AL (P = 0.0005, 0.0034, and 0.0222, respectively). Neither an anal drainage tube nor diverting stoma creation correlated with incidence of AL. Multivariate analysis demonstrated that being a man (odds ratio = 18.0; 95% confidence interval: 2.4–138) and having an anal verge distance ≤7 cm (odds ratio = 3.8; 95% confidence interval: 1.5–9.4) were significant risk factors. These two factors were present in 61 cases, including 14 who developed AL (23.0%). In this high‐risk group, diverting stoma creation significantly reduced the occurrence of AL (P = 0.0363), but an anal drainage tube had no effect on incidence of AL (P = 0.3399).

Conclusion

We identified the high‐risk population for AL after laparoscopic low anterior resection with double stapling technique reconstruction based on two factors. This will enable surgeons to appropriately recommend diverting stoma creation.
Effects of limit‐feeding diets with different forage‐to‐concentrate ratios on nutrient intake, rumination, ruminal fermentation, digestibility, blood parameters and growth in Holstein heifers
Authors: Zhang Jun , Shi Haitao , Wang Yajing , Li Shengli , Zhang Hongtao , Cao Zhijun , Yang Kailun
Published: December 2017

The objective of this study was using a wide range of dietary concentrate levels to investigate the major effects of limit‐feeding on heifers. Twenty‐four Holstein heifers were blocked into six groups and fed with one of four diets containing different levels of concentrate (20%, 40%, 60% and 80% on a dry matter (DM) basis) but with same intakes of metabolizable energy for 28 days. Increasing levels of dietary concentrate caused decreased (P ≤ 0.02) intakes of dry matter (DMI) and neutral detergent fiber and total rumination time, but increased (P < 0.01) nonfiberous carbohydrates intake, ruminal concentrations of NH3‐N, propionate and butyrate, and digestibility of DM and crude protein. Dietary concentrate levels had no significant effect on most plasma concentrations and body measurements. The corrected average daily gain (CADG) and feed efficency (ADG/DMI, CFE) were linearly increased (P < 0.01) with increasing dietary concentrate levels when gut fill impact was removed. In conclusion, heifers limit‐fed high concentrate diets increased most ruminal fermentation parameters, CADG and CFE with similar body growth and blood metabolites as heifers fed low concentrate diets, and had the potential to be used as an effective feeding strategy in dairy heifers.
Analysis of the costs of veterinary education and factors associated with financial stress among veterinary students in Australia
Authors: Gregory KP , Matthew SM , Baguley JA
Published: December 2017

Objective

To investigate the course‐related and other costs involved in obtaining a veterinary education in Australia and how these costs are met. The study also aimed to identify sociodemographic and course‐related factors associated with increased financial stress.

Methods

Students from seven Australian veterinary schools were surveyed using an online questionnaire. A total of 443 students participated (response rate 17%). Responses to survey items relating to finances, employment and course‐related costs were compared with sociodemographic factors and prior research in the area of student financial stress.

Results

Respondents reported spending a median of A$300 per week on living costs and a median of A$2,000 per year on course‐related expenses. Over half of respondents received the majority of their income from their parents or Youth Allowance (56%). A similar proportion (55%) reported that they needed to work to meet basic living expenses. Circumstances and sociodemographic factors linked to perceived financial stress included requiring additional finances to meet unexpected costs during the course; sourcing additional finances from external loans; an expected tuition debt at graduation over A$40,000; being 22 years or older; working more than 12 hours per week; living costs above A$300 per week; and being female.

Conclusion

The costs involved in obtaining a veterinary education in Australia are high and over half of respondents are reliant on parental or Government income support. Respondents with certain sociodemographic profiles are more prone to financial stress. These findings may have implications for the psychological health, diversity and career plans of veterinary students in Australia.
Patient perspectives on loss of local obstetrical services in rural northern Minnesota
Authors: Pearson Jennifer , Siebert Kale , Carlson Samantha , Ratner Nathan
Published: December 2017

Background

Obstetrical care has been declining in rural communities. We examined patient choices and perspectives from two rural northern Minnesota communities who lost their local obstetrical services in July 2015. Our purpose was to characterize obstetrical use patterns through the years leading to and following the closure and to explore the effects of the closure on these communities.

Methods

Information introducing the project and providing access to the survey was mailed to women who received prenatal care in the communities of interest. Responses were analyzed quantitatively and qualitatively.

Findings

Two hundred and one participants completed the survey with 356 deliveries reported from 1990 to 2016. Before the closure, there was a trend toward an increasing percentage of women electing regional delivery (P < .001); however, women were still 1.6 times more likely to choose local (62%) than regional (38%) delivery. Reasons for choosing delivery location changed over the decades. While birth experiences remained positive or extremely positive, anxiety about getting to the hospital rose 10‐fold from 1990 to 2016 (5%‐51%, P < .001). Women voiced substantial concern about the lack of local obstetrical services. Qualitative analysis revealed significant negative emotional reactions and concerns for the consequences of this loss for the viability of their rural communities.

