bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Intravesical Mitomycin C on Recurrence of Newly Diagnosed Superficial Bladder Cancer
Authors: Narayan Vikram M.
Published: March 2021

This study summarizes the seminal study assessing the instillation of intravesical mitomycin C after transurethral resection in patients with newly diagnosed Ta or T1 transitional urothelial cell carcinoma of the bladder. The study randomized patients with immediate mitomycin C, immediate mitomycin C plus four weekly installations, versus no further treatment. The main findings were that a single immediate instillation of mitomycin C following transurethral resection of a suspected noninvasive urothelial cell carcinoma confers a reduced risk of disease recurrence.
A Midurethral Sling to Reduce Incontinence After Vaginal Prolapse Repair
Authors: Lane Giulia I. , Dixon Colby A. , Louis Moy M. , Fok Cynthia S.
Published: March 2021

This chapter summarizes the results of the Outcomes Following Vaginal Prolapse Repair and Midurethral Sling (OPUS) trial, in which women without stress urinary incontinence undergoing prolapse surgery were randomized to a midurethral sling or no concomitant midurethral sling. The OPUS trial found that women randomized to undergo prophylactic concomitant midurethral sling at the time of transvaginal repair for pelvic organ prolapse had lower rates of urinary incontinence at 3 and 12 months but also experienced higher rates of adverse events such as bladder perforation, major bleeding, and urinary tract infections.
Oral Sildenafil in the Treatment of Erectile Dysfunction
Authors: Bodie Joshua
Published: March 2021

This chapter summarizes the results of a landmark trial comparing different doses of oral sildenafil versus placebo to treat erectile dysfunction. Patients received either an identical placebo or 25- mg, 50-mg, or 100-mg tablets of sildenafil to be taken approximately one hour before planned sexual activity (but not more than once daily) for 24 weeks. Higher doses of sildenafil resulted in higher mean score for frequency of penetration and maintenance of erection, which were also consistently better than placebo. The most common side effects were headaches, flushing, dyspepsia, rhinitis, and visual disturbances. This study established sildenafil as an effective, reasonably well-tolerated treatment for men with erectile dysfunction of varying etiologies.
A Comparison of Transurethral Surgery With Watchful Waiting for Moderate Symptoms of Benign Prostatic Hyperplasia
Authors: Jung Jae Hung
Published: March 2021

This chapter summarizes the landmark Veterans Affairs Cooperative Study Group Trial that randomized men with moderate to severe lower urinary tract symptoms to either transurethral resection of prostate (TURP) or watchful waiting. The primary outcome was treatment failure; this was a composite outcome that included components of very different importance to patients (ranging from death to high postvoid residuals). Treatment failure was more than twice as common in the watchful waiting group. Approximately one in four men in the watchful waiting group underwent surgery within 3 years. About one in 10 men in the TURP group experienced a complication. This study helped to establish TURP as the “gold standard” surgical treatment for men with lower urinary tract symptoms.
Respiratory assessment
Authors: Robinson Terry , Scullion Jane
Published: March 2021

Many nurses in both primary and secondary care are working as respiratory nurse specialists and nurse practitioners. These roles involve assessing and diagnosing many conditions, including common respiratory disorders. This chapter covers the undertaking of a respiratory assessment. It shows how making a diagnosis can be difficult because the principal symptoms of respiratory disease are common to many different conditions. The respiratory assessment also determines which investigations may be required to reach a diagnosis. Respiratory assessments involve skilled communication with patients and carers and other medical professionals, along with an understanding of informed consent and the ethical implications of gaining consent.
Lung cancer and mesothelioma
Authors: Robinson Terry , Scullion Jane
Published: March 2021

Lung cancer is the most common cancer in the UK. This chapter covers the epidemiology of the disease, the two main types of lung cancers (non-small cell lung cancer—NSCLC, and small cell lung cancers—SCLC), presenting symptoms, investigations, and diagnostic procedures. The role of the multidisciplinary team and techniques for breaking bad news are both covered. Treatment options, including surgery, systemic anticancer treatment, concurrent chemoradiation, and radiotherapy are all described for both NSCLC and SCLC. Interventions for pain, the analgesic ladder, and the role of the lung cancer specialist nurse are defined. Finally, the aspects of mesothelioma are covered.
Smoking and public health
Authors: Robinson Terry , Scullion Jane
Published: March 2021

This chapter starts by discussing tobacco addiction, and the physiological effects of smoking on the respiratory syndrome. It lists the lung diseases and other non-respiratory diseases caused by smoking. It gives examples of the health benefits of smoking cessation, and potential pharmacological treatments to aid quitting. Different types of nicotine replacement therapy are outlined, with different options for the number of cigarettes the patient smokes per day. Non-nicotine-based pharmacotherapy is also included, and the role of the nurse in smoking cessation is described. Respiratory health surveillance in the workplace is outlined, as well as issues with respiratory health that may arise in housing, such as damp, overcrowding, and the presence of asbestos. Environmental factors, income, and respiratory disease, and the role of nutrition and obesity are all covered.
Intensive cardiovascular care units: structure, organization, and staffing
Authors: Bonnefoy-Cudraz Eric , Quinn Tom
Published: March 2021

