bluuebunny/crossref_metadata_2025 huggingface dataset:
Newly graduated nurses' clinical competencies and need for further training in acute care hospitals
Authors: Willman Anna , Bjuresäter Kaisa , Nilsson Jan
Published: February 2020

Aim

To assess self‐reported clinical competence and the need for further training among newly graduated registered nurses (NGRNs) working in Swedish acute care hospital settings.

Background

NGRNs are expected to take full responsibility for patients' nursing care in an increasingly complex clinical context, and professional nurses' clinical competence is critical in providing high‐quality and safe nursing care.

Design

A cross‐sectional design.

Methods

Data were collected using the 50‐item ProffNurse SAS II. A total of 85 NGRNs who had recently commenced working with direct patient care at three hospitals in central Sweden participated in the study. The response rate was 69%. The STROBE cross‐sectional reporting guidelines were used.

Results

The NGRNs assessed their clinical competence as being highest in areas relating to team collaboration and ethics and lowest in areas relating to professional development and direct clinical practice. The need for further training was greatest in areas such as direct clinical practice and patient safety and lowest in areas such as team collaborating and ethics.

Conclusion

The use of instruments to identify NGRNs' self‐assessed clinical competence is of value when designing and evaluating introductory programmes for NGRNs taking on positions in acute care hospital settings. The availability of experienced nurses from whom NGRNs can gain clinical competence and learn from is of importance, both from the perspective of the NGRNs themselves and patient safety.

Relevance to clinical practice

An understanding of NGRNs' clinical competence and their need for further training may assist in both planning and organising nursing programmes and in making clinical policy decisions when designing introduction programmes in acute care settings.
Enteral hydration in high‐flow therapy for infants with bronchiolitis: Secondary analysis of a randomised trial
Authors: Babl Franz E , Franklin Donna , Schlapbach Luregn J , Oakley Ed , Dalziel Stuart , Whitty Jennifer A , Neutze Jocelyn , Furyk Jeremy , Craig Simon , Fraser John F , Jones Mark , Schibler Andreas ,   Paediatric Research in Emergency Departments International Collaborative and Pediatric Critical Care Research Group
Published: February 2020

Aim

Nasal high‐flow oxygen therapy is increasingly used in infants for supportive respiratory therapy in bronchiolitis. It is unclear whether enteral hydration is safe in children receiving high‐flow.

Methods

We performed a planned secondary analysis of a multi‐centre, randomised controlled trial of infants aged <12 months with bronchiolitis and an oxygen requirement. Children were assigned to treatment with either high‐flow or standard‐oxygen therapy with optional rescue high‐flow. We assessed adverse events based on how children on high‐flow were hydrated: intravenously (IV), via bolus or continuous nasogastric tube (NGT) or orally.

Results

A total of 505 patients on high‐flow via primary study assignment (n = 408), primary treatment (n = 10) or as rescue therapy (n = 87) were assessed. While on high flow, 15 of 505 (3.0%) received only IV fluids, 360 (71.3%) received only enteral fluids and 93 (18.4%) received both IV and enteral fluids. The route was unknown in 37 (7.3%). Of the 453 high‐flow infants hydrated enterally patients could receive one or more methods of hydration; 80 (15.8%) received NGT bolus, 217 (43.0%) NGT continuous, 118 (23.4%) both bolus and continuous, 32 (6.3%) received only oral hydration and 171 (33.9%) a mix of NGT and oral hydration.

None of the patients receiving oral or NGT hydration on high‐flow sustained pulmonary aspiration (0%; 95% confidence interval N/A); one patient had a pneumothorax (0.2%; 95% confidence interval 0.0–0.7%).

Conclusions

The vast majority of children with hypoxic respiratory failure in bronchiolitis can be safely hydrated enterally during the period when they receive high‐flow.
Complete surgical excision versus Penrose drainage for the treatment of elbow hygroma in 19 dogs (1997 to 2014)
Authors: Angelou V. , Papazoglou L. G. , Tsioli V. , Psalla D. , Anagnostou T. , Chatzimisios K. , Pavlidis L.
Published: February 2020

Objectives

To report results of surgical excision and Penrose drainage for the treatment of elbow hygromas in dogs.

Materials and Methods

Retrospective review of the clinical records of 19 dogs with elbow hygromas treated with Penrose drainage or surgical excision between 1997 and 2014. The data retrieved from the records included breed, gender, age, duration of clinical signs, weight, historical data, complete blood count and serum biochemistry, physical examination findings, diameter of the hygroma, cytology of needle aspirates, method of treatment, histological findings, postsurgical complications and their management and outcome.

Results

Twenty‐one hygromas were treated in 19 dogs. Eleven were right‐sided, six were left‐sided and four were bilateral. First‐line treatment was Penrose drain placement in 12 and complete surgical excision in nine. Bilateral hygromas were addressed simultaneously. Four of the 12 hygromas managed with Penrose drain recurred and one developed ulceration over the olecranon. Recurrent hygromas were treated by surgical excision. The ulceration was surgically excised and reconstructed with a thoracodorsal axial pattern flap. No further complications developed. All the dogs were clinically healthy after a median follow‐up of 16 months.