Conclusions

Choices and opinions about obstetric care have significantly changed from 1990 to 2016 in rural Minnesota. Understanding these changes can help address shifting risks and costs to rural communities here and elsewhere in an effort to support and sustain healthy, viable rural communities.
Therapeutic effects of endoscopic ablation in patients with Hunner type interstitial cystitis
Authors: Ko Kwang Jin , Chung Hyunwoo , Suh Yoon Seok , Lee Sin Woo , Kim Tae Heon , Lee Kyu‐Sung
Published: December 2017

Objective

To investigate the efficacy of endoscopic ablation of Hunner lesions (HLs) in patients with interstitial cystitis (IC) and to find predictors of early recurrence of HLs.

Patients and Methods

A prospective study was performed of patients with Hunner type IC who underwent transurethral ablation. We repeated endoscopic ablation when symptoms and HLs recurred during the follow‐up period. The primary endpoint was recurrence‐free time. Secondary endpoints were a change in frequency, nocturia, and urgency episodes, and changes in visual analogue scale (VAS) pain scores and other symptom indices at follow‐up visits.

Results

A total of 72 patients were analysed. The median (range) follow‐up period was 29.5 (12.0–50.0) months. After primary ablation treatment, HLs recurred in 75.0% (54/72) of patients, and the median (sd) recurrence‐free time was 12.0 (1.6) months. Amongst the 54 patients with recurrence, 50 underwent a second ablation treatment. HLs occurred in 44.0% (22/50) of individuals after the second operation, and the median (sd) recurrence‐free time was 18.0 (5.1) months. Lower maximal cystometric capacity (odds ratio 1.01, 95% confidence interval 1.001–1.013) was the predictive factor for early recurrence. There were significant improvements in the VAS pain scores, O'Leary‐Sant Interstitial Cystitis Symptom Index and Problem Index, Pelvic Pain and Urgency/Frequency Patient Symptom Scale after treatment (all, P < 0.05).

Conclusions

Endoscopic ablation is an effective treatment option for HLs and significantly reduces pain and improves voiding symptoms. Repeat ablation upon recurrence could help symptom control and bladder preservation only if the bladder capacity is maintained.
Hospital volume and outcomes of robot‐assisted partial nephrectomy
Authors: Xia Leilei , Pulido Jose E. , Chelluri Raju R. , Strother Marshall C. , Taylor Benjamin L. , Raman Jay D. , Guzzo Thomas J.
Published: December 2017

Objective

To evaluate the impact of hospital volume on outcomes of robot‐assisted partial nephrectomy (RAPN).

Materials and Methods

Patients with renal cell carcinoma who underwent RAPN between 2010 and 2013 were identified in the National Cancer Database. Hospital yearly RAPN volume was categorized into groups by sorting patients as closely as possible into five groups of equal size (quintiles): very low; low; medium; high; and very high volume. Outcomes included 30‐day mortality, 90‐day mortality, open conversion, prolonged length of hospital stay (PLOS; defined as >3 days), 30‐day readmission rate, and positive surgical margin (PSM) rate. Unadjusted analyses and multivariable logistic regressions were used to compare outcomes. Sensitivity analyses with hospital volume considered as a continuous variable were also performed.

Results

A total of 18 724 RAPN cases were included. Hospital volume quintiles were: very low volume, 1–7 cases (n = 3 693); low volume, 8–14 cases (n = 3 719); medium volume, 15–23 cases (n = 3 833); high volume, 24–43 cases (n = 3 649); and very high volume, ≥44 cases (n = 3 830). There was no significant difference in 30‐day or 90‐day mortality among the five groups. Multivariable logistic regression analysis (reference: very low volume) showed that higher hospital volume was associated with lower odds of conversion (low [odds ratio {OR}: 0.88; P = 0.377]; medium [OR: 0.60; P = 0.001]; high [OR: 0.57; P < 0.001]; very high [OR: 0.47; P < 0.001]), lower odds of PLOS (low [OR: 0.93; P = 0.197], medium [OR: 0.75; P < 0.001]; high [OR: 0.62; P < 0.001]; very high [OR: 0.45; P < 0.001]), and lower odds of PSMs (low [OR: 0.76; P < 0.001]; medium [OR: 0.76, P < 0.001]; high [OR: 0.59; P < 0.001]; very high [OR: 0.34; P < 0.001]). Sensitivity analyses confirmed increasing hospital volume (per 1‐case increase) was associated with lower odds of conversion (OR: 0.986; P < 0.001), PLOS (OR: 0.989; P < 0.001) and PSMs (OR: 0.984; P < 0.001). A difference in 30‐day readmission rate was found in unadjusted analysis but not in adjusted analyses.

Conclusion

Undergoing RAPN at higher‐volume hospitals may have better peri‐operative outcomes (conversion to open and LOS) and lower PSM rates. Future studies are needed to explore the detailed components that lead to the superior outcomes in higher‐volume hospitals.
Antibiotic prophylaxis in ureteroscopic lithotripsy: a systematic review and meta‐analysis of comparative studies
Authors: Deng Tuo , Liu Bing , Duan Xiaolu , Cai Chao , Zhao Zhijian , Zhu Wei , Fan Junhong , Wu Wenqi , Zeng Guohua
Published: December 2017

Objective

To explore the efficacy of antibiotic prophylaxis and the different strategies used to prevent infection in ureteroscopic lithotripsy (URL) by conducting a systematic review and meta‐analysis.