The nature and complexity of acute cardiovascular care has changed markedly since the early days of the coronary care unit (CCU), introduced in the 1960s to prevent and treat life threatening arrhythmias associated with acute myocardial infarction. In the present day, the patient population is older, has more multimorbidity, comprises a range of conditions alongside critical cardiovascular disease and associated multi-organ failure, requiring increasingly sophisticated management. To reflect this, the Acute Cardiovascular Care Association (ACCA) published a comprehensive update of recommendations in 2018, developed by a multinational working group of experts. These recommendations, which inform this chapter, address the definition, structure, organisation and function of the contemporary intensive cardiovascular care unit (ICCU). Reflecting the modern casemix, three levels of acuity of care are described, and corresponding requirements for ICCU organisation defined. Recommendations on ICCU staffing (medical, nursing and allied professions), equipment and architecture, are presented, alongside considerations of the role of the ICCU within the wider hospital and cardiovascular care network.
Ethical issues in cardiac arrest and acute cardiac care: a European perspective
Authors: Vincent Jean-Louis , Creteur Jacques
Published: March 2021

Acute cardiac syndromes are common and responsible for considerable mortality and morbidity. Decision making in such patients can be difficult clinically but can also be complex and challenging from an ethical perspective. This chapter reviews some of the ethical problems, including organ donation and withholding/withdrawing, that can occur in the acutely ill adult cardiac patient, starting with a brief look at the ethical principles that should guide our decision making: beneficence, non-maleficence, autonomy, and distributive justice. The role of advance directives and considerations related to family presence during cardiopulmonary resuscitation will also be discussed. With the increasing incidence and prevalence of coronary artery disease worldwide, the number of patients with cardiac arrest and requiring acute cardiac care is going to increase, and doctors will increasingly be faced with difficult ethical decisions associated with these patients. Open discussion and debate about these issues and good communication among patients, family members, and members of the health care team are essential to ensure that all patients receive the best possible end-of-life care.
The emergency medical system
Authors: Hoogmartens Olivier , Stiers Michiel , Bronselaer Koen , Sabbe Marc
Published: March 2021

The mission of the emergency medical services is to promote and support a system that provides timely, professional and state-of-the art emergency medical care, including ambulance services, to anyone who is victim of a sudden injury or illness, at any time and any location. A medical emergency has five different phases, namely: population awareness and behaviour, occurrence of the problem and its detection, alarming of trained responders and help rendered by bystanders and trained pre-hospital providers, transport to the nearest or most appropriate hospital, and, if necessary, admission or transfer to a tertiary care centre which provides a high degree of subspecialty expertise. In order to meet these goals, emergency medical services must work aligned with local, state officials; with fire and rescue departments; with other ambulance providers, hospitals, and other agencies to foster a high performance network. The term emergency medical service evolved to reflect a change from a straightforward system of ambulances providing nothing but transportation, to a complex network in which high-quality medical care is given from the moment the call is received, on-scene with the patient and during transportation. Medical supervision and/or participation of emergency medicine physicians (EP) in the emergency medical service systems contributes to the quality of medical care. This emergency medical services network must be capable to respond instantly and to maintain efficacy around the clock, with well-trained, well-equipped personnel linked through a strong communication system. Research plays a pivotal role in defining necessary resources and in continuously improving the delivery of high-quality care. This chapter gives an overview of the different aspects of emergency medical services and calls for high quality research in pre-hospital emergency care in a true partnership between cardiologists and emergency physicians.
Neurological assessment of the acute cardiac care patient
Authors: Jagt Mathieu van der , Bunge Jeroen JH , Taccone Fabio S
Published: March 2021

Neurological assessment of the acute cardiac patient is important since neurological complications may have important therapeutic and prognostic implications. This chapter aims to provide the basic knowledge that enables those caring for the acute cardiac patients to effectively monitor and recognize neurological problems arising in their patients.
Cardiac magnetic resonance in the intensive and cardiac care unit
Authors: Schwitter Juerg , Bremerich Jens
Published: March 2021

Current applications of cardiac magnetic resonance offer a wide spectrum of indications in the setting of acute cardiac care. In particular, cardiac magnetic resonance is helpful for the differential diagnosis of chest pain through the detection of ischaemia, myocardial stunning, myocarditis, including chemotherapy-induced myocarditis, and pericarditis. Also, Takotsubo cardiomyopathy and acute aortic diseases can be evaluated by cardiac magnetic resonance and are important differential diagnoses in patients with acute chest pain. In patients with restricted windows for echocardiography, according to guidelines, cardiac magnetic resonance is the method of choice to evaluate complications of an acute myocardial infarction. In an acute myocardial infarction, cardiac magnetic resonance allows for unique characterization of myocardial damage by quantifying necrosis, microvascular obstruction, oedema (i.e. areas at risk), and haemorrhage. These features will help us to understand better the pathophysiological events during infarction and will also allow us to assess new treatment strategies in acute myocardial infarction. To which extent the information on tissue damage will guide patient management is not yet clear, and further research is ongoing to address this issue. Recent studies also demonstrated the possibility to reduce costs in the management of acute coronary syndromes when cardiac magnetic resonance is integrated into the routine work-up. In the near future, applications of cardiac magnetic resonance will continue to expand in acute cardiac care units, as manufacturers are now strongly focusing on this aspect of user-friendliness. Finally, in the next decade or so, magnetic resonance imaging using other nuclei, such as fluorine and carbon, might become a reality in clinics, which would allow for metabolic and targeted molecular imaging with excellent sensitivity and specificity.
Temporary pacing
Authors: Gorenek Bulent
Published: March 2021