Clinical Significance

Surgical excision of canine elbow hygroma is an effective technique that appears to have fewer postoperative complications than Penrose drain placement.
Metabolic regulation of hepatic PNPLA3 expression and severity of liver fibrosis in patients with NASH
Authors: Bruschi Francesca V. , Tardelli Matteo , Herac Merima , Claudel Thierry , Trauner Michael
Published: February 2020

Background and Aims

The genetic PNPLA3 polymorphism I148M has been extensively associated with higher risk for development and progression of NAFLD towards NASH.

Methods

PNPLA3 and α‐SMA expression were quantified in liver biopsies collected from NASH patients (n = 26) with different fibrosis stages and PNPLA3 genotypes. To study the potential mechanisms driving PNPLA3 expression during NASH progression towards fibrosis, hepatocytes and hepatic stellate cells (HSCs) were cultivated in low and high glucose medium. Moreover, hepatocytes were treated with increasing concentrations of palmitic acid alone or in combination with glucose. Conditioned media were collected from challenged hepatocytes to stimulate HSCs.

Results

Tissue expression of PNPLA3 was significantly enhanced in biopsies of patients carrying the I148M polymorphism compared to wild type (WT). In NASH biopsies, PNPLA3 significantly correlated with fibrosis stage and α‐SMA levels independently of PNPLA3 genotype. In line, PNPLA3 expression was higher in α‐SMA positive cells. Low glucose increased PNPLA3 in HSCs, whereas high glucose induced PNPLA3 and de‐novo lipogenesis‐related genes expression in hepatocytes. Palmitic acid induced fat accumulation and cell stress markers in hepatocytes, which could be counteracted by oleic acid. Conditioned media collected from lipotoxic challenged hepatocytes markedly induced PNPLA3 mRNA and protein levels, fibrogenic and autophagic markers and promoted migration in HSCs. Notably, conditioned media collected from hepatocytes cultivated with both glucose and palmitic acid exacerbated HSCs migration, PNPLA3 and fibrogenic gene expression, promoting release of cytokines from HSCs.

Conclusions

Collectively, our observations uncover the diverse metabolic regulation of PNPLA3 among different hepatic cell populations and support its relation to fibrosis progression.
Why Are There So Many Lawyers in Congress?
Authors: Bonica Adam
Published: February 2020

Scholars have long sought to explain the overrepresentation of lawyers in Congress. This article draws on a wealth of data to explore the causes and consequences of this representational imbalance. While lawyers enter politics at higher rates, self‐selection at best provides a partial explanation. Conditional on running, lawyers win at twice the rate of candidates from other backgrounds. Contrary to prevailing theories in the literature, voters do not reward candidates with backgrounds in law. Rather, lawyers win because of a sizable competitive advantage in early fundraising, owing in large part to their professional networks. This study has important implications for who runs for office, who wins, and the demographic composition of Congress. It also identifies an underexplored mechanism by which the US system of campaign finance sustains deep representational imbalances.
Galactic cosmic ray effects on iron and nickel isotopes in iron meteorites
Authors: Cook David L. , Leya Ingo , Schönbächler Maria
Published: February 2020

We present model calculations for cosmogenic production rates in order to quantify the potential effects of spallation and neutron capture reactions on Fe and Ni isotopes in iron meteorites. We aim to determine whether the magnitude of any cosmogenic effects on the isotopic ratios of Fe and/or Ni may hinder the search for nucleosynthetic variations in these elements or in the application of the 60Fe‐60Ni chronometer. The model shows that neutron capture reactions are the dominant source of shifts in Fe and Ni isotopic ratios and that spallation reactions are mostly negligible. The effects on 60Ni are sensitive to the Co/Ni ratio in the metal. The total galactic cosmic ray (GCR) effects on 60Ni and 64Ni can be minimized through the choice of normalizing isotopes (61Ni/58Ni versus 62Ni/58Ni). In nearly all cases, the GCR effects (neutron capture and/or spallation) on Fe and Ni isotopic ratios are smaller than the current analytical resolution of the isotopic measurements. The model predictions are compared to the Fe and Ni isotopic compositions measured in a suite of six group IAB irons with a range of cosmic ray exposure histories. The experimental data are in good agreement with the model results. The minimal effects of GCRs on Fe and Ni isotopes should not hamper the search for nucleosynthetic variations in these two elements or the application of the 60Fe‐60Ni chronometer in iron meteorites or chondrites.
Can Skeptics Earn Their Keep?
Authors: Kvanvig Jonathan L.
Published: February 2020

This paper investigates the prospects for skepticism once we distinguish between bare skeptical theses and arguments and mature philosophical theory. If all skeptics have to offer is bare theses and arguments, skepticism presents only a challenge of reflective equilibrium. But if skeptics can move toward developed theory, then skeptics have, as I will put it, earned their keep. Just as foundationalism should be taken seriously in part because theory development goes well beyond a mere regress argument for the view, just so skepticism needs theory development to be taken seriously as well. The problem is that it is not clear that theory development is possible for skeptics. Here I articulate this concern and give some grounds for thinking that it can be overcome.
Recombinant elongation factor 1 alpha of Haemonchus contortus affects the functions of goat PBMCs
Authors: Ehsan Muhammad , Gadahi Javaid Ali , Lu MingMin , Yan RuoFeng , Xu LiXin , Song XiaoKai , Zhu Xing‐Quan , Du AiFang , Hu Min , Li XiangRui
Published: February 2020