Materials and Methods

A systematic literature search using Pubmed, Embase, Medline, the Cochrane Library, and the Chinese CBM, CNKI and VIP databases was performed to find comparative studies on the efficacy of different antibiotic prophylaxis strategies in URL for preventing postoperative infections. The last search was conducted on 25 June 2017. Summarized unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the efficacy of different antibiotic prophylaxis strategies.

Results

A total of 11 studies in 4 591 patients were included in this systematic review and meta‐analysis. No significant difference was found in the risk of postoperative febrile urinary tract infections (fUTIs) between groups with and without antibiotic prophylaxis (OR: 0.82, 95% CI 0.40–1.67; P = 0.59). Patients receiving a single dose of preoperative antibiotics had a significantly lower risk of pyuria (OR: 0.42, 95% CI 0.25–0.69; P = 0.0007) and bacteriuria (OR: 0.25, 95% CI 0.11–0.58; P = 0.001) than those who did not. Intravenous antibiotic prophylaxis was not superior to single‐dose oral antibiotic prophylaxis in reducing fUTI (OR: 1.00, 95% CI 0.26–3.88; P = 1.00).

Conclusions

We concluded that preoperative antibiotic prophylaxis did not lower the risk of postoperative fUTI, but a single dose could reduce the incidence of pyuria or bacteriuria. A single oral dose of preventive antibiotics is preferred because of its cost‐effectiveness. The efficacy of different types of antibiotics and other strategies could not be assessed in our meta‐analysis. Randomized controlled trials with a larger sample size and more rigorous study design are needed to validate these conclusions.
Male circumcision for the prevention of human immunodeficiency virus (HIV) acquisition: a meta‐analysis
Authors: Sharma Sanjeev C. , Raison Nicholas , Khan Shamim , Shabbir Majid , Dasgupta Prokar , Ahmed Kamran
Published: December 2017

We aimed to assess male circumcision for the prevention of human immunodeficiency virus (HIV) acquisition in heterosexual and homosexual men using all available data. A systematic literature review was conducted searching for studies that assessed male circumcision as a method to prevent HIV acquisition in homosexual and/or heterosexual men. PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov were searched in March 2017. A random effects model was used to calculate a pooled risk ratio (RR) and its associated 95% confidence interval (CI). In total, 49 studies were included in this meta‐analysis. The overall pooled RR for both homosexual and heterosexual men was 0.58 (95% CI 0.48–0.70), suggesting that circumcision was associated with a reduction in HIV risk. Circumcision was found to be protective for both homosexual and heterosexual men (RR: 0.80, 95% CI 0.69–0.92 and 0.28, 95% CI 0.14–0.59, respectively). Heterosexual men had a greater RR reduction (72% compared with 20% for homosexual men). There was significant heterogeneity among the studies (χ2 = 1378.34, df = 48; I2 = 97%). This meta‐analysis shows that male circumcision was effective in reducing HIV risk for both heterosexual and homosexual men.
Development of transient carbonate ramps in an evolving foreland basin
Authors: Ćosović Vlasta , Mrinjek Ervin , Nemec Wojciech , Španiček Jelena , Terzić Krešimir
Published: December 2017

This study of Eocene carbonate succession in the Dinaric Foreland Basin of northern Dalmatia, Croatia, integrates palaeontological and sedimentological data to document a range of carbonate ramps formed intermittently during the basin tectonic development. The end‐Cretaceous basal erosional unconformity records the coupling of Adria and Eurasia crustal plates, with an antiformal uplift along their suture zone. The overlying late Ypresian carbonate ramp, spanning biozones SBZ 11–12, developed on the forebulge flank of a shallow‐marine early synclinal basin. Basal grainstone/packstone facies, dominated by encrusting foraminifers with alveolinids and miliolids, pass upwards into packstones dominated by miliolids and rotaliids with bryozoan and echinoid fragments, indicating an increased bathymetry of the retreating forebulge flank. Deposition of grainstone facies preceded an end‐Ypresian (SBZ 12/13 transition) subaerial exposure due to post‐subductional isostatic uplift. The younger, middle to late Eocene carbonate ramps (SBZ 13–19) formed episodically as perched isolated features on blind‐thrust anticlines in a bathymetrically diversified wedge‐top basin, where phases of clastic and skeletal biogenic sedimentation alternated due to disharmonic thrusting and relative sea‐level changes. Clastic sedimentation reflects anticline crest erosion and a forced‐regressive progradation of gravelly foreshore and sandy shoreface facies over heterolithic offshore‐transition and muddy offshore facies on the anticline flank. Biogenic sedimentation represents inner‐ to middle‐ramp environments, with the latter terminating bluntly in muddy offshore environment. An outer‐ramp environment, known from classic ramp models, was lacking due to bathymetric threshold. Analysis of larger benthic foraminifers (LBF), as biostratigraphic age indicators and palaeobathymetric proxies, helped distinguish systems tracts and determine their time span. A comparison of local and global sea‐level changes allowed the interplay of tectonic and eustatic forcing to be deciphered for the study area.
Sleep patterns and problems in infants and young children in Ireland
Authors: Hanafin S.
Published: December 2017

Background

There is an increasing recognition that sleep is an important aspect of health and well‐being, and this is particularly the case in infancy and early childhood where sleep behaviours and patterns can result in substantial problems.

