bluuebunny/crossref_metadata_2025 huggingface dataset:
A combination of captopril challenge test after saline infusion test improves diagnostic accuracy for primary aldosteronism
Authors: Lin Chuan , Yang Jun , Fuller Peter J. , Jing Huan , Song Ying , He Wenwen , Du Zhipeng , Luo Ting , Cheng Qingfeng , Yang Shumin , Wang Hongman , Li Qifu , Hu Jinbo ,   The Chongqing Primary Aldosteronism Study (CONPASS) Group
Published: November 2019

Context

The saline infusion test (SIT) is a common confirmatory test for primary aldosteronism (PA). According to the guideline, a postinfusion plasma aldosterone concentration (PAC) of 5‐10 ng/dL is considered indeterminate, and recommendations for diagnostic strategies are currently limited in this situation.

Objective

To explore whether an addition of the captopril challenge test (CCT) could improve the diagnostic accuracy in patients with indeterminate SIT.

Methods

A total of 280 hypertensive patients with high risk of PA completed this study. Subjects were defined as SIT indeterminate based on their PAC post‐SIT. These patients then underwent the CCT where PACs post‐CCT >11 ng/dL were considered positive. Using fludrocortisone suppression test (FST) as the reference standard, diagnostic parameters including area under the receiver‐operator characteristic curves (AUC), sensitivity and specificity were calculated.

Results

There were 65 subjects (23.2%) diagnosed as PA indeterminate after SIT. With the addition of CCT, true‐positive numbers increased from 134 to 147, and false‐negative numbers decreased from 27 to 14. Compared to SIT alone, a combination of SIT and CCT showed a higher AUC (0.91 [0.87,0.94] vs 0.87 [0.83,0.91], P = .041) and an increased sensitivity for the diagnosis of PA (0.91 [0.86,0.95] vs 0.83 [0.76,0.89], P = .028), while the specificity remained similar. In the subgroup with indeterminate SIT results, using PAC post‐CCT resulted in a 36% higher AUC than using PAC post‐SIT alone for the diagnosis of PA.

Conclusion

For patients under investigation for possible PA who have indeterminate SIT results, an addition of CCT improves the diagnostic accuracy.
Lie detection using extreme learning machine: A concealed information test based on short‐time Fourier transform and binary bat optimization using a novel fitness function
Authors: Dodia Shubham , Edla Damodar R. , Bablani Annushree , Cheruku Ramalingaswamy
Published: November 2019

Lie detection is one of the major challenges that is being faced by the forensic sciences. Identification of lie on the basis of a person's mental behavior is a tedious task. Brain‐computer interface is one such medium which provides a solution to this problem by displaying visual stimuli and recording subject's brain responses. A P300 response is elicited whenever a person comes across a familiar stimuli in a series of rare stimuli. This P300 response is used for the lie detection method. In the proposed concealed information test, acquired signals are preprocessed to discard noise. Then, short‐time Fourier transform method is applied to extract features from the preprocessed electroencephalogram signals. To avoid the curse of dimensionality and to reduce computational overhead, binary bat algorithm is applied, which helps in choosing optimal subset of features. The obtained set of features is given as an input to the extreme learning machine classifier for training of guilty and innocent samples. The performance of the system is assessed using 10‐fold cross‐validation. The resultant accuracy obtained from the proposed lie detection system is 88.3%. The system has provided efficient results in contrast with most of the state‐of‐the‐art lie detection methods.
Seed Banking as Cryopower: A Cryopolitical Account of the Work of the International Board of Plant Genetic Resources, 1973–1984
Authors: Peres Sara
Published: November 2019

The implications of freezing seeds to conserve genes statically and for the long term are complex and deserve further reflection to appreciate seed banking as an attempt to detach seeds from their life cycle. Here, I use a cryopolitical framework to explore this in the context of the activities of the International Board of Plant Genetic Resources (IBPGR) between 1973 and 1984. I suggest that the emergence of seed banks is a shift toward a cryopower mode of governance, where technoscientific intervention in the biology of seeds was presented as a means to manage the survival of seeds. The project of ex situ conservation is a socio‐technical effort by international institutions such as IBPGR and a variety of institutions with seed repositories. In creating a coldscape, they sought to make genetic resources into frozen seeds that were stable and mobile, not only across space but, importantly, over time. Consequently, our interpretations of seed banks as sites of geopolitical significance in the controversies over access to seeds can be complemented by considering their biopolitical importance as interventions that extend the power of IBPGR and other institutions toward plant life, and the future.
The interaction effect between intraspecific competition and seed quality on the life‐history traits of the seed‐feeding beetleAcanthoscelides macrophthalmus
Authors: Cesar Cássia S. , Rossi Marcelo N.
Published: November 2019