Temporary cardiac pacing by electrical stimulation of the heart is indicated as a short-term treatment of life-threatening bradyarrhythmias or tachyarrhythmias. It can be used temporarily until the arrhythmias resolve or as a bridge to permanent pacing. Symptomatic bradycardias needing temporary pacing may occur in acute myocardial infarction, during percutaneous coronary intervention, and in patients with sinus node dysfunction. Temporary pacing can also be useful for terminating or suppressing some types of supraventricular and ventricular arrhythmias. Single-chamber, dual-chamber, or biventricular pacing modes can be used. In haemodynamically compromised patients, dual-chamber pacing is preferred. Ideally, this procedure is performed under fluoroscopy, but electrode catheters can also be inserted without fluoroscopy, with ECG and/or pressure monitoring. Several methods of temporary pacing are available: transvenous, external, and transoesophageal pacing. Transvenous pacing is the most commonly used technique. Although this method is safe and easy, some complications related to venous access or caused by the inserted electrode catheters or by an electrical dysfunction of the pacing device may occur, either during or after the implantation.
Chest tubes
Authors: Maurizi Giulio , Vanni Camilla , Rendina Erino Angelo
Published: March 2021

The insertion of a chest tube is a common therapeutic procedure routinely employed to restore the natural negative pressure in the pleural space and ensure complete pulmonary reexpansion through the drainage of a pathologic collection of fluid and/or air from the thoracic cavity. The method for inserting the tube, as well as management and withdrawal of the drain unit, should be guided by clinical judgement and amended depending on different circumstances. Similarly, the selection of the appropriate size and type of chest tube to be placed varies according to indications. Despite their widespread use, just a few evidence based guidance on insertion and management of chest drains are currently available. Among these, the British Thoracic Society (BTS) stated in 2003 clinical practice guidelines for the insertion of a chest drain; moreover, the BTS Pleural Disease Guideline Group recently reviewed indications on management of spontaneous pneumothorax and malignant pleural effusion.
Nutrition support in acute cardiac care
Authors: Casaer Michael P , Van den Berghe Greet
Published: March 2021

Malnutrition in cardiac and critical illness is associated with a compromised clinical outcome. The aim of nutrition therapy is to prevent these complications and particularly to attenuate lean tissue wasting and the loss of muscle force and of physical function. During the last decade, several well-powered randomized controlled nutrition trials have been performed. Their results challenge the existing nutrition practices in critically ill patients. Enhancing the nutritional intake and the administration of specialized formulations failed to evoke clinical benefit. Some interventions even provoked an increased mortality or a delayed recovery. These unexpected new findings might be, in part, caused by an important leap forward in the methodological quality in the recent trials. Perhaps reversing early catabolism in the critically ill patient by nutrition or anabolic interventions is impossible or even inappropriate. Nutrients effectively suppress the catabolic intracellular autophagy pathway. But autophagy is crucial for cellular integrity and function during metabolic stress, and consequently its inhibition early in critical illness might be deleterious. Evidence from large nutrition trials, particularly in acute cardiac illness, is scarce. Full enteral feeding in vasopressor dependent patients recovering from hemodynamic shock increases the risk for bowel ischemia. Nutrition therapy is therefore focused on avoiding iatrogenic harm. Some enteral nutrition is administered if possible and eventually temporary hypocaloric feeding is tolerated. Above all, the refeeding syndrome and other nutrition-related complications should be prevented. There is no indication for early parenteral nutrition, increased protein doses, specific amino acids, or modified lipids in critical illness.
Fibrinolytic, antiplatelet, and anticoagulant drugs in acute coronary syndromes
Authors: Halvorsen Sigrun , Gargiulo Giuseppe , Valgimigli Marco , Huber Kurt
Published: March 2021

Antithrombotic therapy is a major cornerstone in the treatment of acute coronary syndromes (ACS), as thrombus formation upon a plaque rupture or an erosion plays a pivotal role in non-ST-segment elevation as well as ST-segment elevation acute coronary syndromes. Both acute and long-term oral antiplatelet therapies, targeting specific platelet activation pathways, have demonstrated significant short- and long-term benefits. The use of anticoagulants is currently largely confined to the acute setting, except in patients with a clear indication for long-term treatment, including atrial fibrillation or the presence of intraventricular thrombi. Despite the benefit of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction, fibrinolytic therapy continues to play an important role throughout the world. In this chapter, the fibrinolytic, antiplatelet, and anticoagulant agents used in the management of acute coronary syndrome patients are discussed.
Stroke
Authors: Leys Didier , Moulin Solène , Caso Valeria
Published: March 2021