Methods

This paper draws on Wave 1, 2, and 3 data from Growing Up in Ireland, the national longitudinal study of children in Ireland to provide an overview of sleep patterns in a population of children aged 9 months (n = 11,112), 3 years (n = 9,790), and 5 years (n = 8,996). The anonymised data made available through the Irish Social Science Data Archive were analysed using descriptive statistics.

Results

Findings from the analysis show that about two thirds of infants (66.9%; n = 7,433) and just under 3 quarters of children aged 3 years (72.8%; n = 7,127) go to sleep between 7:00 p.m. and 9:00 p.m. and about 3 quarters (78.6%; n = 7,070) of 5‐year‐old children are in bed by 9:00 p.m. Just under half of infants (48.5%; n = 5,000) wake up between 7:00 a.m. and 8:00 a.m. and 13.5% (n = 1,500) wake up between 6:00 a.m. and 7:00 a.m.

More than 80% (n = 8,889) of mothers report their 9‐month‐old infant wakes up at least occasionally and 13.8% report it happens every night. Almost all infants nap during the daytime, with the majority (56.0%; n = 6,222) doing so for between 1 and 2 hours. About one third (65.4%; n = 6,402) of 3‐year‐olds take daytime naps, but only 5.0% (n = 449) of 5‐year‐olds do so. Substantial proportions of mothers report children's sleep patterns are at least a small problem for them (ranging from about 30% (n = 3,333) in infancy to 22% (n = 2,444) at 3 years and 12% (n = 1,079) at 5 years).

Conclusions

These findings highlight a substantial unmet need, and it is suggested that public health nurses and health visitors have a key role to play in supporting positive sleep patterns in early childhood.
Cardiac function in paediatric patients with congenital adrenal hyperplasia due to 21 hydroxylase deficiency
Authors: Mooij Christiaan F. , Pourier Milanthy S. , Weijers Gert , de Korte Chris L. , Fejzic Zina , Claahsen‐van der Grinten Hedi L. , Kapusta Livia
Published: December 2017

Background

Hyperandrogenism and exogenous glucocorticoid excess may cause unfavourable changes in the cardiovascular risk profile of patients with congenital adrenal hyperplasia (CAH).

Objective

To evaluate the cardiac function in paediatric patients with CAH.

Patients and methods

Twenty‐seven paediatric patients with CAH, aged 8‐16 years, were evaluated by physical examination, electrocardiogram (ECG), conventional echocardiography, tissue Doppler imaging and two‐dimensional (2D) myocardial strain (rate) imaging. Results were compared to 27 age‐ and gender‐ matched healthy controls.

Results

No signs of left ventricular hypertrophy or dilatation were detected on echocardiography. ECG revealed a high prevalence (25.9%) of incomplete right bundle branch block. Left ventricular posterior wall thickness in diastole (LVPWd) was significantly lower in patients with CAH compared to controls (5.55 vs 6.53 mm; P = .009). The LVPWd Z‐score was significantly lower in patients with CAH yet within the normal range (−1.12 vs −0.35; P = .002). Isovolumetric relaxation time was significantly lower in patients with CAH (49 vs 62 ms; P = .003). Global longitudinal, radial and circumferential strain was not significantly different compared to controls. Global radial strain rate was significantly higher compared to healthy controls (2.58 vs 2.06 1/s; P = .046). Global longitudinal strain was negatively correlated with 24‐hour blood pressure parameters.

Conclusion

Cardiac evaluation of paediatric patients with CAH showed no signs of left ventricular hypertrophy or ventricular dilatation. LVPWd was lower in patients with CAH than in controls but within the normal range. A shorter isovolumetric relaxation time in patients with CAH may be a sign of mild left ventricular diastolic dysfunction.
A prospective controlled trial comparing xenograft/autogenous bone and collagen‐stabilized xenograft for maxillary sinus augmentation—Complications, patient‐reported outcomes and volumetric analysis
Authors: Alayan Jamil , Ivanovski Saso
Published: December 2017

Objective

Compare maxillary sinus augmentation (MSA) using two different materials—anorganic bovine bone mineral (ABBM) + autogenous bone (AB) (control group) vs. collagen‐stabilized ABBM (test group) in terms of complications, patient‐reported outcome measures (PROMs) and volumetric analysis.

Materials and Methods

Sixty patients underwent sinus augmentation (30 control + 30 test group). Intra‐ and postoperative complications were recorded. PROMs measured the impact of grafting on daily activities, pain and morbidity. CT scans were used to measure graft volume, ridge height, material selection and degree of contact of graft‐to‐surrounding sinus walls. Dental implant placement parameters were also recorded.

Results

All complications were minor and did not prevent completion of the augmentation or subsequent implant placement. Schneiderian membrane perforation was the most frequently encountered complication. Both treatment groups reported moderate limitation in the 1st 48 hr post‐surgery but little or none by day 3 or 4. Jaw opening, chewing and bruising were significantly higher in the control group. The impact on work and social life was moderate initially but reduced to little or none by the 2nd day. Mild to moderate pain and interference to daily activities were reported for the first 3 days requiring the use of NSAIDs only. A mean graft volume of 1.46 cm3 (±0.77) was calculated in the control group and 1.27 cm3 (±0.65) in the test group. Extent of contact between graft and surrounding sinus walls had a significant impact on bone volume. Shorter (8 mm) implants were utilized more frequently in the test group, which was also more likely to require additional vertical augmentation, but this was not statistically significant.