It has been shown that intraspecific competition and resource quality may affect life‐history traits of insects, such as body size, fecundity, and survival. However, intraspecific competition and resource quality may interact with each other. The study of such interacting effects is crucial for understanding the influence of these ecological variables on the selection of specific life‐history traits. Here, we investigated whether the interaction between intraspecific larval competition and variation in resource quality affects adult emergence and survival, egg size, fecundity, body size, and sexual size dimorphism (SSD) of the seed‐feeding beetleAcanthoscelides macrophthalmus(Schaeffer) (Coleoptera: Chrysomelidae: Bruchinae) when infestingLeucaena leucocephala(Lam.) De Wit (Fabaceae), its host plant. In the laboratory, beetles were reared on seeds that differed in quality (e.g., different hardness, seed size, water content), in the presence or absence of larval competition. Body size and SSD did not differ between treatments (with and without competition), nor were they affected by varying resource quality. Females subjected to competition during the larval stage and females emerging from seeds of higher quality, displayed the highest fecundity. The proportion of emergent adults was higher in the absence of competition. In addition, larger eggs were laid on the low‐quality resource in the absence of competition, showing a trade‐off between egg size and egg number. Adult survival differed among treatments and resource qualities, suggesting a higher investment in adult survival for individuals emerging from seeds of low quality in the presence of competition. Whether changes in specific traits could be selected for in detriment of others will depend on the strength of intraspecific competition, the variation in resource quality, and the plasticity in the life‐history traits investigated. This needs further clarification.
The inverted postnational constellation: Identitarian populism in context
Authors: Azmanova Albena , Dakwar Azar
Published: November 2019

As exemplified by the pan‐European ‘Identitarian movement’ (IM), contemporary far‐right populism defies the habitual matrix within which right‐wing radicalism has been criticised as a negation of liberal cosmopolitanism. The IM's political stance amalgamates features of cultural liberalism and racialist xenophobia into a defence of ‘European way of life.’ We offer an alternative decoding of the phenomenon by drawing on Jürgen Habermas's ‘postnational constellation.’ It casts the IM's protectionist qua chauvinistic populism as ‘inverted’ postnationalism, engendered through territorial and ethnic appropriation of universal political values. As such, inclusionary ideals of cosmopolitan liberalism and democracy purporting humanistic postnationalism have been transformed by Identitarians into elements of a privileged civilisational life‐style to be protected from ‘intruders.’ Remaining within the remit of the grammar of the postnational constellation, trans‐European chauvinism, we contend, is susceptible to inclusive articulation. Foregrounding radical emancipatory social transformation would however require not more democracy, but a principled critique of capitalism.
Discourse theory of law in times of populism
Authors: Marxsen Christian
Published: November 2019

Jürgen Habermas's discourse theory of law has shaped debates on what we consider to be legitimate law. This contribution will firstly identify the Zeitgeist in which discourse theory emerged. Secondly, it points out the emancipatory potential of law that discourse theory has helped us to understand, both on a domestic and a transnational level. Thirdly, the paper turns to discuss two recent challenges for the discourse theory of law, namely (a) the realities of social power that undermine and contradict its promises, and (b) the rise of populism, which places the core normative assumptions of discourse theory in doubt.
Of citizens and plebeians: Postnational political figures in Jürgen Habermas and Jacques Rancière
Authors: Flatscher Matthias , Seitz Sergej
Published: November 2019

This paper focuses on Habermas's notion of cosmopolitan democracy. Reconfiguring the basic ideas of democracy in postnational terms is inevitable if social and political integration is to succeed on a supranational level. In exploring Habermas's ideas, we draw on Rancière, whose thought stands in a complex relationship to Habermas. On the one hand, Rancière largely shares Habermas's diagnosis of the present. Both bemoan the erosion of the political caused by post‐democracy and censure the rise of right‐wing extremism in Western societies. On the other hand, and in contrast to Habermas, Rancière holds that these problems should be addressed not primarily by strengthening political institutions and reaching a consensus between conflicting parties, but by rethinking conflict and resistance. We show that Habermas's and Rancière's propositions can be productively brought in dialogue by focusing on the paradigmatic types of political subjectivity involved in their accounts: the citizen (Habermas) and the plebeian (Rancière).
Toxicity modelling of nanomaterials by origin evaluation of their physicochemical descriptors using a combination of principal component analysis and support vector machine methods
Authors: Jha Sunil Kr , Yoon Tae Hyun
Published: November 2019

In the present study, the performance of physicochemical descriptors of metal oxide nanomaterials on the basis of their origins, including descriptors related to element/ion, the metal oxide in bulk, and metal oxide in the media for toxicity modelling has been evaluated. Three published experimental nanomaterial data sets were selected for the study. The data set was divided into three subsets on the basis of the origin of descriptors; thereafter, each of them was analysed using principal component analysis for visual discrimination of toxic versus nontoxic nanomaterials in the principal component (PC) space. The metal oxide in media‐based descriptor subset results in the best visual clustering of toxicity of nanomaterials compared with the rest two subsets. It was also confirmed with the class separability measures in the PC space and classification accuracy of the support vector machine (SVM) method. PC scores of the metal oxide in media‐related descriptors results in the maximum value of class separability index (J = 0.0049) and the maximum classification accuracy of 96.43% of SVM classifier (sensitivity of 100%). A toxicity classification model of nanomaterials has been established using PC scores of optimal descriptor subset and SVM method.
Hospital use for non‐traumatic dental conditions among older adults in Florida
Authors: Tomar Scott L. , Morón Elías , Alwalie Amna
Published: November 2019

Objective

Older Americans are at risk of many oral diseases and conditions, but limited access to dental care may lead to the use of hospital emergency departments (EDs) or inpatient admissions. This study examined the use of hospitals for non‐traumatic dental conditions (NTDCs) among persons aged ≥65 years in the Florida.