Excretory/secretory proteins of Haemonchus contortus (HcESPs) intermingle comprehensively with host immune cells and modulate host immune responses. In this study, H contortus ES antigen named as elongation factor 1 alpha (HcEF‐1α) was cloned and expressed. The influences of recombinant HcEF‐1α on multiple functions of goat peripheral blood mononuclear cells (PBMCs) were observed in vitro. Immunoblot analysis revealed that rHcEF‐1α was recognized by the serum of goat infected with H contortus. Immunofluorescence analysis indicated that rHcEF‐1α was bound on surface of PBMCs. Moreover, the productions of IL‐4, TGF‐β1, IFN‐γ and IL‐17 of cells were significantly modulated by the incubation with rHcEF‐1α. The production of interleukin IL‐10 was decreased. Cell migration, cell proliferation and cell apoptosis were significantly increased; however, nitric oxide production (NO) was significantly decreased. The MHC II molecule expression of cells incubated with rHcEF‐1α was increased significantly, whereas MHC‐I was not changed as compared to the control groups (PBS control and pET32a). These findings indicated that rHcEF‐1α protein might play essential roles in functional regulations of HcESPs on goat PBMC and mediate the immune responses of the host during host‐parasite relationship.
Now You See It, Now You Don't: Explicit Contract Benefits In Extralegal Exchanges
Authors: Scott Alex , Craighead Christopher W. , Parker Chris
Published: February 2020

To enhance performance, buying firms often use supplier governance mechanisms, such as explicit contracts, to coordinate efforts. Yet, it is unclear how these governance mechanisms would perform in extralegal exchanges, whereby suppliers may renege on the contract with little or no legal recourse. Furthermore, there is a paucity of studies examining these extralegal exchanges in the presence of an external market willing to pay higher prices, thus tempting suppliers to renege on existing agreements. Accordingly, we seek insight into the effectiveness of implicit and explicit contracts juxtaposed with the evolving payoff for a supplier's reneging. We do so with a dataset from a buying firm and its suppliers in the for‐hire trucking industry. Our results reveal that implicit contracts do, indeed, enhance performance (i.e., suppliers reject business offerings less often), eventhough the buying firm has no viable legal recourse for rejected business offerings. Likewise, we find that explicit contracts (i.e., providing more specificity to the supplier) further enhance performance; yet, as the external market conditions change in the supplier's favor, more explicit contracts’ effectiveness drastically weakens. Indeed, when external market prices reach their highest, our results suggest that explicit contracts’ benefits virtually disappear. Overall, our results provide a rare look into implicit and explicit contracts’ outcomes in an extralegal exchange when suppliers’ reneging becomes more/less threatening, thereby offering insight for researchers and managers.
Granuloma in the explanted lungs: Infectious causes and impact on post‐lung transplant mycobacterial infection
Authors: Kabbani Dima , Kozlowski Hannah N. , Cervera Carlos , Chaparro Cecilia , Singer Lianne , Rotstein Coleman , Keshavjee Shaf , Husain Shahid
Published: February 2020

Introduction

The significance of granuloma in explanted lungs of lung transplant recipients (LTR) on the development of post‐transplant mycobacterial infection is unclear.

Methods

A retrospective review comparing LTRs and heart‐lung transplant (H‐LTR) recipients with granuloma in the explanted lungs between 2000 and 2012 (excluding those LTRs with granuloma due to sarcoidosis) and LTRs or H‐LTRs without granuloma. Patients were followed for 2 years post‐transplant.

Results

A total of 144 LTRs and 4 H‐LTRs with granulomas (75 necrotizing and 73 non‐necrotizing) and a comparator cohort of 144 LTRs and 4 H‐LTRs without granuloma were analyzed. In LTRs with granulomas, identification of infectious organisms was more common by histopathology (35 AFB and 22 fungal) compared to cultures (six NTM and seven fungal) taken around time of the transplant. LTRs with granulomas were more likely to have pre‐transplant non‐tuberculous mycobacteria (NTM) infection compared to LTRs without granuloma; P < .01. In the multivariate analysis, having granuloma or positive mycobacterial cultures at time of transplant were associated with increased risk of post‐transplant mycobacterial infection (HR = 1.8 95% CI [1.024‐3.154]; P = .041 and HR = 2.083 95% CI [1.011‐4.292]; P = .047). Although there was a trend toward increase mycobacterial disease in those with granulomas P = .056, there was no difference in survival post‐transplantation between those with or without granuloma in the explanted lung; P = .886.