Many strokes are treatable in the acute stage, provided patients are admitted soon enough. There is evidence that stroke unit care improves outcomes, and that the benefit does not depend on age, severity, and stroke subtype. In ischaemic strokes, specific therapies include intravenous recombinant tissue plasminogen activator, given as soon as possible and mechanical thrombectomy in case of proximal arterial occlusion, on top of thrombolysis in the absence of contraindication or alone otherwise, aspirin 300 mg, immediately or after 24 hours in case of thrombolysis, and, in a few patients, decompressive surgery. The time window for thrombolysis or thrombectomy can be extended beyond the usual 4.5h and 6h in a few patients who are likely to have significant penumbra. In intracerebral haemorrhages, blood pressure lowering and haemostatic therapy, when needed, are the two targets, while surgery does not seem effective to reduce death and disability.
Bleeding and haemostasis disorders
Authors: Mannucci Pier Mannuccio , Lettino Maddalena
Published: March 2021

The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, and those with comorbid conditions such as renal and liver insufficiency and diabetes. The identification of patients at higher risk of bleeding is the most important preventive strategy. Red cell and platelet transfusions, which may become necessary in patients with severe bleeding, should be used with caution, because transfused patients with acute coronary syndrome have a high rate of adverse outcomes (death, myocardial infarction, and stroke).
Higher Rates of Processed Pseudogene Acquisition in Humans and Three Great Apes Revealed by Long-Read Assemblies
Authors: Feng Xiaowen , Li Heng
Published: March 2021

LINE-1-mediated retrotransposition of protein-coding mRNAs is an active process in modern humans for both germline and somatic genomes. Prior works that surveyed human data mostly relied on detecting discordant mappings of paired-end short reads, or exon junctions contained in short reads. Moreover, there have been few genome-wide comparisons between gene retrocopies in great apes and humans. In this study, we introduced a more sensitive and accurate method to identify processed pseudogenes. Our method utilizes long-read assemblies, and more importantly, is able to provide full-length retrocopy sequences as well as flanking regions which are missed by short-read based methods. From 22 human individuals, we pinpointed 40 processed pseudogenes that are not present in the human reference genome GRCh38 and identified 17 pseudogenes that are in GRCh38 but absent from some input individuals. This represents a significantly higher discovery rate than previous reports (39 pseudogenes not in the reference genome out of 939 individuals). We also provided an overview of lineage-specific retrocopies in chimpanzee, gorilla, and orangutan genomes.
Surgical Relevance of the Suprameatal Tubercle During Superior Petrosal Vein-Sparing Trigeminal Nerve Microvascular Decompression
Authors: Rennert Robert C , Brandel Michael G , Stephens Marcus L , Rodriguez Analiz , Morris Thomas W , Day J D
Published: March 2021

BACKGROUND

An enlarged suprameatal tubercle (SMT) can obscure visualization of the trigeminal nerve and require removal during microvascular decompression (MVD) surgery, especially when the superior petrosal vein (SPV) complex is preserved.

OBJECTIVE

To define the incidence and important variables affecting the need for SMT removal with an SPV-sparing trigeminal nerve MVD.

METHODS

Retrospective single-institution review identified patients who underwent a first-time, SPV-sparing MVD for trigeminal neuralgia (TGN) over a 26-mo period. SMT length (SMT-L), SMT width (SMT-W), and peri-trigeminal cerebellopontine cisternal thickness (CT) were measured from axial high-resolution magnetic resonance images. Need for SMT removal and use of endoscopic assistance was recorded. Data were analyzed using unpaired t-tests, and receiver operating characteristic (ROC)/area under the curve testing.

RESULTS

A total of 43 MVD surgeries for TGN on 42 patients (mean age 52.7 ± 14.4 yr) were analyzed. Mean SMT-L, SMT-W, and CT were 9.8 ± 1.6, 2.0 ± 0.8, and 4.2 ± 1.5 mm, respectively. SMT removal via drilling was required in 4/43 cases (9.3%). Endoscopic assistance was used in 3 cases (2 SMT removed and 1 SMT preserved). SMT-W was the biggest predictor of the need for SMT removal on ROC analysis (area under the curve 0.97, 0.92-1.0 95% CI). The combined thresholds of SMT-W ≥ 3.2 mm and CT ≤ 3.5 mm demonstrated 100% sensitive and 100% specificity for the need to remove the SMT on optimal cutoff analysis.