Methods

We analysed hospital use for NTDCs in Florida in 2018 from health department data sets. We calculated frequencies and rates of ED visits and hospital inpatient admissions, overall and by county, age, sex, race/ethnicity and principal payer. We also examined the source of hospital admission, primary diagnoses and charges.

Results

In 2018, there were 4894 ED visits and 747 inpatient admissions for NTDCs among persons aged ≥65 years in Florida. The rate for ED visits was 112.30 per 100 000 population and for hospital inpatient admissions was 17.14; rates varied widely among counties. Medicare was the most common primary payer. Referrals from EDs accounted for 76.2% of inpatient admissions for NTDCs by older adults. Total charges were $21.4 million for ED visits and $40.2 million for inpatient admissions. The most common principal diagnosis for ED visits for NTDCs was “periapical abscess without sinus tract” (K04.7; 26.2%) and for inpatient admissions was “inflammatory conditions of the jaw” (M27.2; 19.1%). Of the 747 inpatient admissions, two people died.

Conclusions

Hospital use for NTDCs in Florida among persons aged ≥65 years is a clinical and financial challenge. Public coverage for basic adult dental services may lead to more effective use of funds and better health outcomes.
Gingivitis and plaque scores among residents of low‐income senior housing
Authors: Reisine Susan , Schensul Jean J. , Li Jianghong , Grady James , Ha Toan , Lalla Rajish
Published: November 2019

Objectives

The purpose of this paper is to present Gingival Index (GI) and Plaque Scores (PS) of older and disabled adults living in low‐income senior housing and their association with sociodemographic, health status and oral health behaviours.

Methods

Participants were recruited from six low‐income senior housing residences in Connecticut. Primary outcome measures were Gingival Index (GI) and Plaque Scores (PS). Surveys assessed sociodemographic characteristic, beliefs and behaviours. Logistic regression analysis was used to model the binary outcomes of probability of unfavourable GI status (>=0.34) and unfavourable PS (>=74%) against variables including demographic characteristics, oral hygiene behaviours and health status.

Results

331 participants volunteered for the study. Mean baseline GI was 0.38 (SD: 0.3), and mean PS was 71.7% (SD: 18%). Logistic regression showed that males were more likely to have higher GI and plaque scores than females. Those with less formal education were more likely to have worse GI scores and high PS compared to those with college educations. Those with lower incomes and those who rated their oral health poor/fair were more likely to have higher PS.

Conclusion

Participants had remarkably good gingival health regardless of relatively high PS. Males and less educated individuals should receive special attention when implementing oral hygiene interventions because of their relatively poor oral hygiene status.
Analyses of objective response rate, progression‐free survival, and adverse events in hepatocellular carcinoma patients treated with lenvatinib: A multicenter retrospective study
Authors: Hatanaka Takeshi , Kakizaki Satoru , Nagashima Tamon , Namikawa Masashi , Tojima Hiroki , Shimada Yasushi , Takizawa Daichi , Naganuma Atsushi , Arai Hirotaka , Sato Ken , Harimoto Norifumi , Shirabe Ken , Uraoka Toshio
Published: November 2019

Aim

The aim of this study was to investigate the predictive factors of objective response rate (ORR) and progression‐free survival (PFS), and the correlation of albumin‐bilirubin (ALBI) grade with decreased appetite and fatigue in hepatocellular carcinoma patients treated with lenvatinib.

Methods

From March 2018 to December 2018, a total of 94 patients was included in this retrospective multicenter study.

Results

The median age of all patients was 73 years (interquartile range 66–79.3 years), and approximately 78% patients were men. The ALBI grade was 1, 2, and 3 in 27 (28.7%), 64 (68.1%), and three patients (3.2%), respectively. The Barcelona Clinic Liver Cancer stage was early, intermediate, and advanced in one (1.1%), 22 (23.4%), and 71 patients (75.5%), respectively. Best radiological response was determined to complete response, partial response, stable disease, and progressive disease in 0 (0.0%), 24 (30.4%), 38 (48.1%), and 17 patients (21.5%), respectively, giving the ORR of 30.4%. The 3‐, 6‐, and 12‐month PFS was calculated to be 78.7% (95% CI 70.3–87.1%), 46.7% (95% CI 36.1–57.3%), and 17.4% (95% CI 6.6–28.2%). Multivariate analysis showed that the Barcelona Clinic Liver Cancer intermediate stage was shown to be the only significant factor affecting the ORR (odds ratio 3.78, 95% CI 1.14–12.5, P = 0.030) and PFS (hazard ratio 0.49, 95% CI 0.26–0.94, P = 0.030). The incidence of all grades of decreased appetite and fatigue was significantly less in patients with ALBI grade 1 compared with ALBI grade 2 + 3.