Conclusion

MSA using a lateral wall approach is safe and associated with mild to moderate pain and restrictions to daily activities for 48–72 hr. Patients’ reports of morbidity were greater with autogenous bone harvesting. Collagen‐stabilized ABBM provides comparable bone volume to AB + ABBM that is sufficient for placement of implants of adequate size with no need for further vertical augmentation. Engaging the surrounding sinus walls had a significant positive impact on graft volume.
Photoaggravated allergic contact dermatitis and transient photosensitivity caused by methylisothiazolinone
Authors: Aerts Olivier , Goossens An , Marguery Marie‐Claude , Castelain Michel , Boursault Lucile , Giordano‐Labadie Françoise , Lambert Julien , Milpied Brigitte
Published: December 2017

Background

Photoaggravated allergic contact dermatitis caused by methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) and MI has been reported.

Objectives

To describe the clinical characteristics and results of (photo)patch tests and photo‐tests of 10 patients in Belgium and France suffering from photoaggravated contact dermatitis caused by MI.

Patients and Methods

Five men and five women, with a median age of 49.5 years, were investigated between January 2012 and February 2017 because of suspected photoaggravated contact dermatitis. Patch tests, photopatch tests and/or photo‐tests were performed.

Results

Seven patients had positive patch test reactions to both MCI/MI and MI, whereas 3 patients had positive patch test reactions only to MI. In most cases, MI was the (strong) primary sensitizer. Photopatch tests with MCI/MI and/or MI gave stronger reactions than patch tests with these derivatives, indicating photoaggravation. Sensitization probably took place from cosmetics and work‐related biocides, whereas elicitation of dermatitis was remarkably often related to airborne exposure to MI present in paints or industrial biocides. Four patients suffered from transient photosensitivity.

Conclusion

Photoaggravated allergic contact dermatitis and transient photosensitivity caused by MI is a peculiar clinical presentation of allergic contact dermatitis caused by this preservative, and should be considered in daily clinical practice.
S‐Nitrosohemoglobin Levels and Patient Outcome After Transfusion During Pediatric Bypass Surgery
Authors: Matto Faisal , Kouretas Peter C. , Smith Richard , Ostrowsky Jacob , Cina Anthony J. , Hess Douglas T. , Stamler Jonathan S. , Reynolds James D.
Published: December 2017

Banked blood exhibits impairments in nitric oxide (NO)‐based oxygen delivery capability, reflected in rapid depletion of S‐nitrosohemoglobin (SNO‐Hb). We hypothesized that transfusion of even freshly‐stored blood used in pediatric heart surgery would reduce SNO‐Hb levels and worsen outcome. In a retrospective review (n = 29), the percent of estimated blood volume (% eBV) replaced by transfusion directly correlated with ventilator time and inversely correlated with kidney function; similar results were obtained in a prospective arm (n = 20). In addition, an inverse association was identified between SNO‐Hb and postoperative increase in Hb (∆Hb), reflecting the amount of blood retained by the patient. Both SNO‐Hb and ∆Hb correlated with the probability of kidney dysfunction and oxygenation‐related complications. Further, regression analysis identified SNO‐Hb as an inverse predictor of outcome. The findings suggest that SNO‐Hb and ∆Hb are prognostic biomarkers following pediatric cardiopulmonary bypass, and that maintenance of red blood cell‐derived NO bioactivity might confer therapeutic benefit.
The status of support for cannabis regulation in Uruguay 4 years after reform: Evidence from public opinion surveys
Authors: Cruz José Miguel , Boidi Maria Fernanda , Queirolo Rosario
Published: December 2017

Introduction and Aims

The objective of this study was to measure the public support for marijuana legalisation in Uruguay, both overall and in its provisions, in nearly 4 years after its implementation.

Design and Methods

Three separate cross‐national surveys were conducted in early 2014, late 2015 and mid‐2017 with national representative samples of adults. The first study was carried out during the initial months of implementation of the law and used face‐to‐face interviews (N = 1490); the second survey was conducted using a computer‐assisted telephone interviewing system (N = 703); and the third study (N = 1515), using face‐to‐face interviews, was completed just before the implementation of pharmacy sales.

Results

About 60.7% of respondents in 2014 were against marijuana legalisation; in 2017, 54.1% remained opposed to the marijuana law. In 2015, half of the people interviewed (49.9%) supported access to marijuana through self‐cultivation, while 38.6% favoured the provision of cannabis clubs and 33.1% agreed with the pharmacy retail provision. Support for medical cannabis was high in 2015, with 74.5% favouring it.