CONCLUSION

SMT drilling is necessary in nearly 10% of SPV-sparing MVDs for TGN. The combination of SMT width and cerebellopontine cistern thickness is predictive of the need for SMT removal.
Education and management practices
Authors: Valero Anna
Published: March 2021

The empirical management literature has found that the education of both managers and the workforce more generally appears to be an important driver of better management practices. This article sets out how such relationships might be conceptualized, and suggests that in a complementarities framework, modern management practices can be thought of as a type of skill-biased technology. It then summarizes the literature that has explored the relationships between human capital and surveyed management practices in manufacturing firms and other sectors, highlighting the handful of papers that have found a positive correlation between management practices and measures of local skills supply. It concludes with a discussion of the policy implications that stem from what we know so far, together with avenues for future research that could shed more light on the causal mechanisms at play.
Experience With Autologous Nasal Septum Cartilage Combined With Conchal Cartilage in Nasal Tip Reconstruction
Authors: Shi Yanyan , Tan Xiaoyan , Sun Haiyang , Char Sydney
Published: March 2021

Objective

There has been an increase in use of autologous costal cartilage for nasal tip shaping material. However, there are deficiencies in using this plastic material, such as a hard nasal tip, poor nasal tip elasticity and mobility postoperatively, and some nasal tip skin thinning that allows the shape of the cartilage grafts to be felt on the surface of the nasal tip skin. To address these problems, we have combined autologous nasal septum cartilage and conchal cartilage as nasal tip graft materials, which achieve a natural shape and realistic touch postoperatively.

Methods

From January 2017 to September 2019, a total of 47 patients with nasal septal cartilage combined with conchal cartilage transplantation for nasal tip plasty were screened for a retrospective study. They were followed up and evaluated for 6 to 25 months postoperatively. The operation was performed through an incision in the nose. During the operation, a piece of septal cartilage was cut to make a columella strut. Using one side of the cavitas conchae and cymba conchae cartilage as the graft material, 2 long strips of cartilage were excised for the septum extension graft, and a piece of cap cartilage was transplanted to the top of the nasal tip cartilage scaffold.

Results

The time between the operation and follow-up was greater than 6 months, with the range of follow-up and evaluation being from 6 to 25 months. Forty-six patients were satisfied with the shape of the nose. One patient complained that the nasal tip was round and large after 1 month postoperatively, but after 6 months, he was satisfied with the shape of the nasal tip after daily use of a nasal clip. In one male case, the implant was removed more than 7 months postoperatively because of hematoma and infection secondary to nasal trauma. There were 2 cases of nasal tip numbness, both of which recovered spontaneously after 12 months. After the operation, the shape of the nasal tip was round, no cartilage contour was seen on the surface, no collapse of upper nasal tip, no obvious deviation of the nasal dorsum and columella, and no deformation and displacement of the nasal tip cartilage scaffold. At the 6-month follow-up visit, each patient palpated the nasal tip for evaluation. Most patients felt their nose felt realistic and that they had good nasal tip motion. Only 1 patient felt that the nasal tip and the nasal dorsum were moving together when the tip of the nose was being pushed.

Conclusions

Nasal septum cartilage and conchal cartilage can be combined as a graft material for reconstruction of the nasal tip. This technique uses different characteristics of each of the 2 cartilages to achieve a more realistic and esthetic outcome.
Implementation and Evaluation of Quality Improvement Training in Surgery
Authors: Pallari Elena , Khadjesari Zarnie , Aceituno David , Odhiambo Catherine Anyango , Warner Ross , Bastianpillai Christopher , Green James S. A. , Sevdalis Nick
Published: March 2021

Objective:

The aim of this study was to review and appraise how quality improvement (QI) skills are taught to surgeons and surgical residents.

Background:

There is a global drive to deliver capacity in undertaking QI within surgical services. However, there are currently no specifications regarding optimal QI content or delivery.

Methods:

We reviewed QI educational intervention studies targeting surgeons or surgical trainees/residents published until 2017. Primary outcomes included teaching methods and training materials. Secondary outcomes were implementation frameworks and strategies used to deliver QI training successfully.

Results:

There were 20,590 hits across 10 databases, of which 11,563 were screened following de-duplication. Seventeen studies were included in the final synthesis. Variable QI techniques (eg, combined QI models, process mapping, and “lean” principles) and assessment methods were found. Delivery was more consistent, typically combining didactic teaching blended with QI project delivery. Implementation of QI training was poorly reported and appears supported by collaborative approaches (including building learning collaboratives, and coalitions). Study designs were typically pre-/post-training without controls. Studies generally lacked clarity on the underpinning framework (59%), setting description (59%), content (47%), and conclusions (47%), whereas 88% scored low on psychometrics reporting.

Conclusions:

The evidence suggests that surgical QI training can focus on any well-established QI technique, provided it is done through a combination of didactic teaching and practical application. True effectiveness and extent of impact of QI training remain unclear, due to methodological weaknesses and inconsistent reporting. Conduct of larger-scale educational QI studies across multiple institutions can advance the field.
Development of a direct NGM(1,1) prediction model based on interval grey numbers
Authors: Li Ye , Ding Yuanping , Jing Yaqian , Guo Sandang
Published: March 2021

Purpose

The purpose of this paper is to construct an interval grey number NGM(1,1) direct prediction model (abbreviated as IGNGM(1,1)), which need not transform interval grey numbers sequences into real number sequences, and the Markov model is used to optimize residual sequences of IGNGM(1,1) model.

Design/methodology/approach

A definition equation of IGNGM(1,1) model is proposed in this paper, and its time response function is solved by recursive iteration method. Next, the optimal weight of development coefficients of two boundaries is obtained by genetic algorithm, which is designed by minimizing the average relative error based on time weighted. In addition to that, the Markov model is used to modify residual sequences.