Conclusions

The Barcelona Clinic Liver Cancer intermediate stage was the predictive factor affecting the ORR and PFS, and ALBI grade was a good predictive factor affecting the incidence of fatigue and decreased appetite.
Why do firms seek shareholders ratification of the independent audit function? The case of foreign cross‐listed companies in the United States
Authors: Tanyi Paul , Cathey Jack
Published: November 2019

Many factors influence why companies require routine auditor ratifications. In this study, we seek to examine factors that increase or decrease the likelihood of shareholders’ involvement in the ratification of the independent auditor's appointment for foreign cross‐listed companies in the United States. Foreign cross‐listed companies provide a unique opportunity to observe how country‐specific factors impact the auditor ratification vote decision and outcome. Our analysis shows that bank financing, the location of the cross‐listed firm's independent auditor (U.S.‐based vs. non‐U.S.‐based audit office), and non‐audit fee ratio as having the highest marginal effects on the probability of companies requiring their shareholders to ratify the auditor's appointment. We also examine how these factors influence the outcome of the vote. We find that several engagement and country‐specific factors also influence the outcome of the vote.
When basal cell carcinomas became giant: an Italian multicenter study
Authors: Gualdi Giulio , Monari Paola , Calzavara‐Pinton Piergiacomo , Caravello Simone , Fantini Fabrizio , Bornacina Carlo , Specchio Francesca , Argenziano Giuseppe , Simonetti Vito , Caccavale Stefano , La Montagna Maddalena , Cecchi Roberto , Landi Christian , Simonacci Marco , Dusi Daniele , Puviani Mario , Zucchi Alfredo , Zampieri Pierfrancesco , Inchaurraga Maria A. G. , Savoia Francesco , Melandri Davide , Capo Alessandra , Amerio Paolo
Published: November 2019

Background

Giant basal cell carcinoma (GBCC) is a basal cell carcinoma (BCC) enlarged in a diameter more than 5 cm. Since GBCCs are a highly infrequent entity and the occurrence rate is approximately 0.5–1% out of all BCC types, only anecdotal cases are reported, and causes and characteristics inducing development of this tumor are not defined.

Objectives

Evaluate causative factors and clinico‐histological characteristics of GBCCs.

Methods

The study is a 6‐month, hospital‐based case series study performed in 12 Italian dermatologic centers.

Results

A total of 59 cases and 458 control BCCs were collected. No significant differences existed between the two groups if we take into account social or cultural factors. The average duration of GBCCs is considerably longer than controls. GBCCs are located on unexposed areas while BCCs are on areas not usually covered by clothes. Superficial histological subtype was more frequent in the BCCs group, while infiltrative in GBCCs. GBCCs showed significantly higher local invasiveness, and greater metastatic capacity. More than half of GBCCs had been previously treated with one or more treatments.

Conclusions

Patients with GBCCs appear to belong to two categories: (i) those who present with GBCC due to delay in accessing medical attention, and (ii) those who have BCCs previously treated with inappropriate strategies. Only very few cases can be carried out with intrinsic biological features of tumor aggressiveness. Social and cultural conditions do not appear to be involved in the development of GBCCS. These observations may help clinicians in selecting correct therapeutic strategies in the treatment of BCCs, which give rise to GBCC.
A healthy lifestyle education programme for health literacy and health‐promoting behaviours: A pre‐implementation and post‐implementation study
Authors: Ayaz‐Alkaya Sultan , Terzi Handan , Işık Betül , Sönmez Ebru
Published: November 2019

Aim

The aim of this study was to determine whether implementation of a healthy lifestyle education programme resulted in improved health literacy levels and healthy life style behaviours.

Methods

A one‐group pretest‐posttest study design was used. This study was carried out with 30 women who were enrolled in a family health centre. A questionnaire comprising the Adult Health Literacy Scale, Healthy Lifestyle Behaviour Scale‐II, Perception of Health Scale, and Short Test of Functional Health Literacy was used for data collection. Eight home visits including training and follow‐up followed the first interview at the family health centre. The healthy lifestyle training was applied once per week during home visits. After the training sessions were completed, women were followed‐up through four home visits biweekly in the second and the third months.

Results

The difference between the Adult Health Literacy Scale and Short Test of Functional Health Literacy pretest‐posttest mean scores was statistically significant (P < .05). Although the Perception of Health Scale and the Healthy Lifestyle Behaviour Scale‐II posttest scores were higher than the pretest scores, the difference between the groups was not statistically significant.

Conclusion

The training and counselling intervention visits increased health literacy but did not significantly change the healthy life style behaviours and health perceptions of the women.
Patient factors affecting the proper completion of a goals‐of‐care form in a general medicine hospital admission
Authors: Potenzi Bradley , Lim Andy K. H.
Published: November 2019

Background

The goals‐of‐care (GOC) form is a resuscitation planning tool used to document informed decisions tailored for individual patients admitted to hospital. Proper and timely completion of the GOC form is essential for its effective utility.

Aims

To identify patient factors which may affect the timely discussion and documentation of GOC forms in patients admitted under a general medicine unit.

Methods

We performed a cross‐sectional study of 2589 patients during 3093 admissions under the general medicine unit from January 2017 to July 2017 at Dandenong Hospital in Melbourne, Australia. The main outcome was the proper completion of GOC forms, defined as GOC completion within 48 h of admission and adequate discussion with the patient or substitute decision maker. We used logistic regression to determine the association between the main outcome and several patient‐related independent variables.

Results

A GOC form was completed in 66% of all admissions but only 35% were considered properly completed (timely and adequately discussed). In the general multivariable logistic regression model, the variables associated with proper completion of GOC forms were age (OR = 1.58), English as the main spoken language (OR = 1.43) and readmissions (OR = 1.27). In patients 75 years and older, additional factors associated with proper GOC completion were confusion on admission (OR = 1.31) and number of comorbidities (OR = 1.27).