Discussion and Conclusions

This study shows a change in the public opinion toward legalisation of marijuana although most people still remain opposed to the law. However, the data do not provide indication of a significant change in its use. Results suggest that opposition to legalisation may be focused on the pharmacy retail provision.
Utility of HbA1c and fasting plasma glucose for screening of Type 2 diabetes: a meta‐analysis of full ROC curves
Authors: Hoyer A. , Rathmann W. , Kuss O.
Published: December 2017

Aims

There is still debate on the optimal threshold for population‐based screening of diabetes (diagnosed by the oral glucose tolerance test) using tests like HbA1c or fasting plasma glucose. Meta‐analyses provide meaningful input in such situations. The aim of this article is to perform a meta‐analysis that includes the complete information reported in the individual studies of two existing systematic reviews.

Methods

We screened the individual studies from two systematic reviews and reconstructed the full four‐fold tables for every reported threshold. Using a recently proposed meta‐analysis model for the comparison of two diagnostic tests, we compared HbA1c with fasting plasma glucose, and estimated meta‐analytic receiver operating characteristic curves for both tests using the 11.1 mmol/l threshold of the 2‐h post‐challenge glucose level (2 h‐PG) as the gold standard.

Results

We included nine studies from two existing systematic reviews in our analysis.

Based on our data set, the optimal threshold lies between 42 and 44 mmol/mol (6.0–6.2%) for HbA1c, and 6.2–6.4 mmol/l for fasting plasma glucose choosing the Youden index as the technical criterion. In addition, we found that there is no relevant difference in the performance of HbA1c and fasting plasma glucose.

Conclusions

In our meta‐analysis, we found that the optimal threshold with reference to the 2 h‐PG should be chosen between 42 and 44 mmol/mol (6.0–6.2%) for HbA1c, and 6.2–6.4 mmol/l for fasting plasma glucose on the basis of maximal sensitivity and specificity.
Methylation‐based estimated biological age and cardiovascular disease
Authors: Lind Lars , Ingelsson Erik , Sundström Johan , Siegbahn Agneta , Lampa Erik
Published: December 2017

Background

DNA methylation changes over life at specific sites in the genome, which can be used to estimate “biological age.” The aim of this population‐based longitudinal cohort study was to investigate the association between estimated biological age and incident cardiovascular disease (CVD).

Materials and methods

Based on formulas published by Hannum et al and Horvath et al, “biological age” was calculated using data from the Illumina 450k Bead Methylation chip in 832 participants free from cardiovascular disease in the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS) study (50% women, all aged 70 years at the examination). The difference between estimated biological and chronological age was calculated (DiffAge).

Results

During 10 years of follow‐up, 153 incident cases of cardiovascular disease occurred. In the sex‐adjusted analyses, the Horvath estimation of DiffAge was significantly related to incident cardiovascular disease (HR 1.040, 95% CI 1.010‐1.071, P = .0079). Thus, for each year of increased biological age, a 4% increased risk of future cardiovascular disease was observed. This relationship was still significant following adjustment for the traditional risk factors sex, BMI, diabetes, HDL and LDL‐cholesterol, systolic blood pressure and smoking (HR 1.033, 95% CI 1.004‐1.063, P = .024). No such significant association was found using the Hannum formula.

Conclusions

DNA methylation‐based estimation of “biological age” per Horvath was associated with incident cardiovascular disease.
Synthesizing an Index of Financial Literacy Using Not‐For‐Purpose Survey Data
Authors: West Tracey , Worthington Andrew C.
Published: December 2017

We use Australian household survey data to formulate a measure of financial literacy. First, we use household responses to questions regarding financial stress and savings habits to derive a factor variable that proxies as an index of financial literacy. Second, the sample is clustered into categories of financial literacy according to their financial literacy index and other household characteristics. Third, we test for the significance of household characteristics on the financial literacy index. We find the methodologies form similar groups and yield comparable estimates. Being young, female, a single parent, in poor health, unemployed and with low income and wealth increases the likelihood of low levels of financial literacy.
Translation That Transforms: Leadership and the Working Poor
Authors: Mills Steven D.
Published: December 2017

Translational science, at its core, is about knowledge making a positive difference in the well‐being of others (Evans, 2012). This article explores how student attitudes, beliefs, and actions toward impoverished and working poor Americans were influenced by a data‐ and experience‐driven understanding of this population. The context is an undergraduate course called ADE 4930: Leadership and the Working Poor, a 3‐credit, service‐learning course requiring students to become Internal Revenue Service–certified tax preparers and provide 40 hours of free tax preparation assistance to the working poor. Students translated empirical evidence and data offered by ADE4930 through three primary applications: (a) behavioral guidance related to tax preparation and the Earned Income Tax Credit, (b) attitudinal shifts about poverty related to structural disadvantages and the psychological impact of scarcity, and (c) social policy sophistication related to political compromise and the complexity of personal experience.
Health and social factors associated with a delayed discharge amongst inpatients in acute geriatric wards: A retrospective observational study
Authors: Moore George , Hartley Peter , Romero‐Ortuno Roman
Published: December 2017

Aim

In the English National Health Service there is an increasing interest in understanding the factors associated with delayed discharges in older hospitalized adults. The present study sought to analyze whether clinical frailty was a significant and independent risk factor for having a delayed discharge when the data were controlled for potential health and social confounders.

Methods

This was a retrospective observational study in an English National Health Service teaching hospital. We analyzed all first hospitalization episodes to the Department of Medicine for the Elderly between 1 May 2016 and 31 July 2016. A delayed discharge was operationally defined as a patient being discharged more than 24 h after his/her last recorded clinically fit date.