Findings

The interval grey numbers’ sequences can be predicted directly by IGNGM(1,1) model and its residual sequences can be amended by Markov model. A case study shows that the proposed model has higher accuracy in prediction.

Practical implications

Uncertainty and volatility information is widespread in practical applications, and the information can be characterized by interval grey numbers. In this paper, an interval grey numbers direct prediction model is proposed, which provides a method for predicting the uncertainty information in the real world.

Originality/value

The main contribution of this paper is to propose an IGNGM(1,1) model which can realize interval grey numbers prediction without transforming them into real number and solve the optimal weight of integral development coefficient by genetic algorithm so as to avoid the distortion of prediction results. Moreover, the Markov model is used to modify residual sequences to further improve the modeling accuracy.
Impact of periodic magnetic source on natural convection and entropy generation of ferrofluids in a baffled cavity
Authors: Zontul Harun , Hamzah Hudhaifa , Sahin Besir
Published: March 2021

Purpose

This paper aims to exhibit a numerical study to analyze the influence of a periodic magnetic source on free convection flow and entropy generation of a ferrofluid in a baffled cavity. In this study, ferrofluid nanofluid was selected due to its ability to image magnetic domain structures within the cavity. The non-uniform magnetic source is considered as a sinusoidal distribution in the vertical direction.

Design/methodology/approach

The finite volume technique is used to evaluate the steady two-dimensional partial differential equations that govern the flow with its corresponding boundary conditions.

Findings

The obtained results indicate that a significant increase in the average Nusselt number can be achieved with the use of the periodic magnetic source instead of a uniform case. In addition, the effectiveness of the adiabatic baffle notably depends on its position and Rayleigh number. Regardless of the values of period and Hartmann numbers, the periodic magnetic source has a higher entropy generation and lower Bejan number than the uniform magnetic source.

Originality/value

The novelty of this research lies in applying a periodic magnetic source on the natural convection of ferrofluids in a baffled cavity.
The required specifications of a fourth-generation university to shape innovation district under anchor approach: a meta-synthesis analysis using text mining
Authors: Asgari Amir , Khorsandi Taskoh Ali , Ghiasi Nodooshan Saeed
Published: March 2021

Purpose

This paper aims to introduce a conceptual model for the shaping of the innovation district under the anchor approach by extracting the specifications of the fourth-generation university.

Design/methodology/approach

This study selected 550 resources and reduced them to 190 to achieve the most appropriate resources. This study used a meta-synthesis analysis approach using a text-mining method due to the multidisciplinary and voluminous nature of contents.

Findings

The results first reveal the shaping process and the components of innovation districts, which are: innovational urban infrastructures, knowledge economy and competitiveness and academic development. Second, this study also shows the specifications of a fourth-generation university to shape innovation districts.

Practical implications

This study also informs the policymakers and researchers internationally about the implementation requirements of a fourth-generation university and the shaping mechanisms of an innovation district.

Originality/value

This paper is pioneer about two concepts, first, it shows the shaping process of an innovation district, providing a large-scale insight about the components and second, this illustrates for the first time the specifications of a fourth-generation University practically as an anchor institute to shape innovation district.
Servitisation through structural adaptation
Authors: Zighan Saad , Alkalha Ziad , Bamford David , Reid Iain , Al-Zu'bi Zu'bi M.F.
Published: March 2021

Purpose

The purpose of this study is to investigate the structural changes needed for project-based organisations (PBOs) to synthesise their project operations and services following the servitisation strategy. It addresses the question of how PBOs should change their organisational structure fitting with service provision strategy.

Design/methodology/approach

This study followed an exploratory research method using a single in-depth case with evidence collected from 51 project managers from five different industry sectors: construction, oil and gas, IT, logistics and health care

Findings

Capitalising on organisational design theory, it has been found that successfully extending PBOs' outcomes into a system of both project output and extra services requires an adjustment of organisational structure that creates greater value for both companies and customers. This required adjustment has been divided into five main categories: (1) collaboration cross-project and customers; (2) flexible workflow, (3) decentralised decision-making, (4) wide span of control and (5) project governance. However, the findings indicate that success can only be ensured by particular mutually coordinated organisational designs with a suitable balance of products and services

Practical implications

This study presents vital indicators to PBOs practitioners when deploying servitisation within their operational strategy by adjusting the organisation's design.

Social implications

Servitisation could add both economic and social values for a diverse set of project stakeholders. However, the sustainability performance of servitisation in servitised project-based organisations is an outcome of reducing the discrepancy between project operation and service provision activities.