Conclusions

The proper GOC form completion rates were suboptimal in general medicine admissions, particularly in younger patients with fewer comorbidities. Additional effort is needed to improve GOC completion in these patients and those whose primary spoken language is not English.
Complications of cardiac implantable electronic device placement in public and private hospitals
Authors: Ganesan Anand N. , Moore Katherine , Horton Dennis , Heddle William , McGavigan Andrew D. , Hossain Sadia , Ali Anna , Hariharaputhiran Saranya , Ranasinghe Isuru
Published: November 2019

Background

Few safety data exist comparing clinical outcomes in Australian public and private hospitals. We hypothesised that differences could exist between public and private hospitals due to differences in acuity and patient‐level co‐morbidities.

Aims

To report comparative complications of cardiac implantable electronic device (CIED) placement in public and private hospitals.

Methods

We conducted an observational cohort study of outcomes of patients aged >18 years from 2010 to 2015 undergoing a new permanent pacemaker (PPM), implantable cardioverter defibrillator (ICD) or cardiac resynchronisation therapy pacemaker or defibrillator (CRT‐D/P) implant in NSW and Queensland public and private hospitals. The primary endpoint was major CIED‐related complications occurring in‐hospital or within 90 days of discharge. The independent effect of hospital sector was determined using multiple logistic regression, adjusting for covariates, including age, sex, co‐morbidities and procedural acuity.

Results

A total of 32 364 new CIED implants (PPM 23 845, ICD 5361 and CRT‐D/P 3158) were included (49% in private hospitals). Overall, 8.0% of private hospital procedures and 9.6% public hospital procedures experienced at least one complication. After adjustment, the overall risk of CIED complications was similar in private and public hospitals (OR: 0.92, 95% CI: 0.84–1.00, P = 0.06). In analysis of individual complications, adjusted all‐cause in‐hospital mortality was higher in private hospitals, (OR: 1.49, 95% CI: 1.03–2.16, P = 0.036) primarily driven by an excess mortality in acute cases. The adjusted risk of in‐hospital generator operation (OR: 0.53, 95% CI: 0.30–0.94, P = 0.03) and post‐discharge infection (OR: 0.61, 95% CI: 0.46–0.81, P < 0.001) was lower in private hospitals.

Conclusions

These data identify important similarities and differences in safety outcomes of CIED implantation between Australian public and private hospitals.
Guillain–Barré syndrome: clinical features, treatment choices and outcomes in an Australian cohort
Authors: Barnes Stephanie L. , Herkes Geoffrey K.
Published: November 2019

Background

Guillain–Barré syndrome (GBS) causes acute neuromuscular weakness. Severe cases are life‐threatening and many are left disabled. Intravenous immunoglobulin (IVIg) and plasma exchange (PE), along with supportive care, are the mainstays of treatment. Treatment choice is influenced by multiple factors. The clinico‐epidemiological features of GBS in Australia have not been reviewed in 30 years and few studies have assessed contemporary treatment choices.

Aims

To investigate the clinico‐epidemiological features, choice of treatment, clinical course and outcomes of GBS patients in an Australian tertiary metropolitan hospital.

Methods

A retrospective observational study was performed of GBS presentations to a tertiary hospital in Sydney, Australia, over 5 years. Clinico‐epidemiological features, treatment choices, clinical course and outcomes were assessed.

Results

We reviewed 46 GBS patients (54% male), average age 55 years. Antecedent infection was identified in 61%. Twenty‐eight per cent had preceding immunogenic events or conditions. Acute inflammatory demyelinating polyradiculoneuropathy was the most common subtype (78%). Cerebrospinal fluid albumino‐cytologic dissociation was present in 43%. Electrodiagnostic testing most frequently demonstrated demyelination (64%). Ninety‐eight per cent received immunotherapy, mostly IVIg (93%). Twenty‐two per cent received further treatment due to treatment‐related fluctuations or lack of improvement. Thirteen per cent required ICU admission and 46% needed rehabilitation. There were no deaths or need for mechanical ventilation. Seventy‐one per cent of the follow‐up cohort had residual disability at 6 months, but this was generally mild.

Conclusions

The clinico‐epidemiological features are consistent with previous cohorts. Our experience in a large Australian tertiary centre demonstrates a clear preference for IVIg over PE.
Clinical decision support in a hospital electronic prescribing system informed by local data: experience at a tertiary New Zealand centre
Authors: Chin Paul K. L. , Chuah QianYi , Crawford Amanda M. , Clendon Olivia R. , Drennan Philip G. , Dalrymple Judith M. , Barclay Murray L. , Doogue Matthew P.
Published: November 2019

Background

An electronic prescribing and administration (ePA) system has been progressively rolled out to Canterbury District Health Board (CDHB, Christchurch, New Zealand) public hospitals since 2014, and is currently used for around 1300 tertiary beds. ePA data can be used to monitor user behaviour, and to evaluate and inform the local customisation of clinical decision support (CDS) tools within the ePA system.

Aims

To describe retrospectively illustrative vignettes of CDHB ePA analyses that have been used for CDS.