Conclusion

The presence of granuloma in the explanted lungs of LTRs or positive mycobacterial cultures at time of transplant is associated with an increased risk of mycobacterial infection post‐transplant.
The Organizational Culture and Local Culture in the Internationalization Process: An Analysis Through Fuzzy Logic
Authors: Baptista Renato Dias , Putti Fernando Ferrari , Santini Pigatto Giuliana Aparecida , Cremasco Gabriel Camila Pires , Gabriel Filho Luís Roberto Almeida
Published: February 2020

The internationalization process of production has marked the world scenarios since the last decades and has influenced the complex interrelationships between the local culture and organizational culture. The culture shock was a recurring phenomenon and made the internationalization started to absorb elements of local culture as determining factors in expansion strategies. The aim of this paper is to analyze the favorable conditions of the organizational culture to manage the local culture. This is a preliminary study that aimed to integrate qualitative and quantitative factors with a fuzzy logic system. To achieve this goal, three elements were analyzed and interrelated: values, organizational structure, and management practices of human resources. A fuzzy mathematical model that considers the different weights to the elements analyzed leading to the identification of the favorability of the organizational culture in managing the local culture was developed. Petrobras, a transnational corporation with unity in Bolivia, whose major shareholder is the Brazilian government, was studied to empirically identify how the elements interact and are incorporated into internationalization strategies.
Dropwise Condensation 2019 Max Jakob Memorial Award Paper
Authors: Rose John W.
Published: February 2020

It was an honor to receive the Max Jakob Memorial Award for 2018. This invited paper is based on the award lecture and is written in an informal style expanding on the lecture and focusing on work in which I have been involved over the past 60 years. Early experimental and theoretical work was published only in conference proceedings when this was regarded an alternative to a journal and not, as seems to be the case nowadays, prior to journal publication or for incomplete work. I welcome this opportunity to clarify and make some of this earlier work more readily accessible. My comments on more recent work of others are also included.
An Investigation of Tooth Tip Leakages in Gerotor Pumps: Modeling and Experimental Validation
Authors: Rituraj Fnu , Vacca Andrea
Published: February 2020

Gerotors are inexpensive positive displacement pumps commonly used in hydrostatic transmissions, fuel injection, and automotive lubrication systems. In these pumps, leakages at the tooth tips of the gears are the major source of volumetric losses that prevents their usage in high pressure applications. However, due to the curvature of typical gear profiles, the flow relations available in the literature do not accurately model this leakage flow. In this paper, a novel tooth tip leakage flow model is developed based on dimensional analysis. Key geometric and flow parameters are identified and a set of computational fluid dynamics (CFD) simulations are conducted on the tooth tip geometry to establish the flow relationship. This relationship is first verified with the analytical formulation derived from Reynolds equation. Then, an experimental setup is designed to reproduce the flow conditions at the tooth tip of gerotors. Experiments are conducted for a range of geometric and flow parameters, and results from the experiments are used to validate the proposed leakage flow model. The tooth tip leakage flow model developed and validated in this work is valuable for pump designers in determining the impact of gear geometry and clearances on volumetric performance of the pump. Moreover, the model can be readily used in any lumped parameter based simulation tool permitting a fast and accurate prediction of the tooth tip leakage flow and hence the volumetric efficiency of the unit.
Work–Family Guilt of Collegiate Athletic Trainers: A Descriptive Study
Authors: Eason Christianne M. , Singe Stephanie M. , Rynkiewicz Kelsey
Published: February 2020

Work–family guilt (WFG) is a measure used to assess guilt related to work interference with family and family interference with work. While work–family conflict (WFC) has been studied in the athletic trainer (AT) population, WFG has not. The purpose of this study was to gather descriptive data on WFG and to determine if WFC can predict WFG. There were significant positive associations between WFG and hours worked, but no sex differences in WFG or WFC exist. WFG was predicted by WFC. Results indicate higher levels of WFG and WFC are associated with a greater number of hours worked. Because guilt can negatively impact overall health, steps should be taken to mitigate WFC and WFG.
Kendo Protective Equipment Prevents Quick Access for Resuscitation During Sudden Cardiac Arrest: A Cross-Over Manikin Study
Authors: Tanaka Shota , Ueta Hiroki , Sagisaka Ryo , Sakanashi Shuji , Hara Takahiro , Tanaka Hideharu
Published: February 2020

Protective equipment in sports can be a barrier to sudden cardiac arrest (SCA) treatment, but no Kendo-related data are available. In order to enhance the SCA survival rate, we aimed to determine whether Kendo protective equipment should be removed before or after an automated external defibrillator (AED) has arrived by measuring the quality and timeframe of cardiopulmonary resuscitation administration. Eighteen collegiate female Kendo players were instructed to treat the patient with SCA under two conditions: (a) equipment removal [ER] condition; (b) no equipment removal [NER] condition. Chest compression initiation was delayed during simulated cardiac arrest situations in Kendo, but the SCA quality was much better without protective equipment. When a layperson is only a nonhealthcare professional female, Kendo protective equipment becomes a barrier for quick access during SCA treatment of Kendo players.
Population Pharmacokinetics of Amikacin Administered Once Daily in Patients with Different Renal Functions
Authors: Aréchiga-Alvarado Norma A. , Medellín-Garibay Susanna E. , Milán-Segovia Rosa del C. , Ortiz-Álvarez Arturo , Magaña-Aquino Martín , Romano-Moreno Silvia
Published: February 2020