Originality/value

This study contributes to the body of knowledge and proposes a structural alteration process in PBOs to help align project operations and service provision activities. It explains how project-based organisations reconfigure their resources to provide services.
Rapid prototyping vaccine approach in mice against multi‐drug resistant Gram‐negative organisms from clinical isolates based on outer membrane vesicles
Authors: Pritsch Michael , Ben Khaled Najib , Liegl Gabriele , Schubert Soeren , Hoelscher Michael , Woischke Christine , Arens Nathalie , Thorn‐Seshold Julia , Kammermeier Stefan , Wieser Andreas
Published: March 2021

Hospital‐acquired infections due to multi‐drug resistant Gram‐negative organisms (MDRGNO) pose a major threat to global health. A vaccine preventing colonization and consecutive infection with MDRGNO could be particularly valuable, as therapeutic options become increasingly limited. Outer membrane vesicles (OMV) of Escherichia coli strain CFT073 as well as three MDRGNO strains that had caused severe infections in humans were administered intranasally to mice, with and without cholera toxin as an adjuvant. The humoral immune responses were comparatively matched with the sera of patients, who had suffered an infection caused by the respective bacterium. Additionally, systemic and local toxicity was evaluated. Intranasal vaccination with OMV could elicit solid humoral immune responses (total IgM and IgG), specific for the respective MDRGNO in mice; decoration of vital bacterial membranes with antibodies was comparable to patients who had survived systemic infection with the respective bacterial isolate. After intranasal vaccination of mice with OMV no signs of local or systemic toxicity were observed. Intranasal vaccination with OMV may open up a rapid vaccine approach to prevent colonization and/or infection with pathogenic MDRGNOs, especially in an outbreak setting within a hospital. It may also be an option for patients who have to undergo elective interventions in centers with a high risk of infection for certain common MDRGNO. Future studies need to include challenge experiments as well as phase I trials in humans.
The case for “investigate all”: Assessing the cost‐effectiveness of investigating no CODIS hit cases in a sexual assault kit initiative
Authors: Lovell Rachel E. , Singer Mendel , Flannery Daniel J. , McGuire Margaret J.
Published: March 2021

An increasing number of US jurisdictions have begun to submit their previously untested sexual assault kits (SAKs) for DNA testing. However, best practices for what should happen after testing are not well established. Should all cases be investigated regardless of the testing outcome or only those that returned a DNA hit? We examine an early‐adopter jurisdiction that has completed testing and investigating all 5165 previously never tested kits. We explore and compare the criminal justice outcomes and cost‐effectiveness of investigating: all cases, those with CODIS hits, and those without CODIS hits. Findings indicate the SAK initiative produced a cost savings to the community: $26.48 million ($5127 p/kit) after the inclusion of tangible and intangible costs of future sexual assaults averted through convictions, of which $9.99 million ($1934 p/kit) was from also investigating no CODIS hit cases. When considering only the costs to law enforcement, investigating all cases cost $12,000 p/additional conviction. Findings also illustrate the cost‐effectiveness of investigating no CODIS hits cases and support an “investigate all” approach. This study enhances our understanding of the economic value of what comes after testing kits and investigating cases and provides a framework for jurisdictions for prioritizing resources and maximizing outcomes from testing.
Morbidity and mortality in schizophrenia with comorbid substance use disorders
Authors: Lähteenvuo Markku , Batalla Albert , Luykx Jurjen J. , Mittendorfer‐Rutz Ellenor , Tanskanen Antti , Tiihonen Jari , Taipale Heidi
Published: March 2021

Objective

Schizophrenia is highly comorbid with substance use disorders (SUD) but large epidemiological cohorts exploring the prevalence and prognostic significance of SUD are lacking. Here, we investigated the prevalence of SUD in patients with schizophrenia in Finland and Sweden, and the effect of these co‐occurring disorders on risks of psychiatric hospitalization and mortality.

Methods

45,476 individuals with schizophrenia from two independent national cohort studies, aged <46 years at cohort entry, were followed during 22 (1996–2017, Finland) and 11 years (2006–2016, Sweden). We first assessed SUD prevalence (excluding smoking). Then, we performed Cox regression on risk of psychiatric hospitalization and all‐cause and cause‐specific mortality in SUD compared with those without SUD.

Results

The prevalence of SUD ranged from 26% (Finland) to 31% (Sweden). Multiple drug use (n = 4164, 48%, Finland; n = 3268, 67%, Sweden) and alcohol use disorders (n = 3846, 45%, Finland; n = 1002, 21%, Sweden) were the most prevalent SUD, followed by cannabis. Any SUD comorbidity, and particularly multiple drug use and alcohol use, were associated with 50% to 100% increase in hospitalization (aHR any SUD: 1.53, 95% CI = 1.46–1.61, Finland; 1.83, 1.72–1.96, Sweden) and mortality (aHR all‐cause mortality: 1.65, 95% CI = 1.50–1.81, Finland; 2.17, 1.74–2.70, Sweden) compared to individuals without SUD. Elevated mortality risks were observed especially for suicides and other external causes. All results were similar across countries.