Results

A total of 924 cases were analyzed. The independent risk factors for having a delayed discharge were: needing a new package of care (OR 4.05, 95% CI 2.68–6.10), new institutionalization (OR 2.78, 95% CI:1.67–4.62), living alone (OR 1.98, 95% CI 1.40–2.81), delirium (OR 1.79, 95% CI 1.17–2.74) and frailty (i.e. ≥5 on the Clinical Frailty Scale, OR 1.74, 95% CI 1.15–2.63).

Conclusions

The present results are consistent with previous reports that delayed discharges in older hospitalized patients are mainly related to new formal social care requirements in survivors of acute illness. Frailty was an independent risk factor for delay, but its effect might have been confounded by the unmeasured variable of informal care requirements. Our operational definition of delayed discharge does not mirror the legal definition of delayed transfer of care in England, and the results are not externally valid. Geriatr Gerontol Int 2018; 18: 530–537.
Clinical information seeking in traumatic brain injury: a survey of Veterans Health Administration polytrauma care team members
Authors: Hogan Timothy , Martinez Rachael , Evans Charlesnika , Saban Karen , Proescher Eric , Steiner Monica , Smith Bridget
Published: December 2017

Background

The polytraumatic nature of traumatic brain injury (TBI) makes diagnosis and treatment difficult.

Objectives

To (1) characterise information needs among Veterans Health Administration (VHA) polytrauma care team members engaged in the diagnosis and treatment of TBI; (2) identify sources used for TBI related information; and (3) identify barriers to accessing TBI related information.

Methods

Cross‐sectional online survey of 236 VHA polytrauma care team members.

Results

Most respondents (95.8%) keep at least somewhat current regarding TBI, but 31.5% need more knowledge on diagnosing TBI and 51.3% need more knowledge on treating TBI. Respondents use VHA affiliated sources for information, including local colleagues (81.7%), VHA offsite conferences/meetings (78.3%) and onsite VHA educational offerings (73.6%); however, limited time due to administrative responsibilities (50.9%), limited financial resources (50.4%) and patient care (50.4%) were prominent barriers.

Discussion

Medical librarians are in a unique position to develop information services, resources and other electronic tools that reflect the clinical context in which polytrauma care team members practice, and the different tasks they perform.

Conclusion

Polytrauma care team members could benefit from additional information regarding the diagnosis and treatment of TBI. Addressing their information needs and supporting their information seeking requires a mulit‐pronged approach to time and financial constraints.
FRENCH HISTORIANS AND COLLECTIVE VIOLENCE
Authors: ROBERTS PENNY
Published: December 2017

French historians and French history have dominated the study of early modern violence. This essay addresses why this is so and what has characterized French historians' approaches to collective violence in particular, whether in the form of popular revolt, confessional division, or revolutionary violence. It posits that historians are essentially uncomfortable in defending and explaining popular violence in the past, that they ought to address this issue more directly and not to establish too much cultural distance from their subjects in doing so. It concludes with some reflections on approaches to violence in the past and the present, how historians and others talk about and engage with violence, and how its treatment today should inform how historians address the challenges of writing the history of violence in the future.
Primary antifungal prophylaxis: decrease of invasive fungal disease incidence and reduction of risk factors in haematological patients in a 5‐year retrospective study
Authors: Li Yan , Liu Mingjuan , Zhai Bing , Zhao Xiaoli , Wang Lijun , Li Honghua , Wang Shuhong , Zhu Haiyan , Wang Quanshun , Gao Chunji , Huang Wenrong , Yu Li
Published: December 2017

Background

Invasive fungal disease (IFD) is a major cause of morbidity and mortality in patients with haematological malignancies.

Aim

To evaluate the efficacy and rationality of primary antifungal prophylaxis (PAP) in a 5‐year real‐life setting and choose an appropriate PAP strategy.

Methods

Clinical data of patients were retrospectively reviewed and IFD was diagnosed using the revised diagnostic criteria. The efficacy of PAP and the risk factors for IFD, especially the rationality of PAP, were evaluated.

Results

Of the 1340 patients enrolled, 749 patients received PAP (55.9%), and IFD occurred in 157 patients: 51 (6.8%) in the PAP group and 106 (17.9%) in the non‐PAP group (P = 0.000). The IFD‐related mortality was 10.1 and 29.7% in the PAP group and non‐PAP group (P = 0.000) respectively. PAP was an independent protective factor for IFD (odds ratio = 0.183, 95% confidence interval: 0.122–0.274, P = 0.000) and could reduce the effect of risk factors, such as allogeneic haemopoietic stem cell transplantation, prolonged neutropenia and corticosteroid. The IFD incidence was not significantly different among different PAP regimens and PAP start time subgroups, and it was lowest (4.2%) when PAP started after a short period of neutropenia (1–10 days).