The aim of this work was to evaluate the pharmacokinetics of amikacin in Mexican patients with different renal functions receiving once-daily dosing regimens and the influence of clinical and demographical covariates that may influence the optimization of this antibiotic. A prospective study was performed in a total of 63 patients with at least one determination of amikacin plasma concentration. Population pharmacokinetic (PK) parameters were estimated by nonlinear mixed-effects modeling; validations were performed for dosing recommendation purposes based on PK/pharmacodynamic simulations.
Porphyromonas gingivalis Cell Wall Components Induce Programmed Death Ligand 1 (PD-L1) Expression on Human Oral Carcinoma Cells by a Receptor-Interacting Protein Kinase 2 (RIP2)-Dependent Mechanism
Authors: Groeger S. , Denter F. , Lochnit G. , Schmitz M. L. , Meyle J.
Published: February 2020

Programmed death-ligand 1 (PD-L1/B7-H1) serves as a cosignaling molecule in cell-mediated immune responses and contributes to chronicity of inflammation and the escape of tumor cells from immunosurveillance. Here, we investigated the molecular mechanisms leading to PD-L1 upregulation in human oral carcinoma cells and in primary human gingival keratinocytes in response to infection with
Porphyromonas gingivalis
(
P. gingivalis
), a keystone pathogen for the development of periodontitis.
HilD, HilC, and RtsA Form Homodimers and Heterodimers To Regulate Expression of the
Salmonella
Pathogenicity Island I Type III Secretion System
Authors: Narm Koh-Eun , Kalafatis Marinos , Slauch James M.
Published: February 2020

The SPI1 type three secretion system is a key virulence factor required for
Salmonella
to both cause gastroenteritis and initiate serious systemic disease. The system responds to numerous environmental signals in the intestine, integrating this information via a complex regulatory network. Here, we show that the primary regulatory proteins in the network function as both homodimers and heterodimers, providing information regarding both regulation of virulence in this important pathogen and general signal integration to control gene expression.
Analysis of Yeast Killer Toxin K1 Precursor Processing via Site-Directed Mutagenesis: Implications for Toxicity and Immunity
Authors: Gier Stefanie , Schmitt Manfred J. , Breinig Frank
Published: February 2020

The killer phenotype in the baker’s yeast
Saccharomyces cerevisiae
relies on two double-stranded RNA viruses that are persistently present in the cytoplasm. As they carry the same receptor populations as sensitive cells, killer yeast cells need—in contrast to various bacterial toxin producers—a specialized immunity mechanism. The ionophoric killer toxin K1 leads to the formation of cation-specific pores in the plasma membrane of sensitive yeast cells. Based on the data generated in this study, we were able to update the current model of toxin processing, validating the temporary inactivation of the toxic α subunit during maturation in the secretory pathway of the killer yeast.
Fifteen-minute consultation: Time Out as an alternative to toxic debrief
Authors: Cooper Sian , Winton Mark , Farrington-Exley Joanna
Published: February 2020

Debriefing is well established in healthcare teams after acute events, with a focus on clinical learning, improving practice and performance; however, the term is perceived by psychologists as something quite different. This article describes the Time Out model as a standardised method of providing support to staff after events that may cause distress. In addition to exploring clinical issues, the model aims to promote peer support networks, educate staff regarding common reactions to traumatic events and signpost to other sources of support.
Atypical presentation of cardiac sarcoidosis: role of multimodality imaging and review of literature
Authors: Bhandare Deepti , Kottam Anupama
Published: February 2020

Cardiac sarcoidosis (CS) is challenging to determine, consequently is under-recognised in clinical practice. The accurate prevalence of CS is possibly underestimated due to unspecific symptoms, subclinical illness and the dearth of universally accepted diagnostic criteria. Totally, non-invasive diagnosis of CS was proposed in 2015 by the Japanese Ministry of Health and Welfare using positron emission tomography and cardiac MRI findings as major criteria and substituting histological verification. We present a case of a 60-year-old woman with pulmonary sarcoidosis presenting with progressively worsening palpitations and recurrent syncope. Her initial evaluation at another hospital facility revealed normal cardiac testing. A detailed evaluation with echocardiography and cardiac MRI helped us arrive at the diagnosis of CS, which resulted in appropriate treatment and resolution of symptoms. We discuss CS in general, the clinical disease, diagnostic algorithms, latest guidelines and management
Does a web-based decision aid improve informed choice for fertility preservation in women with breast cancer (DECISIF)? Study protocol for a randomised controlled trial
Authors: Benoit Alexandra , Grynberg Michael , Morello Rémy , Sermondade Nathalie , Grandazzi Guillaume , Moutel Grégoire
Published: February 2020

Introduction

Chemotherapy may cause infertility in young survivors of breast cancer. Various fertility preservation techniques increase the likelihood of survivors becoming genetic mothers. Disclosure of cancer diagnosis may impact decision making about fertility preservation. This protocol will develop and test the effectiveness of a web-based decision aid for helping women with breast cancer to make well-informed choices about fertility preservation.

Methods and analysis

This study will be conducted in three phases using mixed methods. In phase I, the aim is to develop a web-based patient decision aid (PDA) in French with a steering committee and using a focus group of five women already treated for breast cancer. In phase II, the face validity of the decision aid will be assessed using questionnaires. In phase III, the PDA will be assessed by a two-arm randomised controlled trial. This will involve a quantitative evaluation of the PDA in clinical practice comparing the quality of the decision-making process between usual care and the PDA. The primary outcome will be informed choice and its components. The secondary outcomes will be decisional conflict and anxiety. Data will be collected during and after an oncofertility consultation. Phase III is underway. Since September 2018, 52 participants have been enrolled in the study and have completed the survey. We expect to have results by February 2020 for a total of 186 patients.