Conclusion

Co‐occurring SUD, and particularly alcohol and multiple drug use, are associated with high rates of hospitalization and mortality in schizophrenia. Preventive interventions should prioritize detection and tailored treatments for these comorbidities, which often remain underdiagnosed and untreated.
Active modification of cavity nest‐entrances is a common strategy in arboreal ants
Authors: Priest Galen V. , Camarota Flávio , Vasconcelos Heraldo L. , Powell Scott , Marquis Robert J.
Published: March 2021

The majority of tropical arboreal ant species nest in tree cavities. These cavities, often produced initially by wood‐boring beetles, can be in live or dead wood and represent long‐lasting and highly defensible nesting resources. Yet the size of cavity entrances can constrain their use. Active entrance modification may be an effective way to overcome this constraint. Here, we conduct the first systematic study of nest‐entrance modification in an arboreal ant community. Using field experiments deployed across a number of tree species, we show that 14% of 2631 experimental cavities were modified by either enlargement, or reducing entrance size by construction. Entrance modifications, which were made by a majority (18/29 species) of the species that occupied experimental nests, used a variety of construction techniques and materials. Combined, these modifications were context‐dependent with respect to available entrance sizes: Enlargement was more common when the diversity of available entrance sizes was limited, whereas reduction was more prevalent when the diversity of entrance sizes was higher. Nevertheless, the context of tree species identity did not significantly influence the number of modified cavities or the construction materials. Overall, we show that nest‐entrance modification is a widespread, active, and context‐dependent strategy in the nesting ecology of arboreal ants.
Current practice in Australia and New Zealand for defunctioning ileostomy after rectal cancer surgery with anastomosis: Analysis of the Binational Colorectal Cancer Audit
Authors: Grupa Vera E. M. , Kroon Hidde M. , Ozmen Izel , Bedrikovetski Sergei , Dudi‐Venkata Nagendra N. , Hunter Ronald A. , Sammour Tarik
Published: March 2021

Aim

This study aimed to investigate the use of defunctioning stomas after rectal cancer surgery in Australia and New Zealand, as current practice is unknown.

Methods

From the Binational Colorectal Cancer Audit database, data on rectal cancer patients who underwent a resection between 2007 and 2019 with the formation of an anastomosis were extracted and analysed. The primary outcome was the rate of defunctioning stoma formation. Secondary outcomes were anastomotic leakage (AL) rates and other postoperative complications, length of hospital stay (LOS), readmissions and 30‐day mortality rates between stoma and no‐stoma groups. Propensity score matching was performed to correct for differences in baseline characteristics between stoma and no‐stoma groups.

Results

In total, 2581 (89%) received a defunctioning stoma and 319 (11%) did not. There were more male patients in the stoma group (65.5% vs. 57.7% for the no‐stoma group; P = 0.006). The median age was 64 years in both groups. The stoma group underwent more ultra‐low anterior resections (79.9% vs. 30.1%; P < 0.0001), included more American Joint Committee on Cancer Stage III patients (53.7% vs. 29.2%; P < 0.0001) and received more neoadjuvant therapy (66.9% vs. 16.3%; P < 0.0001). The AL rate was similar in both groups (5.1% vs. 6.0%; P = 0.52). LOS was longer in the stoma group (8 vs. 6 days; P < 0.0001) with higher 30‐day readmission rates (14.9% vs. 8.3%; P = 0.003). After propensity score matching (n = 208 in both groups), AL rates remained similar (2.9% for stoma vs. 5.8% for no‐stoma group; P = 0.15), but stoma patients required less reoperations (0% vs. 8%; P = 0.016). The stoma group had higher postoperative ileus rates and an increased LOS.

Conclusion

In Australia and New Zealand, most patients who underwent rectal cancer resections with the formation of an anastomosis received a defunctioning stoma. A defunctioning stoma does not prevent AL from occurring but is mostly associated with a lower reoperation rate. Patients with a defunctioning stoma experienced a higher postoperative ileus rate and had an increased LOS.
Omega‐3 fatty acid in ultra‐high‐risk psychosis: A systematic review based on functional outcome
Authors: Susai Subash Raj , Sabherwal Sophie , Mongan David , Föcking Melanie , Cotter David R.
Published: March 2021

Aim

Among different types of poly unsaturated fatty acids, omega‐3 fatty acids (FA) play a substantial role in brain development and functioning. This review was designed to evaluate and synthesize available evidence regarding omega‐3 FAs and functional outcome in the ultra‐high‐risk (UHR) population.

Methods

An electronic search in PubMed, EMBASE, PSYCINFO and COCHRANE search engines has been performed for all articles published until January 2019. The studies that have data regarding omega‐3 FAs and functional outcome in UHR population were included.

Results

Out of 397 nonduplicate citations, 19 articles met selection criteria. These articles were from four different primary studies, namely the Program of Rehabilitation and Therapy (PORT), the North American Prodromal Longitudinal Studies (NAPLS), Vienna High Risk study (VHR) and the NEURAPRO. The data from the NAPLS study found a positive correlation between functional improvement and frequency of dietary intake omega‐3 FA. Moreover, among the erythrocyte omega‐3 FA only eicosapentaenoic acid (EPA) showed a positive correlation with functional score. The VHR study found long‐term improvement in functional outcome in omega‐3 group compared to control, whereas such difference was noticed in the NEURAPRO. In the VHR study both omega‐3 and omega‐6 together predicted the functional improvement at 12 weeks.

Conclusions

The number of studies available remains insufficient and more studies with standardized outcome measures in a clinically comparable UHR population would be of more value to understand the clinical benefits of omega‐3 FA in the UHR population.