Conclusion

PAP is necessary and efficient to prevent IFD in haematological patients, and the real‐life PAP strategy is reasonable. Different drugs can be chosen, and it is better to start PAP as soon as neutropenia begins.
Relationships between leaf morpho‐anatomy, water status and cell membrane stability in leaves of wheat seedlings subjected to severe soil drought
Authors: Petrov P. , Petrova A. , Dimitrov I. , Tashev T. , Olsovska K. , Brestic M. , Misheva S.
Published: December 2017

The impact of the genotype‐specific leaf morphological and anatomical characteristics on the ability of wheat plants to preserve leaf water balance and cell membranes stability under drought stress was investigated. Seedlings of six modern semi‐dwarf (carriers of Rht, Reduced height genes) and six old tall bread wheat varieties were subjected to soil drought by withholding watering for 6 days. Morpho‐anatomical traits (leaf area, perimeter, thickness, stomata and trichome density) of daily watered (control) plants were characterized by light microscopy, scanning and image analyses. The leaf water status in both control and stressed plants was determined by measuring the relative water content (RWC). The leaf cell membranes stability in stressed plants was estimated by conductometric determination of the membranes injury index. On average, the modern semi‐dwarf varieties had less leaf area and leaf perimeter, and less dissection index, a parameter characterizing the leaf shape. Under drought stress, the modern genotypes maintained better water balance evidenced by significantly higher leaf RWC and better‐preserved the cell membranes stability supported by significantly lower Injury index. The correlations between morpho‐anatomical traits in control plants and drought tolerance‐related traits showed that the higher the leaf dissection index (i.e. more oblong leaves), the greater the water loss and the leaf membrane damages after desiccation were. The effect of shape of the evaporating surface on the water loss was modelled using wet filter paper. Similar to plant leaves, the evaporation and, respectively, water loss from paper pieces of more oblong shape (i.e. higher dissection index) was more intensive. The elucidation of the impact of the leaf shape on transpiration might contribute to better understanding of the mechanisms used by plants to maintain water reserves during drought stress and could be a basis for developing of simple and fast screening methods aiding the selection of drought tolerant genotypes.
The added value of inclusive research
Authors: Walmsley Jan , Strnadová Iva , Johnson Kelley
Published: December 2017

Background

The study asks when does inclusive research add value? The authors argue that this is important, given the additional time and cost of co‐researching with people with intellectual disabilities. The study is situated in debates about a “second generation” of inclusive research which advocates focussing more on outcomes than process. The authors argue that this is premature, rather the authors propose that inclusive research is valuable when it helps to recognize, foster, and above all communicate the contributions people with intellectual disabilities can make.

Method

The authors conducted a literature review of 52 peer‐reviewed journal articles about inclusive research and analysed them..

Results

The authors conclude that inclusive research adds value when there is a distinctive contribution which only co‐researchers with intellectual disabilities can make, when it highlights the contributions people with intellectual disabilities make, and when it contributes to better lives for the wider population of people with intellectual disabilities.

Conclusions

The authors propose a revised definition of inclusive research to replace that published by Walmsley and Johnson in 2003.
Accounting conservatism and short selling: Evidence from China
Authors: Jin Zhi , Lin Bingxuan , Yang Xue , Zhang Ting
Published: December 2017

Using China's short‐selling pilot program as a quasi‐experiment, we find that the prospect of short selling has significantly increased conditional accounting conservatism among firms that are eligible for short selling, consistent with a short sellers’ disciplining effect hypothesis. When short selling takes position ex post, accounting conservatism starts to decrease with an increased downward pressure on stock prices. Moreover, the short‐selling effect of increased conditional accounting conservatism becomes stronger for state‐owned enterprises, and this effect is accompanied by an increase of unconditional conservatism. As corroborating evidence to support the disciplining hypothesis, we show that accounting conservatism is significantly decreased for firms that are removed from the short‐selling eligibility list. Our results are robust after considering the endogeneity issue in measuring downward stock price pressure, and after constructing the control firms by using both a propensity score matching method and an alternative measure for accounting conservatism. Overall, we provide important evidence on the feedback effects that the capital market has on firm financial reporting.
Estimating causal effects for survival (time‐to‐event) outcomes by combining classification tree analysis and propensity score weighting
Authors: Linden Ariel , Yarnold Paul R.
Published: December 2017

Rationale, aims and objectives

A common approach to assessing treatment effects in nonrandomized studies with time‐to‐event outcomes is to estimate propensity scores and compute weights using logistic regression, test for covariate balance, and then estimate treatment effects using Cox regression. A machine‐learning alternative—classification tree analysis (CTA)—used to generate propensity scores and to estimate treatment effects in time‐to‐event data may identify complex relationships between covariates not found using conventional regression‐based approaches.

Method

Using empirical data, we identify all statistically valid CTA propensity score models and then use them to compute strata‐specific, observation‐level propensity score weights that are subsequently applied in outcomes analyses. We compare findings obtained using this framework to the conventional method, by evaluating covariate balance and treatment effect estimates obtained using Cox regression and a weighted CTA outcomes model.

Results

All models had some imbalanced covariates. Nevertheless, treatment effect estimates were generally consistent across all weighted models.

Conclusions

In the study sample, given that all approaches elicited similar results, using CTA increased confidence that bias could not be reduced any further. Because the CTA algorithm identifies all statistically valid propensity score models for a sample, it is most likely to identify a correctly specified propensity score model—and therefore should be used either to confirm results using traditional methods, or to reveal biases that may be missed by traditional methods. Moreover, given that the true treatment effect is never known in observational data, CTA should be considered for estimating outcomes because no statistical assumptions are required.