Ethics and dissemination

This study protocol was approved by the Ouest V Research Ethics Board. Results will be spread through peer-reviewed publications, and reported at suitable meetings.

Trial registration number

The ClinicalTrials.gov registry .(NCT03591848).
Anticoagulation regimens during pregnancy in patients with mechanical heart valves: a protocol for a systematic review and network meta-analysis
Authors: He Shiwei , Zou Yue , Li Juan , Liu Jumei , Zhao Li , Yang Hua , Su Zhiying , Ye Huiming
Published: February 2020

Introduction

Pregnancy in patients with mechanical heart valves (MHVs) is associated with high maternal complications and fetal complications.Anticoagulation treatments serve to decrease their venous clotting risk. Although some anticoagulation regimens have been used for patients during pregnancy with MHVs, no one is definitively superior among different regimens in recent studies. For a better understanding of the clinical treatment which anticoagulation regimen is more effective and safer during the pregnancy in patients with MHVs, a Bayesian network meta-analysis is necessary.

Methods and analysis

This protocol has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Related studies until April 2019 will be searched in the following databases: PubMed, Embase,SinoMed and the using the OVID interface to search for evidence-based medicine reviews. A clinical trial registry (www.ClinicalTrials.gov) was also searched for unpublished trials. Both experimental studies (randomised clinical trials) and observational studies (cohort studies, case–control studies and case series studies) will be included in this study. Quality assessment will be conducted using Cochrane Collaboration’s tool or Newcastle-Ottawa Scale based on their study designs. The primary outcomes of interest will be the frequencies of serious maternal and fetal events. The additional outcomes of interest will be adverse maternal events, mode of delivery and adverse fetal events. Pairwise and network meta-analysis will be conducted using R (V.3.4.4, R Foundation for Statistical Computing, Vienna, Austria) and Stata (V.14, StataCorp). The ranking probabilities will be estimated at each possible rank for each anticoagulation regimen using the surface under the cumulative ranking curve. Statistical inconsistency assessment, subgroup analysis, sensitivity analysis and publication bias assessment will be performed.

Ethics and dissemination

Either ethics approval or patient consent is not necessary, because this study will be based on literature. The results of this study will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42019130659
Lipid accumulation product and late-onset hypogonadism in middle-aged and elderly men: results from a cross-sectional study in China
Authors: Sun Kan , Wang Chengzhi , Lao Guojuan , Lin Diaozhu , Huang Chulin , Li Na , Li Lingling , Li Fangping , Xiao Huisheng , Yan Li
Published: February 2020

Objectives

Hypogonadism in men is related to the deterioration of general health. However, the association between lipid overaccumulation and ageing-related hypogonadism remains an undetermined concept. We aimed to provide an insight into the possible links between the lipid accumulation product (LAP) and late-onset hypogonadism (LOH).

Setting

Sun Yat-sen Memorial Hospital of Sun Yat-sen University.

Participants

We included a population sample of 997 subjects aged 40 years or older.

Primary and secondary outcome measures

The LAP was calculated by gender-specific equations using waist circumference (WC) and triglyceride (TG). LOH was defined by the presence of androgen deficiency symptoms and low serum total testosterone levels.

Results

The prevalence of LOH was 9.4% in this population and gradually increased according to increasing LAP quartiles. Compared with subjects without LOH, ageing men with LOH had higher body mass index, WC, systolic blood pressure, percentage of subjects currently smoking, TG and follicle stimulating hormone and lower low-density lipoprotein cholesterol and sex hormone binding globulin. In multivariate logistic regression analysis, the adjusted ORs of LOH for increasing LAP quartiles 1–4 were 1.00 (reference), 1.10 (95% CI 0.45–2.69), 2.15 (95% CI 0.93–4.94) and 3.83 (95% CI 1.73–8.45), respectively.

Conclusion

Body lipid accumulation evaluated by the LAP is independently associated with the prevalence of LOH in middle-aged and elderly Chinese men.
Assessing full thickness oral mucosal grafting: complications and postoperative outcomes in a broad collective of patients
Authors: Pilger Daniel , von Sonnleithner Christoph , Bertelmann Eckart
Published: February 2020

Background

Conjunctival defects can be repaired with several mucosal tissues. The simplicity of harvesting oral mucosa and its wide availability makes it the preferred graft tissue for all indications requiring mucosal grafting. Through analysing the postsurgical outcomes and rate of revisions, this study explores the suitability of oral mucosa grafts, depending on the initial diagnosis.

Methods

We reviewed all the files of patients with a history of oral mucosal graft surgery, performed at our clinic between 2012 and 2018, focusing on complications and revision rates.

Results

In total, we analysed 173 oral mucosa grafts in 131 patients. The most common initial diagnosis was tumour resection, followed by surgical complications, postenucleation socket syndrome, trauma and ocular surface disorders. Complication and revision rates depended highly on the initial diagnosis. Revision rates were highest if the initial diagnosis included ocular surface disorders or chemical trauma.