Methods

Alerts were developed according to a set of common principles agreed upon by the CDHB CDS Working Group. Alerts were informed and evaluated by extracting and parsing data for various time periods during 2016 to 2018 from the CDHB ePA database.

Results

There was a median of 74 000 prescriptions a month. After examining 525 spironolactone prescriptions, the high dose alert threshold was set at 100 mg with an expected alert burden of 3%. The presence of a ceftriaxone shortage prescribing alert for 1 week was associated with a prescribing rate that was lower than 95% of the preceding 52 weeks. Following review of 367 fentanyl patch alerts, revision of the alert led to false positives falling from 43% to 3% (P < 0.0001). At the point of firing, 6% of antithrombotic drug interactions alerts led to immediate changes in prescriptions (94% overridden), and a further 22% were changed within 30 min after the alert.

Conclusions

Local data extracts from ePA systems can inform iterative configuration of the software and monitor user behaviour.
Low serum albumin levels predict short‐ and long‐term mortality risk in patients hospitalised to general surgery wards
Authors: Akirov Amit , Gorshtein Alexander , Adler‐Cohen Chagit , Steinmetz Tali , Shochat Tzipora , Shimon Ilan
Published: November 2019

Background

Previous studies have reported conflicting results on the association between hypoalbuminaemia and morbidity and mortality in hospitalised patients.

Aims

To investigate the association of albumin levels on admission and change in levels during hospitalisation of patients in general surgery wards with hospitalisation outcomes.

Methods

Historical prospective data of patients hospitalised between January 2011 and December 2017. Albumin levels were classified as follows: marked hypoalbuminaemia (<2.5 mg/dL), mild hypoalbuminaemia (2.5–3.5 mg/dL), normal albumin (3.5–4.5 mg/dL) and hyperalbuminaemia (>4.5 mg/dL). Main outcomes were length of hospitalisation, 30‐days and long‐term mortality.

Results

The cohort included 17 930 patients (mean age 58 ± 20 years, 49% male). Most had normal albumin levels on admission (n = 11 087, 62%), 16% had mild hypoalbuminaemia (n = 2824) and 3% had marked hypoalbuminaemia (n = 529). Hyperalbuminaemia on admission was evident in 20% of the patients (n = 3490). Follow‐up time was up to 7.2 years (median ± SD = 3 ± 2 years). Compared to 30‐day mortality with normal albumin on admission (2%), mortality was higher with mild (9%) and marked hypoalbuminaemia (22%) and lower with hyperalbuminaemia (0.4%). The mortality rate at the end of follow up was 14% with normal albumin levels, and 35% and 58% with mild and marked hypoalbuminaemia respectively. Patients with hyperalbuminaemia on admission and before discharge had the best short‐ and long‐term survival. This pattern was similar when analysed separately in different age groups. In patients with hypoalbuminaemia on admission, normalisation of albumin levels before discharge was associated with lower short‐ (12% vs 1%) and long‐term mortality risk (42% vs 17%).

Conclusions

Low albumin levels on admission to general surgery wards are associated with increased short‐ and long‐term mortality. Normalisation of albumin levels before discharge was associated with lower mortality, compared to hypoalbuminaemia before discharge.
Non‐alcoholic fatty liver disease: a review of epidemiology, risk factors, diagnosis and management
Authors: Huang Tony (Dazhong) , Behary Jason , Zekry Amany
Published: November 2019

Due to the rising prevalence of obesity and type II diabetes mellitus, non‐alcoholic fatty liver disease is becoming the leading cause of chronic liver disease in the Western world. In some patients, simple steatosis can result in non‐alcoholic steatohepatitis which over time can lead to liver cirrhosis and its associated sequelae, including hepatocellular carcinoma. Early identification and management of patients at risk with intensive dietary and lifestyle modification are essential to prevent the development of advanced liver disease and its complications. In this review, we will discuss the epidemiology of non‐alcoholic fatty liver disease, pathogenesis, diagnosis, management and surveillance strategies to offset the morbidity and mortality of this disease, as well as liver and non‐liver‐related complications.
Lupus nephritis in Indigenous Australians: a single‐centre study
Authors: Nigam Amit , Baer Richard , Green Stella , Neuen Brendon L. , Vile Alexander , Mantha Murty
Published: November 2019

Background

The incidence, presentation and outcomes of lupus nephritis (LN) vary with geography, ethnicity, socioeconomic status and gender. There are relatively few data on LN in the non‐Caucasian populations in Australia.

Aims

To describe the clinical presentation, histological features, natural history, and outcomes of a historical cohort of Aboriginal and Torres Strait Islanders people in Far North Queensland with biopsy‐proven LN.

Methods

This is a retrospective observational study, and the study was conducted in Cairns and Hinterland Hospital and Health Service, Queensland, Australia. The study included Aboriginal and Torres Strait Islander patients with biopsy‐proven LN treated between 1990 and 2013. The main outcome measures were renal replacement therapy and overall patient survival.

Results

Aboriginal and Torres Strait Islander people represented a substantial proportion (n = 16/40, 40%) of all patients diagnosed with LN during the observation period. The frequency of nephrotic range proteinuria (n = 11/14, 78.5%), estimated glomerular filtration rate <60 mL/min/1.73 m2 (n = 6/14, 42.8%) and proliferative LN (n = 13/16, 81.25%) was high at the time of presentation. Despite use of multiple immunosuppressive agents, the overall rate of remission was poor (n = 4/14, 28.5%) and incidence of end‐stage kidney disease (n = 4/14, 28.5%) and death (n = 5/16, 31.25%) was high.