Conclusions

Oral mucosa grafting (OMG) is the most effective treatment for a wide range of ocular conditions involving conjunctival defects. Conjunctival defects that result from trauma or cicatricial surface diseases seem less suitable for OMG and may benefit from alternative graft tissue or treatment options.
Doing our work better, together: a relationship-based approach to defining the quality improvement agenda in trauma care
Authors: Purdy Eve Isabelle , McLean Darren , Alexander Charlotte , Scott Matthew , Donohue Andrew , Campbell Don , Wullschleger Martin , Berkowitz Gary , Winearls James , Henry Doug , Brazil Victoria
Published: February 2020

Background

Trauma care represents a complex patient journey, requiring multidisciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues and their work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, co-operation and coordination across diverse groups. We aimed to define and improve relational aspects of trauma care at Gold Coast University Hospital.

Methods

We conducted a mixed-methods collaborative ethnography using the relational coordination survey—an established tool to analyse the relational dimensions of multidisciplinary teamwork—participant observation, interviews and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance.

Findings

We engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of relationships in trauma care and opportunities to improve. Narrative survey and ethnographic findings further highlighted the centrality of a translational simulation programme in contributing positively to team culture and relational ties. A range of 16 interventions—focusing on structural, process and relational dimensions—were co-created with participants and are now being implemented and evaluated by various trauma care providers.

Conclusions

Through engagement of clinicians spanning organisational boundaries, relational aspects of care can be measured and directly targeted in a collaborative quality improvement process. We encourage healthcare leaders to consider relationship-based quality improvement strategies, including translational simulation and relational coordination processes, in their efforts to improve care for patients with complex, interdependent journeys.
‘Hospice inpatient deep vein thrombosis detection (HIDDen) in advanced non-malignant diseases’: a longitudinal pilot study
Authors: White Clare , Noble Simon , Swan Flavia , Watson Max , Allgar Victoria , Napier Eoin , Nelson Annmarie , Johnson Miriam J
Published: February 2020

Objectives

To gain preliminary data regarding the prevalence of proximal deep vein thrombosis (DVT) in those with non-malignant conditions admitted to specialist palliative care units (SPCUs).

Methods

Data were collected as part of a prospective longitudinal observational study in five SPCUs in England, Wales and Northern Ireland (Registration:ISRCTN97567719) to estimate the prevalence of proximal femoral vein DVT in people admitted to SPCUs. The primary outcome for this exploratory substudy was the prevalence of DVT in patients with non-malignant palliative conditions. Consecutive consenting adults underwent bilateral femoral vein ultrasonography within 48 hours of admission. Data were collected on symptoms associated with venous thromboembolism. Patients were ineligible if the estimated prognosis was <5 days. Cross-sectional descriptive analysis was conducted on baseline data and prevalence estimates presented with 95% CIs.

Results

1390 patients were screened, 28 patients had non-malignant disease and all were recruited. The mean age 68·8 (SD 12·0), range 43–86 years; men 61%; survival mean 86 (SD 108.5) range 1–345 days. No patient had a history of venous thromboembolism. Four (14%) were receiving thromboprophylaxis. Of 22 evaluable scans, 8 (36%, 95% CI: 17% to 59%) showed femoral vein DVT. The level of reported relevant symptoms (leg oedema, leg pain, chest pain and breathlessness) was high irrespective of the presence of DVT.

Conclusions

Our exploratory data indicate one in three people admitted to an SPCU with non-malignant disease had a femoral vein DVT. Although definitive conclusions cannot be drawn, these data justify a larger prospective survey.
Placebo response in trials of drug treatments for cancer-related fatigue: a systematic review, meta-analysis and meta-regression
Authors: Roji Rocio , Stone Patrick , Ricciardi Federico , Candy Bridget
Published: February 2020

Background

Cancer-related fatigue (CRF) is one of the most distressing symptoms experienced by patients. There is no gold standard treatment, although multiple drugs have been tested with little evidence of efficacy. Randomised controlled trials (RCTs) of these drugs have commented on the existence or size of the placebo response (PR). The objective of this systematic review was to establish the magnitude of the PR in RCTs of drugs to relieve CRF and to identify contributing factors.

Method

RCTs were included in which the objective was to treat CRF. A meta-analysis was conducted using the standardised mean change (SMC) between baseline and final measurement in the placebo group. To explore factors that may be associated with the PR (eg, population or drug), a meta-regression was undertaken. Risk of bias was assessed using the revised Cochrane tool.

Results

From 3916 citations, 30 relevant RCTs were identified. All had limitations that increased their risk of bias. The pooled SMC in reduction in fatigue status in placebo groups was −0.23 (95% confidence intervals −0.42 to −0.04). None of the variables analysed in the meta-regression were statistically significant related to PR.

Conclusion

There is some evidence, based on trials with small samples, that the PR in trials testing drugs for CRF is non-trivial in size and statistically significant. We recommend that researchers planning drug studies in CRF should consider implementing alternative trial designs to better account for PR and decrease impact on the study results.
Evaluation of a temporal causal model for predicting the mood of clients in an online therapy
Authors: Becker Dennis , Bremer Vincent , Funk Burkhardt , Hoogendoorn Mark , Rocha Artur , Riper Heleen
Published: February 2020

BackgroundSelf-reported client assessments during online treatments enable the development of statistical models for the prediction of client improvement and symptom development. Evaluation of these models is mandatory to ensure their validity.

MethodsFor this purpose, we suggest besides a model evaluation based on study data the use of a simulation analysis. The simulation analysis provides insight into the model performance and enables to analyse reasons for a low predictive accuracy. In this study, we evaluate a temporal causal model (TCM) and show that it does not provide reliable predictions of clients’ future mood levels.

ResultsBased on the simulation analysis we investigate the potential reasons for the low predictive performance, for example, noisy measurements and sampling frequency. We conclude that the analysed TCM in its current form is not sufficient to describe the underlying psychological processes.

ConclusionsThe results demonstrate the importance of model evaluation and the benefit of a simulation analysis. The current manuscript provides practical guidance for conducting model evaluation including simulation analysis.
Five models for child and adolescent data linkage in the UK: a review of existing and proposed methods
Authors: Mansfield Karen Laura , Gallacher John E , Mourby Miranda , Fazel Mina
Published: February 2020

Over the last decade dramatic advances have been made in both the technology and data available to better understand the multifactorial influences on child and adolescent health and development. This paper seeks to clarify methods that can be used to link information from health, education, social care and research datasets. Linking these different types of data can facilitate epidemiological research that investigates mental health from the population to the patient; enabling advanced analytics to better identify, conceptualise and address child and adolescent needs. The majority of adolescent mental health research is not able to maximise the full potential of data linkage, primarily due to four key challenges: confidentiality, sampling, matching and scalability. By presenting five existing and proposed models for linking adolescent data in relation to these challenges, this paper aims to facilitate the clinical benefits that will be derived from effective integration of available data in understanding, preventing and treating mental disorders.
A cadaveric study of the erector spinae plane block in a neonatal sample
Authors: Govender Sabashnee , Mohr Dwayne , Bosenberg Adrian , Van Schoor Albert Neels
Published: February 2020

Background

The aim of this article was to provide a detailed description of the neonatal anatomy related to the erector spinae plane block and to report the spread of the dye within the fascial planes and potential dermatomal coverage.

Methods

Using ultrasound guidance, the bony landmarks and anatomy of the erector spinae fascial plane space were identified. The erector spinae plane block was then replicated unilaterally in two fresh unembalmed neonatal cadavers. Using methylene blue dye, the block was performed at vertebral levels T5—using 0.5 mL in cadaver 1—and T8—using 0.2 mL in cadaver 2. The craniocaudal spread of dye was tracked within the space on the ultrasound screen and further confirmed on dissection.

Results

Craniocaudal spread was noted from vertebral levels T3 to T6 when the dye was introduced at vertebral level T5 and from vertebral levels T7 to T11 when the dye was introduced at vertebral level T8. Furthermore, the methylene blue spread was found anteriorly in the paravertebral and epidural spaces, staining both the dorsal and ventral rami of the spinal nerves T2 to T12. Small amounts of dye were also found in the intercostal spaces.

Conclusion

In two neonatal fresh cadavers, the dye was found to spread to multiple levels and key anatomic locations.
A review on rejuvenating materials used with reclaimed hot mix asphalt
Authors: Al-Saffar Zaid Hazim , Yaacob Haryati , Satar Mohd Khairul Idham Mohd , Saleem Mhmood Khleel , Lai Jau Choy , Putra Jaya Ramadhansyah
Published: February 2020

In recent years, flexible pavement construction technology has relied heavily on the use of reclaimed asphalt pavement (RAP). However, the brittle nature of RAP, which stems from the use of an aged asphalt, has introduced numerous complexities into the process, with important implications to pavement service life. The properties of the aged asphalt can be rejuvenated to improve the performance and the behavior of RAP mixtures. This paper presents a review of past works that have used rejuvenating materials with RAP, including their benefits and drawbacks, as well as the optimal approach to increase RAP content in asphaltic mixtures. The method of rejuvenating aged asphalt and the mechanism of rejuvenation are also reviewed. The findings of this review can be used to predict the current and future challenges in the regeneration of RAP mixtures using rejuvenating materials.
Local saturation and square everywhere
Authors: Eskew Monroe
Published: February 2020

We show that it is consistent relative to a huge cardinal that for all infinite cardinals [Formula: see text], [Formula: see text] holds and there is a stationary [Formula: see text] such that [Formula: see text] is [Formula: see text]-saturated.
f-Biderivations and Jordan biderivations of unital algebras with idempotents
Authors: Bahmani Mohammad Ali , Bennis Driss , Vishki Hamid Reza Ebrahimi , Fahid Brahim
Published: February 2020

The notion of [Formula: see text]-derivations was introduced by Beidar and Fong to unify several kinds of linear maps including derivations, Lie derivations and Jordan derivations. In this paper, we introduce the notion of [Formula: see text]-biderivations as a natural “biderivation” counterpart of the notion of “[Formula: see text]-derivations”. We first show, under some conditions, that any [Formula: see text]-biderivation is a Jordan biderivation. Then, we turn to study [Formula: see text]-biderivations of a unital algebra with an idempotent. Our second main result shows, under some conditions, that every Jordan biderivation can be written as a sum of a biderivation, an antibiderivation and an extremal biderivation. As a consequence, we show that every Jordan biderivation on a triangular algebra is a biderivation.