Conclusions

The clinical presentation of LN in Aboriginal and Torres Strait Islanders in Far North Queensland is severe and the response to standard immunosuppressive therapy is unsatisfactory. Larger prospective multi‐centre studies are required to better understand ethnic disparities in prognosis and response to immunosuppressive therapy in this specific population.
Reciprocal longitudinal relationship between dental fear and oral health in schoolchildren
Authors: Soares Fernada Cunha , Lima Rodrigo Antunes , Salvador Daniela M. , de Barros Mauro Virgilio Gomes , Dahllöf Göran , Colares Viviane
Published: November 2019

Background

No longitudinal study has evaluated the mutual relationship between dental fear and oral health in the same investigation.

Aim

To evaluate the reciprocal longitudinal relationship between dental fear and oral health in schoolchildren.

Design

This longitudinal study monitored 416 Brazilian children aged 5‐7 years of age at baseline for 2 years. The decayed, filled and missing teeth were clinically assessed for each child. Dental fear was evaluated by Dental Anxiety Question. Multilevel mixed‐effects linear and logistic regressions analysed the reciprocal relationship between dental fear and oral health.

Results

Children with caries experience had 1.8 times higher odds of dental fear compared to children who were caries free. The presence of a carious tooth increased the odds of dental fear by 1.2 times. Children with dental fear had 0.46 additional carious tooth; an additional 0.22 tooth indicated for extraction; and a 0.67 higher caries experience score compared to children without dental fear.

Conclusions

We observed a reciprocal relationship between dental fear and poor oral health. Both parents and dentists should provide realistic information for the children, discouraging biased negative expectations regarding dental treatment. Ultimately, the child would acquire positive perceptions of the dental environment, reducing their phobia and consequently improving oral health.
Efficacy of a povidone‐iodine foam dressing (Betafoam) on diabetic foot ulcer
Authors: Gwak Heui C. , Han Seung H. , Lee Jinwoo , Park Sejin , Sung Ki‐Sun , Kim Hak‐Jun , Chun Dongil , Lee Kyungmin , Ahn Jae‐Hoon , Kwak Kyunghee , Chung Hyung‐Jin
Published: November 2019

This study aimed to assess the efficacy of a new povidone‐iodine (PVP‐I) foam dressing (Betafoam) vs foam dressing (Medifoam) for the management of diabetic foot ulcers. This study was conducted between March 2016 and September 2017 at 10 sites in Korea. A total of 71 patients (aged ≥19 years) with type 1/2 diabetes and early‐phase diabetic foot ulcers (Wagener classification grade 1/2) were randomised to treatment with PVP‐I foam dressing or foam dressing for 8 weeks. Wound healing, wound infection, patient satisfaction, and adverse events (AEs) were assessed. The PVP‐I foam and foam dressing groups were comparable in the proportion of patients with complete wound healing within 8 weeks (44.4% vs 42.3%, P = .9191), mean (±SD) number of days to complete healing (31.00 ± 15.07 vs 33.27 ± 12.60 days; P = .6541), and infection rates (11.1% vs 11.4%; P = 1.0000). Median satisfaction score (scored from 0 to 10) at the final visit was also comparable between groups (10 vs 9, P = .2889). There was no significant difference in AE incidence (27.8% vs 17.1%, P = .2836), and none of the reported AEs had a causal relationship with the dressings. The results of this study suggest that PVP‐I foam dressing has wound‐healing efficacy comparable with foam dressing, with no notable safety concerns. This study was funded by Mundipharma Korea Ltd and registered at ClinicalTrials.gov (identifier NCT02732886).
Novel thermally stable, high quality factor Ba4(Pr0.4Sm0.6)28/3Ti18−yGa4y/3O54 microwave dielectric ceramics
Authors: Wang Geng , Fu Qiuyun , Shi Hao , Tian Fan , Guo Pengju , Yan Liang , Yu Shijin , Zheng Zhiping , Luo Wei
Published: November 2019

High dielectric constant Ba4(Pr0.4Sm0.6)28/3Ti18−yGa4y/3O54 (BPSTG) (0 ≤ y ≤ 1) microwave ceramics with enhanced dielectric properties were synthesized via the traditional solid‐state processing for the first time. The crystal structure, microstructure, and microwave dielectric characteristics were investigated in details. X‐ray diffraction results showed that all well‐sintered samples belonged to a single tungsten bronze type phase. Results showed that partial substitution of Ga3+ for Ti4+ is an effective way in adjusting the temperature coefficient of resonant frequency (TCF) value of the Ba4(Pr0.4Sm0.6)28/3Ti18O54 ceramics and increased the quality factor (Qf) values. The variation tendency of dielectric constant was in accordance with the ionic polarizability. The Qf values highly depend on the grain size from the scanning electron microscopy results. A near zero TCF value can be obtained by carefully adjusting the substitution of Ga3+ content. Infrared reflectivity (FIR) spectra were employed to reveal the relationship between the phonons and microwave dielectric properties. At last, excellent combinations dielectric properties of εr = 78.5, Qf = 12,400 GHz, TCF = +2.1 ppm/°C were achieved in BPSTG ceramics when y = 0.75.
Spray‐dry synthesis of β‐Cu1.8Zn0.2V2O7 ceramic fine particles showing giant negative thermal expansion
Authors: Takenaka Koshi , Sato Miku , Mitamura Masaya , Yokoyama Yasunori , Katayama Naoyuki , Okamoto Yoshihiko
Published: November 2019

We used spray‐dry method to synthesize fine powder of β‐Cu1.8Zn0.2V2O7 showing large negative thermal expansion (NTE) linearly to temperature over a wide temperature range. The NTE of β‐Cu1.8Zn0.2V2O7 is produced by microstructures consisting of voids and anisotropic thermal deformation of crystal grains in ceramics. By reducing the size of the microstructures that produce NTE, large NTE equivalent to that of bulk was realized, even for ceramic particles of about 2 μm size. Comparison with particles produced using a conventional method demonstrates that the particle size distribution is narrow and that the particles are nearly spherical. This achievement is expected to pave the way to use of NTE materials in micrometer‐scale control of thermal expansion.
Closed porosity ceramics and glasses
Authors: Vakifahmetoglu Cekdar , Semerci Tugce , Soraru Gian Domenico
Published: November 2019

In the last three decades, considerable effort has been devoted to obtain both open and closed porosity ceramics & glasses in order to benefit from unique combination of properties such as mechanical strength, thermal and chemical stability at low‐relative density. Most of these investigations were directed to the production and the analysis of the properties for open porosity materials, and regrettably quite a few compositions and manufacturing methods were documented for closed porosity ceramics & glasses in the scientific literature so far. This review focuses on the processing strategies, the properties and the applications of closed porosity ceramics & glasses with total porosity higher than 25%. The ones below such level are intentionally left out and the paper is set out to demonstrate the porous components with deliberately generated closed pores/cells. The processing strategies are categorized into five different groups, namely sacrificial templating, high‐temperature bonding of hollow structures, casting, direct foaming, and emulsions. The principles underlying these methods are given, with particular emphasis on the critical issues that affect the pore characteristics, mechanical, thermal and electrical properties of the produced components.
Prevalence and characteristics of prediabetes in workers in industry
Authors: Reynolds Raquel Yvonne
Published: November 2019

Aim

To examine the prevalence of work stress and prediabetes in computer technology company employees; to analyse the relationships among stress, work stress, and prediabetes; and to explore the potential mediating effects sleep on the relationship between work stress and prediabetes.

Design

A descriptive, cross‐sectional design was used. A convenience sample included employees from a large computer technology company in central Texas.

Methods

Data collection during March–October 2015 included: retrospective electronic medical record review and online surveys. Electronic medical record review data included: height, weight, waist circumference, blood pressure, high‐density lipids, triglycerides, and fasting glucose. Online surveys collected demographic, global stress, diet, exercise, coping, sleep and work stress data from participants. Spearman rho calculations analyzed associations between demographic, socio‐cultural factors, health behaviours, work stress, and prediabetes variables. Logistic regression analyses identified probability variables. A structural equation model examined mediating variables.

Results

Prediabetes prevalence was lower and prevalence of work stress was higher in the participant sample than in the USA population. Findings suggested that low job imbalance increases the probability for prediabetes. Job imbalance was inversely related to prediabetes. Three variables increased the probability prediabetes: alcohol, job imbalance, and sleep. Sleep potentially modified the relationship between job imbalance and prediabetes.

Participants were college‐educated males working in white‐collar, technical jobs. Participants had high rates of work stress. Job imbalance was inversely related to prediabetes, which challenges previous empirical data. Future research should continue to explore the relationship between work stress and prediabetes in this population.

Conclusions

This study explored the relationship between work stress and prediabetes in a white‐collar worker population in technical industry. Findings suggested that workers in industry have a unique type of stress. Nurses who learn to recognize the non‐traditional risk factors for prediabetes can improve screening for prediabetes by including work stress and poor sleep questions.
Annual Research Review: Critical windows – the microbiota–gut–brain axis in neurocognitive development
Authors: Cowan Caitlin S. M. , Dinan Timothy G. , Cryan John F.
Published: November 2019

The gut microbiota is a vast, complex, and fascinating ecosystem of microorganisms that resides in the human gastrointestinal tract. As an integral part of the microbiota–gut–brain axis, it is now being recognized that the microbiota is a modulator of brain and behavior, across species. Intriguingly, periods of change in the microbiota coincide with the development of other body systems and particularly the brain. We hypothesize that these times of parallel development are biologically relevant, corresponding to ‘sensitive periods’ or ‘critical windows’ in the development of the microbiota–gut–brain axis. Specifically, signals from the microbiota during these periods are hypothesized to be crucial for establishing appropriate communication along the axis throughout the life span. In other words, the microbiota is hypothesized to act like an expected input to calibrate the development of the microbiota–gut–brain axis. The absence or disruption of the microbiota during specific developmental windows would therefore be expected to have a disproportionate effect on specific functions or potentially for regulation of the system as a whole. Evidence for microbial modulation of neurocognitive development and neurodevelopmental risk is discussed in light of this hypothesis, finishing with a focus on the challenges that lay ahead for the future study of the microbiota–gut–brain axis during development.